WHAT’S WRONG WITH SMALL GROUP BENEFITS UNDERWRITING? 1. Employees with health issues cannot qualify for plans they need, unless other employees also buy the same plan. 2. Participation requirements are a hassle to achieve. 3. Guaranteed-issue face amounts for small groups are too small. 4. Plans are too expensive for employer to purchase. 5. Some employers are too small to qualify for good benefits. A HOT NEW CONCEPT APPROVED FOR TEXAS OVERCOMES THESE CHALLENGES EMPLOYER’S DEFINED CONTRIBUTION PLANS FOR GROUPS 2 – 99 GUARANTEED-ISSUE (GI) WITH MINIMAL PARTICIPATION REQUIREMENTS, EVEN IF ONLY ONE EMPLOYEE PARTICIPATES PER PRODUCT* A+ RATED CARRIER IN BUSINESS SINCE 1971 AGENT / MARKETING CONTRACTS AVAILABLE *LTD REQUIRES TEN EMPLOYEES AND AT LEAST TWO PARTICIPANTS. ALL OTHER VOLUNTARY PLANS REQUIRE A MINIMUM TWO EMPLOYEES ON PAYROLL AND ONLY ONE PARTICIPANT.
Contribution This innovative “Defined Contribution” approach allows employees to select specific benefits with premium dollars provided to them by their Employer. The employee may also select additional benefits through the ease of payroll deduction Enrollment A Defined Contribution Approach to Ancillary Benefits Where Employees choose the benefits THEY WANT!
$15 minimum Minimum employer contribution is $15/$30 or $50 PEPM for benefits, however there is no limit. Think of it as handing the employee a gift card to use at the benefits store most employees will spend more than the contribution from the employer. Employer Contribution Requirements The dollar amount the employer chooses for the employee’s PEPM, will become the employer’s Defined Contribution amount. No maximum
The employer may choose any combination of the following benefits to make available to employees: Base Life / AD&D* Voluntary Life Long Term Disability** Short Term Disability Dental Vision Most* products are guaranteed-issue, even if only one employee participates per product. Up to $150, 000 Guarantee Issue when Basic and Voluntary Life or chosen Benefit Options *100% participation needed when offering Employer paid Life/AD&D ** Available for 10+ groups
Life / AD&D Voluntary Life Short Term Disability Long Term Disability Defined Contribution Plan Offerings Dental Vision Employer chooses products and plan options
Employer Paid Life / AD&D Basic Life / AD&D Voluntary Life Employer Selects One of the following Benefits: Base Life AD&D Short Term Disability 1. $25, 000 $25, 000 2. $50, 000 $50, 000 Long Term Disability Dental Vision Dependent Life Insurance: Spouse: $5, 000 Children : 14 Days to 6 Months: $100 6 Months & Over: $5, 000 *100% participation needed when offering Employer paid Life/AD&D
$100, 000 GI Life / AD&D Voluntary Life - AD&D Included Voluntary Life Short Term Disability Employee then has the Option of: • $25, 000 to $250, 000 of Voluntary Term Life Long Term Disability up to $100, 000 (age 65 and under) is Guarantee Issue if you enroll when initially eligible Dental • Spouse Coverage guarantee-issue up to 50% of Employee Amount up to $50, 000 Vision • Child(ren) Options of: $2, 500, $5, 000, $7, 500 or $10, 000 Abbreviated overview – see proposal for more details
3 Standard Plan Optons Life / AD&D Short Term Disability Voluntary Life Employer chooses 1 from following plan designs: Short Term Disability Plan 1 Plan 2 Plan 3 Benefits Begin Dental Accident Sickness 8 8 15 15 Benefit Amount Long Term Disability 60% 60% Weekly Benefit $1, 250 13 Weeks 26 Weeks 52 Weeks Maximum Benefit Period Vision Maternity is covered Guarantee Issue with 12/12 Pre-X Abbreviated overview – see proposal for more details
Groups 10 – 99 Lives Life / AD&D Voluntary Life Long Term Disability All active, full-time employees Groups 10 -99 lives / 2 lives minimum participation 10 -24 eligible lives: up to $3, 000 per month Benefit Replacement Percentage 25 -99 eligible lives: up to $5, 000 per month Benefit Duration 2 -years 5 -years SSNRA Elimination Period 90 or 180 days Social Security Benefit Integration Social Security Definition of Disability 24 months own occ Work Incentive Benefit Duration 12 months Minimum Benefit Add $100 minimum or 10% LTD Benefits Partial Disability Residual w/12 month WIB Mental & Nervous Condition 24 month limit Pre-existing Conditions 12/6/24 Rate Guarantee 2 Years Late Entrants Medical underwriting Waiting Period 90 days Other Standard Features Social Security Full Maternity Benefits Survivor Benefit (3 months) Assistance Short Term Disability Long Term Disability Dental Vision Vocational Rehabilitation Benefit Continuity of Coverage Waiver of Premium Workplace Modification Benefit Cost of Living Freeze Abbreviated overview – see proposal for more details. 2 Lives Minimum Participation Abbreviated overview – see proposal for more details
Choose Any Dentist Life / AD&D Voluntary Life Dental Employer May Choose 2 of the following plan designs: Preferred Takeover on All Groups – Rates Guaranteed for 24 Months Short Term Disability Long Term Disability Option 1 $50 Contract year Deductible 3 Family Limit 3 Yes Waived for Preventative Yes Type I Preventative Dental Vision Option 2 Option 3 Type II Basic Services Option 4 $100 Lifetime No Limit No 100% 80% Endo/Perio 80% 25% Endo/Perio 50% 50% Endo/Perio Annual Maximum $2, 000 $1, 000 $500 Type IV Orthodontia Lifetime Maximum 50% $2, 000 50% $1, 000 0% Not Available Type III Major Services Abbreviated overview – see proposal for more details Dentist in Mexico are acceptable
Eye. Med Network Life / AD&D Voluntary Life Short Term Disability Long Term Disability Dental Vision Employer chooses 1 of the following Options: In Network Member Cost Exam Only Option Exam & Eyewear Option $10 co-pay Vision Exam $50/$70/$105 Standard Lenses Lens Options $15 UV Coating $15 Tint $15 Scratch Resistance $40 Polycarbonate Anti Reflective Coating $45 $65 Progressive 20% off retail Other Add-ons 35% off Retail with Eyeglass purchase Frames Contact Lenses 15% off retail Conventional 15% off retail Disposable N/A Standard Fit & Follow-up N/A Premium Fit & Follow-up Medically Necessary $10 co-pay $15 $15 $40 $45 $65 20% off retail 20% off balance over $130 15% off balance over $120 allowance $0 for Fit and 2 follow-up visits 10% off Retail Charge less $55 $0 Abbreviated overview – see proposal for more details
ADDED BENEFITS Global Dental Tourism Hearing Services Plan Vision Discount Plan Global Emergency Services The Added Benefits are Included with every Defined Contribution Plan sold at no Extra cost.
Case Setup Simplicity ER Sets Contribution Easy Set-up Census Enrollment Employee Choice Agent and Marketing Contracts Available Marketed in Texas exclusively by: National MGA Insurance Alliance, Inc. 210 -340 -0470 / 956 -982 -3998
Скачать презентацию WHAT S WRONG WITH SMALL GROUP BENEFITS UNDERWRITING 1
b0f0b1a04283305efd6f8b42fb9fda28.ppt