- 15,319
How big a bucket? What if the policyholder needs a $50-100K surgery?
Please post a link to the product.
Rick
New Era Contracting
- Thread starter dandan
- Start date
Please post a link to the product.
Rick
Devin01
Guru
- 430
I'll post it tomorrow , it is an underwritten product
Devin01
Guru
- 430
This is an individual Medical plan new to the market.
Main Features:
· $5 million lifetime maximum
· No Network Required
o Optional use of MultiPlan/PHCS PPO Network for added savings
· Choose maximum calendar year benefit amount
o $100k, $250k, or $1 million
· Choose first days reduction benefit
o 100%, 80%, 50%, or 20%
· Choose benefit level
o 1 Unit, 2 Unit, or 3 Unit
· Value-added Benefits at no additional cost
o ScriptSave card
o Teladoc
o Karis 360
Built-in Features
· Hospital Indemnity Benefits
o Hospital Confinement benefit
o Hospital ICU benefit
o Mental Illness, Alcohol and/or Substance Abuse benefit
o Rehabilitation Facility / Skilled Nursing Facility
o Outpatient Radiation or Chemotherapy
o Outpatient Hospital or Ambulatory Surgical Center
· Professional Services
o Surgical Procedure
o Inpatient Pathologist / Radiologist
o Physicians Care Indemnity Benefit Non-Surgical
o Daily Assistant Surgeon Surgical Services Indemnity Benefit
o Daily Anesthesia Indemnity Benefit
· Outpatient Benefits
o Daily Outpatient Physicians Indemnity Benefit
§ Limit of 20 benefit days (6 chiropractor visits) per year.
o Other Outpatient Daily Indemnity Benefits
§ MRI, CAT Scan or Nuclear Testing
§ Other Diagnostic Testing or X-rays
§ Laboratory Testing
§ Injections
o Daily Generic and Brand Name Prescription Indemnity Benefit
o Emergency Room Benefit
o Urgent Care Center Benefit
o Daily Emergency Ambulance Indemnity Benefit
o Preventive Care Indemnity Benefits
§ Preventive Care Benefit for Mammograms
§ Preventive Care Benefit for Colonoscopy (Beginning the 4th policy year)
Main Features:
· $5 million lifetime maximum
· No Network Required
o Optional use of MultiPlan/PHCS PPO Network for added savings
· Choose maximum calendar year benefit amount
o $100k, $250k, or $1 million
· Choose first days reduction benefit
o 100%, 80%, 50%, or 20%
· Choose benefit level
o 1 Unit, 2 Unit, or 3 Unit
· Value-added Benefits at no additional cost
o ScriptSave card
o Teladoc
o Karis 360
Built-in Features
· Hospital Indemnity Benefits
o Hospital Confinement benefit
o Hospital ICU benefit
o Mental Illness, Alcohol and/or Substance Abuse benefit
o Rehabilitation Facility / Skilled Nursing Facility
o Outpatient Radiation or Chemotherapy
o Outpatient Hospital or Ambulatory Surgical Center
· Professional Services
o Surgical Procedure
o Inpatient Pathologist / Radiologist
o Physicians Care Indemnity Benefit Non-Surgical
o Daily Assistant Surgeon Surgical Services Indemnity Benefit
o Daily Anesthesia Indemnity Benefit
· Outpatient Benefits
o Daily Outpatient Physicians Indemnity Benefit
§ Limit of 20 benefit days (6 chiropractor visits) per year.
o Other Outpatient Daily Indemnity Benefits
§ MRI, CAT Scan or Nuclear Testing
§ Other Diagnostic Testing or X-rays
§ Laboratory Testing
§ Injections
o Daily Generic and Brand Name Prescription Indemnity Benefit
o Emergency Room Benefit
o Urgent Care Center Benefit
o Daily Emergency Ambulance Indemnity Benefit
o Preventive Care Indemnity Benefits
§ Preventive Care Benefit for Mammograms
§ Preventive Care Benefit for Colonoscopy (Beginning the 4th policy year)
Do you inform buyers that the plans are NOT compliant and subject to a penalty?
It is my understanding indemnity plans are not to be sold as stand alone coverage, only offered to those who have an existing Obamacare plan.
- 29,467
Careful Bob, he might call you a name.
marc82much
Super Genius
- 240
somarco said: "It is my understanding indemnity plans are not to be sold as stand alone coverage, only offered to those who have an existing Obamacare plan."
You are incorrect.
somarco said: "Do you inform buyers that the plans are NOT compliant and subject to a penalty?" Is this clear enough?
This in an An Affordable Alternative to Major Medical -
The Health Saver Plus A Guaranteed Renewable Hospital/Surgical Policy on an Indemnity Chassis
You May Qualify for One of Two Methods we offer to get You “Out Of The PENALTY BOX.”
Christian Sharing Membership
• Perfect for the Faith Based Community
• Membership costs as little as $45 monthly per member
• Up to $135 monthly for a Family.
• IRS Code 5187 exemption from Tax Penalty under ACA
MEC Plan
• MEC = Minimum Essential Plan
• Offered to the Self Employed
• Affordable
• Gives 1st Dollar Coverage for preventive and essential wellness benefits
Then, they accept and sign this...check bullet point 7,
DISCLOSURE NOTICE - HOSPITAL INDEMNITY INSURANCE POLICY
By my signature affixed hereto, I verify that I have been provided an Outline of Coverage describing the Policy for which I have applied on this date. I verify that the agent representing Philadelphia American Life Insurance Company discussed, in detail, the coverage as explained in the Outline of Coverage. In addition, the agent explained, and I understand the following provisions:
1. The coverage for which I have applied will become effective only when the application is approved by the Home Office and only on the Effective Date assigned by the Company.
2. If I am approved and my Policy is issued, my coverage will begin immediately on the assigned Effective Date.
3. No benefits will be payable for any sickness or injury due to a Pre-Existing Condition. Pre-existing Condition means a condition for which medical treatment was rendered or recommended by a Physician or for which drugs or medicine was prescribed within 12 months prior to a Covered Person’s Effective Date. A condition shall no longer be considered a Pre-Existing Condition after the date a person has been covered under this policy for 12 consecutive months.
4. I understand that a claim for benefits may not be payable under the new Policy due to the above-mentioned Pre-existing Condition waiting period; whereas, the same claim might have been payable under my present coverage, if any, had it remained in force.
5. I understand that until the coverage has been approved and issued, Philadelphia American Life Insurance Company has absolutely no liability to me other than to refund my initial premium if my Application is not approved. Any injury or sickness which may develop between now (today) and the date my coverage is effective will be a Pre-existing Condition, and depending on extent and severity, such injury or sickness may render me (or a dependent) ineligible for coverage.
6. I have read or have been read to me and answered the questions on my Application on behalf of myself and my dependents. I also understand that disclosure of health information is important and any omission may bar the right to recover under the Policy if such answer materially affects the acceptance of the risk or hazard assumed. My Policy, if issued, will contain a photocopy of this document along with the Application for Coverage.
7. I understand that this insurance is not a substitute for comprehensive health insurance coverage and does not qualify as minimum essential health coverage under the Patient Protection and Affordable Care Act.
I am not a fool, and I know this will not satisfy the haters. And I don't care.
You are incorrect.
somarco said: "Do you inform buyers that the plans are NOT compliant and subject to a penalty?" Is this clear enough?
This in an An Affordable Alternative to Major Medical -
The Health Saver Plus A Guaranteed Renewable Hospital/Surgical Policy on an Indemnity Chassis
- The Health Saver Plus is not considered Minimum Essential Coverage that meets the Affordable Care Act (ACA) requirements.
- It is important to understand that your situation is unique to you as it pertains to income, marital status, employment, other insurance and even if you are in a protected class that may make you exempt from the ACA.
- If this is the only health insurance that you have and you are not in a protected class by income or eligibility, you could incur a penalty under the ACA.
You May Qualify for One of Two Methods we offer to get You “Out Of The PENALTY BOX.”
Christian Sharing Membership
• Perfect for the Faith Based Community
• Membership costs as little as $45 monthly per member
• Up to $135 monthly for a Family.
• IRS Code 5187 exemption from Tax Penalty under ACA
MEC Plan
• MEC = Minimum Essential Plan
• Offered to the Self Employed
• Affordable
• Gives 1st Dollar Coverage for preventive and essential wellness benefits
Then, they accept and sign this...check bullet point 7,
DISCLOSURE NOTICE - HOSPITAL INDEMNITY INSURANCE POLICY
By my signature affixed hereto, I verify that I have been provided an Outline of Coverage describing the Policy for which I have applied on this date. I verify that the agent representing Philadelphia American Life Insurance Company discussed, in detail, the coverage as explained in the Outline of Coverage. In addition, the agent explained, and I understand the following provisions:
1. The coverage for which I have applied will become effective only when the application is approved by the Home Office and only on the Effective Date assigned by the Company.
2. If I am approved and my Policy is issued, my coverage will begin immediately on the assigned Effective Date.
3. No benefits will be payable for any sickness or injury due to a Pre-Existing Condition. Pre-existing Condition means a condition for which medical treatment was rendered or recommended by a Physician or for which drugs or medicine was prescribed within 12 months prior to a Covered Person’s Effective Date. A condition shall no longer be considered a Pre-Existing Condition after the date a person has been covered under this policy for 12 consecutive months.
4. I understand that a claim for benefits may not be payable under the new Policy due to the above-mentioned Pre-existing Condition waiting period; whereas, the same claim might have been payable under my present coverage, if any, had it remained in force.
5. I understand that until the coverage has been approved and issued, Philadelphia American Life Insurance Company has absolutely no liability to me other than to refund my initial premium if my Application is not approved. Any injury or sickness which may develop between now (today) and the date my coverage is effective will be a Pre-existing Condition, and depending on extent and severity, such injury or sickness may render me (or a dependent) ineligible for coverage.
6. I have read or have been read to me and answered the questions on my Application on behalf of myself and my dependents. I also understand that disclosure of health information is important and any omission may bar the right to recover under the Policy if such answer materially affects the acceptance of the risk or hazard assumed. My Policy, if issued, will contain a photocopy of this document along with the Application for Coverage.
7. I understand that this insurance is not a substitute for comprehensive health insurance coverage and does not qualify as minimum essential health coverage under the Patient Protection and Affordable Care Act.
I am not a fool, and I know this will not satisfy the haters. And I don't care.
marc82much
Super Genius
- 240
It is available in Florida. Prior poster called the plan, or me, "garbage"... But I don't really care. Somarco asked if I tell the prospect... Blah blah blah That question comes from a place of distrust. And then he said he understood that the plan cannot be sold to someone without an ACA Plan. Shows the ignorance, but this also comes from a place of distrust and cynicism. I have been a licensed insurance professional since 1977. During 9 of those years I was series 7 licensed.... Never once have I had a complaint, but I and I have sold thousands of insurance policies.
- 29,467
You've got me convinced.
Devin01
Guru
- 430
This product is simply an alternative to an ACA Plan, it has its niche just like the Christian Health Share Plans. It is a Fixed-indemnity insurance plan and does not meet the Minimum Essential Coverage requirements under the Affordable Care Act and you may need to pay a tax penalty depending upon your income level and the cost of plans available.
If someone is struggling with an ACA Plan with the cost or is healthy, it is absolutely an option to show them. We need to be fully transparent on what the product is and what it does. Many under 65 clients are looking off marketplace for options. If you do not do alot of under 65 stuff its probably not a product for you. Commission is very competitive compared to ACA Plans. This in and of itself is not a reason to offer the product but it certainly is an option and the product is doing well in the marketplace.
Fixed-indemnity benefits are provided for hospital confinement, specified
medical, surgical and outpatient events. These benefits are paid in specific amounts and do not provide expense reimbursement for charges based on your health
care provider’s bill.
If I could attached the plan documents to this site I would but not sure how I would do that
If someone is struggling with an ACA Plan with the cost or is healthy, it is absolutely an option to show them. We need to be fully transparent on what the product is and what it does. Many under 65 clients are looking off marketplace for options. If you do not do alot of under 65 stuff its probably not a product for you. Commission is very competitive compared to ACA Plans. This in and of itself is not a reason to offer the product but it certainly is an option and the product is doing well in the marketplace.
Fixed-indemnity benefits are provided for hospital confinement, specified
medical, surgical and outpatient events. These benefits are paid in specific amounts and do not provide expense reimbursement for charges based on your health
care provider’s bill.
If I could attached the plan documents to this site I would but not sure how I would do that
