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www.getmed360.com. Agenda. Overview Administrative Partners Carrier Partners Limited Medical Plan Benefits Association Benefits Policy Information. Why Sell GetMED 360?. Top rated Insurance Companies Dr. office visit co-pays

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Agent Training Only

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  • Overview

  • Administrative Partners

  • Carrier Partners

  • Limited Medical Plan Benefits

  • Association Benefits

  • Policy Information

Agent Training Only

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Why Sell GetMED 360?

  • Top rated Insurance Companies

  • Dr. office visit co-pays

  • ER benefit for both injury and sickness – pays up to $1,000

  • $5,000 peraccident - excess accident medical expense

  • $10,000 Critical Illness

  • Weekly $$$

    Benefits vary by state.

Agent Training Only

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  • Great for consumers that may not qualify for full comprehensive Major Medical

  • A reasonable alternative (not replacement) for consumers who cannot afford more costly Major Medical programs

  • The plans provide coverage for the common everyday expenses such as doctor office visits, hospital, ICU and surgical expenses

Agent Training Only

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Sponsored by UCAA

  • United Consumer Awareness Association (www.unitedconsumer.org)

  • A National Association

  • Offers a benefit package of consumer discount products including:

    • Doctor/Hospital network

    • Call MD

    • Tiered Dental and Vision

    • 3-Tier Rx

    • Chiropractic

    • 24-hour nurses hotline

    • And much more!

    • More information about UCAA is available on the GetMed360 site

Agent Training Only

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Administrative Partner: Patriot Health, Inc.

  • Patriot Health is a member of the Cost Containment Group (CCG) of companies, headquartered on Long Island, New York.

  • Established in 1993, CCG services millions of families nationwide through various health care related programs and networks.

  • Patriot Health is a Managing General Underwriter (MGU) and Administrator for Limited Medical Plans.

  • They offer a single source for product development, networks, administration and customer care.

  • They combine multiple insurance carriers and networks to deliver the most complete and highest value membership plans for the consumer.

Agent Training Only

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GetMED 360 Benefit Components

In order to provide its members with the maximum benefit options available in their particular state, UCAA has contracted with the following carrier partners:

Agent Training Only

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Insurance Carrier: Limited Medical Benefit Plans

  • United States Fire Insurance Company

    • Fairmont Specialty is a registered trademark of United States Fire Insurance Company

      • Niche products (accident and health)

  • A member of Crum and Forster group of companies

  • Rated “A” Excellent by AM Best (as of 2009)

Agent Training Only

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Medical Benefit Provisions

  • There are no coordination of benefits with other plans

  • There is a 30 day wait on sickness benefits

  • Pre-X definition: A medical condition, injury or sickness, for which medical advice, consultations, symptoms, care or treatment was recommended by a doctor within 12 months prior to the effective date of coverage – will be considered a pre-existing condition unless the loss incurred at least 12 months after the effective date of coverage.

  • There is a 12/12 pre-x on Hospital Confinement Charges, Surgery and Anesthesia

  • There is a 6/12 pre-x on theEmergency Room Benefit

  • There is a 12/12 pre-x on the Critical Illness Benefit payable only after all valid and collectible insurance for the same claim has been exhausted

Agent Training Only

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  • All Members and Spouses who are 18 to 65 years old. At age 65 the plan ends.

  • Unmarried Children

    • Under age 19

      • Includes stepchild, foster, legally adopted, pending adoption proceedings and natural child

    • Up to age 24 if enrolled as fulltime student at accredited college or university

  • Newborn (born during coverage period) for 31 days

  • Citizens or legal residents of the United States

    • Must be a legal resident for 12 months

Agent Training Only

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Provider Access (Beech Street)

  • GetMed360 utilizes Beech Street – a National PPO network of providers (www.beechstreet.com - choose the limited benefit plan link)

    • 564,181 respected doctors

    • 5,083 acute care hospitals

    • 87,500 ancillary network providers

    • Practitioners in all 50 states!

    • Provider lookup 24/7 on GetMed360 site

  • Utilizing Beech Street Network Providers

    • Maximizes client savings

    • Reduces out-of-pocket expenses

Agent Training Only

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Provider Locator Screen

Agent Training Only

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Plans Offered (varies by state)

State variations and plan offerings will be displayed on the GetMed360 web site in an easy to use format!

Agent Training Only

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Plan Availability Screen

Agent Training Only

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State and Product Availability

Agent Training Only

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Rates: Do not include a one time $99 enrollment fee

Agent Training Only

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Doctor Visits (Fairmont Specialty)

  • Sickness or Accident -5 visits per individual per policy year or 10 per family.

  • Doctor Office Visit co-pay is $20 – the member must utilize a Beech Street provider.

    • If all visits are used (5/10) the in-network provider discount will still apply.

  • Out-of-network Doctor Office Visit Indemnity Reimbursement – maximum of $40 per visit.

Agent Training Only

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Wellness Visit (Fairmont Specialty)

  • In-network Doctor Office Wellness Visit - for routine health examinations or immunizations of Covered Persons.

    • Co-pay is $20 per visit – 2 visits per person per year.

  • The benefit does not cover any wellness testing, such as mammograms, PAP or PSA Testing.

    • Claims for wellness tests will be “re-priced” through Beech Street if a network provider is used.

  • Out-of-network Doctor Office Visit Indemnity Reimbursement – maximum of $40 per visit.

Agent Training Only

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Diagnostic, X-Ray & Lab (Fairmont)

  • Coverage is provided when x-rays, laboratory and other diagnostic tests are ordered or performed by a Doctor.

    • Includes the services of a radiologist or radiology group and the services of a pathologist or pathology group for interpretation of diagnostic tests or studies that are Medically Necessary due to an Injury or Sickness

  • There are a maximum of 3 sittings or draws per Covered Person per Policy Year.

    • If the member stays in-network they can get their bill(s) re-priced before the benefit is applied.

    • If all sittings are used the in-network provider discount will still apply

  • The payment amount is up to $100 per sitting/draw. Only available on the 1000 plan series.

Agent Training Only

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Hospital Confinement (Fairmont)

  • Sickness is payable after a 30 day waiting period.

  • Injury is payable as of the effective.

  • Benefits are payable from 1-31 days, up to $250 or $1,000 per day while confined in a hospital semi-private room, as a result of a covered injury or sickness.

  • Using a Beech Street facility will help lower out-of-pocket costs.

Agent Training Only

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Hospital Confinement – ICU/CCU (Fairmont)

  • Benefits are payable for up to 15 days while confined in a hospital ICU/CCU, as a result of a covered injury or sickness.

    • The benefit is up to $1,000 or $2,000 per day depending on plan chosen.

  • 30 day waiting period for sickness

  • Paid in lieu of hospital confinement benefit

  • Using a Beech Street facility will help lower out of pocket costs.

Agent Training Only

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Ambulance (Fairmont)

  • Up to benefit amount of $100 Per Trip

  • Medical Emergency only

  • 1 Trip per person per year

  • Ground or Air

  • This benefit is available in the 1000 plan series only

Agent Training Only

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Surgery In/Out Patient (Fairmont)

  • Benefits are payable up to $10,000 per surgery.

    • Based off of CPT codes on a surgery schedule.

    • 2 surgeries per covered person per policy year.

    • Sickness benefits are payable after a 30 day waiting period.

  • Benefit Includes but is not limited to charges for:

    • Surgeon fees

    • Use of the operating and recovery room

    • Administration of drugs and medicines during surgery

    • Dressings, casts, splints

    • Diagnostic services including radiology, laboratory, or pathology performed during time of surgery.

Agent Training Only

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Surgery: GetMED 360 vs. RBRVS

  • Surgical Benefit

    • $10,000 Fairmont surgical schedule vs. RBRVS schedule

      • RBRVS – will pay just the cost of the surgical procedure (surgeon charges only) based upon the RBRVS code in the covered persons county

      • GedMed360 – Surgical benefit is provided for use of the operating room and recovery room, including the doctors charge for performing surgery. Benefit also provided for medical services and supplies used in the performance of the surgery. Includes, but not limited to:

        • Administration of drugs and medicines during surgery

        • Dressings, casts, splints

        • Diagnostic services including radiology, laboratory, or pathology performed during time of surgery

Agent Training Only

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Anesthesia In/Out Patient (Fairmont)

  • This benefit is payable at 25% of the surgery benefit

  • Using an in-network provider will lower out-of-pocket costs

Agent Training Only

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Emergency Room (Presidential)

Availability Varies by State

  • Injury or Sickness 2 visits per year (individual/family)

  • Benefit is payable up to $1,000

  • Subject to a $100 deductible per visit

  • There is a 6/12 Pre-ex

  • There is a 30 day waiting period for sickness

Agent Training Only

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Availability Varies by State

  • If you are injured in a covered accident and the injury from such an accident causes death or dismemberment within 365 days from the date of the accident, the insurance company will pay the amount shown.

  • If you sustain more than one such loss as the result of one Accident, the insurance company will pay only one amount, the largest, to which you are entitled.

  • The benefit is $15,000 in states where available.

Agent Training Only

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Excess Accident Medical Expense (GTL)

Availability Varies by State

  • If you are injured in a covered accident and receive treatment from a physician within 365 days from the date of the accident, the insurance company will pay the amount shown for actual expenses, up to the maximum per accident. This is an excess benefit so all other benefits must be used first.

  • Subject to a $100 deductible per accident.

  • Benefit amount is $5,000 per accident for all plans.

Agent Training Only

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Guaranteed Issue Term Life (Hartford Life)

  • Requires NO medical Exam or Tests!

  • The benefit amount shown is paid to the beneficiary or beneficiaries in the event of your death.

  • Benefit payment is subject to the definitions, limitations, exclusions and other provisions within the Certificate.

  • Covered spouse benefit is 50% of benefit amount shown and dependent benefit is 20% of benefit amount shown. Covered dependent child(ren) must be at least 15 days or older to be eligible for coverage.

  • Benefit amount is $10,000 in states where available.

Agent Training Only

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Critical Illness(AIG)

Please see State Product Availability Chart

  • The $10,000 Critical Illness Indemnity Benefit is payable for Insured and covered Spouse

  • Will be paid in addition to any other benefit in the Certificate

  • Subject to a 12/12 Pre-Existing Condition Limitations

  • A benefit is payable for any one of the following:

    • Invasive Cancer

    • Heart Attack

    • Stroke

    • Major Organ Transplant Surgery

    • Coma

    • End Stage Renal Failure

Agent Training Only

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Plan Highlights: Association Benefits

  • Doctor/Hospital Network (Beech Street)

  • 3-Tiered Rx Discount

  • Tiered Dental

  • Tiered Vision

  • Call MD

  • Chiropractic

  • Counseling

  • 24-Hour Nurses Hotline

  • Elder Care

  • Hearing

  • Diabetic Supplies

  • Fitness

  • Holistic Care

  • Much more consumer lifestyle savings benefits!

Agent Training Only

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3-Tiered Prescription Drug “Discount”

  • This plan is accepted at over 50,000 participating pharmacies nationwide.

    • Simply visit a participating pharmacy, present your membership card and pay the pharmacy directly.

    • To access list of pharmacies go to www.getmed360.com

    • Tiers are based on 1 pill per day for 30 days.

      • Tier 1: Drugs at up to a $10.00 maximum cost **

      • Tier 2: Drugs at up to a $20.00 maximum cost **

      • Tier 3: All other drugs are available for your benefit at negotiated rates.

      • ** Please note that some participating pharmacies may charge beyond a particular tier.

    • *Only a licensed physician can recommend or prescribe specific drugs to treat your specific condition

Agent Training Only

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Top 10 Drug Savings

Agent Training Only

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Quality Vision Network (QVN)

  • Tier 1

    • At select participating vision outlets, a no-charge eyeglass vision exam is available once annually for every family member

      • Prescription must be filled by the provider performing the no-charge exam if glasses are required

  • Tier 2

    • You will also receive discounted rates of 10%-50% on eyeglasses, non-prescription sunglasses and contact lenses (excluding disposables) at participating optical locations nationwide.

  • Ophthalmology & LASIK

    • Save 20%-60% on medical eye exams and surgical procedures including LASIK at participating ophthalmology locations.

Agent Training Only

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Call MD

  • All members will receive 2 toll-free physician telephone consultations - available 24/7

    • You have access to a nationwide network of medical doctors and registered nurses that are available to discuss your medical issues.

    • You can access over-the-phone prescriptions (where permitted by law)

Agent Training Only

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Dental Directory Services

  • Multi-tiered dental fee-for-service program

    Tier 1

    • At select participating schedule (A) Tier 1 general practitioners you will receive:

      • a no-charge exam and x-rays in conjunction with a paid annual cleaning

    • Participating providers abide by a fee schedule of fixed payments for most procedures savings are 20% to 60%

  • Tier 2

    • A schedule (A) Tier 1 provider is not available in a given area, a secondary provider is given to member that still provides 20%-60% discounts but does not provide a free exam

  • Tier 3

    • In the event a Tier 1 or Tier 2 provider is not available in your area, member will call customer service for assistance in accessing a Tier 3 provider which will provide them a discount

Agent Training Only

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Tiered Chiropractic Program

  • Save on testing procedures, support and orthotics supplement, massage and other bodywork.

    • Tier 1: save 20%-50% at participating providers on adjustments, therapy, x-rays, exams and specialized procedures using a fee schedule of fixed payments for most procedures.

      • First visit is $35 with adjustments thereafter at $20.

    • Tier 2: Save 5%-20% at participating providers

Agent Training Only

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24 Hour Counseling Hotline

  • You and your immediate family members have unlimited access to a Master’s Level Therapist.

    • Toll-free number available 24/7

    • Free support and self-help group referrals and referrals to local licensed therapist

  • All counselors have been specially trained to offer prompt, confidential counseling.

Agent Training Only

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24 Hour Nurse Hotline

  • Unlimited, Toll-Free, 24/7 Access to Registered Nurses.

  • Confidential service is available to help you become more knowledgeable about healthcare services and more comfortable working in partnership with your healthcare providers

  • You will receive information regarding, the treatment of common illnesses, what to expect during medical testing, diagnostic and surgical procedures, recently diagnosed medical condition, prescriptions, and over-the-counter medical information.

Agent Training Only

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Holistic Care

  • The Holistic Care Service provides a concierge approach to finding a Holistic Care provider that will meet your specific needs.

  • A Customer Care Consultant will take your request for an Acupuncturist, Massage Therapist, Dieticians and Naturopathic providers and call you back with the nearest location.

  • Up to 20% savings on, all treatments and services. There is no limits on number of visits.

Agent Training Only

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Hearing Care

  • Beltone Features

    • Free hearing screening and 15% discount on Beltone hearing aides at more than 1,300 Beltone locations.

    • Lifetime care program includes complimentary hearing aid checkup, free cleaning and inspection while under warranty and a 30 day refund policy.

  • HearPO Features

    • 20%-50% off audiology and hearing aid services at more than 1,400 participating HearPO providers.

    • Comprehensive follow up for one year at no charge. 100% discount on repairs and a 60 day refund policy

    • Your hearing aid comes with a 12 month standard manufacturer’s warranty. Modifications will be made without cost during warranty should a change within hearing levels require different circuitry.

Agent Training Only

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Elder Care

  • Save on home health and long term care services, available for any member for your family including grandparents!

    • Save 10%-25% on home health aides, nursing homes, assisted living facilities, Alzheimer’s special care units and respite care facilities. (savings are available for new patients only)

    • Toll free 24/7 advice hotline

Agent Training Only

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Diabetic Supplies

  • Save 10%-60% on Diabetic supplies

    • This program provides special member pricing on most diabetic supplies such as

      • Test strips, glucose meters, lancing devices and lancets and convenient free home delivery!

Agent Training Only

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  • Enjoy 10%-50% off membership dues at over 1,000 locations nationwide!

    • Month to month memberships at top area fitness centers . ($10 administrative fee may apply upon cancellation)

    • This program includes many franchises of Gold’s Gym, Bally’s Fitness, Curves for Women and other chains as well as independent fitness clubs.

Agent Training Only

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Association Consumer Discount

  • Consumer discount programs vary by plan but include:

    • Medical records software

    • Hotel savings

    • Rental car savings

    • Mortgage and Realtor discounts

    • Financial planning

    • Tax hotline

    • Roadside assistance

    • And many more

Agent Training Only

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Effective Dates and Billing Dates

  • If a member enrolls between the 1st and the 15th they will be effective on the 1st of the following month. Initial charge occurs on the day of enrollmentand recurring charges occur on the 15th of every month there after.

  • If a member enrolls between the 15th and the last day of the month they will be effective the 15th of the following month. Initial charge occurs on the day they enrolland recurring charges occur on the 1st of every month there after.

  • Future effective date options are available up to 60 days.

  • Payments can be made using Credit Card or by drafting a checking/savings account – NO individual paper bills

  • Group list bill available for 10 or more employees

Agent Training Only

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Enrollment – Membership Type

Agent Training Only

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Enrollment – Plan Selection

Agent Training Only

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Enrollment – Billing Screen

Agent Training Only

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Fulfillment Materials

  • The insured will receive an email fulfillment with ID card, certificate, schedule and benefit booklet instantly after enrollment submission.

  • Fulfillment materials will be mailed direct to the insured within 24 hours after premium processing is verified.

Agent Training Only

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Rules For Limited Medical Plan Sales

  • DO NOT Represent Limited Medical Plans as:

    • “Same as your employer plan”

    • Just like “Major Medical”

    • “Full Benefits”

    • A “PPO”

Agent Training Only

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Rules For Limited Medical Plan Sales

  • Clearly explain the limited nature of the plan:

    • This limited medical benefits plan:

      • Does Not Provide comprehensive medical coverage

      • Is a basic or limited benefits policy and is not intended to cover all medical expenses.

      • Is not designed to cover the costs of serious or chronic illness.

      • Contains specific dollar limits that will be paid for medical services which may not be exceeded. (if the cost of services exceeds those limits, the beneficiary and not the insurer is responsible for payment of the excess amounts)

Agent Training Only

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Rules For Limited Medical Plan Sales

  • Explain the key elements of:

    • Guarantee Issue

    • Pre-existing condition limitation

    • 30 day wait on sickness

  • Go through the plan of benefits in detail with the consumer, including their membership in the Association

  • Explain how the Beech Street Network discount works

  • Explain that the Rx card is a “discount” program

  • Explain the claims submission process, billing, and customer service

  • Explain the 30 day free look provision and how refunds work

  • All agents soliciting sales and enrolling consumers must hold a valid health insurance license in the state in which the consumer resides!

Agent Training Only

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Administrative Partner: Patriot Health, Inc.

  • Customer Care

    • Members are encouraged to speak directly with a Patriot Representative.

    • Dedicated consultants assist members with benefits, provider locater, and coordination services.

    • Members can contact Patriot’s toll free phone number Monday through Friday, 9:00 AM until 7:00 PM (EST). 877-693-9095

Agent Training Only

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  • Commissions are level on GetMED 360

    • Checks are sent every Tuesday for all business with approved payments through Monday. (new sales and renewals)

    • Statements are sent via email.

Agent Training Only

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Cancellation & Refund Policy

  • A member may cancel at any time.

    • Cancellation will be required in writing

    • If an insured calls Patriot to cancel, they will be sent a form to sign. Once the form is received, agent will be notified and copied. If agent can conserve the case, and the consumer verifies in writing they wish to keep the policy, Patriot will reinstate the policy back to the original effective date, and premiums will be collected accordingly.

  • If a member cancels within the first 30 days, the membership cost will be refunded. The one time enrollment fee is non-refundable, except where specified by state law. Those states are; AK,MD,NE,FL,SC, SD ,VT

  • If a member cancels within 3 days from the enrollment date, the member will be refunded the first month’s membership costs plus the one time enrollment fee.

Agent Training Only

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Policy Changes

  • The insured or the agent can call or email Patriot to make changes for:

    • Dependent status

    • Plan changes

    • Payment changes

    • Address changes

Agent Training Only

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Claim Processing

  • Claims are processed by Administrative Concepts, Inc. (ACI) located in Wayne, PA (Toll Free 888-293-9229)

  • ACI is an industry leader in providing superior services for specialty insurance products and a valuable resource to insurance companies and brokers

    • Re-pricing for PPO discounts

    • Claim payment

    • Explanation of Benefits sent

      • Providers

      • Patients

  • www.visit-aci.com

Agent Training Only

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Web Site Features

  • www.getmed360.com

    • Plan and Benefit Availability by State with Rates

    • Brochure and Sample Certificates

    • Training Power Point

    • FAQ’s

    • Association Provider and Beech Street Links

    • Enroll On Line for your Customer

    • Agent Back Office

      • Track and manage business

      • 24/7 access to client’s policy information

Agent Training Only

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Agent Back Office

Agent Training Only

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Agent Training Only