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Limited Medical Indemnity Plans
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Limited Medical Indemnity Plans

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  1. Limited Medical Indemnity Plans Provided Through Membership in the United Consumer Awareness Association (UCAA) www.getmed360.com

  2. Insurance Carrier: Limited Medical Indemnity 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 2010) Agent Training Only

  3. 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

  4. 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. • A Managing General Underwriter (MGU) and Administrator for Limited Medical Plans. • Offers a single source for product development, networks, administration and customer care. • Combines multiple insurance carriers and networks to deliver the most complete and highest value membership plans for the consumer. Agent Training Only

  5. Administrative Partner: Patriot Health, Inc. • Customer Care Consultants: • Members are encouraged to speak to a live Patriot Representative. • Dedicated customer care consultants assist members with benefits, provider locater, and coordination services. • Members can contact Patriot through a toll free phone number, Monday through Friday, 9:00 AM until 7:00 PM (EST). (877-693-9095) Agent Training Only

  6. 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 accute 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

  7. ProductOverview • The plans offer valuable association and insurance benefits for consumers who: • May not qualify for full comprehensive major medical • Can not afford full comprehensive major medical • A reasonable alternative(not replacement) for more costly Major Medical programs • GUARANTEED ISSUE – NO UNDERWRITING REVIEW • The plans provide coverage for the common everyday expenses such as doctor office visits, hospital, ICU and surgical expenses Agent Training Only

  8. 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

  9. Plan Highlights: Benefits vary by State • Doctor Office Visits • Co-pay *$20 in-network co-pay. $40 out-of-network benefit • Critical Illness • $10,000 for every covered family member • Term Life Insurance (per covered person) • $10,000 (primary), $5,000 (spouse), $2,000 (child) • Emergency Room • $1,000 (2 per individual/family) Agent Training Only

  10. Plan Highlights: Benefits vary by State • 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

  11. Sample Comparisons (Hillsborough County, Tampa, FL) Agent Training Only

  12. Plans Offered (will vary by state) State variations and plan offerings will be displayed on the GetMed360 web site in an easy to use format! Agent Training Only

  13. State and Product Availability Agent Training Only

  14. Agent Training Only

  15. Agent Training Only

  16. Agent Training Only

  17. Rates: Does not include one time enrollment fee Agent Training Only

  18. Doctor Visits (Fairmont Specialty) • Primary Care or Specialist • Sickness or Accident (5 visits per individual per policy year or 10 per family). • Co-pay is $20 if the member goes in-network to a Beech Street provider. All they pay is the co-pay. • If the member goes out-of-network they pay nothing at time of service and the insurance carrier will pay the indemnity amount – member is billed the difference. Indemnity amount is $40. • If member uses all 5/10 family visits they can still get the discount if they go to an in-network provider. Agent Training Only

  19. Sample In-Network Doctor Visit Agent Training Only

  20. Sample Out-of-Network Doctor Visit Agent Training Only

  21. Wellness Visit (Fairmont Specialty) • Wellness visit at a doctor’s office for routine health examinations or immunizations for Covered Persons • Co-pay is $20 per visit. • 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 the network is used. • If the member goes in-network to a Beech Street provider all they pay is the co-pay for the office visit. • If the member goes out-of-network the insurance carrier pays the indemnity benefit of $40. The member is responsible for the difference. Agent Training Only

  22. Diagnostic, X-Ray & Lab (Fairmont) • When x-rays, laboratory and other diagnostic tests are ordered or performed by a Doctor, coverage is provided for such tests • Including the services of a radiologist or radiology group and for 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. • No co-pay for this benefit, the indemnity amount is $100 per sitting/draw. Only available in the 1000 series of plans . • If the member stays in-network they can get their bill(s) re-priced before the indemnity benefit is applied. Agent Training Only

  23. Hospital Confinement (Fairmont) • Sickness is payable after a 30 day waiting period • Covered Person for an Injury is confined in a Hospital (Semi-Private ) (No 30 day wait, covered immediately) • Benefits are $250 or $1,000 per day depending on plan selected and benefit period is for 31 days per year • Using a Beech Street facility will help lower out-of-pocket costs. Agent Training Only

  24. ICU/CCU(Fairmont) • This benefit provides coverage for 15 days if confined in a hospital ICU/CCU. • 30 day waiting period for sickness • 12/12 pre-x • The benefit is $1,000 or $2,000 per day depending on plan chosen. (Paid in lieu of hospital confinement benefit) • Using a Beech Street facility will help lower out of pocket costs. Agent Training Only

  25. Surgery In/Out Patient (Fairmont) • Up to a $10,000 per surgery benefit. Based on a surgery schedule • In patient or out patient - 2 surgeries per covered person per policy year • 12/12 pre-x • 30 day wait for sickness • Coverage for surgeon charges • Coverage for use of the operating and recovery room It includes, but is 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

  26. Anesthesia In/Out Patient (Fairmont) • This benefit is payable at 25% of the surgery benefit • 12/12 pre-x • Using an in-network provider will lower out-of-pocket costs Agent Training Only

  27. 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

  28. Critical Illness (AIG) Please see Plan State Availability Chart • The Critical Illness Indemnity Benefit is payable for each Insured Person • 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 • Coronary Artery Bypass (25% of benefit amount) • Stroke • Loss of Sight, Hearing or Speech • Paralysis (Quadriplegia -100%) • Severe Burn • Major Organ Transplant Surgery • Coma • End Stage Renal Failure Agent Training Only

  29. Emergency Room (Presidential) Availability Varies by State • Injury or Sickness 2 visits per individual/family per membership year. • Benefit is $1,000 per visit (Max is $2,000 per year) • Subject to a $100 deductible per Injury or sickness per Covered Person • There is a 6/12 Pre-ex • There is a 30 day waiting period for sickness Agent Training Only

  30. 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 in either plan selected. Agent Training Only

  31. AD&D (GTL) 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 either plan selected. Agent Training Only

  32. Guaranteed Issue Term Life(Hartford Life) • Requires no medical Exam or tests! • The benefit amount shown is paid to your beneficiary or beneficiaries in the event of your death. • Benefit payment is subject to the definitions, limitations, exclusions and other provisions within the Certificate. • There is a 90 day waiting period before eligibility. • 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 either plan selected. Agent Training Only

  33. Medical Benefit Provisions • Plans are limited medical indemnity plans • There are no coordination of benefits with other plans • Primary must be 18 years or older up to age 65. The plan ends upon the attained age of 65. • 30 day wait on sickness benefits (not accidents and wellness visits) • 90 day wait on term life benefit • Pre-X is 12/12 for: • Hospital confinement • Surgery and anesthesia • 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. • Pre-X is applicable only to: • Hospital room and board • General nursing services • Intensive and cardiac care unit • Surgery and anesthesia related to surgery • 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

  34. New Alternative Plans! Agent Training Only

  35. 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! Plan Highlights: Association Benefits Agent Training Only

  36. Beech Street Top 100 Procedures Sample Savings Agent Training Only

  37. 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. • Link for pricing and pharmacies is on web site • 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. • Mail order is available • ** 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

  38. Top 10 Drug Savings Agent Training Only

  39. 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 • You will also receive discounted rates of 10%-50% on eyeglasses, non-prescription sunglasses and contact lenses (excluding disposables) at participating independent and retail optical locations nationwide. Most frames, lenses and specialty items are available. Agent Training Only

  40. Quality Vision Network (QVN) • Tier 2 • At participating independent and retail optical locations nationwide, you will receive a 10%-50% discount on eyeglasses, non-prescription sunglasses and contact lenses (excluding disposables). Most frames, lenses and specialty items are available. • Ophthalmology & LASIK Features • Save 20%-60% on medical eye exams and surgical procedures including LASIK at participating ophthalmology locations. Agent Training Only

  41. Call MD • All members will receive 2 toll-free physician telephone consultations which are 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) • Your electronic medical records will be maintained in a highly secured internet accessible environment which is available to network doctors prior to your consultations. Agent Training Only

  42. Dental Directory Services • Multi-tiered dental fee-for-service program Tier 1 • At select participating schedule (A) Tier 1 general practitioners across the country, you will receive: • a no-charge exam and x-rays in conjunction with a paid annual cleaning • Provider link on GetMed360 web site • Participating providers abide by a fee schedule of fixed payments for most procedures • Fixed schedule procedure rate savings are 25%-60% on dental care as compared to the American Dental Association Agent Training Only

  43. Dental Directory Services • Tier 2 • In the event 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

  44. Tiered Chiropractic Program • Tier 1: save 20%-50% at participating providers on adjustments, therapy, x-rays, exams and specialized procedures. • Tier 2: Save 5%-20% at participating providers. • Save 10%-50% on testing procedures, support and orthotics supplement, massage and other bodywork • Visit www.memberproviders.com/chiro Agent Training Only

  45. 24 Hour Counseling Hotline ■ You and your immediate family members have unlimited access to a master’s level therapist via a toll-free number. ■ All counselors have been specially trained to offer prompt, confidential counseling to help you and your immediate family members deal with and overcome the problems that they may encounter everyday. ■This plan features, toll-free, confidential access to a master level therapist 24 hours a day 365 days a year. Free support and self-help group referrals and referrals to local licensed therapist. Agent Training Only

  46. 24 Hour Nurseline ■Unlimited, Toll-Free, 24/7 Access to Registered Nurses. ■ This completely 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

  47. Holistic Care ■The Holistic Care Service providers 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. ■ 20% savings on, all treatments and services. There is no limits on number of visits. Agent Training Only

  48. 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 aids 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. □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

  49. Elder Care • Call toll-free 24/7 for advice about your loved ones. 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) Agent Training Only

  50. 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