foundation training deck - ahcp

National General Foundation HealthFOR AGENT TRAINING USE ONLY. NOT FOR DISTRIBUTION TO CONSUMERSNational General Accident and Health markets products underwritten by National Health Insurance Company, Time Insurance Company, Integon National Insurance Company, and Integon Indemnity Corporation.

National General Foundation Health

Why a fixed-benefit indemnity plans

Why supplements help

Plan design & how it works


Why fixed-benefit indemnity plans

• 2017 Open Enrollment, ACA plans’ premiums rose by 25% on

average 1

• 2017 Open Enrollment: There was an average of 3.9 insurers

on the Health Insurance Marketplace (down from 5.4 in

2016)2

• Approximately 62% of Americans have less then $1,000 in

savings 3

1 Retrieved 11/29/2016 from http://fortune.com/2016/10/25/obamacare-insurance-premiums-2017-healthcare/

2 Retrieved 11/29/2016 from http://kff.org/health-reform/issue-brief/2017-premium-changes-and-insurer-participation-in-the-affordable-care-acts-health-insurance-marketplaces/

3 Retrieved 11/29/2016 from http://www.marketwatch.com/story/most-americans-have-less-than-1000-in-savings-2015-10-06



An affordable way for your clients to get the health care

they need by:

– Helping to cover the anticipated cost of every day health

care services with set-dollar amounts

– Providing access to telemedicine services, prescription and

vitamin discounts, lab discounts, negotiation services, and

more, for additional savings on health care.



A fixed-benefit indemnity plan is great for clients who:

– Don’t have the budget for major medical plans

– Don’t want to pay for benefits they don’t use

– Missed Open Enrollment and still need help paying for

health care expenses

THESE PLANS PROVIDE LIMITED BENEFITS. Make sure your clients know this is not a major medical plan and does not satisfy the requirements

of minimum essential coverage under the Affordable Care Act. They may be subject to a tax penalty.


National General Foundation Health overview

• Benefits start right away – no waiting period

• First-dollar benefits – no deductibles or copays

• Access to the MultiPlan Network of doctors and

hospitals for added savings

• Includes a L.I.F.E. Association membership


Why National General Foundation Health

Offers predictable and affordable access to health care

• Clients can go to any doctor or hospital they want

• They save more when they use MultiPlan Network providers

• Benefits for office visits, lab and x-rays, surgeon costs, and more

• Benefits are paid on top of other coverage

• No coordination of benefits

• Automatic renewals - no need to reapply


L.I.F.E. Association

MyTeleMedicine:

• Connect with a physician 24/7 regardless of the time or location

• No limits to the number of consultations - at no extra cost to you.

• Requires registration

WellCard Savings:

• Provides access to pre-negotiated savings on prescriptions, hearing aids, vitamins, and diabetic supplies

• Requires registration

The membership provides:

• Access to Direct Labs - with special group rating

• Hospital and diagnostic facility cost negotiations

• Identity Theft Protection

• Fitness Programs

• World-Wide Travel Assistance

• Roadside Assistance

• and moreMemberships not available in all states

If sold with the National General STM or TrioMED, client would receive only one L.I.F.E. Association Membership

LIFE Association memberships give your clients access to :


Plan Details: Hospital and Ambulance benefits

Level 1 Level 2 Level 3

Ho

spit

al C

har

ges

Confinement BenefitRequires a stay for more than 24 hours

$1,000 per dayUp to 31 days per year

$2,000 per dayUp to 60 days per year

$3,000 per day Up to 90 days year

Hospital AdmissionLimited to one admissions per year

$250 $500 $1,000

Emergency Room Visit$100 per day1 day per year

$200 per day2 days per year

$300 per day2 days per year

Am

bu

lan

ce

Ground 1 time per year

$300 $400 $500

Air1 time per year

$1,000 $2,000 $3,000


Plan Details: Benefits for office visits and lab work


Off

ice

visi

ts &

lab

wo

rk

Doctor’s Office Visit$50/day2 days per year

$70 /day2 days per year

$90 /day2 days per year

Diagnostic TestsEx: MRI, Mammogram

$100/day1 day per year

$200/day2 days per year


X-Ray Benefits$100/day1 day per year



Laboratory BenefitEx: Cholesterol, A1C

$50/day1 day per year




How the plan worksLike other insurance plans, customers should:

Use the network website to search for network providers:

www.multiplan.com

Set an appointment with the provider

Present his/her ID Card when checking in

After receiving treatment(s),

The EOB will show the network discount and the plan

benefit paid

The insured is responsible for paying any remaining

balance after the plan benefit is paid

The plan benefit your client receives is the same regardless of where they receive care or how much the provider charges.

http://www.multiplan.com/


Plan Details: Surgeon Benefits


Surg

eon

Ben

efit Inpatient

Admitted for no less than 24 hours

$1,000/per day $2,000/per day $3,000/per day

OutpatientAdmitted and released in a period less than 24 hours

$500/per day $1,000/per day $1,500/per day

Benefits are paid per covered person, per policy year.

Maximum days per policy year: 3 (combined inpatient and outpatient benefits)

Benefits and product availability may vary by state


Plan Details: Network

MultiPlan Network

• Over 4,800 hospitals

• 100,000 ancillary facilities

• 800,000 health care professionals

• Assignment of benefits – we pay

providers directly

Average 42% discount for Physicians and Specialists!

www.multiplan.com

http://www.multiplan.com/


How the plan works:

Office visit $2001

Chest x-ray $3702

Total charges $570

Network discount 3 $239

Office visit/ X-ray benefits $70/$100

Total out-of-pocket: $161

National General Foundation Health - Level 2

Office visit for illness

1.http://www.jhsph.edu/news/news-releases/2015/primary-care-visits-available-to-most-uninsured-but-at-a-high-price.html2.http://health.costhelper.com/chest-x-rays.html3. Multiplan discounts average 42% for physicians and specialists

That’s over 70% savings when you add the network discount and plan benefits

Not an actual case. For Illustration purposes only.

http://www.jhsph.edu/news/news-releases/2015/primary-care-visits-available-to-most-uninsured-but-at-a-high-price.html

http://health.costhelper.com/chest-x-rays.html


National General Foundation Health plan – Level 2

Not an actual case. For Illustration purposes only

1.https://www.healthcarebluebook.com/page_ProcedureDetails.aspx?id =69&dataset=MD&g=Appendectomy2. Anesthesia not covered under plan3. Multiplan network discount for acute inpatient average 19.72%

How the plan works:

That’s big savings when you add the network discount

and plan benefits

Overnight stay for an Appendectomy1

Hospital stay charge $5,784

Surgeon fee $1,586

Anesthesia fee2$908

Network discount 3 $1,453

Cost after network discount $6,825

Surgeon benefit $2,000

Hospital admission benefit (1st visit) $500

Hospital confinement benefit $2,000

Total out-of-pocket: $2,325


NG Foundation Health Plan Sample Rates

Family Composition

Plan Level 1

Plan Level 2

Plan Level 3

Individual $87.46 $169.96 $252.96

Couple $174.93 $339.92 $505.93

1 Parent Family

$202.04 $391.12 $581.59

2 ParentFamily

$289.51 $561.08 $834.55

Sample rates for primary age 18 - 49

FamilyComposition

PlanLevel 1

Plan Level 2

Plan Level 3

Individual $120.48 $235.00 $350.11

Couple $240.96 $470.01 $700.22

1 Parent Family

$221.49 $429.97 $639.90

2 Parent Family

$341.98 $664.97 $990.01

Sample rates for primary age 50 - 54

Rates shown are representative of rates in most states, however, rates may vary by state and age. Always refer to the quoting tool for specific rates for your clients.


NG Foundation HealthState availability

AL ID MS OK TX

AR IL NC PA VA

AZ IN NM* RI WI**

DC LA NV SC WV

FL MI OH TN WY

GA MO

*In New Mexico, any person applying for coverage that has prior health insurance with any carrier, including a National General Foundation Health plan, must have at least a 95-day gap before applying for a National General Foundation Health plan. **L.I.F.E. Association not available in WI


Eligible Ages

Primary applicant

– Age 18 – 64 at time of application

• Children up to age 26– No child only

• Requires a Health Questionnaire

• Renewable to age 65


Who it’s good for

A fixed-benefit indemnity plan is good for clients who:

– Don’t have the budget for major medical plans

– Don’t want to pay for benefits they don’t use

– Missed Open Enrollment and still need help paying for

health care expenses

These plans are not suitable for clients who:

Utilize a lot of medical services

Want comprehensive medical coverage and don’t mind paying higher

premiums

Have a serious illnesses or chronic conditions


• Pre-existing conditions

• Dental procedures

• Elective or cosmetic surgery

• Prescriptions and

medications

Example of exclusions

*Not a comprehensive list of exclusions. Please refer to the policy of the marketing product brochure for a complete list.

• Pregnancy

• Workers compensation

• Hazardous activities

• Mental disability and chemical

abuse


5 days before the monthly anniversary of start date (monthiversary)

EFT

Visa, MasterCard, or Discover

Enrollment

Initial Payment

Drawn at time of application

Reoccurring Payment Form of Payment

– 1st or 15th

– Must apply by 25th for 1st

– Must apply by 9th for 15th


Plan Enhancer• Accident Medical Expense

Plan Enhancer with riders*• Cancer and Heart Stroke• Sickness Hospitalization

Accident Fixed Benefit• Fixed dollar amount per

service from and accident

Critical Illness• First ever diagnosis of Critical Illness• 15 Covered Conditions

Cancer & Heart/Stroke• Benefit pay out for first-ever diagnosis

of Cancer & first-ever heart attack or stroke

TrioMED• AME | CI | AD&D• Guaranteed Issue

Bundle with our supplemental plans for even more coverage

*Riders not available in all states Dental PPO or Dental Indemnity plans also make a great add-on!


Bundled with supplemental coverage

Treatment Cost 1 $9,300


NG Foundation Health paid: 3 hospital days

Admission (1st under plan)Chest x-ray (1st under plan)

$3,000$250$100

Sickness Hospitalization Rider with Plan Enhancer paid: $5,000

Remaining out-of-pocket cost $0

Client fell while walking dog and injured shoulder resulting in surgeryNG Foundation Health – Level 1 plan and a $5,000 Plan Enhancer with riders

1 Average cost of shoulder surgery and MRI2 Multiplan network discount for acute inpatient average 19.72%3 48-year-old male AZ, non-smoker

Leaves $884 to help pay for other expenses

With a monthly premium of $137.46 3

Not an actual case. For Illustration purposes only Quotes ran 4.3.17


Ex 1.| Bundled with supplemental coverage


Network discount 2 $1,441.93

Client’s cost after discount $5870.07

Benefit’s Paid:

NG Foundation Health-- Outpatient surgeryNG Foundation Health-- MRI

Accident Benefit LV 2--MRI Accident Benefit LV 2--MRI

Plan Enhancer—Accident benefit

$500$100$200$600$5,000

Total Benefits Paid $6,400


Shoulder Surgery – Male, 78717, 01/01/1972NG Foundation Health – Level 1 plan and a $5,000 Plan Enhancer AME + Accident Fixed Benefit Level 2


Client receives check for $529.93

1.https://www.healthcarebluebook.com/page_ProcedureDetails.aspx?cftId=553&g=Shoulder+Surgery+(non-arthroscopic)2. Multiplan network discount for acute inpatient average 19.72%

https://www.healthcarebluebook.com/page_ProcedureDetails.aspx?cftId=553&g=Shoulder+Surgery+(non-arthroscopic)





Client’s cost after discount $10,122.57

Benefit’s Paid:NG Foundation Health – Outpatient surgery

NG Foundation Health – MRING Foundation Health – ER Accident Fixed Benefit – ER

Accident Fixed Benefit – MRI Accident Fixed Benefit – Hip Surgery Open Reduction

$1,000$200$200$100$200$5,000


Remaining out-of-pocket cost $3,422.57

Hip Fracture – Male, 78717, 01/01/1972, NT – Quoted 4/3NG Foundation Health – Level 2 plan and a Dental PPO Essentials and Accident Fixed Benefit Level 2

67% of the total cost was covered when combining

benefits of multiple products

1.www.healthcarebluebook.com/page_ProcedureDetails.aspx?cftid=589&g=Hip%20Fracture%20Repair&directsearch=true2. Multiplan network discount for acute inpatient average 19.72%2. Multiplan network discount for acute inpatient average 19.72%






Client’s cost after discount $10,048.86

Benefit’s Paid by:

NG Foundation Health – Out-Patient SurgeryNG Foundation Health – X ray

NG Foundation Health – ERAccident Fixed Benefit – ER

Accident Fixed Benefit LV 2 – MRIAccident Fixed Benefit LV 2 – Leg surgery

HEP – Hospital AdmissionsHEP – X ray

$500$100$100$100$200$2,500$1,500$50


Remaining out-of-pocket cost $4,998.46

Femur fracture – Male, 78717, 01/01/1972NG Foundation Health – Level 1 plan with Hospital Expense Protection and Accident Fixed Benefit Level 2

60% of the total cost was covered by benefits of

combined products

1.https://www.healthcarebluebook.com/page_ProcedureDetails.aspx?cftId=30&g=Femur+Fracture+Treatment2. Multiplan network discount for acute inpatient average 19.72%2. Multiplan network discount for acute inpatient average 19.72%





Gallbladder removal – Male, 78717, 01/01/1972NG Foundation Health – Level 2 plan and Hospital Expense Protection

Client receives check for $729



Client’s cost after discount $11,721


NG Foundation Health – Inpatient SurgeryNG Foundation Health – 1st time admission

NG Foundation Health – Confinement 4x daysHealth Expense Protection – 1st time admission

Health Expense Protection – Confinement 4x days

$2,000$500$8,000$1,500$450


1.www.healthcarebluebook.com/page_ProcedureDetails.aspx?cftid=75&g=Cholecystectomy%20(surgical)&directsearch=true2. Multiplan network discount for acute inpatient average 19.72%





Client has heart attack – Male, 78717, 01/01/1972NG Foundation Health – Level 2 plan and TrioMed 30k

1. Average cost of an AMI. Source: Agency for Healthcare Research and Quality, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, National Inpatient Sample, 2013 2. Multiplan network discount for acute inpatient average 19.72%

Client receives check for $23,350






NG Foundation Health – Confinement 3x daysNG Foundation Health – Emergency Room

NG Foundation Health – Ambulance (ground)NG Foundation Health – Lab/diagnostic/X ray

TrioMed – Critical Illness Lump Sum

$2,000$500$6,000$200$400$375$30,000

Total Benefits Paid $39,475Not an actual case. For Illustration purposes only Quotes ran 4.3.17




Client has heart attack – Male, 78717, 01/01/1972NG Foundation Health – Level 1 plan with Critical Illness-Term Life 50k

1. Average cost of an AMI. Source: Agency for Healthcare Research and Quality, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, National Inpatient Sample, 2013 2.Multiplan network discount for acute inpatient average 19.72%2. Multiplan network discount for acute inpatient average 19.72%









Critical Illness Term Life – Critical Illness Lump-Sum

$1,000$250$3,000$100$300$250$50,000

Total Benefits Paid $54,900Not an actual case. For Illustration purposes only Quotes ran 4.3.17




Client has heart attack – Male, 78717, 01/01/1972NG Foundation Health – Level 2 plan and Critical Illness Term Life 50k and Plan Enhancer with CHS and SIP riders

1. Average cost of an AMI. Source: Agency for Healthcare Research and Quality, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, National Inpatient Sample, 2013 2.Multiplan network discount for acute inpatient average 19.72%2. Multiplan network discount for acute inpatient average 19.72%









Critical Illness Term Life – Critical Illness Lump-sumPlan Enhancer + CHS – Lump-sumPlan Enhancer + SIP – Lump-sum

$2,000$500$6,000$200$400$375$50,000$5,000$5,000






Client has Colon Cancer – Male, 78717, 01/01/1972NG Foundation Health – Level 1 plan and Cancer & Heart/Stroke






NG Foundation Health – Inpatient SurgeryNG Foundation Health – Outpatient SurgeryNG Foundation Health – 1st time admission

NG Foundation Health – Confinement 2x daysNG Foundation Health – Lab/diagnostic/X ray

Cancer & Heart/Stroke lump-sum

$1,000$500$250$2,000$250$50,000


1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2832226/table/t4-hcfr-31-01-035/#tfn9-hcfr-31-01-035

2. 2. Multiplan network discount for acute inpatient average 19.72%






NG Foundation Health paid: 3 hospital days

Surgery BenefitAdmission (1st under plan)

leg x-ray (1st under plan)

$3,000$4,000$250$100

Accident Fixed-Benefit paid: $3,800

Remaining out-of-pocket cost $2,096

Admission to a hospital for 3 days with broken ankle with surgery. NG Foundation Health – Level 1 plan and a Level 2 Accident Fixed Benefit

1 Average cost of a hospital stay due injury according to the Agency for Healthcare Resource and Quality, statistical brief #146, January 2013.2.Multiplan network discount for acute inpatient average 19.72%

Not an actual case. For Illustration purposes only.*Rate based on 45 year old Single male in Texas (Zip: 78717)

For $22.90* a month, we paid out $3,800 to

the customer!


– E-Signature

• www.vipmemberbenefits.com

• Login to e-sign their application

• Easiest Method

Product Enrollment

– Voice Signature

• 3-way call with insured on the line

• Dial 210-835-9969

• Instructions present on each application

http://www.vipmemberbenefits.com/


Post Sale: Instant Access

Electronic policy fulfillment • Customers can view all policy documents at

www.NGAHDocuments.com

ID card(s) will arrive separately in the mail.

Customers can manage their policies at www.VIPmemberbenefits.com• Change payment types • Change of address

http://www.ngahdocuments.com/

http://www.vipmemberbenefits.com/


Post Sale: Member Services

• Cancellations

– Plan cancellations • 10 days prior to the

monthiversary to stop premium withdraw

Member Services

888-781-0585

National General Accident & HealthPO BOX 1070Winston Salem, NC 27102-1070

888-344-3232


National General Foundation Health plan

Set dollar amounts to help with health care costs

3 benefit levels to choose from

Easy to use and easy to understand

No lifetime limits

Pick any doctor or hospital- Could save more by staying within

MultiPlan Network

No deductible or coinsurance


LIFE ASSOCIATION TERMS & CONDITIONS

LIFE Association, Inc. (“LIFE”) provides Members with benefits and services designed to enhance their lives and stretch the value of their hard earned dollars. Once a LIFE Member, a variety of association products, services and group insurance plans are available for consideration.

Payments for the LIFE Program are due in advance. Payments will be collected on or about 15 days before the due date. If you choose to cancel your membership, it is your responsibility to make sure that your membership cards and a written request for cancellation are sent to LIFE at least 15 days prior to the anniversary of your effective date in order for your account not to be charged for additional fees. Membership is effective on the 1st of the month following enrollment acceptance by LIFE, Inc.

LIFE reserves the right to terminate any enrollment or deny eligibility in the association for lack of payment to LIFE. Returned checks, insufficient notices on bank drafts or denial by the member’s credit card company for payment of the membership fee are deemed to be evidence of non-payment by a Member. There will be a $30.00 charge to be reinstated in the Association after such denial.

Proxy - In regard to your participation as a member of LIFE Association, Inc. (the “Association”) you appoint the Secretary of the Association in office at any particular time as your proxy to receive notice of and attend all meetings of the members and vote on your behalf and to otherwise act for you in the same manner and with the same effect as if you were personally present. This proxy shall be valid until revoked by you at any time prior to voting at any meeting, by executing and delivering a written notice of revocation to the Secretary of the Association, by executing and delivering a subsequently dated proxy to the Secretary of the Association, or by voting in person.

LIFE is not an insurer, guarantor or underwriter and does not provide any medical treatment, medical services, products, product liability or guarantees for any Member. Providers of products and services are independent contractors and are not employees or agents of LIFE. Due diligence of any provider of products or services and the final selection of a provider, facility or merchant and the approval or disapproval of products or services are the Member’s choice alone. LIFE and its affiliates do not have the responsibility or liability for a Member or Member’s dependents medical care or for any other goods or services provided to Member or Member’s dependents. Member shall have no recourse against LIFE by reason of its referral to a provider of products or services and shall hold LIFE harmless against any claims. No payments to medical providers or Members will be made by LIFE Association, Inc.

This Agreement shall be governed and construed in accordance with the laws of the State of Texas. Any dispute or claim in law equity arising out of this Agreement or any resulting transaction, including disputes or claims involving the parties to this Agreement, their officers, agents, or employees, shall be submitted to neutral, non-binding mediation prior to the commencement of arbitration, litigation, or any other proceeding before a trier of fact. The parties to the dispute or claim agree to act in good faith to participate in mediation, and to identify a mutually acceptable mediator. If a mediator cannot be agreed upon by the parties, each party shall designate a mediator and those mediators shall select a third mediator who shall act as the neutral mediator, assisting the parties in attempting to reach a resolution. All parties to the mediation shall share equally in its cost. If the dispute or claim is resolved successfully through the mediation, the resolution will be documented by a written agreement executed by all parties. If the mediation does not successfully resolve the dispute or claim, the mediator shall provide written notice to the parties reflecting the same, and the parties may then proceed to seek an alternative form of resolution of the dispute or claim, in accordance with the remaining terms of this Agreement and other rights and remedies afforded to them by law. Exclusive venue for such mediation shall be in Dallas, Texas. Members shall submit all grievances in writing via U.S. Mail to LIFE Association, Inc., P.O. Box 26338, El Paso, TX 79926. These provisions shall survive termination of membership. This Agreement constitutes the entire Agreement between Members and LIFE. There are no warranties, express or implied, other than those expressly stated herein. This Agreement may only be amended in writing by LIFE. LIFE may assign its duties and responsibilities hereunder to third parties.

By utilizing any LIFE products and services, Member agrees to these terms and conditions.

Cancellation: Members may cancel their LIFE membership at any time upon written notification to LIFE and return of all identification cards. Once again Members must return their membership cards. Membership dues in the first thirty days of membership shall be refunded if the above requirements are met. There are no prorated fees or rebates after the first thirty days of membership. Cancellation will become effective on the Member’s anniversary date of membership. Failure of a member to pay LIFE membership dues will be cause for cancellation of the membership by LIFE.

These Terms & Conditions are subject to change without notice.

LIFE Association, Inc. P.O. Box 26338 El Paso, TX 79926 800-557-5024