purple cow 2012 (medical button)
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2012
Medical
Purple Cow gives you all 3 of today’s major employee benefits in 1 package, designed to provide multiple layers of protection:
Group Life: P50,000 – P1,000,000
Group Accident: P50,000 – P1,000,000
Group Health: P10,000 – P200,000
More VALUE…
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You can get MORE benefits for ALL of your staff
Purple Cow 2012
Value Proposition
1. Paid vacations, 75% 2. Health insurance, 61%3. Paid sick leave, 59%4. Disability insurance, 41%5. Education reimbursement, 39%6. Pension plan, 30%7. Life insurance, 29%8. Dental insurance, 24%
What are the most common EB?
All 4 insurance benefits are offered by Purple Cow
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- Small Business Poll on Compensating Employees (NFIB, US: 2003)
Purple Cow 2012
EB Primer
What makes Insurance ‘sulit?’
• LIFE INSURANCE provides you with instant cash in the event of death or total and permanent disability; (.25% of population between 18-65)
• ACCIDENT INSURANCE provides you with instant cash in the event of accidental death or disablement; (10% of inpatient & outpatient cases)
• HEALTH INSURANCE (medical insurance or HMO) protects you from losing money in the event of sickness or accident. (10% inpatient / 300% outpatient)
Insurance saves you from losing your money
4Purple Cow 2012
EB Primer
3 Major Employee BenefitsLIFE – ACCIDENT – HEALTH
1. LIFE INSURANCE
3a. MEDICAL HMO
3b. Optional DENTAL HMO
3c. Optional APE
3d. WELLNESS PROGRAM
2. ACCIDENT INSURANCE
1Purple Cow 2012
Benefits
Benefit SummaryLIFE – ACCIDENT – HEALTH
1. Life = 5x MBL 13. Access to Big 5 Hospitals & Healthway
2. Terminal Illness = up to 50% of 5x MBL 14. 100% Pre-Existing Conditions coverage
3. Total & Perm. Disability Income = 5x MBL 15. 100% Congenital Conditions coverage
4. Accidental Death = 5x MBL 16. 100% Special Procedures coverage
5. Murder = 5x MBL 17. Benefits on top of Philhealth
6. Accidental Disablement = __% of 5x MBL 18. Pooled Employee utilization
7. Assault = __% of 5x MBL 19. Separate Dependent utilization
8. Medical = HMO buffet of benefits 20. Optional Dental = HMO buffet of benefits
9. Combined inpatient & outpatient limits 21. Optional APE = choice of mobile or clinic
10. Max. Benefit Limits per disability per year 22. Free Wellness Program
11. HMO patient for no-cash-out 23. Same benefits for Dependents
12. Private patient for HMO reimbursement 24. Access through Social Media
2Purple Cow 2012
Benefits
3a. Medical HMO (nationwide)ASIANLIFE (8,205 affil. MD, 383 hospitals, 428 clinics) TERMS & CONDITIONS
1. Traditional HMO buffet of benefits 1. Instant rates, regardless of size
2. Combined inpatient & outpatient limits 2. No franchising required
3. Max. Benefit Limits per disability per year 3. No utilization report required
4. HMO patient for no-cash-out 4. No individual applications required
5. Private patient for reimbursement (HMO rate) 5. Minimum group size = 10
6. Access to Big 5 hospitals & Healthway 6. Minimum mode of payment = monthly
7. 100% Pre-Existing Conditions coverage 7. Pooled Employee utilization to spread risk
8. 100% Congenital Conditions coverage 8. Split Dependent utilization to reduce cost
9. 100% Special Procedures coverage 9. Buy now, pay later
10. Benefits on top of Philhealth 10. 1st year Virgin promo rate, if applicable +Principals 18yo-65yo; Dependents 30dy-22yo / 18yo-65yo +Same rates for Dependents in 2012
Medical HMO benefits are covered on top of Life & Accident benefits
7Purple Cow 2012
Benefits
3a. Medical HMO…PRE-EXISTING CONDITIONS (Dreaded) PRE-EXISTING CONDITIONS (Non-Dreaded)
1. Blood dyscrasias 1. Asthma, pleural effusion or other chronic airway obstruction conditions
2. Benign / malignant new growths 2. Benign cyst / tumor and malignant conditions
3. Chronic cardiac / cardio-vascular diseases 3. Chronic gynecologic conditions
4. Collagen / connective diseases 4. Hemorrhoids and other chronic colonic and ano-rectal illnesses
5. Diseases of the immune system 5. Diseased tonsils requiring surgery, cataracts & other opthalmo-otolaryngologic conditions
6. Chronic hepatobiliary diseases 6. Pathological abnormalities of nasal septum and turbinate
7. Neuro-surgical / neurological conditions 7. Sinus condition requiring surgery
8. Chronic pulmonary diseases 8. Chronic neurologic conditions
9. Chronic genito-urinary diseases 9. Calculus cholecystitis / cholelithiasis and/or urolithiasis
10. Chronic gynecological conditions 10. Chronic conditions of the genitourinary system
11. Chronic gastrointestinal conditions 11. Polyps, ulcers, liver cirrhosis and other chronic gastrointestinal diseases
12. Endocrine abnormalities 12. Endocrine illnesses
13. Antibiotic / chemotherapy-resistant diseases / bactemia / septicemia 13. Seizure disorders
14. Chronic opthalmo-otolaryngologic diseases 14. Moderately to far advanced tuberculosis
15. Chronic musculo-skeletal diseases 15. Chronic musculo-skeletal malignancies
16. Pathological / accidental fractures 16. Malignancies of the blood and bone marrow
17. Illnesses / injuries necessitating the use of isolation room / ICU or other IC facilities 17. Hypertension, coronary artery disease / myocardial ischemia, cerebrovascular accident and other chronic cardiac diseases18. Accidental injuries
19. Second and third degree burns 18. Collagen / connective tissue diseases
20. Surgical procedures requiring application / use of prosthesis for immediate treatment 19. Diseases of the immune system
21. PEC (except congenital ones) subject to the provision on ‘PEC’ in this Agreement [waived] Dreaded & Non-Dreaded PEC are covered 100% up to MBL
8Purple Cow 2012
Benefits
3a. Medical HMO…SPECIAL PROCEDURES or NEW MODALITIES OF TREATMENT
1. Lithotripsy 11. Sclerotherapy
2. Arthroscopic procedures 12. Physical & speech therapy
3. Laparoscopic procedures 13. Angiography
4. Laser therapy (excludes use for correcting vision) 14. Nuclear technologies
5. Nuclear / radioactive isotope scans 15. Thallium scintigraphy
6. Cost of artificial limbs, joint prosthesis and heart valve prosthesis
16. CT scan / MRI
17. Pulmonary perfusion scan
7. Other new modalities of treatment for conditions with established etiologies and used as alternatives to conventional or traditional procedures
18. Endoscopy
19. Bone densitometry scan
20. Anti-nuclear anti-body (ANA)
8. Dialysis 21. C-reactive protein (rheumatic & complications)
9. Chemotherapy 22. Lupus cell exam
10. Radiation oncology / therapeutic radiology 23. Sleep therapy
Special Procedures or New Modalities of Treatment are covered 100% up to MBL
Purple Cow 2012
Benefits 9
3a. Medical HMO…EXCLUSIONS
1. Expenses that should be taken care of by any government programs such as Philhealth 13. Illnesses / injuries attributable to the plan member’s own misconduct / gross negligence / immoral habits, and willful and unnecessary exposure to danger or health hazards 2. Services rendered or supplies provided free of charge
3. Additional hospital charges and/or professional fees resulting from a plan member taking a room accommodation more than his R&B limit (excesses and/or incremental costs)
14. Self-inflicted injuries including, but not limited to, any form of suicide attempt
4. Maternity and maternity-related conditions and/or complications except those benefits that may be provided by the (optional) Maternity benefit
15. Sexually transmitted disease, AIDS, rehabilitative treatment for alcoholism and drug abuse
5. Sterilization of either sex or reversal of such, artificial insemination, sex change, consultation/confinement regarding fertility
16. Acquisition of prosthetic appliances, artificial aids, durable equipment, surgically implanted devices and external prosthetic devices except those that are explicitly covered and enumerated in the ‘Special Procedures or New Modalities of Treatment’ provision of this agreement6. Non-recommended confinement, convalescent / domiciliary / custodial care, rest cures
7. Dental-related cases except those that may be provided by the Dental Benefits and to the extent that are necessary for the repair or alleviation of damage caused solely by accidental injury sustained (and not caused by the plan member)
17. Organ transplant-expense relating to organ donation of the donating party/parties
18. Executive check-ups, unless explicitly provided in the master policy, and/or confinements purely for diagnostic purposes, as well as non-recommended confinements
8. Circumcision, cosmetic / aesthetic procedures except re-constructive surgery to treat functional defects due to a covered disease and/or accidental injury
9. Psychiatric disorders, psychosomatic conditions, treatment for any mental or nervous disorders, illness / injury / condition / complication arising from the plan member’s excessive alcohol intake and/or use of regulated/prohibited drugs
19. Take-home medicines, unless optional ‘Reimbursement of Prescribed Medicines’ benefit is provided, and vaccines, except for first doses of either anti-venom, anti-rabies or anti-tetanus used for emergency treatment
10. Illnesses and/or injuries arising from the plan member’s participation in brawls, riots, commission of a crime, violation of ordinances, or the like
20. Medico-legal fees including the cost of Medical Certificates that a plan member may require for any purpose it may serve him or her
11. Illnesses / injuries resulting from conditions of war or sustained from combat-related activities
21. Congenital disease / deformity that is evident to the plan member at birth and/or can be clinically determined to be congenital [waived]
12. Illnesses / injuries resulting from the plan member’s active participation in hazardous activities such as, but not limited to, bungee jumping, hang-gliding, scuba diving, mountain/wall climbing, and professional sports
22. Medical / surgical procedures and/or diagnostic tests that are experimental in nature and/or not generally accepted by the medical profession such as, but not limited to, iridology, chiropractic services, and acupuncture
10Purple Cow 2012
Benefits
2 Ways to Access Healthcare: You can see an HMO doctor for free,
or your own doctor for reimbursement at the HMO rate – each time you avail.
(Unlike most HMO plans)
You can see your own doctor, cheaper
2Why Purple Cow?
Purple Cow 2012
Competitive Advantages
3 Major Employee Benefits in 1 Plan: You get Group Life, Accident & Health
(medical HMO, optional dental HMO, optional APE, and Wellness) – all in 1 plan.
(Unlike most HMO plans)
You get all the Employee Benefits you will ever need
3Why Purple Cow?
Purple Cow 2012
Competitive Advantages
100% Pre-Existing Conditions: You get 100% coverage up to MBL for
Pre-Existing Conditions such as cancer, hypertension, diabetes & asthma.
(Unlike most HMO plans)
You are covered for dreaded & non-dreaded diseases
6Why Purple Cow?
Purple Cow 2012
Competitive Advantages
100% Congenital Conditions: You get 100% coverage up to MBL for
Congenital Conditions such as mitral valve prolapse, rheumatic heart disease & hernia.
(Unlike most HMO plans) You are covered for medical conditions since birth
7Why Purple Cow?
Purple Cow 2012
Competitive Advantages
100% Special Procedures: You get 100% coverage up to MBL for Special Procedures such as arthroscopy,
laparoscopy, chemotherapy, P/T & MRI.
(Unlike most HMO plans) You are covered for newer modalities of treatment
8Why Purple Cow?
Purple Cow 2012
Competitive Advantages
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Benefits on Top of Philhealth: Your HMO limits are on top of Philhealth,
so you won’t be needing as much MBL: Benefits = Philhealth + MBL (not just MBL).
(Unlike most HMO plans)
You get full HMO benefits on top of Philhealth benefits
Why Purple Cow?
Purple Cow 2012
Competitive Advantages
Medical HMO Network: You can get inpatient and outpatient treatment from 8,205 affiliated doctors,
383 hospitals, and 428 clinics nationwide.
(Unlike some HMO plans)
You can go to MMC/ SLMC/ CSMC/ AHMC/ TMC/ Healthway
19Why Purple Cow?
Purple Cow 2012
Competitive Advantages
EE Features EE BenefitsA complete Employee Benefits package that can make you financially secure
You get more financial security from Purple Cow than from any other HMO
Life INS, Accident INS, Medical HMO, Optional Dental HMO & Optional APE
You won’t need to get any more insurance benefits for yourself
Nationwide Medical & Dental networks, inclusive of all major hospitals & clinics
You can use any accredited hospital or clinic for medical or dental treatment
Choice of doctor as a Private Patient for insurance reimbursement at HMO rates
You can see your own doctor and get reimbursed the rate of an HMO doctor
100% Pre-Existing, 100% congenital, & 100% Special Procedures coverage
You are covered for existing illnesses, natal conditions, & special procedures
Employee Benefits on top of Philhealth You get full HMO + Philhealth benefits
Access to benefit information through C3 on www.purplecow.ph & Facebook
You can take charge of your own health, and know before you go
1 health card for every employee You can avail anytime, anywhere
1♠ What’s in it for…Employees?
Purple Cow 2012
Summary