PLATINUM SERIES Agent Training Only

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PLATINUM SERIES
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GA, LA, NC, SD, TX, WA NO Critical illness
portion CA, CO, MN, NV, NH, SD, TX, WA NO ER
benefit available
Product NOT available in the green states
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Agenda

• Overview
• Administrative Partners
• Carrier Partners
• Limited Medical Plan Benefits
• Association Benefits
• Policy Information

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Product Overview

• GUARANTEED ISSUE NO UNDERWRITING REVIEW
• 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

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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!

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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.

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

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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 the Emergency 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

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Eligibility

• 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

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Provider Access (Beech Street)

• Health Option One 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
• Utilizing Beech Street Network Providers
• Maximizes client savings
• Reduces out-of-pocket expenses

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Members can be enrolled only once. Duplicate or
multiple memberships, including United States
Fire Insurance Company benefits, is not
allowed. Underwritten by the United States Fire
Insurance Company, rated A (Excellent) by AM
Best Company (2009 Edition). Benefits not
available to residents of AK, CT, KS, MD, NJ, NY,
and VT. Maternity is not covered, and there is a
30 day waiting period for sickness. 12/12
Pre-Existing Condition Limitations apply to
Hospital Confinement Benefit, Surgery and
Anesthesia related to Surgery, Maternity is not
covered, and there is a 30 day waiting period for
sickness.
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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.

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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.

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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.

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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.

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Hospital Confinement ICU/CCU
(Fairmont)

• Benefits are payable for up to 31days while
  confined in a hospital ICU/CCU, as a result of a
  covered injury or sickness.
• The benefit is up to 1,000
• 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.

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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

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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.

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Surgery Health Option One 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
• Health Option One 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

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Sample Comparisons (Hillsborough County, Tampa,
FL)
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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

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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

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ADD (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 states where available.

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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.

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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.

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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

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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!

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Beech Street Top 100 Procedures Sample Savings
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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.
• 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.

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Top 10 Drug Savings
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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.

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• 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)
• Additional calls available _at_ 35.00 each

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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

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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

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24 Hour Counseling Hotline

• You and your immediate family members have
  unlimited access to a Masters 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.

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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.

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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.

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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
  manufacturers warranty. Modifications will be
  made without cost during warranty should a change
  within hearing levels require different
  circuitry.

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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, Alzheimers special
  care units and respite care facilities. (savings
  are available for new patients only)
• Toll free 24/7 advice hotline

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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!

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Fitness

• 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 Golds
  Gym, Ballys Fitness, Curves for Women and other
  chains as well as independent fitness clubs.

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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

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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 enrollment and 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 enroll and 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

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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.

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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

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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)

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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!

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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 Patriots toll free phone
  number Monday through Friday, 900 AM until 700
  PM (EST). 888-633-5080

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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
  AR,MD,NE,FL,SC, TN ,
• If a member cancels within 3 days from the
  enrollment date, the member will be refunded the
  first months membership costs plus the one time
  enrollment fee.

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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

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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

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Web Site Features

• Plan and Benefit Availability by State with Rates
• Brochure and Sample Certificates
• Training Power Point
• FAQs
• Association Provider and Beech Street Links
• Enroll On Line for your Customer
• Agent Back Office
• Track and manage business
• 24/7 access to clients policy information

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Thank You and Welcome to H.O.1