Health Insurance Information
When we have a conversation about healthcare the only product that our clients have knowledge of is Major Medical. But how much do they really know?
It's our jobs as agents to educate them by making them aware of a more affordable product. The product I am speaking of is a "Defined Benefit Plan"
So let's take a side by side look at both Major Medical vs. Defined Benefit Medical Plan
(Health Choice Select)
MAJOR MEDICAL PLAN vs. DEFINED BENEFIT MEDICAL PLAN
Deductible: $1,000 - $6,350 (Avg$5,000) Deductible: $0
Deductible Applies: Both in or out of Hospital Pays First Day Hospital Confinement Benefit Percentage
100% 80% 50% 20%
Co-Insurance: 20% - 30% - 40% Co-Insurance: None
Additional $2,000 - $6,350 Out-of-Pocket
Out-patient Services: Out-Patient Services:
If you have a co-pay: Daily Outpatient Services-Up to 20 visits for each covered person
Co-pay chgs. do not count towards deductible $0 Out-Patient Deductible
All expenses between $0 and the annual deductible 1st Dollar Visits & Wellness each yr.
are out-of-pocket to client. Potentially zero out-of-pocket for office visits
All other Out-Patient Expenses: All other Out-Patient Benefits:
100% out-of-pocket to policy holder: Immediate Coverage
Out-Patient Surgery Out-Patient Surgery--- No Deductible
MRI's Annual MRI's Immediate Benefit
Labs Deductible & Labs Immediate Benefit
X-ray's Co-Insurance X-ray's Immediate Benefit
Testing Must Be Satisfied First Testing Immediate Benefit
Off. Visits To cover these services Off. Visits Immediate Benefit
Prescription Drugs: Prescription Drugs:
Rx co-pay: $15 Generic/ $35-$75 Brand Name Rx Rx Covered $0 out-patient deductible
Rx co-pay does not count towards calendar yr. ded. Net Rx cost to patient equivalent or better than that of a co-pay
Most Plans have a $200, $500, $700, or $1,000
additional deductible for brand name prescriptions No deductible for Brand Name Rx
in addition to the calendar year deductible.
Emergency Room: Emergency Room:
Additional $100-$300 Ded. if not admitted to the hospital No additional Deductible
PPO Network: Mandatory use by client PPO Network: Freedom to Choose hospital or doctor
Penalty: Doubles your Deductible & Co-Ins. Penalty: No Out of Network Penalty Applied
PPO Network: Designed to benefit insurance PPO Network: PPO Network benefit acts independently
company - not the client Client receives 100% of the consumer based network PPO discount
Optional Accident Benefit: Optional Accident Benefit Features:
$500 - $2,500 available on some plans a. Pays up to $4,000 per accident
Pays first ...(but not in addition to base benefits) b. Pays benefits "in addition" to other medical benefits
c. Pays $2,100/ wk. income if hospitalized due to injury
d. Includes $10,000 additional ambulance benefit
e. Includes $100,000 accidental death benefit
Add. Critical Illness Benefit: None Optional Critical Illness Benefit:
Pays $10,000 to $50,000 "tax-free" benefit upon diagnosis
of heart attack, stroke, cancer, kidney failure, organ transplant.
Funds may be used for any medical or non-medical purpose.
Free Sponsored Benefits
Teledoc -24 hour phone access to a US Board-Certified Physician
Script Save-Prescription Discount Card
Optional Riders
Family Term Life- Up to $50,000
Critical Illness Rider