Balance
Critical Illness & Accident Plans
Brought to you by:
Anthem and The IHC
Group
CO/NV
Confidential and Proprietary – may not be used or distributed without Anthem consent
What is Balance?
Anthem brokers now have access to a guaranteed issue product that
is a great complement to your client’s medical plan - Balance
• Balance is an association membership that provides a package
of insurance coverage, services and discounts, which include:
• Critical Illness
• Medical Expenses Due To Accidents
• Hospital Confinement Due To Accidents
• Disability Income Due To Accidents
• Balance helps members “Balance” their finances in the wake
of a critical illness or accident
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2
Balance
• With four membership levels, Balance allows your clients to focus
on getting well because payments help cover everyday expenses
such as:
• Mortgage payments
• Daycare
• Household bills
• Credit cards
• Balance insurance benefit payments go directly to your clients
Confidential and Proprietary – may not be used or distributed without Anthem consent
3
Health Care Reform: Consumer Perspective
• Average deductible in 2010 for single coverage
on individual plans was $2,632 and $3,531 for a
family¹
• Higher deductibles and out-of-pocket limits
impact those with lower
Affordability disproportionately
²
incomes
is still an
issue
• 21 percent of adults surveyed indicated that
they paid a medical bill late in the past 12
months³
• Anecdotal information indicates that employees
are choosing not to insure their dependents
on employer sponsored plans due to cost
1
eHealth Insurance Cost Report; 2 NHEA (Centers for Medicare and Medicaid Services & Deloitte Analysis); 3 Harris Poll, National
Quorum telephone survey
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4
Critical Illness and Accident
•
Carriers are developing more new products than years past
•
Critical Illness and Accident plans leading the way
•
The heightened burdens and costs of regulation imposed by healthcare reform
on health insurance is leading carriers to explore other products and means of
providing protection from illness, accident or injury.
Source: Eastbridge Consulting's annual “U.S. Worksite Sales Report”
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5
Health Care Reform: Consumer Perspective
HowBalance
Balance Helps
How
Helps
• Critical illness and accident plans assist in funding out-of-pocket
cost
• Payments may be assigned to providers or paid directly to
insured
• Critical illness can provide income in excess of plan out-of-pocket
to help defray the impact of significant illnesses on family
budgets
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6
Balance Participants
Communicating
For America
Madison
National &
Independence Holding
Co.
Brokers
Anthem
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Communicating for America Association
• Approximately 50,000 members across all 50 states
• Separate board of directors not affiliated with The IHC
Group or Madison National Life Insurance Company
• Offices in Fergus Falls, Minn. and Minneapolis, Minn.
• National membership organization founded in 1972
• Active in the Alliance for International Educational and
Cultural Exchange
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Why Balance? The Broker Perspective
Balance is easy to sell and service
Single
Product
Source
Low Cost
Product
Ease
• No need to deal with multiple underwriters or
administrators for the ancillary plans
• Outstanding customer service for all bundled
Balance products at one location
• Bundling ancillary products lessens the impact
of selection
• Lower administrative cost due to multiple
products on single bill
• Guaranteed issue products
• Co branding arrangement limits client confusion
• Online policy fulfillment
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Why Balance? The Broker Perspective
Balance benefits you directly
Commissions
Broker
Benefits
• Balance values you and your client –
commissions of 30%
• Supplements your medical commissions
• Diversifies your book of business
• Improves retention and monthly sales
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Balance Is Technology Focused
•
Interested brokers (in good standing with Anthem) can be easily
appointed with MNL by simply submitting a sub-agent agreement
•
Each broker will receive a unique URL that allows him or her to enroll
customers online*
•
If a client applies online through the Anthem site they will be offered the
opportunity to enroll in Balance at the end of the medical application
•
The broker number is carried over from the Anthem enrollment site
through secure web services
•
Policies are fulfilled online immediately upon payment verification
*Multiple URL’s are possible if writing broker has multiple parent TINs
Confidential and Proprietary – may not be used or distributed without Anthem consent
11
Confidential and Proprietary – may not be used or distributed without Anthem consent
12
Balance
Balance membership includes:
Bundled guaranteed issue insurance coverage consisting of:
•
•
•
•
Critical illness
Medical Expenses Due To Accidents
Hospital Confinement Due To Accidents
Disability Income Due To Accidents
Additional benefits include:
•
•
•
•
•
Teledoc
Low-rate student loans
Reimbursement for towing and emergency roadside services
Discounts on remote meeting, remote PC access and backup
Legislative hotline to let your voice be heard in Washington
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Balance Benefits Appeal To:
• Families with children looking for
accident medical expense coverage
• Those over the age of 45 in need of
critical illness insurance
• Sole proprietors and the self employed who
cannot find disability coverage
• Consumers who want the convenience of guaranteed issue
coverage, online enrollment and credit card payment
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Critical Illness and Accident benefit levels
Balance 1 Balance 2 Balance 3 Balance 4
Critical illness
$2,500
$5,000
$7,500
$10,000
Accident medical
$2,500
$5,000
$7,500
$10,000
Accident hospital
confinement
$150
$150
$150
$150
per day
per day
per day
per day
Accident disability
income
$1,000
$1,000
$1,000
$1,000
per month
per month
per month
per month
Individual monthly cost
$34.95
$44.95
$54.95
$64.95
Family monthly cost
$51.95
$69.95
$89.95
$109.95
Exclusions and limitations apply
*Underwritten by Madison National Life Insurance Company, a Wisconsin Insurance company. All benefits terminate at age 70 and coverage is not
available in all states. Accident Medical Expense benefits are reduced by benefits payable under other insurance plans. Additional limitations and
exclusions apply and provisions may vary by state. Refer to the policy form number GAO-P-1207 for a complete listing of benefits, exclusions and
limitations.
Confidential and Proprietary – may notConfidential
be used or distributed
and Proprietary
without
– may
Anthem
not be
consent
used or distributed without Anthem consent
15
Critical Illness
Critical Illness
Coverage
Balance 1
Balance 2
Balance 3
Balance 4
$2,500
$5,000
$7,500
$10,000
Pays a lump sum benefit upon diagnosis of:
• Life-threatening
cancer
• Heart attack
• Kidney failure
• Stroke
• Coma
• Coronary bypass
• Loss of sight,
speech or hearing
• Major organ
transplant
• Paralysis
• Severe burn
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Critical Illness
Some additional points regarding Critical Illness Coverage:
• A family membership covers the primary insured and spouse only
• Dependent children are not covered for Critical Illness Coverage
• Subject to a 12 month pre-existing condition limitation (based on
date of first diagnosis)
• Benefit varies by type of illness and other terms; benefit reduces
by 50% when the insured attains age 65
• Coverage terminates at age 70
• Unless otherwise noted, coverage must be in effect for 30 days
before benefits are payable
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Accident Medical Expense
Accident medical
insurance
Deductible per
accident
Balance 1
Balance 2
Balance 3
Balance 4
$2,500
$5,000
$7,500
$10,000
$100
$250
$500
$500
• After the deductible, benefits are payable for medical
expenses incurred as a result of each covered accident
• Pays medical expenses resulting from a covered accident
• Non-duplication of benefits: The benefit is reduced by the
amount paid by any other health care plan
• A family membership covers the primary member, spouse and
all dependents up to age 26
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Accident Hospital Confinement
Balance 1
Accident hospital
confinement
Balance 2
Balance 3
Balance 4
$150
Per day
• Benefits are available for up to 30 days when hospital
confined due to a covered injury
• A family plan covers the primary member, spouse and all
dependents to age 26
Confidential and Proprietary – may not be used or distributed without Anthem consent
19
Accident Disability Income
Balance 1
Balance 2
Accident Disability
Income Insurance
Balance 3
Balance 4
$1,000
per month
• Pays a monthly benefit up to 12 months for disability due
to a covered accident
• After a 90 day elimination period
• This benefit is available only to the primary insured
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Critical Illness Example
•
Member suffers from a stroke
•
Member completes a claim form and
sends to IHC
•
IHC Reviews
•
IHC (on behalf of Madison National)
sends check for a lump sum
(depending on plan selection) to the
member
Request and complete claim form for
IHC
IHC Reviews
Check sent to customer
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Accident Medical Expense
Example - $5,000 claim:
The member’s major medical
coverage:
Insured receives an EOB from their
medical insurance company
Insured sends a completed accident
medical claim form to IHC with copy
of medical EOB
$5,000 deductible
Balance plan selected:
•Balance 1 ($2,500)
IHC reviews, and on behalf of MNL,
sends a check to the client for $2,250
($2,500 minus the $250 deductible)
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22
Member Welcome Kit
Your member will receive a welcome kit via email that will include:
• A contact list including information on how to submit a claim
• A brief explanation of the Balance ancillary services
• Link to specific set of critical illness and accident certificates
(based on membership level purchased)
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Commissions – External Broker
Let’s take a look at what you could be earning:
The average monthly cost of a Balance Plan is $60. If you sell 5
memberships a week, you could earn $90 in commissions. Here’s the math:
In a week:
• $60 x 5 memberships = $300 premium
• $300 x 30% = $90 commission each week
In a month:
• $90 x 4 weeks = $360 commission
In a year:
• $90 x 52 weeks = $4,680 each year!
As you can see, Balance plans can be a good source of
supplemental income!
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Broker Appointment Process
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25
External Broker Contracting & Appointment
Process
Here’s how the contracting and appointment process will work:
Start
Broker completes
the sub-agent
agreement
Broker sends signed
contract to Anthem
via fax or email to
Licensing and
Credentialing
Anthem sends daily
file of brokers to IHC
Note: Anthem’s Licensing and Credentialing department will need to confirm the broker is active
w/ Anthem and is in good standing before logging the contract and sending the file to IHC.
IHC loads brokers
into their admin
system
IHC will send NV
broker to DOI for
appointment
(This step is not
necessary in CO)
IHC sends welcome
email with
personalized broker
URL within 4
business days
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26
Once appointed by IHC – External Brokers
Broker receives a welcome email that includes their IHC broker number and
instructions to access the IHC website (www.ihcsales.com/balance). This
website is the online source for:
•
•
•
•
•
Viewing new business case status/application
Downloading forms
Statements
Accessing compensation statements (external broker)
IHC Broker Support
Brokers should include the IHC broker number on all Balance
correspondence and paper applications to ensure sales are properly credited,
and commissions are paid
Broker receives an email that contains their unique URL for forwarding to
customers to apply for Balance
•
Available to current medical clients who wish to add Balance, and clients
without medical coverage
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Application Process
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PlanFinder
When an applicant visits Planfinder, they will see a new icon on all Medical
Plans/Deductibles. Hovering over the icon will provide a description.
Critical Illness and Accident
Coverage offered through
Balance
Balance is a package of
benefits designed to
supplement your health
insurance plan and give you
additional financial support
when you need it most.
Balance is provided by
Communicating for America
which provides financial
benefits to help you recover
from a covered critical illness
or accident as well as other
valuable services.
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29
PlanFinder – Final Confirmation Page
By clicking continue, the applicant will be taken to the Balance website to start
the application process. There, they will fill out a short, simple application.
Broker number will carry over from Planfinder.
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PlanFinder – Final Confirmation Page
Upon selecting the continue button, the applicant will see a popup message:
“You are now leaving Anthem’s website and will be routed to the IHC Secure
Website to complete the Balance application. If you do not wish to apply
for Balance, please click cancel.”
Disclaimer:
Disclaimer at bottom of page: Balance is a membership in Communicating for America, Inc. and includes benefits underwritten
by Madison National Life Insurance Company, Inc., along with valuable discounts and services. Association membership services
are provided by Communicating for America, Inc. There is no ownership affiliation between Madison National Life Insurance
Company, Communicating for America or Anthem Blue Cross and Blue Shield. Each entity is separate, independent and
unaffiliated with Anthem Blue Cross and Blue Shield and its products and services Anthem Blue Cross and Blue Shield, or its
affiliates, may receive compensation from membership fees or otherwise in connection with association membership.
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31
IHC URL
•
A second way to direct applicants to the Balance website is to email
them the Balance URL link directly. This will take them directly to the
website, and will credit the sale to your IHC Broker Number.
EASY ENROLLMENT PROCESS!
•
Whether the applicant arrives at the Balance website via Planfinder or
by clicking on the IHC link, the application process will be the same. The
applicant will then complete the enrollment process on the Balance
website.
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Balance Website – Application Process
Once the applicant arrives at the IHC Website, the application
process is quick and easy!
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33
Balance Website – Application Process
Step 1 – Applicant completes basic demographic information
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Balance Website – Application Process
Step 2 – Payment information
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Balance Website – Application Process
Step 3 – Summary
It’s as easy as that!
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Balance – Payment Methods
Monthly Payment Options Include:
• Automatic Withdraw From Checking Account
• Recurring Credit Card Payment
(Paper Billing is not an option)
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Balance – Effective Dates
Possible Effective Dates Include:
• 1st, 8th, 15th, and 22nd.
• Example:
• If the application is submitted prior to 9:00 PM Mountain time on the 1st,
the applicant will receive the 1st as the effective date (unless they request
a later date.) If the application is submitted after 9:00 PM Mountain time
on the first, the effective date will default to the 1st of the following
month (unless otherwise specified.)
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38
Member Collateral
There are two places where brokers can
view and download Balance brochures:
• AgentAccess Site
• IHC Agent Website
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39
Important Dates
Event
Date
PlanFinder Availability
5/21/12
First Available Effective Date
6/01/12
First Commission Payments Made
3rd business day of the month*
*Commissions will be paid once commissions reach $25
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Disclaimer
The information included in this training is an outline of features, plan provisions,
benefits and other information about the Balance membership benefit packages. Plans
offered may be subject to change and terms and limitations apply. Availability and
benefits may vary based on state of residence.
This training is not intended to serve as legal interpretation of benefits. Benefits exclusive
to the Balance series are provided under master policies (GAO-ACC-C-1207, GAO-CI-C1207, GAO-P-1207) issued to Communicating for America, Inc. and underwritten by
Madison National Life Insurance Company, Madison, Wisconsin. Policy form numbers may
vary by state.
Refer to the insurance policies all riders for complete eligibility information, termination
provisions and a full list of exclusions and limitations.
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Thank you!
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