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Offered Exclusively Through

Offered Exclusively Through

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Offered Exclusively Through

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  1. Offered Exclusively Through Seniors Choice is the premier group retiree medical plan for employees and retirees age 65+ which originates where Medicare ends.

  2. The Basics • Employer Options • Underwritten by Guarantee Trust Life inGlenview, IL • Administered by MBA • MBA, Inc. owner/distributor

  3. Today’s Discussion • SC Benefit Design • Optional Benefits • “How Deductibles Work” • SC Part D • Eligibility • TEFRA • Prospects • Enrollment

  4. The Seniors Choice Plan Design Basic Plan F Design • Base Plan Benefits • No Lifetime Maximum • Part A & B Deductible Coverage • Coverage for Excess Charges Included • Skilled Nursing up to 100 Days • Foreign Travel included

  5. The Seniors Choice Plan Design Cont. • $10 – Office Visit, Lab and X-ray Co-pay • $10- Durable Medical Equipment • $20 – All other outpatient services • $100 – Emergency Room Co-pay (waived if admitted) • Excess charges are covered (up to 15% above MAC) • No Co-pay plan is also available

  6. Deductible Options • Multiple Deductible Options • From $0 to $4,000 • All deductible options include the Medicare Part B deductible ($147) • Sponsor can choose one or as many deductibles as desired • Non-traditional Deductible

  7. Example Deductible • Enrolled in SC $500 deductible plan option • Member incurs $1,000 in physician services Remaining Annual Deductible Calculation

  8. Optional Benefits • Comprehensive Wellness Benefit • Up to $250 per calendar year • Private Duty Nursing Benefit • $100 per 8 hour shift; 30 shifts per calendar year. • At Home Recovery Benefit • Certified by a doctor • Approved by Medicare • Additional Skilled Nursing Coverage • From 101 days to 365 days

  9. Enhanced Benefits EPIC Hearing Service Plan • Included with all plans • National network of local ear physicians and audiologists • Testing, evaluations and hearing aid fittings by licensed audiologists • Savings of 35% to 65% on brand name hearing aids • Toll free telephone support • No Administrative forms or paperwork

  10. Enhanced BenefitsOutlook Vision Services • Outlook Vision Services • Included with all plans • Discounts on eye exams at approved locations • Up to 50% off eyewear • Up to 50% discount on mail order contact lens replacement • Providers within a 15 minute drive for 85% of the U.S. population

  11. Part D Late Enrollment Penalty *The current national base beneficiary premium is set by CMMS (Medicare) and is subject to change each calendar year. Previous Years: [2011: $32.34] [2010: $31.94] [2009: $30.36] [2008: $27.93] [2007: $27.35] [2006: $32.20]

  12. Plan Highlights • Always Guaranteed Acceptance • Full takeover of pre-existing conditions • Enhanced Benefits • Optional Benefits • Part D Coverage Gap coverage

  13. Eligibility for Seniors Choice Group Retiree Medical Plans • Enrollee Qualification • Currently Age 65 or over • Enrolled in Medicare Parts A & B • SC grandfathers any individual who has been employed by the sponsoring entity

  14. Group Sponsorship Requirement • A group of 1 life may sponsor SC – Sole proprietors such as : • Lawyers • Dentists • Doctors • Insurance Agents • Real Estate Agents

  15. Tax Equity and Fiscal Responsibility Act (TEFRA) • Employers with 20 or more FT/PT employees • 20 or more weeks in the current or preceding year • The 20 weeks do not have to be consecutive • The requirements are based on the number of employees, not the number of individuals covered under the medical plan.

  16. Seniors Choice Prospects • Groups of Under 20 employees • Age 65 and over FT Employees • TEFRA does not apply thus Medicare is primary • Premiums are generally higher for employees age 65 and over • Can raise the average age of group

  17. Seniors Choice Prospects Continued • Groups with 20 or More Employees • Must comply with TEFRA regulations • Employees eligible for the employer sponsored group plan are ineligible for SC • Employees not eligible for the employer sponsored group plan are eligible for SC

  18. Why Choose SC over a Traditional Medicare Supplement or MA Plan? • Tax benefits for premium contribution • SC is always guaranteed issue • Section 125 POP eligible • Portable • Extensive Part D Plan • Open Enrollment Every December • Enhanced Benefits Included

  19. Example Monthly Savings = $1,050

  20. How To Enroll In Seniors Choice • Sponsoring Employers Must: • Complete Employer Trust Participation Agreement • Employer may sponsor one or as many deductibles as they desire • If voluntary, the Optional Prescription Drug Benefit is elected by the enrollee • Enrollee and/or Spouse Must: • Complete Enrollment Form • Make check or money order payable to “Seniors Choice” • Make copy of Medicare I.D. card and Medical I.D. card, if applicable

  21. Remember . . . • This is Group Retiree Medical Insurance • All Agents and Brokers must be appropriately licensed where the employer is domiciled • Any and all Marketing Materials utilized in connection with SC must first be approved in writing by Merchants Benefit Administration, Inc. prior to use