Medico Insurance CompanyDental, Vision & HearingInsurance Product Information Meeting September 2008 (For Agent Use Only) (This product information presentation is intended to provide a general description of the policy benefits and features. Policy provisions and benefits may vary from state to state. Please see the policy for details.)
How the DVH started: • Medico & BHINI worked together to develop the Dental, Vision & Hearing product. • A need exists for this type of supplemental product. • BHINI provided input on policy benefits, pricing and product packaging. • This is just one of the niche products we are currently working on to sell with the Medicare Supplement product.
The DVA18 product isApproved & Announcedin the following 27 states: • New Mexico • Ohio • Oklahoma • Oregon • Pennsylvania • South Carolina • South Dakota • Tennessee • Texas • Washington • West Virginia • Wisconsin • Wyoming Alabama Arkansas Colorado Idaho Iowa Indiana Kansas Kentucky Louisiana Michigan Missouri Mississippi Nebraska North Dakota
The DVA18 product isbeing filedin the following 7 states: • Arizona • California • Georgia • Illinois • Montana • Utah • Virginia
The DVA18Premium Rates(may vary by state) Monthly - Automatic Bank Withdrawal With Household Discount Issue Age $1,000 Max $1,500 Max $1,000 Max $1,500 Max 18-39 $23.00 $31.05 $20.70 $27.95 40-59 $26.00 $35.10 $23.40 $31.59 60-74 $29.00 $39.15 $26.10 $35.24 75-79 $30.00 $40.50 $27.00 $36.45 80-84 $32.00 $43.20 $28.80 $38.88 *Special considerations in OH – no household discount. The above rates are control rates and include the following states: AL, AR, ID, KS, LA, MO, MS, ND, NE, NM, OK, PA, SC, TX, WI, WV, WY. Other states have different loss ratios and different rates. See specific rate guides on MIC.gomedico.com.
The DVA18Policy Benefitsinclude: Deductible - $100 Policy Year Deductible. Maximum Benefit – The applicant can choose between a $1,000 or a $1,500 Policy Year Maximum at the time of application. Benefits – After the $100 Policy Year Deductible is satisfied, the policy pays the following percentages of Reasonable and Customary Charges for Covered Expenses up to the $1,000 or $1,500 Policy-Year Maximum: 60% - First Policy Year 70% - Second Policy Year 80% - Third Policy Year and Thereafter Covered Expenses, subject to the Exceptions and Limitations, are: Dental services performed by a licensed dentist, including semi-annual examinations and cleanings, x-rays, the cost of fillings, prophylaxis, bridges, crowns, dentures, and outpatient dental surgery prescribed as Medically Necessary. Visits to a Physician for a basic eye examination or eye refraction, including the cost of eyeglasses or contact lenses prescribed by the Physician, up to a Maximum Benefit of $150 in any one Policy Year. Hearing examinations performed by a Physician or audiologist, the purchase of hearing aids prescribed as Medically Necessary by a Physician or audiologist, including the cost of the hearing aid and any necessary repairs. In addition to the benefits listed above – After the policy has been in force three months, the policy will pay 100% of the cost of one dental cleaning up to a Maximum Benefit of $50 each Policy Year. This benefit is not subject to the deductible; however, it is included in the $1,000.00 or $1,500 Policy Year Maximum.
The DVA18Exceptions & Limitations Pre-Existing Conditions Limitation: Benefits will not be payable for the following items and/or services during the first six months following the Policy Date. Root Canals; or Existing eyeglasses or contact lenses (including the renewal or changing of prescriptions). Benefits will not be payable for the following items and/or services during the first Policy Year: Bridges, Crowns, Full Dentures or Partials, any work relating to replacement of natural teeth which were missing at the time coverage becomes effective, “full mouth” extractions or fluoride treatments; Existing hearing aids. Other Exceptions & Limitations apply. See policy for full details.
DVA18Additional Information & Featuresinclude: Guaranteed Renewable Issue Ages – 18 - 84 Optional Benefit Riders – None Individually Issued – (dual application for applicant and co-applicant to apply at same time) Policy Fee – No Premiums – Issue Age Rates with Household Discount (in most states) Premium Modes – Automatic Bank Withdrawal – Monthly, Bi-Monthly & Quarterly Direct Bill – Annual, Semi-Annual, Quarterly and Bi-Monthly We do not accept credit cards or debit cards Initial Premium – The initial premium can be drafted from the insured’s checking account. The premium is not drafted until the policy is issued. Rate Guarantee – This policy does not have a rate guarantee. The product has been designed to minimize rate increases. However, if an increase is necessary, we can change the premium only if we do the same to all policies of this form issued to persons of the same class. Class means the factors of age, gender, underwriting class and geographic area in the state of residence that determined the premium rate when coverage was issued.
DVA18Additional Information & Features Premium Rates Based on State of Issue - Premium rates are based on required state-by-state loss ratios. Most of the country will have the same rates; however, some states require higher loss ratios, which make lower premiums (and lower commissions) necessary. Policy Effective Date – The policy is not effective until it is approved by the Home Office. However, upon approval by the Underwriting Department, the policy will become effective on the day after the date the applicant signs the application unless a special effective date is requested by the applicant. Coordination of Benefits – This policy does not coordinate benefits with other policies. Medical Assignment – We do not have a PPO or a dental network. However, benefits may be assigned to the medical provider. The claim payment would then be sent directly to the provider. Reasonable & Customary Charge – “The normal and prevailing charge, fee or expense for the service rendered or for the material furnished in the geographic area where rendered or furnished.” The policy pays a percent (60%, 70% or 80%, depending on how long the policy has been in force) of the actual charges, not to exceed Reasonable and Customary Charges for Covered Expenses up to the Policy Year Maximum Benefit. Ingenix is the vendor we use to provide us with the Reasonable and Customary Charge. They calculate the charges on a zip code basis, at the 90th percentile. The charges are updated quarterly. Example of a claim benefit in the second Policy Year after the $100 Policy Year Deductible has been satisfied: $100.00 – Actual Charge $ 95.00 – Reasonable and Customary Charge (determined by Ingenix) $ 66.50 – Benefit Paid – 70% of $95
The DVA18Forms & Marketing Materials As the product is approved in each state, the forms will be made available on the MIC Website https://mic.gomedico.com/login/login.htm in PDF form. Sales packets and forms can also be ordered from Agent Services at 1-800-547-2401. Dual Application – Although the policies are issued individually, two people (an applicant and a co-applicant) can apply for a policy using the dual application as long as they live in the same household, at the same address. Household Discount – A 10% premium discount is available when two or more persons from the same household apply at the same time. This discount is permanent and does not get removed if one of the members of the household moves. Not available in Ohio. South Dakota requires a FAMILY discount. Application Booklet – This booklet was designed to make it easier for the producer to present the product to the applicant. The Application Booklet includes all forms necessary (except the Medicare Buyers Guide) to write and submit an application for one or two applicants. The forms can be torn out and mailed or faxed to the Home Office.
The DVA18Forms & Marketing Materials(continued) Contents of (NE & MO) Application Booklet: (State variations are listed on the Product page on MIC) Front Cover Welcome MI9F-4334A – Producer Instructions MI9F-077 – New Business Transmittal MIHAA18-1 – Application MI21F-074 – Bank Authorization MI9F-1060 – Replacement Notice MI9F-4218 – HIPAA Authorization MI9F-1060 – Replacement Notice MI9F-4218 – HIPAA Authorization MI9F-4330 – Receipt MI9F-4331 – Outline of Coverage MI9F-4331 – Outline of Coverage MI9F-1060 – Replacement Notice MI9F-4218 – HIPAA Authorization MI9F-1060 – Replacement Notice MI9F-4218 – HIPAA Authorization MI2F-156 – HIPAA Notice MI2F-156 – HIPAA Notice MI2F-155NO – GLB Notice MI2F-155NO – GLB Notice Notes Page Back Cover – “About the Company”
The DVA18Forms & Marketing Materials(continued) • If the producer uses the Application Booklet, the only other form that may be required to be left with the applicant is the Medicare Buyers Guide and that would only be necessary if the applicant is eligible for Medicare. Like our Medicare Supplement, the application also has an option for the applicant to access the Medicare Buyers Guide electronically. The link is shown on the applicant’s receipt – MI9F-4330. • The producer may also elect to print the necessary forms individually or order them through the Agent Services Department. If this option is chosen, there are a few forms that are necessary in addition to the actual forms listed for the Application Booklet. • INSMIA18(NE) – Instructions. The instructions are state-specific. • ADVMIA18 – Brochure (or a special state version). • RGA18 – Rate Guide (or a special version). One Rate Guide is sent with each Sales Order (regardless of the number of Sales Packets ordered).
The DVA18New Business • How can you send Medico your new business? • It is simple! • Fax: Toll-Free to 1.888.363.3420 • Upload: from MIC – • My Desk, Applications, Applications Upload • Mail: Medico Insurance Company • 1515 S 75th St. • Omaha, NE 68124 • * Be sure to include the New Business Transmittal Form with each group of applications that you submit!
The Underwriting process for the DVH policy is simple & straightforward • There is no risk assessment – all applicants will qualify • The information that is captured at time of application is used to determine how claims will be paid • Some benefits are excluded for the first 6 months • Some benefits are excluded for the first 12 months • We code if any applicant: • Wears dentures • Has bridges, crowns • Has had a root canal • Wears eyeglasses, contacts • Wears a hearing aid • There is no Personal Health Interview with the applicant The DVA18Underwriting
The DVA18Commission Advancing • Commission Advancing is available at FMO discretion for this product. • 9 months • Charge is 1% per month on debit balances
DVH Claim Submission is • Fast, Simple & Predictable. • Use the standard form from the dentist’s office • Request a form from Medico (will soon be on MIC) • Fax: 402.398.0898 (direct to Claims Department) • Email: firstname.lastname@example.org • Mail: Medico Insurance Company • 1515 S 75th St • Omaha, NE 68124 • Turnaround time: 7-10 days The DVA18Claims Submission
Claims Examples Following are examples of benefits payable for dental examination and cleaning in correlation with the annual $50 Preventive Care Benefit. Example #1 • After policy is in force for at least 3 months, but $100 Policy Year Deductible NOT yet met: $196 Actual Charge $180 Reasonable & Customary $180 - 50 – Paid by MIC – Preventive Care Benefit (payable once per Policy Year) $130 - 100 – Applied to Policy Year Deductible $ 30 x 60% – During First Policy Year (70% Second Policy Year and 80% Third Policy Year) $ 18 – Paid by MIC during First Policy Year (70% - Second Policy Year; 80% Third Policy Year) MIC Pays $68 – $50 – Preventive Care Benefit, plus $18 – 60% of the remaining Reasonable & Customary Charge after the Preventive Care Benefit has been paid & the $100 Policy Year Deductible has been applied Patient Pays $128 – $ 16 – Difference between Actual Charge and the Reasonable & Customary Charge $100 – Policy Year Deductible $ 12 – 40% Co-payment during First Policy Year Example #2: • After policy is in force for at least 3 months and $100 Policy Year Deductible HAS been met: $196 Actual Charge $180 Reasonable & Customary $180 - 50 – Paid by MIC – Preventive Care Benefit (payable once per Policy Year) $130 x 60% – During First Policy Year (70% Second Policy Year and 80% Third Policy Year) $ 78 – Paid by MIC during First Policy Year (70% - Second Policy Year; 80% Third Policy Year) MIC Pays $128 – $50 – Preventive Care Benefit, plus $78 – 60% of the remaining Reasonable & Customary Charge after the Preventive Care Benefit has been paid Patient Pays $68 – $ 16 – Difference between Actual Charge and the Reasonable & Customary Charge $ 52 – 40% Co-payment during First Policy Year
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