Proposal Illustrations - Home - Warner Pacific · Your Roadmap to PRO Quote Proposal Illustrations...

T: (800) 801-2300

F: (800) 609-0111

www.warnerpacific.com

Warner Pacific Insurance Services

32110 Agoura Road

Westlake Village, CA 91361

CA Insurance License No. 0764260 CO Insurance License No. 351162 Revised 6/8/17

Roadmap to PRO Quote Proposal Illustrations

Your Roadmap to PRO Quote Proposal Illustrations

Last Modified: May 30, 2017 Page 1 of 6

When you complete your proposal, PRO Quote offers many options for your presentation. This guide will help you choose the best options for your client when making

that important decision of the best benefits to offer his/her employees.

Snapshot Name Description Standard Multi Plan

Calculator

Employee Enrollment Worksheet

Build Your Own

Comparison Excel

Cover Page Customize with you logo for a nice Cover Page on your proposal

Census All Employees and Dependents with Age, Zip Code and Tier

Ineligible Plan Report

Sometimes you may want to show your client why plans are not available for their group

Benefit Summary Side by Side Comparison of Plan Benefits




Calculator


Build Your Own

Comparison Excel

Underwriting Guidelines Quick guide of the carrier guidelines for your group’s plans

ACA Rate Table Your group’s monthly rates for all ages

Grand Summary At-a-Glance Comparison of Rates and Benefits




Calculator


Build Your Own

Comparison Excel

Rate and Benefit Comparison

Quickly compare plan benefits and rates for each employee, broken out by Employee and Dependent rates

Rate Comparison

When you only need the rates for each employee, use the Rate Comparison

Benefit Comparison

When you only need the plan benefits, use the Benefit Comparison




Calculator


Build Your Own

Comparison Excel

Multi-Plan Calculator Summary (Grid View)

Plan Totals, broken out by Employer Cost and Employee Cost – arranged by rows

Multi-Plan Calculator Detail (Grid View)

Rates for each employee’s plan election broken out by Employer Cost and Employee Cost – arranged by rows

Multi-Plan Calculator Summary (Columnar

View)

Plan Totals, broken out by Employer Cost and Employee Cost – arranged by columns

Multi-Plan Calculator Detail (Columnar View)

Rates for each employee’s plan election broken out by Employer Cot and Employee Cost – arranged by columns




Calculator


Build Your Own

Comparison Excel

Enrollment Worksheet Without Benefits

Worksheet for each employee with rates broken out for self and each dependent

Enrollment Worksheet Without Benefits in

Spanish

Worksheet for each employee with rates broken out for self and each dependent; includes Spanish translation

Enrollment Worksheet With Benefits

Worksheet for each employee with rates and key benefits broken out for self and each dependent

Enrollment Worksheet With Benefits In Spanish

Worksheet for each employee with rates and key benefits broken out for self and each dependent; includes Spanish translation




Calculator


Build Your Own

Comparison Excel

Rate and Benefit Comparison

When run as a Custom Comparison, includes current vs renewal

T: (800) 801-2300

F: (800) 609-0111

www.warnerpacific.com

Warner Pacific Insurance Services

32110 Agoura Road

Westlake Village, CA 91361

CA Insurance License No. 0764260 CO Insurance License No. 351162

PRO Quote Proposals Reference Guide

www.warnerpacific.com | 800·801·2300 | CA Insurance License No. 0764260 | CO Insurance License No. 351162 |

Cover Page

Customize with you logo for a nice Cover Page on your proposal

Find it in: Standard Quote Multi Plan Calculator Employee Enrollment

Worksheets Build Your Own

Comparison

http://www.warnerpacific.com/

ProQuote Samples- So CA

Burbank, Los Angeles County, CA 91502

Professional Broker IILicense#: NOLIC

(818) 225-0101

Effective date: 6/1/2017

Proposal created: 4/26/2017

SIC Code: 5193 - Flowers, Nursery Stock, and Florists'Supplies

Presented By:

Add your logo!

Change Presented By Name

Available in all Quote Types


Census

All employees and Dependents with Age, Date of Birth and Tier



Comparison Available in Excel


CountyCOBRAMed ZipAge Date of Birth

EE27London, Ken Los Angeles912051. 3/14/1990

EE34Smith, Lisa Los Angeles912052. 10/7/1982

EE32Lee, Ben Los Angeles912053. 5/20/1985

FA37Patel, Ann Los Angeles912054. 9/4/1979

Patel, Mark 39Spouse/Partner √12/5/1977

Patel, Sally 6Child √7/6/2010

EE30Richardson, Ken Los Angeles912055. 2/6/1987

EE47Cello, Joe Los Angeles912056. 11/13/1969

SIC: 5193Los Angeles County, 91502Effective Date: June 1, 2017

Presented By: Professional Broker IILicense #: NOLIC

ProQuote Samples - So CA

Employee OnlyEmployee + Spouse

EC - FA -

Employee + Child(ren)Employee + Spouse + Child(ren)

Waived W -

Quote ID: 2134-7189

EE - ES -

Create Date: 4/26/2017

Age, DOB, Tier, COBRA, Zip and County

All dependent info




Sometimes you may want to show your client why plans are not

available for your group



Comparison




Effective Date: 6/1/2017

Broker: Professional Broker IISales Executive: Sales Pool

The following lists the reasons that the Group did not qualify for one or more Carriers/Plans.

Burbank, Los Angeles County, CA 91502Group Size: 6SIC Code: 5193 - Flowers, Nursery Stock, andFlorists' Supplies

CaliforniaChoice

All employees are outside the plan's service area for the plan: Gold HMO A Sharp Health Plan -Performance

All employees are outside the plan's service area for the plan: Gold HMO A Western Health - Full

All employees are outside the plan's service area for the plan: Gold HMO B Sharp Health Plan - Premier

All employees are outside the plan's service area for the plan: Gold HMO B Western Health - Full

All employees are outside the plan's service area for the plan: Gold HMO C Sharp Health Plan - Premier

All employees are outside the plan's service area for the plan: Gold HMO C Western Health - Full

All employees are outside the plan's service area for the plan: Gold HMO D Western Health - Full

Too many employees outside the plan's service area for the plan: Gold HMO A Sutter Health Plus - Full

Too many employees outside the plan's service area for the plan: Gold HMO B SutterHealth Plus - Full

Create Date: 4/26/2017 Presented By: Professional Broker II License# NOLIC Quote Id: 2134-7189

Final rates are determined by the Carrier. This quote is not valid without the separate general disclaimer.# Dependent children 21-25 years old are rated as adults. Dependent children may become ineligible for coverage on their 26th birthday; effectivedate of change may vary by carrier.


Handy reference for your group's plan availability


Benefit Summary

A side by side comparison of plan benefits



Comparison


Anthem BCEffective Date: 6/1/2017


Benefit Summary

Anthem Bronze PPO6000/35%/7150

(2EWP)PPO / Bronze

Anthem Silver PPO1750/35%/7150

(2EYE)PPO / Silver

Anthem Bronze PPO5000/30%/7150

(2EVN)PPO / Bronze

Anthem Silver PPO2000/35%/7150

(2EY2)PPO / Silver

PPO PPOPPO PPO

DEDUCTIBLE

$6,000Individual $5,000 $2,000 $1,750

$12,000 (embedded)Family $10,000 (embedded) $4,000 (includes ded.) $3,500 (embedded)

OUT-OF-POCKET MAX

$7,150 (includes ded.)Individual $7,150 (includes ded.) $7,150 (embedded) $7,150 (includes ded.)

$14,300 (embedded;includes ded.)

Family $14,300 (embedded,includes ded.)



PHYSICIAN SERVICES

$70 copay (ded. waived 3visits) then 35% after ded.

Office Visits $30 (ded. waived 3 visits)then 30% after ded.

(combined 3 visit limit)

$25/$50 copay/visit (ded.waived)

$25/$50 copay/visit (ded.waived)

$0 (ded. waived)Preventive Care 0% (ded. waived) $0 (ded. waived) $0 (ded. waived)

PRESCRIPTION DRUGS

Tier 1A: $5; Tier 1B: $20 (upto 30 day supply)

Tier 1 (Generic Formulary) Tier 1A: $5; Tier 1B: $20 (upto 30 day supply; Select Rx)

Tier 1A: $5; Tier 2B: $20 (upto 30 day supply; Select Rx)

Tier 1A: $5; Tier 2B: $20 (upto 30 day supply; Select Rx)

$50 (up to 30 day supply;Select Rx)

Tier 2 (Preferred Brand Formulary) $50 (up to 30 day supply;Select Rx)




Tier 3 (Non-Preferred BrandFormulary)




HOSPITAL FACILITY SERVICES

35% after ded.Inpatient Hospital Services $500 copay per admissionthen 0% after ded.

35% after ded. 35% after ded.

35% after ded.Outpatient Surgery in a Hospital $300 copay per admissionthen 30% after ded.

35% after ded. 35% after ded.

EMERGENCY SERVICES

35% after ded.Emergency Room $300 copay then 30% afterded. (copay waived if

admitted)

$300 copay then 35% afterded. (copay waived if

admitted)

$300 copay then 35% afterded. (copay waived if

admitted)

The summary above is meant to be a brief description of plan benefits and features only. This is not a policy. Please consult the contract and/or evidence ofcoverage and disclosure brochure, either of which is available upon request, for a complete description of benefits, exclusions, limitations and participationrequirements. The accuracy of this summary is not guaranteed and the information herein is subject to change without notice. This is not an offer ofcoverage.

Sorted By: Carrier,PlanType,Premium(Ascending)

Presented By: Professional Broker II License# NOLICCreate Date: 4/26/2017 Quote Id: 2134-7189


You choose from 29 benefit category the best fit for your presentation

This is handy guide for Enrollment Meetings


ACA Rate Table

Your group’s monthly rates for all ages



Comparison


Age Band Ped. Dental included Ped. Dental included Ped. Dental included Ped. Dental included Ped. Dental included Ped. Dental included Ped. Dental included

PPOPPOPPO PPO PPO PPO PPO

GoldGoldPlatinum Platinum Gold Gold Gold

Anthem Gold PPO2000/20%/4000

(2EWH)Anthem Gold PPO

700/20%/6600 (2EXQ)Anthem Platinum PPO20/10%/4000 (2F9Q)

Anthem Platinum PPO200/10%/4000 (2EXY)

Anthem Gold PPO20/30%/6500 (2EXB)

Anthem Gold PPO1000/20%/6000 (2EXU)

Anthem Gold PPO500/20%/6500 (2EXF)

6/1/20176/1/20176/1/2017 6/1/2017 6/1/2017 6/1/2017 6/1/2017

0-18 $247.74 $242.91 $212.41 $206.65 $206.53 $205.01 $202.99$202.99$205.01$206.53$206.65

19-20 247.74 242.91 212.41 206.65 206.53 205.01 202.99202.99205.01206.53206.65

21 390.14 382.53 334.51 325.43 325.25 322.85 319.67319.67322.85325.25325.43

22 390.14 382.53 334.51 325.43 325.25 322.85 319.67319.67322.85325.25325.43

23 390.14 382.53 334.51 325.43 325.25 322.85 319.67319.67322.85325.25325.43

24 390.14 382.53 334.51 325.43 325.25 322.85 319.67319.67322.85325.25325.43

25 391.70 384.06 335.85 326.73 326.55 324.14 320.95320.95324.14326.55326.73

26 399.50 391.71 342.54 333.24 333.06 330.60 327.34327.34330.60333.06333.24

27 408.87 400.89 350.57 341.05 340.86 338.35 335.01335.01338.35340.86341.05

28 424.08 415.81 363.61 353.74 353.55 350.94 347.48347.48350.94353.55353.74

29 436.57 428.05 374.32 364.16 363.95 361.27 357.71357.71361.27363.95364.16

30 442.81 434.17 379.67 369.36 369.16 366.43 362.83362.83366.43369.16369.36

31 452.17 443.35 387.70 377.17 376.96 374.18 370.50370.50374.18376.96377.17

32 461.54 452.53 395.73 384.98 384.77 381.93 378.17378.17381.93384.77384.98

33 467.39 458.27 400.74 389.87 389.65 386.77 382.96382.96386.77389.65389.87

34 473.63 464.39 406.10 395.07 394.85 391.94 388.08388.08391.94394.85395.07

35 476.75 467.45 408.77 397.68 397.46 394.52 390.64390.64394.52397.46397.68

36 479.87 470.51 411.45 400.28 400.06 397.11 393.19393.19397.11400.06400.28

37 482.99 473.57 414.12 402.88 402.66 399.69 395.75395.75399.69402.66402.88

38 486.11 476.63 416.80 405.49 405.26 402.27 398.31398.31402.27405.26405.49

39 492.36 482.75 422.15 410.69 410.47 407.44 403.42403.42407.44410.47410.69

40 498.60 488.87 427.50 415.90 415.67 412.60 408.54408.54412.60415.67415.90

41 507.96 498.05 435.53 423.71 423.48 420.35 416.21416.21420.35423.48423.71

42 516.94 506.85 443.23 431.19 430.96 427.78 423.56423.56427.78430.96431.19

43 529.42 519.09 453.93 441.61 441.36 438.11 433.79433.79438.11441.36441.61

44 545.03 534.39 467.31 454.63 454.37 451.02 446.58446.58451.02454.37454.63

45 563.36 552.37 483.03 469.92 469.66 466.20 461.60461.60466.20469.66469.92

46 585.21 573.80 501.77 488.15 487.88 484.28 479.51479.51484.28487.88488.15

47 609.79 597.89 522.84 508.65 508.37 504.61 499.64499.64504.61508.37508.65

48 637.88 625.44 546.92 532.08 531.78 527.86 522.66522.66527.86531.78532.08

49 665.58 652.60 570.67 555.18 554.88 550.78 545.36545.36550.78554.88555.18

50 696.79 683.20 597.43 581.22 580.90 576.61 570.93570.93576.61580.90581.22

51 727.61 713.42 623.86 606.93 606.59 602.12 596.18596.18602.12606.59606.93

52 761.55 746.70 652.96 635.24 634.89 630.20 624.00624.00630.20634.89635.24

53 795.89 780.36 682.40 663.88 663.51 658.61 652.13652.13658.61663.51663.88

54 832.95 816.70 714.18 694.79 694.41 689.28 682.50682.50689.28694.41694.79

55 870.01 853.04 745.96 725.71 725.31 719.96 712.86712.86719.96725.31725.71

56 910.20 892.44 780.41 759.23 758.81 753.21 745.79745.79753.21758.81759.23

57 950.77 932.23 815.20 793.07 792.63 786.79 779.04779.04786.79792.63793.07

58 994.08 974.69 852.33 829.20 828.74 822.62 814.52814.52822.62828.74829.20

59 1,015.53 995.73 870.73 847.09 846.63 840.38 832.10832.10840.38846.63847.09

60 1,058.84 1,038.19 907.86 883.22 882.73 876.21 867.58867.58876.21882.73883.22

61 1,096.29 1,074.91 939.97 914.46 913.95 907.21 898.27898.27907.21913.95914.46

62 1,120.87 1,099.01 961.05 934.96 934.44 927.55 918.41918.41927.55934.44934.96

63 1,151.69 1,129.23 987.47 960.67 960.14 953.05 943.67943.67953.05960.14960.67

64+ 1,170.42 1,147.59 1,003.53 976.29 975.75 968.55 959.01959.01968.55975.75976.29

Rate Table for:Anthem BCRating Area: CA15

Los Angeles County (91502)

Create Date: 4/26/2017 Presented By: Professional Broker II Quote Id: 2134-7189

Some zip codes span multiple counties. Please ensure your county and zip code is listed in the rating area above.

License# NOLIC



Underwriting Guidelines

A quick guide of the carrier guidelines for your group’s plans



Comparison



California Small Group: Medical Guidelines and Important Features

Anthem Blue Cross (2017) PRODUCT OFFERINGS

Plan combinations EmployeeElect: Employer may offer all metallic plans and may select 2 HMO networks and 1 PPO network (Dual HMO networks available thru 9/15/17)

Plan option PPO, HSA, HMO Split carrier combinations All plans. Anthem Blue Cross will now allow writing alongside CaliforniaChoice or CoveredCA for Small Business.

Networks HMO HMO Network (CaliforniaCare) (Full) Select HMO Network (Narrow)

PPO, HSA Prudent Buyer PPO Network (Full) Select PPO Network (Narrow)

Drug formulary options

Anthem’s drug list is divided into five tiers: Generic Tier 1a, Generic Tier 1b, Brand, Non-Formulary, and Injectibles. All 2017 plans use the Select Drug List which is a narrower list of drugs that includes a select number of medications in all therapeutic categories and classes. 90 Day Retail Benefit allows members to get up to a 90 day supply in one fill at the retail pharmacy. Applies to Tier 1, Tier 2 and Tier 3.

Wrapping position Anthem Small Group plans cannot be sold or utilized in conjunction with any product, whether insured or self- funded, that funds any annual deductible, copayment, coinsurance or out-of-pocket expense of the health benefit plan (i.e., “wrapping”)

Pediatric dental and vision Benefits and rates are embedded in the medical plan. Expenses apply to medical out-of-pocket max. Benefit level varies by plan type.

Optional benefits Infertility ELIGIBILITY

Group size Sole Proprietors and Partnerships: 1-100 eligible FT/PT W2 employees for 50% of the preceding calendar year. Cannot be comprised of owner and spouse/domestic partner only. Most recently filed DE9C is required. Corporations & LLCs: 1-100 eligible FT/PT W2 employees or 2 owners for 50% of the preceding calendar year. Cannot be comprised of owner and spouse/domestic partner only.

1-5 enrolled: Most recently filed DE9C is required. 6+ enrolled: DE9C waived for groups with prior coverage (available thru 9/15/17):

Prior carrier bill is required Payroll is required for eligible employees not listed on the bill.

Rates CA employee rates based on employer ZIP code. OOS employee rates based on employer ZIP code. Rates will adjust for age at contract renewal. New hires will be rated based on the age at inception of the employee’s contract.

Contribution Traditional: 50% of employee premium Fixed-dollar option: $100/employee (in $5 increments) Percentage and plan: 50% toward a specific plan, chosen by the employer Note: When the employer contributes 100% towards the employee premium, 100% of the eligible employee must enroll (excluding any valid waivers).

Participation Relaxed Participation: (available thru 9/15/17): 5+ enrolled: 30% participation Standard Participation: 1-14 eligible: 70% participation: 15+ eligible: 50% participation (Round up)

Participation alongside another carrier

Same participation requirements as above. Waivers for another carrier would count against participation. Anthem will allow multiple carriers. Anthem will not write alongside CalChoice or Covered CA for Small Business.

Valid waiver Employer-sponsored group coverage, Medi-Cal, MediCare, SAG/AFTRA, Champus, TRICARE, Active Military Duty/Leave, and Cal-COBRA/Federal COBRA through prior employer, Individual coverage on or off exchange. Note: An owner of multiple entities will not be considered a valid waiver if the owner is declining due to coverage under another entity of which he/she holds ownership.

Carve-outs Only non-union carve-outs are allowed as long as the union employees are subject to a collective bargaining agreement.

Anthem does not consider this a carve-out provided the total group size is less than 100 (union and non-union)

The union employees are considered eligible waivers (waivers are not required)

A copy of the union roster is required

Employee-only coverage Employers may not offer employee-only coverage; dependents must be offered coverage.

Owner-only groups Sole Proprietors & Partnerships: Not eligible, must have at least 1 eligible W2 employee who is not an owner LLCs and Corporations: Eligible

1 eligible FT/PT W2 EE or 2 owners for 50% of the preceding calendar quarter or year

Cannot be comprised of owner and spouse/domestic partner only Owners may demonstrate they meet the eligible EE criteria by providing W2s or Eligibility Statement

Information is believed to be current as of the last date listed below and is subject to change. This is not a guarantee and the carrier will make the final decision.

Revised 04/20/17.

Page | 1


Answers at your fingertips - no need to search multiple sites



Grand Summary

At-a-Glance comparison of rates and benefits. It includes links to the

carrier Summary Benefit Comparison and breakdown of rates by

employee.

Find it in: Standard Quote Employee Enrollment




ProQuote Samples - So CABurbank, Los Angeles County, CA 91502 SIC Code: 5193 - Flowers, Nursery Stock, and Florists' Supplies

MEDICAL - Effective Date: 6/1/2017

Presented By: Professional Broker II License#: NOLIC

EE inarea

EE Rate Dep RateDeductibleOffice Visits

(PCP/Specialist) *Inpatient Hospital

Services *Out-of-Pocket

MaxRX Tiers 1/2/3/4

PlanType

CarrierNetworkPlan

PedDent

Total Rate

475.41

$7,150/ $14,300embedded;includes ded.35%

$70 (ded. waived3 visits) then 35%

$6,000/ $12,000embedded

$250/$500 Ded (2-4) $5A;$20B/$50/$90/30% (Select)

Anthem BCPrudent Buyer PPO

1,849.75 $2,325.166/6

Anthem Bronze PPO6000/35%/7150 (2EWP) EmbPPO

490.77

$7,150/$14,300embedded;includes ded.$500/Admission

$30 (ded. waived3 visits) then 30%

$5,000/$10,000embedded

$250/$500 Ded (2-4) $5A;$20B/$50/$90/30% (Select)


1,909.53 $2,400.306/6

Anthem Bronze PPO5000/30%/7150 (2EVN) EmbPPO

546.72

$7,150/$14,300embedded;includes ded.35%

$25/$50 (ded.waived)

$2,000/$4,000embedded

$5A;$20B/$50/$90/30% (Select)


2,127.20 $2,673.926/6

Anthem Silver PPO 2000/35%/7150(2EY2) EmbPPO

554.05



$1,750/$3,500embedded

$5A;$20B/$50/$90/30% (Select)


2,155.77 $2,709.826/6

Anthem Silver PPO 1750/35%/7150(2EYE) EmbPPO

558.94



$1,250/$2,500embedded

$5A;$20B/$50/$90/30% (Select)


2,174.73 $2,733.676/6

Anthem Silver PPO 1250/40%/7150(2EY6) EmbPPO

606.41



$2,000/$4,000embedded

$5A;$20B/$40/$80/30% (Select)


2,359.48 $2,965.896/6

Anthem Gold PPO 2000/20%/4000(2EWH) EmbPPO

612.45



$700/$2,100embedded

$250/$500 Ded (2-4); $5A;$20B/$40/$80/30% (Select)


2,382.95 $2,995.406/6

Anthem Gold PPO 700/20%/6600(2EXQ) EmbPPO

Create Date: 4/26/2017Sorted by: Carrier,PlanType,Premium(Ascending)

Quote Id: 2134-7189

* Unless stated, all services are subject to deductible.Final rates are determined by the Carrier. This quote is not valid without the separate general disclaimer.# Dependent children 21-25 years old are rated as adults. Dependent children may become ineligible for coverage on their 26th birthday; effective date of change may vary by carrier.

Click to see each employee rates and plan benefits

Click to see Carrier Summary Benefit Comparison

Available in Standard

Enrollment W

orksheets

Build Your Own Comparison

https://Quoting.warnerpacific.com/GAITQuoting/GrandSummaryReportDetail.aspx?servicerequestid=7747514c-23b2-411d-8274-67eea18cd408&servicerequestselectionid=65846d79-6586-4f4a-b9d9-1619a28cd408

https://Quoting.warnerpacific.com/GAITQuoting/fileServer.aspx?FileID=9cced765-be66-4ffc-8c37-3ac2ec8bd408&fileName=Anthem_BronzePPO_6000.35.7150_PrudentBuyer_2EWP_Eff1.17_Rec4.17.pdf

https://Quoting.warnerpacific.com/GAITQuoting/GrandSummaryReportDetail.aspx?servicerequestid=7747514c-23b2-411d-8274-67eea18cd408&servicerequestselectionid=a5d108a2-0fda-4c06-b46e-0319a28cd408

https://Quoting.warnerpacific.com/GAITQuoting/fileServer.aspx?FileID=590e9b07-d032-4671-a8c5-d0a0ec8bd408&fileName=Anthem_BronzePPO_5000.30.7150_PrudentBuyer_2EVN_Eff1.17_Rec4.17.pdf

https://Quoting.warnerpacific.com/GAITQuoting/GrandSummaryReportDetail.aspx?servicerequestid=7747514c-23b2-411d-8274-67eea18cd408&servicerequestselectionid=61edf317-49f0-4d6f-bd15-0d19a28cd408

https://Quoting.warnerpacific.com/GAITQuoting/fileServer.aspx?FileID=90f86ade-bdb6-4e8f-8cd2-22cff08bd408&fileName=Anthem_SilverPPO_2000.35.7150_PrudentBuyer_2EY2_Eff1.17_Rec4.17.pdf

https://Quoting.warnerpacific.com/GAITQuoting/GrandSummaryReportDetail.aspx?servicerequestid=7747514c-23b2-411d-8274-67eea18cd408&servicerequestselectionid=8562f4d2-d937-4284-8d2d-2e19a28cd408

https://Quoting.warnerpacific.com/GAITQuoting/fileServer.aspx?FileID=822873fd-dd2d-4130-a052-1baff08bd408&fileName=Anthem_SilverPPO_1750.35.7150_PrudentBuyer_2EYE_Eff1.17_Rec4.17.pdf

https://Quoting.warnerpacific.com/GAITQuoting/GrandSummaryReportDetail.aspx?servicerequestid=7747514c-23b2-411d-8274-67eea18cd408&servicerequestselectionid=3134f22b-6b2e-4fe8-81ba-2919a28cd408

https://Quoting.warnerpacific.com/GAITQuoting/fileServer.aspx?FileID=2d6a16c5-c226-48a8-baca-6f9cf08bd408&fileName=Anthem_SilverPPO_1250.40.7150_PrudentBuer_2EY6_Eff1.17_Rec4.17.pdf

https://Quoting.warnerpacific.com/GAITQuoting/GrandSummaryReportDetail.aspx?servicerequestid=7747514c-23b2-411d-8274-67eea18cd408&servicerequestselectionid=b91e0ec2-36ab-4c39-a7d7-fa18a28cd408

https://Quoting.warnerpacific.com/GAITQuoting/fileServer.aspx?FileID=b76a9984-18d4-4752-adc5-2d20ee8bd408&fileName=Anthem_GoldPPO_2000.20.4000_PrudentBuyer_2EWH_Eff1.17_Rec4.17.pdf

https://Quoting.warnerpacific.com/GAITQuoting/GrandSummaryReportDetail.aspx?servicerequestid=7747514c-23b2-411d-8274-67eea18cd408&servicerequestselectionid=be68d928-b468-4241-a13d-2719a28cd408

https://Quoting.warnerpacific.com/GAITQuoting/fileServer.aspx?FileID=b0e0510f-1301-441a-8f8c-093eee8bd408&fileName=Anthem_GoldPPO_700.20.6600_PrudentBuyer_2EXQ_Eff1.17_Rec4.17.pdf


Rate and Benefit

Comparison

Quickly compare plan benefits and rates for each employee, broken out

by employee and dependent rates. You choose the benefit categories to

illustrate.





Anthem BCAnthem BC Anthem BCAnthem BC Anthem BCAnthem Silver PPO

1250/40%/7150 (2EY6)Anthem Bronze PPO

6000/35%/7150 (2EWP)Anthem Silver PPO

1750/35%/7150 (2EYE)Anthem Bronze PPO

5000/30%/7150 (2EVN)Anthem Silver PPO

2000/35%/7150 (2EY2)

Effective Date: 6/1/2017Effective Date: 6/1/2017 Effective Date: 6/1/2017Effective Date: 6/1/2017 Effective Date: 6/1/2017

Plan Premium: $2,733.67$2,325.16 $2,709.82$2,400.30 $2,673.92

Medical

DEDUCTIBLE

PPO: $1,250PPO: $6,000Individual PPO: $5,000 PPO: $2,000 PPO: $1,750

PPO: $2,500 (embedded)PPO: $12,000 (embedded)Family PPO: $10,000 (embedded) PPO: $4,000 (includes ded.) PPO: $3,500 (embedded)

OUT-OF-POCKET MAX

PPO: $7,150 (includes ded.)PPO: $7,150 (includes ded.)Individual PPO: $7,150 (includes ded.) PPO: $7,150 (embedded) PPO: $7,150 (includes ded.)

PPO: $14,300 (embedded; includesded.)


Family PPO: $14,300 (embedded, includesded.)



PHYSICIAN SERVICES

PPO: $30/$60 copay/visit (ded.waived)

PPO: $70 copay (ded. waived 3 visits)then 35% after ded.

Office Visits PPO: $30 (ded. waived 3 visits) then30% after ded. (combined 3 visit limit)



PPO: $0 (ded. waived)PPO: $0 (ded. waived)Preventive Care PPO: 0% (ded. waived) PPO: $0 (ded. waived) PPO: $0 (ded. waived)

PRESCRIPTION DRUGS

PPO: Tier 1A: $5; Tier 1B: $20 (up to30 day supply Select Rx)

PPO: Tier 1A: $5; Tier 1B: $20 (up to30 day supply)

Tier 1 (Generic Formulary) PPO: Tier 1A: $5; Tier 1B: $20 (up to30 day supply; Select Rx)

PPO: Tier 1A: $5; Tier 2B: $20 (up to30 day supply; Select Rx)


PPO: $50 (up to 30 day supply; SelectRx)


Tier 2 (Preferred BrandFormulary)




PPO: $90 (up to 30 day supply SelectRx)







PPO: 40% after ded.PPO: 35% after ded.Inpatient Hospital Services PPO: $500 copay per admission then0% after ded.

PPO: 35% after ded. PPO: 35% after ded.

PPO: 40% after ded.PPO: 35% after ded.Outpatient Surgery in aHospital

PPO: $300 copay per admission then30% after ded.


EMERGENCY SERVICES

PPO: $250 copay then 40% after ded.(copay waived if admitted)

PPO: 35% after ded.Emergency Room PPO: $300 copay then 30% after ded.(copay waived if admitted)




Presented By: Professional Broker II License# NOLIC

Burbank, Los Angeles County, CA 91502 SIC Code: 5193 - Flowers, Nursery Stock, and Florists' Supplies



Quote Id: 2134-7189

Final rates are determined by the Carrier. This quote is not valid without the separate general disclaimer.# Dependent children 21-25 years old are rated as adults. Dependent children may become ineligible for coverage on their 26th birthday; effective date of change may vary by carrier.

Sorted By: Carrier,PlanType,Premium(Ascending)You choose from 29 benefit category the best fit for your presentation







Anthem Bronze PPO6000/35%/7150 (2EWP)

Anthem Silver PPO1250/40%/7150 (2EY6)

Anthem Silver PPO1750/35%/7150 (2EYE)


Anthem Bronze PPO5000/30%/7150 (2EVN)

Anthem BCAnthem BC Anthem BCAnthem BC Anthem BCMedical

Effective Date: 6/1/2017 Effective Date: 6/1/2017Effective Date: 6/1/2017Effective Date: 6/1/2017Effective Date: 6/1/2017

AreaDepEE TotalAreaEmployee Name Age Tier Area EE Dep TotalArea EE Dep TotalArea EE Dep TotalEE Dep Total

308.780.00308.78CA15306.090.00306.09CA15302.030.00302.03CA15271.130.00271.13CA15262.640.00262.64CA15EE27Ken London

357.690.00357.69CA15354.570.00354.57CA15349.870.00349.87CA15314.070.00314.07CA15304.240.00304.24CA15EE34Lisa Smith

348.560.00348.56CA15345.520.00345.52CA15340.940.00340.94CA15306.050.00306.05CA15296.470.00296.47CA15EE32Ben Lee

923.70558.94364.76CA15915.63554.05361.58CA15903.51546.72356.79CA15811.05490.77320.28CA15785.67475.41310.26CA15FA37Ann Patel

334.420.00334.42CA15331.500.00331.50CA15327.110.00327.11CA15293.640.00293.64CA15284.440.00284.44CA15EE30Ken Richardson

460.520.00460.52CA15456.510.00456.51CA15450.460.00450.46CA15404.360.00404.36CA15391.700.00391.70CA15EE47Joe Cello

Totals: $1,849.75 $475.41 $2,325.16 $1,909.53 $490.77 $2,400.30 $2,127.20 $546.72 $2,673.92 $2,155.77 $554.05 $2,709.82 $2,174.73 $558.94 $2,733.67






Quote Id: 2134-7189



Enrollment W

orksheets

Multi Plan Calculator

Available in Standard


Rates broken out by employee, employee only rate, dependent rate and total







Rate Comparison

When you only need the rates, use the Rate Comparison to quickly

compare plan rates for each employee, broken out by employee and

dependent rates.





Anthem Bronze PPO6000/35%/7150 (2EWP)


Anthem Silver PPO1750/35%/7150 (2EYE)


Anthem Bronze PPO5000/30%/7150 (2EVN)

Anthem BCAnthem BC Anthem BCAnthem BC Anthem BCMedical






923.70558.94364.76CA15915.63554.05361.58CA15903.51546.72356.79CA15811.05490.77320.28CA15785.67475.41310.26CA15FA37Ann Patel



Totals: $1,849.75 $475.41 $2,325.16 $1,909.53 $490.77 $2,400.30 $2,127.20 $546.72 $2,673.92 $2,155.77 $554.05 $2,709.82 $2,174.73 $558.94 $2,733.67






Quote Id: 2134-7189




Rates broken out by employee, employee only rate, dependent rate and total








Benefit Comparison

Quickly compare plan benefits. You choose the benefit categories to

illustrate.





Anthem BCAnthem BC Anthem BCAnthem BC Anthem BCAnthem Silver PPO

1250/40%/7150 (2EY6)Anthem Bronze PPO

6000/35%/7150 (2EWP)Anthem Silver PPO

1750/35%/7150 (2EYE)Anthem Bronze PPO

5000/30%/7150 (2EVN)Anthem Silver PPO

2000/35%/7150 (2EY2)


Plan Premium: $2,733.67$2,325.16 $2,709.82$2,400.30 $2,673.92

Medical

DEDUCTIBLE

PPO: $1,250PPO: $6,000Individual PPO: $5,000 PPO: $2,000 PPO: $1,750

PPO: $2,500 (embedded)PPO: $12,000 (embedded)Family PPO: $10,000 (embedded) PPO: $4,000 (includes ded.) PPO: $3,500 (embedded)

OUT-OF-POCKET MAX

PPO: $7,150 (includes ded.)PPO: $7,150 (includes ded.)Individual PPO: $7,150 (includes ded.) PPO: $7,150 (embedded) PPO: $7,150 (includes ded.)



Family PPO: $14,300 (embedded, includesded.)



PHYSICIAN SERVICES


PPO: $70 copay (ded. waived 3 visits)then 35% after ded.

Office Visits PPO: $30 (ded. waived 3 visits) then30% after ded. (combined 3 visit limit)



PPO: $0 (ded. waived)PPO: $0 (ded. waived)Preventive Care PPO: 0% (ded. waived) PPO: $0 (ded. waived) PPO: $0 (ded. waived)

PRESCRIPTION DRUGS

PPO: Tier 1A: $5; Tier 1B: $20 (up to30 day supply Select Rx)

PPO: Tier 1A: $5; Tier 1B: $20 (up to30 day supply)

Tier 1 (Generic Formulary) PPO: Tier 1A: $5; Tier 1B: $20 (up to30 day supply; Select Rx)









PPO: $90 (up to 30 day supply SelectRx)







PPO: 40% after ded.PPO: 35% after ded.Inpatient Hospital Services PPO: $500 copay per admission then0% after ded.


PPO: 40% after ded.PPO: 35% after ded.Outpatient Surgery in aHospital

PPO: $300 copay per admission then30% after ded.


EMERGENCY SERVICES


PPO: 35% after ded.Emergency Room PPO: $300 copay then 30% after ded.(copay waived if admitted)








Quote Id: 2134-7189


Sorted By: Carrier,PlanType,Premium(Ascending)You choose from 29 benefit category the best fit for your presentation

Click to see Carrier Summary Benefit ComparisonAvailable in all Q

uote Types








Summary (Grid View)

Plan totals, broken out by employer cost and employee cost,

arranged in rows.

Find it in: Multi Plan Calculator Available in Excel


Current: 6/1/2016*

(HN) Health Net Enhanced Choice A w/Full Network EE Contrib: 90% Dep Contrib: 0% based on Full Network HMO Gold $30. Apply Overflow to Dep? No

TotalEEERDeductibleOffice Visits

(PCP/Specialist) **Inpatient Hospital

Services **Out-of-Pocket Max RX Tiers 1/2/3/4Plan EE's

(HN) Full Network HMO Gold $30 4 $0/$0 $30/$50 $600 $6,000/ $12,000embedded-aggregate

$15/$50/$70/30% 1,371.91 740.83 2,112.74

(HN) Health Net Bronze 60 PPO 6000/70 2 $6,000/ $12,000embedded-aggregate

$70/$90 (1st 3 visits dedwaived)

100% $6,500/ $13,000embedded-aggregate;

includes ded

100% after $500/$1,000Ded

654.49 0.00 654.49

Totals $2,026.40 $740.83 $2,767.236

Renewal: 6/1/2017

(HN) Health Net Enhanced Choice A w/Full Network EE Contrib: 90% Dep Contrib: 0% based on Full Network HMO Gold $30. Apply Overflow to Dep? No

TotalEEERDeductibleOffice Visits

(PCP/Specialist) **Inpatient Hospital

Services **Out-of-Pocket Max RX Tiers 1/2/3/4Plan EE's

(HN) Bronze 60 PPO 6300/75 + Child Dental 2 $6,300/ $12,600embedded

$75/$105 (1st 3 visits dedwaived)

100% $6,800/ $13,600embedded; includes ded

100% after $500/$1,000Ded

673.06 0.00 673.06

(HN) Full Network HMO Gold $30 4 $0/$0 $30/$50 $1,200/admission $6,750/ $13,500embedded

$15/$50/$70/30% 1,611.90 860.79 2,472.69

Totals $2,284.96 $860.79 $3,145.75

% Difference compared to 6/1/2016 Health Net Enhanced Choice A w/Full Network 13% 16% 14%

6

$258.56 $119.96 $378.52$ Difference compared to 6/1/2016 Health Net Enhanced Choice A w/Full Network

Professional Broker II DBA:Burbank, Los Angeles County, CA 91502SIC Code: 5193 - Flowers, Nursery Stock, and Florists'Supplies

Medical


These rates are based on the ages of employees and their dependents as of the requested effective date.The Contribution amounts listed on this report may not reflect actual final contribution totals.Pediatric Dental is included in the Medical rate for all Off-Exchange plans in this quote.

Create Date: 4/26/2017Quote Id: 2134-7307

Multi-Plan Calculator SummaryGrid View

Lic# NOLIC

** Unless stated, all services are subject to deductible.Final rates are determined by the Carrier. This quote is not valid without the separate general disclaimer.# Dependent children 21-25 years old are rated as adults. Dependent children may become ineligible for coverage on their 26th birthday; effective date of change may vary by carrier.Certain plans and products shown here are offered only on a bundled basis. Please consult carrier guidelines for definitive product and plan combinations.Rates have not been adjusted for Federal or State COBRA enrollees.* The current rates reflect the employees' age as of their last birthday to more closely reflect the group's current bill.

Available in Multi Plan Calculator

Compare Current to Renewal

Includes Employer Contribution

See the bottom line for employer and employees

https://Quoting.warnerpacific.com/GAITQuoting/fileServer.aspx?FileID=9c752f09-4ef2-4042-b9dc-0ffa2336d308&fileName=HN_Full HMO Gold $30_Eff1.16_Rec2.16 r.pdf

https://Quoting.warnerpacific.com/GAITQuoting/fileServer.aspx?FileID=d5fd4009-b184-4015-92cb-44f32336d308&fileName=HN_Bronze 60 PPO 6000.70_Eff1.16_Rec2.16 r.pdf

https://Quoting.warnerpacific.com/GAITQuoting/fileServer.aspx?FileID=73cd6c32-0021-4b04-a91f-77587939d408&fileName=HN_Bronze60PPO6300.75-ChildDental_Eff1.17_Rev1.17.pdf

https://Quoting.warnerpacific.com/GAITQuoting/fileServer.aspx?FileID=a309e371-29ca-4b21-b42c-333adc28d408&fileName=HN_FullNetworkHMO-Gold30_Eff1.17_Rev1.17 r.pdf


Multi Plan Calculator Detail

(Grid View)

Rates for each employee’s plan election brown out by employer cost

and employee cost, arranged in rows.



Current: 6/1/2016* (HN) Health Net Enhanced Choice A w/Full Network

Total PremiumEmployee

ContributionEmployer

ContributionTier

RatingArea

(Carrier) PlanEmployee Age

(HN) Full Network HMO Gold $30Ken London 288.29 32.03 320.3226 EE CA15

(HN) Health Net Bronze 60 PPO 6000/70Lisa Smith 332.66 0.00 332.6633 EE CA15

(HN) Health Net Bronze 60 PPO 6000/70Ben Lee 321.83 0.00 321.8331 EE CA15

(HN) Full Network HMO Gold $30Ann Patel 346.28 626.88 973.1636 FA CA15

(HN) Full Network HMO Gold $30Ken Richardson 315.04 35.00 350.0429 EE CA15

(HN) Full Network HMO Gold $30Joe Cello 422.30 46.92 469.2246 EE CA15

Health Net Totals: 6 EE's $2,026.40 $740.83 $2,767.23EE Contrib: 90% Dep Contrib: 0% based on Full Network HMO Gold $30. Apply Overflow to Dep? No

Renewal: 6/1/2017 (HN) Health Net Enhanced Choice A w/Full Network

Total PremiumEmployee

ContributionEmployer

ContributionTier

RatingArea

(Carrier) PlanEmployee Age

(HN) Full Network HMO Gold $30Ken London 338.94 37.66 376.6027 EE CA15

(HN) Bronze 60 PPO 6300/75 + Child DentalLisa Smith 340.88 0.00 340.8834 EE CA15

(HN) Bronze 60 PPO 6300/75 + Child DentalBen Lee 332.18 0.00 332.1832 EE CA15

(HN) Full Network HMO Gold $30Ann Patel 400.39 726.18 1,126.5737 FA CA15

(HN) Full Network HMO Gold $30Ken Richardson 367.07 40.79 407.8630 EE CA15

(HN) Full Network HMO Gold $30Joe Cello 505.49 56.17 561.6647 EE CA15

% Difference compared to 6/1/2016 Health Net Enhanced Choice A w/Full Network 13% 16% 14%

Health Net Totals: 6 EE's $2,284.96 $860.79 $3,145.75EE Contrib: 90% Dep Contrib: 0% based on Full Network HMO Gold $30. Apply Overflow to Dep? No

$258.56 $119.96 $378.52$ Difference compared to 6/1/2016 Health Net Enhanced Choice A w/Full Network

Professional Broker II ProQuote Samples - So CADBA:Burbank, Los Angeles County, CA 91502SIC Code: 5193 - Flowers, Nursery Stock, and Florists'SuppliesCreate Date: 4/26/2017

Quote Id: 2134-7307


Medical

Grid View

Multi-Plan Calculator DetailLic# NOLIC

Final rates are determined by the Carrier. This quote is not valid without the separate general disclaimer.# Dependent children 21-25 years old are rated as adults. Dependent children may become ineligible for coverage on their 26th birthday; effective date of change may vary by carrier.Certain plans and products shown here are offered only on a bundled basis. Please consult carrier guidelines for definitive product and plan combinations.Rates have not been adjusted for Federal or State COBRA enrollees.* The current rates reflect the employees' age as of their last birthday to more closely reflect the group's current bill.


See current vs renewal broken out by employee plan elections















Summary (Columnar View)

Plan totals, broken out by employer cost and employee cost,

arranged in columns.



Alternative Option: 6/1/2017

(ABC) Anthem Blue Cross (CA) Prudent Buyer PPO w/ TraditionalHMO/Select HMO

EE Contrib: 90% Dep Contrib: 0% based on Anthem Gold HMO25/20%/6600 (2EZU). Apply Overflow to Dep? No

Plan EE's ER EE Total

(ABC) Anthem BronzePPO 5000/30%/7150(2EVN)

620.12 0.00 620.122

(ABC) Anthem Gold HMO25/20%/6600 (2EZU)

1,560.86 833.53 2,394.394

$2,180.98 $833.53 $3,014.51Total:

% Difference:

$ Difference:

8%

$154.59

13%

$92.70

9%

$247.28

6

Renewal: 6/1/2017

(HN) Health Net Enhanced Choice A w/Full Network

EE Contrib: 90% Dep Contrib: 0% based on Full Network HMO Gold $30.Apply Overflow to Dep? No


(HN) Bronze 60 PPO6300/75 + Child Dental

673.06 0.00 673.062

(HN) Full Network HMOGold $30

1,611.90 860.79 2,472.694

$2,284.96 $860.79 $3,145.75Total:

% Difference:

$ Difference:

13%

$258.56

16%

$119.96

14%

$378.52

6

Current: 6/1/2016*


EE Contrib: 90% Dep Contrib: 0% based on Full Network HMO Gold $30.Apply Overflow to Dep? No


(HN) Full Network HMOGold $30

1,371.91 740.83 2,112.744

(HN) Health Net Bronze60 PPO 6000/70

654.49 0.00 654.492

$2,026.40 $740.83 $2,767.23Total: 6

Professional Broker II

Multi-Plan Calculator SummaryColumnar View

DBA:Burbank, Los Angeles County, CA 91502SIC Code: 5193 - Flowers, Nursery Stock, and Florists'Supplies

ProQuote Samples - So CACreate Date: 4/26/2017Quote Id: 2134-7307

Medical


Lic# NOLIC



Includes Employer Contribution


See the bottom line for employer and employees


https://Quoting.warnerpacific.com/GAITQuoting/fileServer.aspx?FileID=aec50ec7-64fa-4050-8e66-046eed8bd408&fileName=Anthem_GoldHMO_ 25.20.6600_CaliforniaCareHMO_2EZU_Eff1.17_Rec4.17.pdf






Multi Plan Calculator Detail

(Columnar View)

Rates for each employee’s plan election brown out by employer cost

and employee cost, arranged in columns.

Find it in: Multi Plan Calculator

Available in Excel


Census

Employee Age/Tier

Ken London 27/EE

Lisa Smith 34/EE

Ben Lee 32/EE

Ann Patel 37/FA

Ken Richardson 30/EE

Joe Cello 47/EE

Total: 6 EE's

Renewal: 6/1/2017


EE Contrib: 90% Dep Contrib: 0% based on Full Network HMO Gold $30. Apply Overflow toDep? No

Plan ER EE Total

(HN) Full Network HMO Gold $30 338.94 37.66 376.60

(HN) Bronze 60 PPO 6300/75 + Child Dental 340.88 0.00 340.88

(HN) Bronze 60 PPO 6300/75 + Child Dental 332.18 0.00 332.18

(HN) Full Network HMO Gold $30 400.39 726.18 1,126.57



$2,284.96 $860.79 $3,145.75Total:

% Difference:

$ Difference:

13%

$258.56

16%

$119.96

14%

$378.52

Current: 6/1/2016*


EE Contrib: 90% Dep Contrib: 0% based on Full Network HMO Gold $30. Apply Overflow toDep? No

Plan ER EE Total


(HN) Health Net Bronze 60 PPO 6000/70 332.66 0.00 332.66

(HN) Health Net Bronze 60 PPO 6000/70 321.83 0.00 321.83




$2,026.40 $740.83 $2,767.23Total:

Professional Broker II

Create Date: 4/26/2017Quote Id: 2134-7307

DBA:Burbank, Los Angeles County, CA 91502SIC Code: 5193 - Flowers, Nursery Stock, and Florists'Supplies

ProQuote Samples - So CAMulti-Plan Calculator Detail

Columnar View

Medical

These rates are based on the ages of employees and their dependents as of the requested effective date.Pediatric Dental is included in the Medical rate for all Off-Exchange plans in this quote.The Contribution amounts listed on this report may not reflect actual final contribution totals.

Lic# NOLIC



See current vs renewal broken out by employee plan elections














Enrollment Worksheets

without Benefits

Worksheet for each employee with rates broken out for self and

each dependent.

Find it in: Employee Enrollment

Worksheets


Monthly Rate Employee Cost Breakdown

Health Net Enhanced Choice A w/Full Network

These rates reflect your cost after your employer's contribution of 90% toward employee and 0% toward dependent(s) based on Health Net - Full NetworkHMO Gold $30 rates and are for an Effective Date of 6/1/2017.The Contribution amounts listed on this report may not reflect actual final contribution totals.

Dependent Cost Breakdown

MEDICAL

Area

354.36178.30Embedded532.66(0.00)532.66

347.62Embedded(347.62)0.00

Bronze 60 PPO 6300/75 + Child Dental

CA15$532.66PPO/Bronze/ PPO

Employee:Ped. Dental:

Employer Pays:Enrollee Pays:

SP:CH 1:

Ped. Dental:TOT:


453.50228.19Embedded681.69(0.00)681.69

444.88Embedded(400.39)44.49

Full Network HMO Gold $30

CA15$726.18HMO/Gold/ Full



SP:CH 1:

Ped. Dental:TOT:


Enrollment Worksheet for:Ann PatelFemale, DOB: 09-04-1979, Zip Code: 91205, Los Angeles County

Spouse/Partner: M, DOB: 12-05-1977, Child(ren): DOB: 07-06-2010

Presented By: Professional Broker II License # NOLICProQuote Samples - So CA, 91502, Los Angeles County

Final rates are determined by the Carrier. This quote is not valid without the separate general disclaimer.# Dependent children 21-25 years old are rated as adults. Dependent children may become ineligible for coverage on their 26th birthday; effective date of change may vary bycarrier.

Create Date: 4/26/2017 Quote ID: 2134-9001

Available in Enrollment W

orksheets

Break out of rates for employee and each dependent





without Benefits in Spanish

Worksheet for each employee with rates broken out for self and

each dependent. Includes Spanish translations.


Worksheets


Monthly RatePrima Mensual

Employee Cost BreakdownPrimas


These rates reflect your cost after your employer's contribution of 90% toward employee and 0% toward dependent(s) based on Health Net - Full NetworkHMO Gold $30 rates and are for an Effective Date of 6/1/2017.Estas primas reflejan el costo para usted, después de la contribución de su patrón: el 90% para EE y el 0% para Dep basado en la prima para Health Net - FullNetwork HMO Gold $30. y son para una fecha efectiva de 6/1/2017.The Contribution amounts listed on this report may not reflect actual final contribution totals.Los montos de la contribuciones mostradas en este reporte no necesariamente reflejan las contribuciones totales finales.

Dependent Cost BreakdownCosto del(de los) Dependiente(s)

MEDICAL (Seguro Médico)

Area

354.36178.30Embedded532.66(0.00)532.66

347.62Embedded(347.62)0.00

Bronze 60 PPO 6300/75 + Child Dental

CA15$532.66PPO/Bronze/ PPO



SP:CH 1:

Ped. Dental:TOT:


453.50228.19Embedded681.69(0.00)681.69

444.88Embedded(400.39)44.49


CA15$726.18HMO/Gold/ Full



SP:CH 1:

Ped. Dental:TOT:



Spouse/Partner(Cónyuge/Pareja): M, DOB: 12-05-1977, Child(ren)(Hijo(s)): DOB: 07-06-2010


Final rates are determined by the Carrier. This quote is not valid without the separate general disclaimer.Las primas finales son determinadas por la Aseguradora. Esta cotización no es válida si no tiene anexa la hoja de renuncia de responsabilidad.# Dependent children 21-25 years old are rated as adults. Dependent children may become ineligible for coverage on their 26th birthday; effective date of change may vary bycarrier. # Los hijos dependientes entre 21 y 25 años de edad son cotizados como adultos. Los hijos dependients pueden dejar de ser elegibles para cobertura al cumplir los 26años; la fecha efectiva para este cambio puede variar de una aseguradora a otra.



orksheets

Nice for your bilingual meetings!





with Benefits

Worksheet for each employee with rates and key benefits broken

out for self and each dependent.


Worksheets


Monthly Rate DeductibleRX Tiers1/2/3/4

Employee Cost Breakdown


These rates reflect your cost after your employer's contribution of 90% toward employee and 0% toward dependent(s) based on Health Net - Full NetworkHMO Gold $30 rates and are for an Effective Date of 6/1/2017.The Contribution amounts listed on this report may not reflect actual final contribution totals.

Dependent CostBreakdown

Out-of-PocketMax

InpatientHospital

Services *

Office Visits(PCP/

Specialist) *

MEDICAL

354.36178.30Embedded532.66(0.00)532.66

347.62Embedded(347.62)0.00

Bronze 60 PPO 6300/75+ Child Dental

$6,300/ $12,600embedded

$75/$105 (1st 3visits ded waived)

100%$6,800/ $13,600

embedded;includes ded

100% after$500/$1,000 Ded$532.66

PPO/Bronze/ PPO



SP:CH 1:

Ped. Dental:TOT:


453.50228.19Embedded681.69(0.00)681.69

444.88Embedded(400.39)44.49

Full Network HMO Gold$30

$0/$0 $30/$50 $1,200/admission$6,750/ $13,500

embedded$15/$50/$70/30%

$726.18HMO/Gold/ Full



SP:CH 1:

Ped. Dental:TOT:



Spouse/Partner: M, DOB: 12-05-1977, Child(ren): DOB: 07-06-2010


* Unless stated, all services are subject to deductible.Final rates are determined by the Carrier. This quote is not valid without the separate general disclaimer.# Dependent children 21-25 years old are rated as adults. Dependent children may become ineligible for coverage on their 26th birthday; effective date of change may vary bycarrier.



orksheets

Rates and Benefits!

Break out of rates for employee and each dependent

Plan Benefit Summary





with Benefits in Spanish

Worksheet for each employee with rates and key benefits broken out for

self and each dependent. Includes Spanish translations.


Worksheets


Monthly RatePrima Mensual

DeductibleRX Tiers1/2/3/4

Employee Cost BreakdownCosto del Empleado


These rates reflect your cost after your employer's contribution of 90% toward employee and 0% toward dependent(s) based on Health Net - Full NetworkHMO Gold $30 rates and are for an Effective Date of 6/1/2017.Estas primas reflejan el costo para usted, después de la contribución de su patrón: el 90% para EE y el 0% para Dep basado en la prima para Health Net - FullNetwork HMO Gold $30. y son para una fecha efectiva de 6/1/2017.The Contribution amounts listed on this report may not reflect actual final contribution totals.Los montos de la contribuciones mostradas en este reporte no necesariamente reflejan las contribuciones totales finales.

Dependent CostBreakdown

Costo del(de los)Dependiente(s)

Out-of-PocketMax

InpatientHospital

Services *

Office Visits(PCP/

Specialist) *

MEDICAL (Seguro Médico)

354.36178.30Embedded532.66(0.00)532.66

347.62Embedded(347.62)0.00

Bronze 60 PPO 6300/75+ Child Dental

$6,300/ $12,600embedded

$75/$105 (1st 3visits ded waived)

100%$6,800/ $13,600

embedded;includes ded

100% after$500/$1,000 Ded$532.66

PPO/Bronze/ PPO



SP:CH 1:

Ped. Dental:TOT:


453.50228.19Embedded681.69(0.00)681.69

444.88Embedded(400.39)44.49

Full Network HMO Gold$30

$0/$0 $30/$50 $1,200/admission$6,750/ $13,500

embedded$15/$50/$70/30%

$726.18HMO/Gold/ Full



SP:CH 1:

Ped. Dental:TOT:



Spouse/Partner(Cónyuge/Pareja): M, DOB: 12-05-1977, Child(ren)(Hijo(s)): DOB: 07-06-2010


* Unless stated, all services are subject to deductible.* Excepto que se mencione lo contrario, todos los servicios están sujetos al deducible.Final rates are determined by the Carrier. This quote is not valid without the separate general disclaimer.Las primas finales son determinadas por la Aseguradora. Esta cotización no es válida si no tiene anexa la hoja de renuncia de responsabilidad.# Dependent children 21-25 years old are rated as adults. Dependent children may become ineligible for coverage on their 26th birthday; effective date of change may vary bycarrier. # Los hijos dependientes entre 21 y 25 años de edad son cotizados como adultos. Los hijos dependients pueden dejar de ser elegibles para cobertura al cumplir los 26años; la fecha efectiva para este cambio puede variar de una aseguradora a otra.


Nice for your bilingual meetings!


orksheets


orksheets




Rate and Benefit

Comparison

When run as a Build Your Own Custom Comparison, includes current vs

renewal. You can enter your own custom plan, and drag and drop to sort

your plans.

Find it in: Build Your Own



# Dependent children 21-25 years old are rated as adults. Dependent children may become ineligible for coverage on their 26th birthday; effective date of change may vary by carrier.Final rates are determined by the Carrier. This quote is not valid without the separate general disclaimer.

Health NetHealth Net Health NetHealth Net Health NetFull Network HMO Gold $30Health Net Bronze 60 PPO

6000/70Bronze 60 PPO 6300/75 +

Child DentalFull Network HMO Gold $30 Bronze 60 PPO 6300/75 +

Child Dental


Plan Premium: $3,334.05$2,529.93 $2,768.52$2,850.04 $2,605.19

Medical

DEDUCTIBLE

HMO: $0PPO: $6,000Individual HMO: $0 PPO: $6,300 PPO: $6,300

HMO: $0PPO: $12,000 (embedded-aggregate)Family HMO: $0 PPO: $12,600 (embedded) PPO: $12,600 (embedded)

OUT-OF-POCKET MAX

HMO: $6,750PPO: $6,500 (includes ded.)Individual HMO: $6,000 PPO: $6,800 (includes ded.) PPO: $6,800 (includes ded.)

HMO: $13,500 (embedded)PPO: $13,000 (embedded-aggregate;includes ded.)

Family HMO: $12,000 (embedded-aggregate) PPO: $13,600 (embedded; includesded.)


PHYSICIAN SERVICES

HMO: $30/$50PPO: $70/$90 (first 3 visits ded.waived; combined office visits)

Office Visits HMO: $30/$50 PPO: $75/$105 (first 3 visits ded.waived; combined office visits)

PPO: $75/$105 (first 3 visits ded.waived; combined office visits)

HMO: $0PPO: $0 (ded. waived)Preventive Care HMO: $0 PPO: $0 (ded. waived) PPO: $0 (ded. waived)

PRESCRIPTION DRUGS

HMO: $15 (up to 30 day supply)PPO: 100% up to $500/prescription(up to a 90-day supply)

Tier 1 (Generic Formulary) HMO: $15 (up to a 30-day supply) PPO: 100% up to $500/prescription(up to a 30-day supply)

PPO: 100% up to $500/prescription(up to a 30-day supply)



HMO: $50 (up to a 30-day supply) PPO: 100% up to $500/prescription(up to a 30-day supply)




HMO: $70 (up to a 30-day supply) PPO: 100% up to $500/prescription(up to a 30-day supply)



HMO: $1,200/admissionPPO: 100% after ded. (up to OOPMax)

Inpatient Hospital Services HMO: $600 PPO: 100% after ded. (up to OOPMax)

PPO: 100% after ded. (up to OOPMax)

HMO: $900PPO: 100% after ded. (up to OOPMax)

Outpatient Surgery in aHospital

HMO: $400 PPO: 100% after ded. (up to OOPMax)

PPO: 100% after ded. (up to OOPMax)

EMERGENCY SERVICES

HMO: $300 (copay waived ifadmitted)

PPO: 100% after ded. (up to OOPMax; waived if admitted)

Emergency Room HMO: $300 (copay waived ifadmitted)




Create Date: 4/26/2017 Quote Id: 2134-7473


Available in Build Your Own Comparison

You choose from 29 benefit category the best fit for your presentation






Health Net Bronze 60 PPO6000/70

Full Network HMO Gold $30Bronze 60 PPO 6300/75 +Child Dental

Bronze 60 PPO 6300/75 +Child Dental


Health NetHealth Net Health NetHealth Net Health NetMedical






1,126.57681.69444.88CA15935.48566.06369.42CA15880.28532.66347.62CA15973.16588.40384.76CA15863.86522.32341.54CA15FA37Ann Patel



Totals: $2,007.61 $522.32 $2,529.93 $2,261.64 $588.40 $2,850.04 $2,072.53 $532.66 $2,605.19 $2,202.46 $566.06 $2,768.52 $2,652.36 $681.69 $3,334.05

% Difference: 0.0% 12.7% 3.0% 9.4% 31.8%

$ Difference: $0.00 $320.11 $75.26 $238.59 $804.12


Create Date: 4/26/2017 Quote Id: 2134-7473



Available in Build Your Own Comparison


Add your own custom plan and drag and drop to sort columns!






Proposal Illustrations - Home - Warner Pacific · Your Roadmap to PRO Quote Proposal Illustrations...

Documents

Transcript of Proposal Illustrations - Home - Warner Pacific · Your Roadmap to PRO Quote Proposal Illustrations...