Purple cow employee benefits benefits

download Purple cow employee benefits   benefits

of 15

Embed Size (px)

description

 

Transcript of Purple cow employee benefits benefits

  • 1. 4. B ENEFITS Your SECRET to Financial Security
  • 2. 1 Purple Cow 2011 Benefits Benefits Overview LIFE ACCIDENT HEALTH LIFE 1. LIFE INSURANCE * Total & Perm. Disability Income HEALTH 3. MEDICAL HMO * 21,519 MD, 352 hospitals, 358 clinics 4. DENTAL HMO * 775 dentists, 645 clinics 5. Opt. Annual Physical Exam * 124 hospitals, 241 clinics, 31 mobile 6. Health & Wellness Program * 2x/year; tailored to utilization report ACCIDENT 2. ACCIDENT INSURANCE a. Accidental Death * Murder b. Disability * Assault
  • 3. 2 Purple Cow 2011 Benefits Benefits Summary LIFE ACCIDENT HEALTH 1. Life = 5x MBL 13. 100% Pre-Existing Conditions coverage 2. Total & perm. disability income = 5x MBL 14. 100% Congenital Conditions coverage 3. Accidental death = 5x MBL 15. Benefits on top of Philhealth 4. Murder = 5x MBL 16. Special procedures = 30%/100% of MBL 5. Accidental disability = __% of 5x MBL 17. Opt. Outpatient Reimb. for meds, dental, vision 6. Assault = __% of 5x MBL 18. Dental = HMO (775 dentists / 645 clinics) 7. Medical = HMO (21,519 MD / 352 hospitals / 358 clinics) 19. Dental access to major malls in Metro-Manila 8. Access to Big 5 Hospitals & Healthway 20. 1 permanent filling, 2 oral prophylaxes, etc. 9. Combined inpatient & outpatient limits 21. Opt. APE = designated or mobile clinic 10. Max. Benefit Limits per disability per year 22. Free Health & Wellness Program 2x/year 11. HMO patient for no-cash-out 23. Same benefits for all Employees 12. Private patient for reimbursement (HMO rate) 24. Same benefits for all Dependents
  • 4. 3 Purple Cow 2011 Benefits 1. LIFE INSURANCE (worldwide) ASIANLIFE EXCLUSIONS 1. Life 1 5x MBL 1. Suicide within the 1 st year of coverage 2. Total & Perm Disability Income 2 5x MBL +Principals 18yo-65yo; Dependents 30dy-21yo / 18yo-65yo 1 Life insurance = 5x MBL, for death by any cause (suicide covered after 1 year); 2 Total & Permanent Disability Income (TPDI) = 5x MBL, in lieu of the Life benefit, after 6 months of TPD, whether sick or hurt. Example : If MBL = 20T, Life or TPDI = 100,000; If MBL = 40T, Life or TPDI = 200,000; If MBL = 60T, Life or TPDI = 300,000; If MBL = 80T, Life or TPDI = 400,000; If MBL = 100T, Life or TPDI = 500,000. Life benefits are payable on top of Accident and Health benefits
  • 5. 4 Purple Cow 2011 Benefits 2a. ACCIDENT INSURANCE (worldwide) ASIANLIFE 1. Accidental Death 1 5x MBL 3. Disability 3 _% 5x MBL 2. Murder 2 5x MBL 4. Assault 4 _% 5x MBL +Principals 18yo-65yo; Dependents 30dy-21yo / 18yo-65yo 1 Accidental Death = 5x MBL, for death from any type of accident; 2 Murder = 5x MBL, in lieu of the Accidental Death benefit, for death not due to accident but murder (provoked or not). Example : If MBL = 20T, Accidental Death or Murder = 100,000; If MBL = 40T, Accidental Death or Murder = 200,000; If MBL = 60T, Accidental Death or Murder = 300,000; If MBL = 80T, Accidental Death or Murder = 400,000; If MBL = 100T, Accidental Death or Murder = 500,000. +Principals 18yo-65yo; Dependents 30dy-21yo / 18yo-65yo 3 Disability = __% of 5x MBL, according to a long schedule of disabilities; 4 Assault = __% of 5x MBL, in lieu of the Disability benefit, for disability not due to accident but assault (provoked or not). Example : If MBL = 20T, Disability or Assault = __% of 100,000; If MBL = 40T, Disability or Assault = __% of 200,000; If MBL = 60T, Disability or Assault = __% of 300,000; If MBL = 80T, Disability or Assault = __% of 400,000; If MBL = 100T, Disability or Assault = __% of 500,000. Accident benefits are payable on top of Life and Health benefits
  • 6. 5 Purple Cow 2011 Benefits 2b. ACCIDENT INSURANCE SCHEDULE OF DISABILITIES 1. Life (same as Accidental Death) 100% 14. Middle finger 6% 2. Both hands or feet or sight of both eyes 100% 15. Ring finger 5% 3. One hand and one foot 100% 16. Little finger 4% 4. Either hand or foot and sight of one eye 100% 17. Metacarpals 1 st /2 nd - 3 rd/ 4 th /5 th 3% - 2% 5. Injuries resulting in being perm. bedridden 100% 18. Leg at or above knee 60% 6. Any other injury causing Total Perm. Disab. 100% 19. Leg below knee 50% 7. Arm at or above elbow 70% 20. One foot 50% 8. Arm between elbow and wrist 50% 21. All toes on one foot 25% 9. One hand 50% 22. Big toe 5% 10. Four fingers and thumb of one hand 50% 23. Any toe other than big toe (each) 1% 11. Four fingers 35% 24. Sight of one eye 50% 12. Thumb 15% 25. Hearing - both ears 50% 13. Index finger 10% 26. Hearing - one ear 25% +Multiple losses from 1 accident will be limited to the highest loss, not to exceed 100%. If a member suffered the loss of 1 hand/foot/eye prior to coverage, the benefit for a subsequent loss of the same will be . Losses refer to total and permanent loss of use or complete severance
  • 7. 6 Purple Cow 2011 Benefits 2c. ACCIDENT INSURANCE EXCLUSIONS 1. Bodily or mental infirmity, hernia, ptomaine, bacterial or viral infection (except pyogenic infection occurring with and through an accidental cut or wound) 12. War, invasion, act of foreign enemy or warlike operation (whether declared or undeclared), mutiny, strikes, demonstrations, riots, civil commotion, conspiracy, military takeover, state of siege, or any weapon or instrument employing atomic fission or radioactive force whether in time of peace or war 2. Disease, sickness, parasite, or disorder of the body/ mind 3. Poison, gas or fumes voluntarily or involuntarily taken 4. Insect bites 13. Serving in the armed forces of any country, or international authority, whether in war or peace 5. Earthquake, volcanic eruption or tidal wave 6. Atomic explosion, nuclear fission, or radioactive gas 14. Entering, operating, servicing, ascending or descending from any aerial or submarine device or conveyance, except as provided under a passenger aviation provision 7. Pregnancy, childbirth, miscarriage or any complications 8. Accident occurring while or because the Insured is under the influence of alcohol or any drug 15. Hunting, motorcycling or pillion riding, mountaineering which necessitates the use of ropes or pitons, racing of any kind, other than on foot, ice or winter sports, water-ski jumping and tricks, yachting beyond 5 km. off a coastline, underwater activities involving the use of underwater apparatus, or using woodworking machinery driven by mechanical power other than portable tools, applied by hand and used solely for private purposes without reward 9. Suicide or any attempted threat while sane or insane, or any intentionally self-inflicted injury 10. Participation in any brawl, or committing any crime or felony 11. Provoked murder / assault or attempted threat [waived]
  • 8. 7 Purple Cow 2011 Benefits 3a. MEDICAL HMO (nationwide) ASIANLIFE (21,519 MD / 352 hospitals / 358 clinics) TERMS & CONDITIONS 1. Combined inpatient & outpatient limits 1. Instant rates, regardless of size 2. Max. Benefit Limits per disability per year 2. No franchising required 3. HMO patient for no-cash-out 3. No utilization report required 4. Private patient for reimbursement (HMO rate) 4. No individual applications required 5. Access to Big 5 Hospitals and Healthway 5. Minimum group size = 10 6. 100% Pre-Existing Conditions coverage 6. Minimum mode of payment = monthly 7. 100% Congenital Conditions coverage 7. Pooled Employee utilization to spread risk 8. Benefits on top of Philhealth 8. Separate Dependent utilization to reduce cost 9. Special Procedures = 30%/100% of MBL 9. Buy now, pay later 10. Opt. Outpatient Reimb. for meds, dental, vision 10. 1 st year Virgin promo rate, if applicable +Principals 18yo-65yo; Dependents 30dy-21yo / 18yo-65yo +Same rates for Dependents in 2011 Medical HMO benefits are covered on top of Life and Accident benefits
  • 9. 8 Purple Cow 2011 Benefits 3b. MEDICAL HMO PRE-EXISTING CONDITIONS (Dreaded) PRE-EXISTING CONDITIONS (Non-Dreaded) 1. Blood dyscrasias 1. Asthma, pleural effusion or other chronic airway obstruction conditions 2. Benign / malignant new growths 2. Benign cyst / tumor and malignant conditions 3. Chronic cardiac / cardio-vascular diseases 3. Chronic gynecologic conditions 4. Collagen / connective diseases 4. Hemorrhoids and other chronic colonic and ano-rectal illnesses 5. Diseases of the immune system 5. Diseased tonsils requiring surgery, cataracts & other opthalmo-otolaryngologic conditions 6. Chronic hepatobiliary diseases 6. Pathological abnormalities of nasal septum and turbinate 7. Neuro-surgical / neurological conditions 7. Sinus condition requiring surgery 8. Chronic pulmonary diseases 8. Chronic neurologic conditions 9. Chronic genito-urinary diseases 9. Calculus cholecystitis / cholelithiasis and/or urolithiasis 10. Chronic gynecological condition