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Agent Training Only 1

Agenda

Overview

Administrative Partners

Carrier Partners

Limited Medical Plan Benefits

Association Benefits

Policy Information


Why Sell GetMED 360?

Top rated Insurance Companies

Dr. office visit co-pays

ER benefit for both injury and sickness – pays up to $1,000

$5,000 per accident - excess accident medical expense

$10,000 Critical Illness

Weekly $$$

Benefits vary by state.


Product Overview

GUARANTEED ISSUE – NO UNDERWRITING REVIEW

Great for consumers that may not qualify for full comprehensive Major Medical

A reasonable alternative (not replacement) for consumers who cannot afford more costly Major Medical programs

The plans provide coverage for the common everyday expenses such as doctor office visits, hospital, ICU and surgical expenses


Sponsored by UCAA

United Consumer Awareness Association (www.unitedconsumer.org)

A National Association

Offers a benefit package of consumer discount products including:

Doctor/Hospital network Call MD Tiered Dental and Vision 3-Tier Rx Chiropractic 24-hour nurses hotline And much more!

More information about UCAA is available on the GetMed360 site


Administrative Partner: Patriot Health, Inc. Patriot Health is a member of the Cost Containment Group (CCG) of

companies, headquartered on Long Island, New York.

Established in 1993, CCG services millions of families nationwide through various health care related programs and networks.

Patriot Health is a Managing General Underwriter (MGU) and Administrator for Limited Medical Plans.

They offer a single source for product development, networks, administration and customer care.

They combine multiple insurance carriers and networks to deliver the most complete and highest value membership plans for the consumer.


GetMED 360 Benefit Components

UCAAAssociation

United States Fire

Limited MedicalGuaranteed Issue

Hartford Life

Term LifeGuaranteed Issue

Guarantee Trust

Accident MedicalExpense Benefit

(AME)Accidental Death

& Dismemberment(AD&D)

Presidential

Emergency Room(ER) Benefit

AIG

Critical Illness (CI)Benefit


In order to provide its members with the maximum benefit options available in their particular state, UCAA has contracted with the following carrier partners:

Insurance Carrier: Limited Medical Benefit Plans

United States Fire Insurance Company

Fairmont Specialty is a registered trademark of United States Fire Insurance Company Niche products (accident and health)

A member of Crum and Forster group of companies

Rated “A” Excellent by AM Best (as of 2009)


Medical Benefit Provisions

There are no coordination of benefits with other plans

There is a 30 day wait on sickness benefits

Pre-X definition: A medical condition, injury or sickness, for which medical advice, consultations, symptoms, care or treatment was recommended by a doctor within 12 months prior to the effective date of coverage – will be considered a pre-existing condition unless the loss incurred at least 12 months after the effective date of coverage.

There is a 12/12 pre-x on Hospital Confinement Charges, Surgery and Anesthesia

There is a 6/12 pre-x on the Emergency Room Benefit

There is a 12/12 pre-x on the Critical Illness Benefit payable only after all valid and collectible insurance for the same claim has been exhausted


Eligibility

All Members and Spouses who are 18 to 65 years old. At age 65 the plan ends.

Unmarried Children Under age 19

Includes stepchild, foster, legally adopted, pending adoption proceedings and natural child

Up to age 24 if enrolled as fulltime student at accredited college or university

Newborn (born during coverage period) for 31 days Citizens or legal residents of the United States

Must be a legal resident for 12 months


Provider Access (Beech Street)

GetMed360 utilizes Beech Street – a National PPO network of providers (www.beechstreet.com - choose the limited benefit plan link)

564,181 respected doctors 5,083 acute care hospitals 87,500 ancillary network providers Practitioners in all 50 states! Provider lookup 24/7 on GetMed360 site

Utilizing Beech Street Network Providers Maximizes client savings Reduces out-of-pocket expenses


Provider Locator Screen


Plans Offered (varies by state)Platinum MAX

$250 and $1000

Limited Med

Life

Accident

AD&D

ER

Critical Illness

Platinum

$250 and $1000

Limited Med

Life

Accident

AD&D

ER

Gold MAX

$250 and $1000

Limited Med

Life

Accident

AD&D

Critical Illness

Gold

$250 and $1000

Limited Med

Life

Accident

AD&D

Silver

$250 and $1000

Limited Med

Life


State variations and plan offerings will be displayed on the GetMed360 web site in an easy to use format!

Plan Availability Screen


State and Product Availability



PLATINUM SERIESBenefit

(PER INSURED)

Based on policy annual period, not calendar year $250 $1000 Max $250 Max $1000

Hospital Confinement 31 days per year $250 per day $1000 per day

$250 per day $1000 per day

ICU/CCU 15 days per year $1000 per day

$2000 per day

$1000 per day $2000 per day

Surgery Benefit Inpatient / Outpatient $10,000 – 2 surgeries per insured per year

Anesthesia 25% of surgery 25%

Doctor Office Visit5 visits per insured per yr10 visits per family per yr

In Network:Out of Network:

$20 co-pay$40 benefit

Ambulance (Ground or Air) 1 trip per year N/A $100 N/A $100

Wellness 2 visits per insured per yr



Diagnostic Lab/X-Ray (DXL)

N/A $1003 sittings

N/A $1003 sittings

Emergency Room (ER) $1000 2 per insured/family

Accident Medical (AME) Excess Benefit $5,000 - $100 deductible

Accidental Death & Dsmemberment (AD&D)

$15,000

Critical Illness (CI) Per covered insured N/A N/A $10,000 $10,000

Term Life Insurance 50% covered spouse20% covered children

$10,000


GOLD SERIESBenefit

(PER INSURED)

Based on policy annual period, not calendar year $250 $1000 Max $250 Max $1000

Hospital Confinement 31 days per year $250 per day $1000 per day $250 per day $1000 per day

ICU/CCU 15 days per year $1000 per day $2000 per day $1000 per day $2000 per day



Doctor Office Visit5 visits per insured per yr10 visits per family per yr

In Network:

Out of Network:

$20 co-pay

$40 benefit

Ambulance (Ground or Air) 1 trip per year N/A $100 N/A $100

Wellness

2 visits per insured per yr

In Network:

Out of Network:

$20 co-pay

$40 benefit


N/A $1003 sittings

N/A $1003 sittings

Emergency Room (ER) N/A

Accident Medical (AME) Excess Benefit $5,000 - $100 deductible

Accidental Death & Dismemberment (AD&D)

$15,000

Critical Illness (CI) Per covered insured N/A N/A $10,000 $10,000


$10,000


SILVER SERIESBenefit

(PER INSURED)

Based on policy annual period, not calendar year $250 $1000

Hospital Confinement 31 days per year $250 per day $1000 per day

ICU/CCU 15 days per year $1000 per day $2000 per day



Doctor Office Visit

5 visits per insured per yr10 visits per family per yr

In Network:

Out of Network:

$20 co-pay

$40 benefit

Ambulance (Ground or Air) 1 trip per year N/A $100

Wellness 2 visits per insured per yr




N/A $1003 sittings

Emergency Room (ER) N/A

Accident Medical (AME) Excess Benefit N/A

Accidental Death & Dismemberment (AD&D)

N/A

Critical Illness (CI) Per covered insured N/A


$10,000


Plan Individual w/Spouse or Child

Family

Platinum 250, Gold 250 or Silver 250

$199.90 $379.90 $499.90

Platinum Max 250 or Gold Max 250

$229.90 $439.90 $559.90

Platinum 1000 or Gold 1000

$299.90 $529.90 $729.90

Platinum Max 1000 Gold Max 1000

$329.90 $589.90 $789.90

Doctor Visits (Fairmont Specialty)

Sickness or Accident -5 visits per individual per policy year or 10 per family.

Doctor Office Visit co-pay is $20 – the member must utilize a Beech Street provider.

If all visits are used (5/10) the in-network provider discount will still apply.

Out-of-network Doctor Office Visit Indemnity Reimbursement – maximum of $40 per visit.


Wellness Visit (Fairmont Specialty)

In-network Doctor Office Wellness Visit - for routine health examinations or immunizations of Covered Persons.

Co-pay is $20 per visit – 2 visits per person per year.

The benefit does not cover any wellness testing, such as mammograms, PAP or PSA Testing.

Claims for wellness tests will be “re-priced” through Beech Street if a network provider is used.

Out-of-network Doctor Office Visit Indemnity Reimbursement – maximum of $40 per visit.


Diagnostic, X-Ray & Lab (Fairmont)

Coverage is provided when x-rays, laboratory and other diagnostic tests are ordered or performed by a Doctor.

Includes the services of a radiologist or radiology group and the services of a pathologist or pathology group for interpretation of diagnostic tests or studies that are Medically Necessary due to an Injury or Sickness

There are a maximum of 3 sittings or draws per Covered Person per Policy Year.

If the member stays in-network they can get their bill(s) re-priced before the benefit is applied.

If all sittings are used the in-network provider discount will still apply

The payment amount is up to $100 per sitting/draw. Only available on the 1000 plan series.


Hospital Confinement (Fairmont)

Sickness is payable after a 30 day waiting period.

Injury is payable as of the effective.

Benefits are payable from 1-31 days, up to $250 or $1,000 per day while confined in a hospital semi-private room, as a result of a covered injury or sickness.

Using a Beech Street facility will help lower out-of-pocket costs.


Hospital Confinement – ICU/CCU (Fairmont)

Benefits are payable for up to 15 days while confined in a hospital ICU/CCU, as a result of a covered injury or sickness.

The benefit is up to $1,000 or $2,000 per day depending on plan chosen.

30 day waiting period for sickness

Paid in lieu of hospital confinement benefit

Using a Beech Street facility will help lower out of pocket costs.


Ambulance (Fairmont)

Up to benefit amount of $100 Per Trip

Medical Emergency only

1 Trip per person per year

Ground or Air

This benefit is available in the 1000 plan series only


Surgery In/Out Patient (Fairmont)

Benefits are payable up to $10,000 per surgery.

Based off of CPT codes on a surgery schedule. 2 surgeries per covered person per policy year. Sickness benefits are payable after a 30 day waiting period.

Benefit Includes but is not limited to charges for:

Surgeon fees Use of the operating and recovery room Administration of drugs and medicines during surgery Dressings, casts, splints Diagnostic services including radiology, laboratory, or pathology

performed during time of surgery.


Surgery: GetMED 360 vs. RBRVS Surgical Benefit

$10,000 Fairmont surgical schedule vs. RBRVS schedule

RBRVS – will pay just the cost of the surgical procedure (surgeon charges only) based upon the RBRVS code in the covered persons county

GedMed360 – Surgical benefit is provided for use of the operating room and recovery room, including the doctors charge for performing surgery. Benefit also provided for medical services and supplies used in the performance of the surgery. Includes, but not limited to:

Administration of drugs and medicines during surgery Dressings, casts, splints Diagnostic services including radiology, laboratory, or

pathology performed during time of surgeryAgent Training Only 27

Sample Comparisons (Hillsborough County, Tampa, FL)

Surgery CPT Code RBRVS GetMed360

Gall Bladder 47600 $817 $5,000

Arm Amputation 24920 $685 $2,500

Breast Reconstruction 19350 $896 $5,000

Repair: Heart Defects 33697 $2,086 $8,500

Aortic Valve Repair 33403 $2,163 $8,500

Fractured Finger 26720 $173 $1,000

Arterial Blockage 35472 $2,574 $10,000

Hysterectomy 58150 $930 $5,000

Triple By-Pass 33535 $2,191 $8,500

Appendectomy 44950 $595 $2,500


Anesthesia In/Out Patient (Fairmont)

This benefit is payable at 25% of the surgery benefit

Using an in-network provider will lower out-of-pocket costs


Emergency Room (Presidential)

Availability Varies by State Injury or Sickness 2 visits per year (individual/family)

Benefit is payable up to $1,000

Subject to a $100 deductible per visit

There is a 6/12 Pre-ex There is a 30 day waiting period for sickness


AD&D (GTL)

Availability Varies by State

If you are injured in a covered accident and the injury from such an accident causes death or dismemberment within 365 days from the date of the accident, the insurance company will pay the amount shown.

If you sustain more than one such loss as the result of one Accident, the insurance company will pay only one amount, the largest, to which you are entitled.

The benefit is $15,000 in states where available.


Excess Accident Medical Expense (GTL)

Availability Varies by State

If you are injured in a covered accident and receive treatment from a physician within 365 days from the date of the accident, the insurance company will pay the amount shown for actual expenses, up to the maximum per accident. This is an excess benefit so all other benefits must be used first.

Subject to a $100 deductible per accident.

Benefit amount is $5,000 per accident for all plans.


Guaranteed Issue Term Life (Hartford Life)

Requires NO medical Exam or Tests!

The benefit amount shown is paid to the beneficiary or beneficiaries in the event of your death.

Benefit payment is subject to the definitions, limitations,

exclusions and other provisions within the Certificate.

Covered spouse benefit is 50% of benefit amount shown and dependent benefit is 20% of benefit amount shown. Covered dependent child(ren) must be at least 15 days or older to be eligible for coverage.

Benefit amount is $10,000 in states where available.


Critical Illness (AIG)

Please see State Product Availability Chart

The $10,000 Critical Illness Indemnity Benefit is payable for Insured and covered Spouse

Will be paid in addition to any other benefit in the Certificate

Subject to a 12/12 Pre-Existing Condition Limitations

A benefit is payable for any one of the following:

Invasive Cancer Heart Attack Stroke Major Organ Transplant Surgery Coma End Stage Renal Failure


Plan Highlights: Association Benefits

Doctor/Hospital Network (Beech Street)

3-Tiered Rx Discount Tiered Dental Tiered Vision Call MD Chiropractic Counseling

24-Hour Nurses Hotline Elder Care Hearing Diabetic Supplies Fitness Holistic Care Much more consumer lifestyle

savings benefits!



Beech Street Top 100 Procedures Sample Savings


3-Tiered Prescription Drug “Discount” • This plan is accepted at over 50,000 participating pharmacies

nationwide.• Simply visit a participating pharmacy, present your membership

card and pay the pharmacy directly.• To access list of pharmacies go to www.getmed360.com• Tiers are based on 1 pill per day for 30 days.

• Tier 1: Drugs at up to a $10.00 maximum cost **• Tier 2: Drugs at up to a $20.00 maximum cost **• Tier 3: All other drugs are available for your benefit at

negotiated rates. • ** Please note that some participating pharmacies may charge

beyond a particular tier.

• *Only a licensed physician can recommend or prescribe specific drugs to treat your specific condition


Top 10 Drug Savings


Quality Vision Network (QVN) Tier 1

At select participating vision outlets, a no-charge eyeglass vision exam is available once annually for every family member Prescription must be filled by the provider performing the

no-charge exam if glasses are required

Tier 2 You will also receive discounted rates of 10%-50% on

eyeglasses, non-prescription sunglasses and contact lenses (excluding disposables) at participating optical locations nationwide.

Ophthalmology & LASIK Save 20%-60% on medical eye exams and surgical procedures

including LASIK at participating ophthalmology locations.


Call MD

All members will receive 2 toll-free physician telephone consultations - available 24/7 You have access to a nationwide network of medical doctors

and registered nurses that are available to discuss your medical issues.

You can access over-the-phone prescriptions (where permitted by law)


Dental Directory Services Multi-tiered dental fee-for-service program

Tier 1 At select participating schedule (A) Tier 1 general practitioners

you will receive: a no-charge exam and x-rays in conjunction with a paid

annual cleaning Participating providers abide by a fee schedule of fixed

payments for most procedures savings are 20% to 60%

Tier 2 A schedule (A) Tier 1 provider is not available in a given area, a

secondary provider is given to member that still provides 20%-60% discounts but does not provide a free exam

Tier 3 In the event a Tier 1 or Tier 2 provider is not available in your

area, member will call customer service for assistance in accessing a Tier 3 provider which will provide them a discount


Tiered Chiropractic Program Save on testing procedures, support and orthotics supplement,

massage and other bodywork.

Tier 1: save 20%-50% at participating providers on adjustments, therapy, x-rays, exams and specialized procedures using a fee schedule of fixed payments for most procedures.

First visit is $35 with adjustments thereafter at $20.

Tier 2: Save 5%-20% at participating providers


24 Hour Counseling Hotline

• You and your immediate family members have unlimited access to a Master’s Level Therapist.

• Toll-free number available 24/7• Free support and self-help group referrals and referrals to

local licensed therapist

• All counselors have been specially trained to offer prompt, confidential counseling.


24 Hour Nurse Hotline

• Unlimited, Toll-Free, 24/7 Access to Registered Nurses.

• Confidential service is available to help you become more knowledgeable about healthcare services and more comfortable working in partnership with your healthcare providers

• You will receive information regarding, the treatment of common illnesses, what to expect during medical testing, diagnostic and surgical procedures, recently diagnosed medical condition, prescriptions, and over-the-counter medical information.


Holistic Care

• The Holistic Care Service provides a concierge approach to finding a Holistic Care provider that will meet your specific needs.

• A Customer Care Consultant will take your request for an Acupuncturist, Massage Therapist, Dieticians and Naturopathic providers and call you back with the nearest location.

• Up to 20% savings on, all treatments and services. There is no limits on number of visits.


Hearing Care• Beltone Features

• Free hearing screening and 15% discount on Beltone hearing aides at more than 1,300 Beltone locations.

• Lifetime care program includes complimentary hearing aid checkup, free cleaning and inspection while under warranty and a 30 day refund policy.

• HearPO Features

• 20%-50% off audiology and hearing aid services at more than 1,400 participating HearPO providers.

• Comprehensive follow up for one year at no charge. 100% discount on repairs and a 60 day refund policy

• Your hearing aid comes with a 12 month standard manufacturer’s warranty. Modifications will be made without cost during warranty should a change within hearing levels require different circuitry.


Elder Care

• Save on home health and long term care services, available for any member for your family including grandparents!

• Save 10%-25% on home health aides, nursing homes, assisted living facilities, Alzheimer’s special care units and respite care facilities. (savings are available for new patients only)

• Toll free 24/7 advice hotline


Diabetic Supplies

• Save 10%-60% on Diabetic supplies

• This program provides special member pricing on most diabetic supplies such as• Test strips, glucose meters, lancing devices and

lancets and convenient free home delivery!


FitnessEnjoy 10%-50% off membership dues at over 1,000

locations nationwide!

Month to month memberships at top area fitness centers . ($10 administrative fee may apply upon cancellation)

This program includes many franchises of Gold’s Gym, Bally’s Fitness, Curves for Women and other chains as well as independent fitness clubs.


Association Consumer Discount Consumer discount programs vary by plan but include:

Medical records software Hotel savings Rental car savings Mortgage and Realtor discounts Financial planning Tax hotline Roadside assistance And many more

Effective Dates and Billing Dates

If a member enrolls between the 1st and the 15th they will be effective on the 1st of the following month. Initial charge occurs on the day of enrollment and recurring charges occur on the 15th of every month there after.

If a member enrolls between the 15th and the last day of the month they will be effective the 15th of the following month. Initial charge occurs on the day they enroll and recurring charges occur on the 1st of every month there after.

Future effective date options are available up to 60 days.

Payments can be made using Credit Card or by drafting a checking/savings account – NO individual paper bills

Group list bill available for 10 or more employees


Enrollment – Customer Info. Screen


Enrollment – Membership Type


Enrollment – Plan Selection


Enrollment – Billing Screen


Enrollment – Confirmation Screen


Enrollment – By Insurance Agent


Fulfillment Materials The insured will receive an email fulfillment with ID card,

certificate, schedule and benefit booklet instantly after enrollment submission.

Fulfillment materials will be mailed direct to the insured within 24 hours after premium processing is verified.


Rules For Limited Medical Plan Sales

DO NOT Represent Limited Medical Plans as:

“Same as your employer plan”Just like “Major Medical”“Full Benefits”A “PPO”


Rules For Limited Medical Plan Sales

Clearly explain the limited nature of the plan:

This limited medical benefits plan:

Does Not Provide comprehensive medical coverage Is a basic or limited benefits policy and is not intended to

cover all medical expenses. Is not designed to cover the costs of serious or chronic

illness. Contains specific dollar limits that will be paid for medical

services which may not be exceeded. (if the cost of services exceeds those limits, the beneficiary and not the insurer is responsible for payment of the excess amounts)


Rules For Limited Medical Plan Sales Explain the key elements of:

Guarantee Issue Pre-existing condition limitation 30 day wait on sickness

Go through the plan of benefits in detail with the consumer, including their membership in the Association

Explain how the Beech Street Network discount works

Explain that the Rx card is a “discount” program

Explain the claims submission process, billing, and customer service

Explain the 30 day free look provision and how refunds work

All agents soliciting sales and enrolling consumers must hold a valid health insurance license in the state in which the consumer resides!

Agent Training Only61

Administrative Partner: Patriot Health, Inc.

Customer Care

Members are encouraged to speak directly with a Patriot Representative.

Dedicated consultants assist members with benefits, provider locater, and coordination services.

Members can contact Patriot’s toll free phone number Monday through Friday, 9:00 AM until 7:00 PM (EST). 877-693-9095


Commissions

Commissions are level on GetMED 360Checks are sent every Tuesday for all business with

approved payments through Monday. (new sales and renewals)

Statements are sent via email.


Cancellation & Refund Policy

A member may cancel at any time.

Cancellation will be required in writing If an insured calls Patriot to cancel, they will be sent a form to

sign. Once the form is received, agent will be notified and copied. If agent can conserve the case, and the consumer verifies in writing they wish to keep the policy, Patriot will reinstate the policy back to the original effective date, and premiums will be collected accordingly.

If a member cancels within the first 30 days, the membership cost will be refunded. The one time enrollment fee is non-refundable, except where specified by state law. Those states are; AK,MD,NE,FL,SC, SD ,VT

If a member cancels within 3 days from the enrollment date, the member will be refunded the first month’s membership costs plus the one time enrollment fee.


Policy Changes

The insured or the agent can call or email Patriot to make changes for:

Dependent statusPlan changesPayment changesAddress changes


Claim Processing

Claims are processed by Administrative Concepts, Inc. (ACI) located in Wayne, PA (Toll Free 888-293-9229)

ACI is an industry leader in providing superior services for specialty insurance products and a valuable resource to insurance companies and brokers

Re-pricing for PPO discounts

Claim payment

Explanation of Benefits sent Providers Patients

www.visit-aci.com


Web Site Featureswww.getmed360.com

Plan and Benefit Availability by State with RatesBrochure and Sample CertificatesTraining Power PointFAQ’sAssociation Provider and Beech Street LinksEnroll On Line for your CustomerAgent Back Office

Track and manage business 24/7 access to client’s policy information


Agent Back Office


FAQ’s


Thank You and Welcome to GetMED 360


Www.getmed360.com Agent Training Only1. Agenda Overview Administrative Partners Carrier Partners...

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