1 Supplemental Insurance ProtectionPPO Dental Gen Approval Date: 06/18/2014 Code : Supplemental Insurance Protection PPO Dental Policy Form CH IP (01/12), or its state variation See Separate Presentation for State Specific Variations ©2014 SureBridge® Product Training Materials | Proprietary and Confidential. For more plan details, refer to the product materials. The benefits described in this presentation are subject to all provisions, terms, definitions, and limitations and exclusions of the applicable policy. Supplemental plans serve a specific purpose in the insurance market. These plans are not intended as substitutes for accident and sickness health insurance and should not be construed as such.
2 Supplemental Products AvailabilitySureBridge has the largest portfolio of supplemental products including critical illness, cancer, accident, disability, dental and vision policies. We also have the broadest marketing footprint. AK WA ID MT ME OR ND MN NH WI NY VT MI WY SD CA MA RI NV CT UT NE IA PA IL OH IN NJ CO WV DE MO VA KS MD KY HI DC AZ NC NM OK TN TX AR SC GA MS AL All products available Subset of products available No products available LA FL
3 Supplemental Products Superior Client/Broker ExperienceQuoting Compare packages with different combinations of supplemental products Present total price for solution Commissions First month’s premium is taken at time of application This results in faster commission payments Book of Business report available on the SureBridge Broker Portal Application Single e-app for any combination of supplemental products Flexibility to select different products and/or benefit options for each family member on app Smart app – only the questions for the products selected are asked Simplicity – all questions are yes/no Outlines of coverage provided Claims Claim form provided with complete instructions for submission Claim forms are received, analyzed and adjudicated within a 7 day turn-around time
4 Supplemental Products Sales PitchChanges in the market present opportunities to sell supplemental plans Essential Health Benefits Plans can have out of pocket expenses as high as $6,350 for individuals or $12,700 for families. This leaves large gaps in coverage which can be filled with supplemental plans. Advanced premium tax credits for EHB plans are available for individuals or families making up to 400% of the federal poverty level. Tax credits can be used to purchase extra coverage and fill the gaps left by high deductibles and coinsurance on EHB plans. Number of family members Poverty Guideline for family income (as of 2013) Can still qualify for a subsidy under the ACA with an income up to 1 $11,490 X 400% $45,960 2 $15,510 $62,040 3 $19,530 $78,120 4 $23,550 $94,200 5 $27,570 $110,280 Tax credits can be seen as a way to pay for Supplemental Plans and reduce coverage gaps. Need a subsidy calculator? Try
5 Coverage Gap PPO Dental Sales PitchThe PPO Dental plan is a good companion to health and vision insurance. In addition, try SureBridge supplemental insurance to help fill in gaps caused by high out of pocket expenses and lost wages. For example, Accident Direct is as inexpensive as $1 a month. On the right, health insurance is supplemented by the following: PPO Dental Vision* Accident Direct* for lump sum accident coverage Coverage Gap Health Coverage PPO Dental Vision Accident Direct *See the appropriate training documents for more details on these other products.
6 PPO Dental Navigation? PPO Dental is located under the Dental/Vision tab of the SureBridge Point of Sale Tool.
7 PPO Dental Marketing and Plan InformationSenior Market Maximum Issue Age: 65-99 Spouse/Domestic Partner Issue Age: 16-99 Application:CH APP (10/13) Non-Senior Market Maximum Issue Age: 0-64 Dependent Issue Age: 0-64 Application: CH APP (10/13) Additional Plan Information Both plans provide benefits for covered expenses through Network Providers and Non-Network Providers Benefits are payable up to the maximum per calendar year, per insured or per family, based on the plan selected Charges exceeding maximums are the insured’s responsibility
8 PPO Dental Marketing Guidelines for the Senior MarketImportant Information Medicare Advantage plans may contain benefit provisions that could potentially duplicate the PPO Dental policy benefits. If you are offering the PPO Dental policy in the senior market, you must determine if the potential applicant has existing dental coverage (refer to the application question regarding other coverage). Do not offer a PPO Dental policy to a customer who has an existing Medicare Advantage plan with dental benefits or other existing dental coverage
9 PPO Dental Benefit SchedulePremiere Basic Calendar Year Deductible $50 per person Limited to 3 per family $100 per person Calendar Year Benefit Maximum $1,200 per insured $6,000 per family $1,000 per insured $5,000 per family Orthodontics Not Included Note: If an insured person opts to receive dental services or procedures that are not covered expenses under the policy, a network provider dentist may charge his or her usual and customary rate for such services or procedures. Prior to providing an insured person dental services or procedures that are not covered expenses, the dentist should provide a treatment plan that includes each anticipated service or procedure to be provided and the estimated cost or each service or procedure.
10 PPO Dental Benefit SchedulePremiere Basic Type I Covered Expenses Preventative Prophylaxis, once every 6 months Topical fluoride, once every 12 months, up to age 16 Sealants, once every 36 months, up to age 16 Diagnostic Oral evaluations, once every 6 months Bitewing x-rays, once every 12 months Vertical bitewings, once every 36 months Diagnostic casts Waiting Period: 0 months Coinsurance Network: 100% Coinsurance Non-Network: 80% Same
11 PPO Dental Benefit SchedulePremiere Basic Type II Covered Expenses Preventive: Space maintainers, up to age 6 Diagnostic: Intraoral films, extraoral films, and panoramic film, once every 36 months Restorative: Amalgam, primary or permanent and resin-based composite Adjunctive Services Includes services such as: Palliative (emergency) treatment of pain Fixed partial denture sectioning Local anesthesia Analgesia, up to age 13 Inhalation of nitrous oxide Occlusion analysis and occlusion adjustment Waiting Period: 6 months Coinsurance Network: 80% Coinsurance Non-Network: 60% Coinsurance Network: 50% Coinsurance Non-Network: 50%
12 PPO Dental Benefit SchedulePremiere Basic Type III Covered Expenses Restorative Includes services such as: Inlays and onlays (and recementing, once every 12 months) Crowns; cast posts and core buildups Pin retention in addition to restoration, up to 2 procedures every 12 months Sedative fillings Endodontics Includes services such as: Pulp caps; therapeutic pulpotomy; pulpal therapy Root canal or endodontic therapy Periodontics Includes services such as: Gingivectomy/gingivoplasty, once every 36 months Gingival flap procedure and osseous surgery, each limited to once every 36 months Soft tissue graft procedures Periodontal scaling and root planning, limited to 4 separate quadrants every 2 years Full-mouth debridement to enable evaluation and diagnosis, once every 36 months Prosthodontics Includes services such as: Complete and partial dentures (once every 5 years for complete dentures to replace missing / broken teeth) Adjustment and repair of dentures Waiting Period: 12 months Coinsurance Network: 60% Coinsurance Non-Network: 50% Not Included
13 PPO Dental Benefit ScheduleDaily Benefits Premiere Basic Type III Covered Expenses, Continued Oral Surgery Includes services such as: Extraction of erupted tooth; removal of impacted tooth Tooth transplantation Alveoloplasty Removal of cyst/tumor Incision and drainage of abscess Waiting Period: 12 months Coinsurance Network: 60% Coinsurance Non-Network: 50% Not Included Tooth Missing But Not Replaced Coverage for the first installation of removable dentures, fixed bridgework and other Type III Prosthetic or Prosthodontic services are subject to the following requirements: Such services are needed to replace one or more natural teeth that were removed while this Policy was in force for the Insured Person; and Such services are not abutments to a partial denture, removable bridge, or fixed bridge installed during the prior 8 years. Included
14 PPO Dental RenewabilityThe policy is guaranteed renewable, subject to the Company’s right to discontinue or terminate the coverage as provided in the TERMINATION OF COVERAGE section of the policy.
15 PPO Dental PPO Dental FAQsNew Business and Underwriting Cannot be sold with any other Dental Plan offered by MEGA, Midwest or CLICO. May be sold with a Non-Senior Dental for a different applicant. No application questions apply to this product. Claim Payment Is there a waiting period? This policy does have a waiting period for any services beyond basic Type I preventative and diagnostic services. Make sure your client understands that any work beyond that must occur between 6 and 12 months later after purchase, depending on the service (see benefit schedule) How do I find a doctor? Insureds can go anywhere, but will maximize benefits by using Careington’s Maximum Care Network providers. This includes access to the Maximum Care Network providers for covered and non-covered services. Participating providers can be found by going to or by calling
16 PPO Dental Underwriting Quick ReferenceImportant Information No underwriting questions apply to this product. See the PPO Dental section of the Chesapeake Underwriting and Product Guide for more information.
17 PPO Dental Pricing ExamplesRates can change. These rates come from the generic brochure dated August 2013: CH DEN PPO 114. The chart below is only an illustration of benefit and premium options per covered person for plans. Premiums may vary by state. Monthly Premiums Basic Premiere Adult $19.00 $39.00 Child $16.00 $28.00 Senior $21.00 $43.00 Sample
18 PPO Dental This presentation is not inclusive of all policy provisions. See product materials for complete details and any additional state variations regarding Termination of Coverage, Renewability, Premium Changes, Eligible Dependents, Exclusions and policy Definitions. SureBridge® is a registered trademark used for both insurance and non-insurance products offered by subsidiaries of HealthMarkets, Inc. Supplemental insurance products are underwritten and administered by The Chesapeake Life Insurance Company®. Administrative offices are located in North Richland Hills, TX. The insurance product referenced in this document is underwritten by The Chesapeake Life Insurance Company. SureBridge products are individual supplemental products and are not available as group coverage. There is no list bill and premiums may not be paid by employers for employees. This material cannot be copied or used in any way for advertising or presentation purposes. THIS POLICY PROVIDES LIMITED BENEFITS. This type of plan is not considered “minimum essential coverage” under the Affordable Care Act and therefore a Dental Insurance Preferred Provider Organization (PPO) Insurance Policy does not satisfy the individual mandate that you have health insurance coverage. This is not Medicare Supplement Insurance Benefits may vary by state. See state variations and product materials for more detail.
19 PPO Dental Thank You For Everything You Do!Dental Insurance Preferred Provider Organization (PPO) Insurance Policy