Optimum Health Saver - Affordable Healthcare Solution
Introducing Optimum Health Saver offering a comprehensive and cost-effective healthcare solution. With lower premiums and minimal out-of-pocket costs, this plan provides peace of mind to consumers. Available from Nov 1, it addresses key healthcare challenges and offers valuable benefits. Optimum Health Saver is the ideal choice for those seeking quality coverage at a fair price.
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Introducing Optimum Health Saver Sales Begin NOV. 1 PROPRIETARY & CONFIDENTIAL 10.30.2023
Marketing Availability 9 state approvals and counting! Available for sales Nov. 1 Approved NOTE: For states not allowing deductible plans, we will have an alternate product Optimum Health Choice (HCS concept) PROPRIETARY & CONFIDENTIAL 10.30.2023
An Optimumsolution to todays healthcare problems. Consumers want affordable premiums. 2022 average premium for family coverage was $22,463 per year Optimum provides a great price point. Consumers save 40% - 50% compared to ACA or major medical. Consumers want minimal out-of-pocket costs. Consumers are functionally uninsured 44% worry about affording their deductible before health insurance kicks in 33% of adults say they or a family member have skipped or delayed recommended care due to cost 50% of adults would be unable to pay for unexpected $500 medical bill in full Optimum pays set, first dollar outpatient benefits. Plan pays the very moment an insurable event occurs Eliminates financial pressure and hassle of copays, coinsurance and deductibles An indemnity plan alone is not enough; PAL s unique bundling concept provides peace-of-mind. Without Specified Disease or Individual Accident Expense (Catastrophic Accident), your client will have exposure to costly severe illnesses, diseases and accidents. Consumers want reasonable and comprehensive coverage. Optimum pays the same set benefits, regardless if care is received in-or-out-of-network. Option to take advantage of cash pay savings or network savings allows a choice to see a doctor that works for your healthcare needs and budget. Consumers enjoy freedom of choice. ACA and major medical plans often have restrictive networks limiting access to care. PAL provides the most healthcare saving tools at no extra cost to the member. Healthcare saving tools are the cornerstone to navigating the free market and help members find quality care at a fair price. Healthcare is confusing; consumers want guidance on finding affordable care at a fair price. https://www.kff.org/report-section/ehbs-2022-section-1-cost-of-health-insurance/ https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/ PROPRIETARY & CONFIDENTIAL 10.30.2023
The best value when it comes to health insurance! Why Optimum Health Saver? Helps your clients achieve the greatest desirable outcomes for the value! Benefits Comparable to Gold Improved inpatient benefits New fixed surgical schedule New therapy benefits Premiums Lower rates - extremely competitive compared to other industry plans Sweet spot is 55 years or younger PROPRIETARY & CONFIDENTIAL 10.30.2023
See it here first! PROPRIETARY & CONFIDENTIAL 10.30.2023
Choose a Benefit Level Value (One Unit) Plus Preferred (Three Units) (Two Units) $5,000 $2,500 $500 $1,000 Choose a Confinement Deductible The Confinement Deductible applies to each Insured witha maximumof three deductiblesper Calendar Year. The ConfinementDeductible only applies to certaininpatient confinement benefits as indicatedin the brochure. An Optimum Plan Design Choose a Calendar Year Maximum (CYM) $250,000 $500,000 $1,000,000 A CalendarYearistheperiodfromJanuary 1 toDecember31ofthesameyear. Lifetime Policy Maximum $5,000,000 Allplansincludea $5,000,000LifetimeMaximumper Policy. PROPRIETARY & CONFIDENTIAL 10.30.2023
Preferred Plan (Three Unit) Value Plan (One Unit) Plus Plan (Two Unit) Facility Fees Hospital Stays Inpatient confinement benefits are payable when confined for 24-hours or more. Facility Fees First Day Hospital Admission Benefit Includes up to 1 day per Calendar Year. $3,000 $2,000 $1,000 Hospital Confinement Benefit for Injury The Calendar Year Confinement Deductible applies. Days 1 - 3 Day 4 Days 5+ $10,500 $8,250 $6,000 $7,000 $5,500 $4,000 $3,500 $2,750 $2,000 Hospital Confinement Benefit for Sickness The Calendar Year Confinement Deductible applies. Days 1 - 3 Day 4 Days 5+ $9,000 $6,750 $4,500 $6,000 $4,500 $3,000 $3,000 $2,250 $1,500 Increased benefits for hospital stays IntensiveCare Unit (ICU)Confinement Benefitfor Injury or Sickness The Calendar Year Confinement Deductible applies. Includes up to 20 days for Three Unit Plans, up to 16 days for Two Unit Plans, and up to 12 days per One Unit Plan, per Calendar Year. Days 1 - 3 Day 4 Days 5+ $10,500 $8,250 $6,000 $7,000 $5,500 $4,000 $3,500 $2,750 $2,000 Observation Stay Confinement Benefit for Injury The Calendar Year Confinement Deductible applies. Days 1 - 3 Day 4 Days 5+ $10,500 $8,250 $6,000 $7,000 $5,500 $4,000 $3,500 $2,750 $2,000 Avg. hospital stay is 3.5 days* Observation Stay Confinement Benefit for Sickness The Calendar Year Confinement Deductible applies. Days 1 - 3 Day 4 Days 5+ $9,000 $6,750 $4,500 $6,000 $4,500 $3,000 $3,000 $2,250 $1,500 Hospital Confinement Benefit for Mental Illness $600 $400 $200 Rehabilitation and Skilled Nursing Stays Inpatient confinement benefits are payable when confined for 24-hours or more. Rehabilitation or Skilled Nursery Facility Confinement Benefit Doesnotincludementalillness;mentalillnessiscoveredundera separatebenefit. $2,250 $1,500 $750 Cancer Care Outpatient Radiation Therapy, Chemotherapy and Immunotherapy Benefit Includes up to $40,000 in benefits payable per Calendar Year. $2,250 $1,500 $750 *Based on PAL claims data for hospital indemnity plans Benefit availability, exclusions and limitations may vary by state. Please refer to the policy in your state for more information. PROPRIETARY & CONFIDENTIAL 10.30.2023
National average Nonprofit hospitals: $3,013 For-profit hospitals: $2,296 State/local government hospitals: $2,742 Average: $2,684 Hospital Stay Averages Three Day Stay for Sickness Example National Avg. Hospital Stay per Day Deductible One Unit Plan Two Unit Plan Three Unit Plan $5,000 $8,052 $5,000 $15,000 $25,000 $2,500 8,052 $7,500 $17,500 $27,500 (Day 1 3 Benefit X Days Deductible) + Admission Benefit https://www.beckershospitalreview.com/finance/hospital-expenses-per-inpatient-day-across-50-states-2023.html PROPRIETARY & CONFIDENTIAL 10.30.2023
Preferred Plan (Three Unit) Value Plan (One Unit) Plus Plan (Two Unit) Facility Fees Hospital Stays Inpatient confinement benefits are payable when confined for 24-hours or more. Facility Fees First Day Hospital Admission Benefit Includes up to 1 day per Calendar Year. $3,000 $2,000 $1,000 Hospital Confinement Benefit for Injury The Calendar Year Confinement Deductible applies. Days 1 - 3 Day 4 Days 5+ $10,500 $8,250 $6,000 $7,000 $5,500 $4,000 $3,500 $2,750 $2,000 Hospital Confinement Benefit for Sickness The Calendar Year Confinement Deductible applies. Days 1 - 3 Day 4 Days 5+ $9,000 $6,750 $4,500 $6,000 $4,500 $3,000 $3,000 $2,250 $1,500 Increased benefits for hospital stays IntensiveCare Unit (ICU)Confinement Benefitfor Injury or Sickness The Calendar Year Confinement Deductible applies. Includes up to 20 days for Three Unit Plans, up to 16 days for Two Unit Plans, and up to 12 days per One Unit Plan, per Calendar Year. Days 1 - 3 Day 4 Days 5+ $10,500 $8,250 $6,000 $7,000 $5,500 $4,000 $3,500 $2,750 $2,000 Observation Stay Confinement Benefit for Injury The Calendar Year Confinement Deductible applies. Days 1 - 3 Day 4 Days 5+ $10,500 $8,250 $6,000 $7,000 $5,500 $4,000 $3,500 $2,750 $2,000 Avg. hospital stay is 3.5 days* Observation Stay Confinement Benefit for Sickness The Calendar Year Confinement Deductible applies. Days 1 - 3 Day 4 Days 5+ $9,000 $6,750 $4,500 $6,000 $4,500 $3,000 $3,000 $2,250 $1,500 Hospital Confinement Benefit for Mental Illness $600 $400 $200 Rehabilitation and Skilled Nursing Stays Inpatient confinement benefits are payable when confined for 24-hours or more. Rehabilitation or Skilled Nursery Facility Confinement Benefit Doesnotincludementalillness;mentalillnessiscoveredundera separatebenefit. $2,250 $1,500 $750 Cancer Care Outpatient Radiation Therapy, Chemotherapy and Immunotherapy Benefit Includes up to $40,000 in benefits payable per Calendar Year. $2,250 $1,500 $750 *Based on PAL claims data for hospital indemnity plans Benefit availability, exclusions and limitations may vary by state. Please refer to the policy in your state for more information. PROPRIETARY & CONFIDENTIAL 10.30.2023
Preferred Plan (Three Unit) Value Plan (One Unit) Plus Plan (Two Unit) Facility Fees Facility Fees & Professional Services Surgical Benefits Additional surgical benefits can be found under Professional Services. Surgery Benefit When Performed Under Anesthesia A Calendar Year Maximum for Surgical Benefits applies.3 $4,500 $3,000 $1,500 Surgery Benefit When Performed Not Requiring Anesthesia A Calendar Year Maximum for Surgical Benefits applies.3 $2,250 $1,500 $750 Preferred Plan (Three Unit) Value Plan (One Unit) Plus Plan (Two Unit) Professional Services Benefits Inpatient Visits 8.5% of policyholders undergo outpatient surgery each year* Inpatient Healthcare Practitioner Benefit (Non-Surgical) Includes up to 20 days for Three Unit Plans, up to 16 days for Two Unit Plans, and up to 12 days per One Unit Plan, per Calendar Year. Days 1 - 10 $160 Days 11+ $80 Days 1 - 8 $120 Days 9+ $60 Days 1 - 6 $80 Days 7+ $40 Inpatient Pathologist or Radiologist Benefit $240 $160 $80 1.5% of policyholders undergo inpatient surgery each year* Surgical Benefits Additional surgical benefits can be found under Facility Fees. 3 X Surgical Schedule4 2 X Surgical Schedule4 1 X Surgical Schedule4 Surgery BenefitWhen Performed in a Hospital or AmbulatorySurgical Center A Calendar Year Maximum for Surgical Benefits applies.3 3 X Surgical Schedule4 2 X Surgical Schedule4 1 X Surgical Schedule4 Assistant Surgeon Benefit A Calendar Year Maximum for Surgical Benefits applies.3 New surgical schedule to comply with HHS regulations 3 X Surgical Schedule4 2 X Surgical Schedule4 1 X Surgical Schedule4 Anesthesia Benefit A Calendar Year Maximum for Surgical Benefits applies.3 *Based on PAL claims data for hospital indemnity plans Benefit availability, exclusions and limitations may vary by state. Please refer to the policy in your state for more information. 2There is a maximum of combined limit for the Urgent Care and Emergency Department Benefits; includes up to 4 days per Calendar Year. 3The Calendar Year Maximum for Surgical Benefits is $50,000. 4The Surgical Schedule can be found in the Policy. PROPRIETARY & CONFIDENTIAL 10.30.2023
Outpatient Services Preferred Plan (Three Unit) Value Plan (One Unit) Plus Plan (Two Unit) Outpatient Services Benefits Benefitsare payable for services performedon an outpatient basis only. Aggregate Calendar Year Maximum $6,000 $4,000 $2,000 Doctor Visits Physician Benefit Includes up to 20 days for Three Unit Plans, up to 16 days for Two Unit Plans, and up to 12 days per One Unit Plan, per Calendar Year.1 Days 1 - 10 $160 Days 11+ $80 Days 1 - 8 $120 Days 9+ $60 Days 1 - 6 $80 Days 7+ $40 <.005% of policyholders reach their outpatient calendar year max per year* Chiropractor Benefit Includes up to 6 days for Three Unit Plans, up to 5 days for Two Unit Plans, and up to 4 days per One Unit Plan, per Calendar Year.1 $160 $120 $80 Therapy Services Therapy Benefit Including but not limited to physical, speech and occupational therapy. Includes up to 20 days for Three Unit Plans, up to 16 days for Two Unit Plans, and up to 12 days per One Unit Plan, per Calendar Year. $80 $60 $40 6% of policyholders utilize more than 6 doctor visits per year* Medical Imaging and Testing Radiology Benefit for MRI, PET, CAT Scan and Nuclear Testing $720 $480 $240 New benefit due to the popularity of therapy services Radiology Benefit for X-Ray and Other Diagnostic Testing Includes up to 4 days per Calendar Year. $240 $160 $80 Other Medical Services Surgery Benefit When Performed in a Physicians or Specialists Office Includes up to 2 days per Calendar Year. $300 $200 $100 Lab Work Benefit Includes up to 4 days per Calendar Year. $120 $80 $40 Injection Benefit Includesbutisnotlimitedtoshotsandimmunizations foradultsandchildren. $30 $20 $10 *Based on PAL claims data for hospital indemnity plans Benefit availability, exclusions and limitations may vary by state. Please refer to the policy in your state for more information. 1There is a maximum of combined limit for the Physician and Chiropractor Benefits; includes up to 20 days for Three Unit Plans, up to 16 days for Two Unit Plans, and up to 12 days per One Unit Plan, per Calendar Year. PROPRIETARY & CONFIDENTIAL 10.27.2023
Preferred Plan (Three Unit) Value Plan (One Unit) Plus Plan (Two Unit) Outpatient Services Benefits Continued Benefitsare payable for services performed on an outpatient basis only. Aggregate Calendar Year Maximum $6,000 $4,000 $2,000 Preventive Care Preventive Care coverage begins 60 days after Insured s Effective Date of Coverage. Mammogram Benefit Includes up to one day per Calendar Year. $250 $250 $250 Colonoscopy Benefit Without Finding Any Polyps Includes up to 1 day every 3 Calendar Years. If polyps are found, colonoscopies are paid under eligible outpatient surgery benefits. Policy Years 1 - 3 Policy Years 4+ $600 $750 $600 $750 $600 $750 Outpatient Services Preventive Care Services Benefits Includes up to 1 day each Calendar Year. $125 $125 $125 Prescription Services Brand Name Prescription Benefit Paid per prescription filled. $30 $20 $10 Generic Prescription Benefit Paid per prescription filled. $15 $10 $5 Urgent and Emergency Care Urgent Care Benefit Includes up to 4 days per Calendar Year.2 $250 $200 $150 Emergency Room or Department Benefit Includes up to 2 of each benefit, Facility Fee and Professional Services, per Calendar Year.2 Total Payable Facility Fee Professional Services $350 $200 $150 $200 $100 $100 $100 $50 $50 Ambulance Benefit for Transportation by Air Includes up to 1 day per Calendar Year. $1,000 $1,000 $1,000 Ambulance Benefit for Transportation by Ground Includes up to 2 days per Calendar Year. $500 $500 $500 Benefit availability, exclusions and limitations may vary by state. Please refer to the policy in your state for more information. 2There is a maximum of combined limit for the Urgent Care and Emergency Department Benefits; includes up to 4 days per Calendar Year. 3The Calendar Year Maximum for Surgical Benefits is $50,000. 4The Surgical Schedule can be found in the Policy. PROPRIETARY & CONFIDENTIAL 10.30.2023
Optional Critical Illness Rider Covered Conditions Stroke Coronary Artery Bypass Surgery Angioplasty Cancer (Internal Cancer) Non-Invasive Carcinoma In Situ Heart Attack Pacemaker Implant End Stage Renal Failure Major Organ Transplant Choose up to $50,000 in Critical Illness coverage Our Critical Illness Rider can help cover extra costs that may come with a serious illness. It provides a lump-sum benefit upon diagnosis of a covered condition. The benefit can be used any way you wish, including paying for medical bills, or paying for non medical expenses such as travel costs, child care, groceries, mortgage, etc. Benefits for certain Covered Conditions may be reduced. Waiting periods, pre- existing conditions and other restrictions may apply. PROPRIETARY & CONFIDENTIAL 10.27.2023
Example One: Hospital Stay Scenario Jill has a Preferred (Three Unit) Plan with a $2,500 Hospital Confinement Deductible. She suddenly becomes ill and is confined to an in-network hospital for seven days. Optimum Health Saver Pays First Day Admission Benefit* $3,000 Hospital Stay Days 1 - 3 Benefit at $9,000 $27,000 Hospital Stay Day 4 Benefit at $6,750 $6,750 This plan pays set benefits for hospital stays. The confinement deductible is reduced from the total confinement benefits payable. Hospital Stay Days 5 - 7 Benefit at $4,500 $13,500 Confinement Deductible ($2,500) $47,750 Remember: National avg. hospital stay per day is $2,684! PROPRIETARY & CONFIDENTIAL 10.27.2023
Example Two: Office Visit With Lab Work Scenario Mike has a Plus (Two Unit) Plan. He visits his primary care doctor and completes lab work. Optimum Health Saver Pays Physician Visit Benefit $120 Laboratory Benefit $120 This plan pays set benefits for lab work and doctor visits no deductibles or copays to meet first! $240 PROPRIETARY & CONFIDENTIAL 10.27.2023
Example Three: Broken Arm Optimum Health Saver Pays Scenario Beth has a Preferred (Three Unit) Plan. She has an accident and breaks her arm. Emergency Room Facility Benefit $200 Emergency Room Professional Services Benefit $150 X-Ray $240 This plan pays set benefits for emergency care. Follow-Up Office Visits (4) at $160 $640 Follow-Up X-Ray $240 $1,470 PROPRIETARY & CONFIDENTIAL 10.27.2023
HealthcareSaving Tools We offer more than just insurance benefits. As your PAL in healthcare, we provide important tools and resources to help you find quality care at a fair price. Healthcare PALs Your PAL when it comes to healthcare! To get the most out of your benefits - and avoid surprise medical bills - call a Healthcare PAL before receiving care. Our experienced team of claims professionals, nurses and care coordinators will help guide you to quality care at a fair price. New Era Telehealth Talk to a doctor, 24/7/365, for $0 with Virtual Urgent Care! This plan provides unlimited Virtual Urgent Care visits with board certified doctors at no cost to you! Talk to a doctor, get a diagnosis, and even a prescription when needed, all within minutes. Additional telehealth services availableat a special memberrate include Virtual Dermatology Care, Virtual Counseling and Psychiatric Medical Care. No other carrier offers this many free services First Health Network An additional opportunity to save! This plan provides access to the First Health Limited Benefit Plan (LBP) Network for discounts on healthcareservices such as doctor visits, hospital stays, labs and more! To search for providers within thisnetwork,visit www.firsthealthlbp.com. Coral Bundled Care Saver Save thousands on surgeries and other medical services with Coral s bundled pricing! Coral removes the middleman in healthcareby providing direct access to specialists and surgeons at top ranking facilities nationwide. All services are bundled into a single bill eliminating surprises and maximizing savings! Fair Pricing Tool Stop overpaying for healthcare services! The cost of healthcareservices varies significantly between providers. Our Fair Pricing Tool can help you determine the Fair Price in your area. That way, you ll know if you are overpaying for services received. Point Health Tech Advocates who work to reduce medical bills! This plan includes an additional layer of concierge-style care, Point Health Tech. This service can help you find care, schedule your appointments and help lower your out-of-pocket portion of medical bills to something more manageable. The Benefit PAL Mobile App Your PAL when it comes to managing healthcare on the go! Access ID cards, benefit information, claims history and more all in one convenient location. PROPRIETARY & CONFIDENTIAL 10.27.2023
Welcome Letter for Optimum Health Saver PROPRIETARY & CONFIDENTIAL 10.30.2023
Sample Premiums Three Unit; $1,000,000 CYM Optimum Health Saver Gold Competitor Age 40 $273.48 Age 40 $239.30 Age 40 $259.43 Age 40 + Child $416.31 Age 40 + Child $366.24 Age 40 + Child $460.97 Female; TX; Non-Smoker PROPRIETARY & CONFIDENTIAL 10.27.2023
Sample Premiums 40 years; male NTU; TX; $250,000 CYM; $5,000 deductible Three Unit Two Unit One Unit $195.11 $130.07 $65.04 PROPRIETARY & CONFIDENTIAL 10.30.2023
Q&A trainingu65@neweralife.com PROPRIETARY & CONFIDENTIAL 10.30.2023
