having access pays ® assurant health access sm for agent use only not for use in az

Having Access Pays®

Assurant Health AccessSM

For agent use only

Not for use in AZ

2 Assurant Health Access

Assurant Health Access features

• Excepted benefits – Event–based fixed-indemnity benefits – Same great commissions from pre-reform era – No deductible, copays or coinsurance– National network discounts– Affordable to buy AND affordable to use– Choice of three plan designs – The value your clients are looking for!


Choosing words carefullyWhat Assurant Health Access is and is notWhat it is:• Excepted-benefit, fixed-indemnity plan• Known benefit amount for each type of care• First-dollar (immediate) benefits*: no deductible, copays or

coinsuranceWhat it is not:• Medical expense coverage• Major medical• Covered charges• Reimbursement• Creditable coverage

*In cases of pre-existing conditions, the plan will pay benefits related to the condition after 12 months.

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Compare clients’ answers to this list to recommend best planAssurant Health Access customers

Individual major medical customers

More likely to have been uninsured due to insurance cost

More likely to be replacing group or other major medical plan

Looking for help with everyday, common medical expenses

Looking for major medical protection, coverage for bigger health care expenses

Value help paying for everyday expenses; willing to give up security of out-of-pocket maximum

Value a plan that protects assets and income through limited out-of-pocket exposure; willing to pay for everyday, smaller costs in return

Willing to pay premium but unwilling or unable to pay other front-end costs (deductible and coinsurance); willing to pay remainders after plan pays fixed benefits for specific medical events

Willing to pay more in premium and front-end cost sharing (deductible and coinsurance) in exchange for plan paying remainder


Why Having Access PaysSM

Access to affordable, quality health care

More for your money

Confidence

Benefits start right away — no deductible or copays

Access to network discounts

Dedicated customer service team

Cash to help clients pay for expenses

Retail health clinic discounts

Guaranteed cost information on certain common services with Assurant® Price Check Guarantee not available in GA

Access to health care with insurance plan ID card

Prescription discounts Help finding the right providers from Patient Care

Discounts on outpatient lab services

Help negotiating medical bills from expert negotiators at Health Payment Advocates


Having Access Pays agents too

• Agents earn more with Assurant Health Access – Pays the full commission you’re used to earning– Pays annualized advance up to $1,000 per policy —

same as major medical

• Addresses the changing market — will have huge appeal– Uninsured population steadily rising because of

increasing premiums– Brings new customers — more than 75% of buyers are

uninsured and looking for different value

Assurant Health Access prospective customers


Whom is Assurant Health Access right for? • Customers who don’t see value in a traditional

high deductible health plan — meeting that deductible might as well be catastrophic

• Place highest value on access to basic health care – They need to stay healthy to keep working– If something really bad happens, they’ll deal with it

• Haven’t had coverage recently or can’t afford traditional plans

• Dropping an individual or group major medical plan• When major medical is not an option


Who can buy Assurant Health Access?

• Individuals• Families

– Same affordable price for two or more children on plan

• Adults• Children (child-only plans available)

10 Assurant Health Access10 Assurant Health Access

Anita

Customers like Anita feel that it’s hard to pay for everything that comes up each month. They can’t afford an unexpected doctor visit. They need to stay healthy so they can work and earn the most possible.

You’ll recognize Anita because she’s likely to be:

• Age: Late 20s to 30s• Single mom with children who

also need coverage• Working as a waitress or in

several part-time jobs• Unsure exactly what her monthly

income will be; it varies

Benefits Anita is looking for:• Basic preventive care to keep her

working• Coverage for her children at an

affordable price• Help paying for inpatient or

outpatient care and ER if something happens

• Preventive dental care

Statements are illustrative.


Tanya

You’ll recognize Tanya because she’s likely to be:

• Single• Age 25-34• A high school graduate with no

college degree• Employed full time as a sales

assistant• Renting her apartment downtown• Shopping at Walmart

Customers like Tanya know their health is important. But they can’t afford to pay a high premium and a deductible. They want a plan that offers assurance that they can see the doctor when they need to and go in for an annual exam.


Benefits Tanya is looking for:• A plan she can use right away, not

one with a deductible she can’t afford

• A plan that saves her money• Additional coverage for inpatient

hospitalization• Dental coverage


Dennis

You’ll recognize Dennis because he’s likely to be:

• Recently married and in need of benefits for his wife

• Age 31-40• A graduate of his local commuter

college• At an income level of $75K• Employed full time• Using coupons and rebates on

day-to-day purchases

Customers like Dennis are worried about their employer’s rates going up, and they need a new option. They like to know how their benefits are working and how they can save the most money. They’re always looking for a deal.


Benefits Dennis is looking for:• A plan that will pay benefits for

his ongoing prescriptions• Good coverage for things he can’t

anticipate, just in case• Added peace of mind from

Accident or Critical Illness plan• Dental plan


ChuckCustomers like Chuck are getting older but are still in good shape. Premiums are too high for them. They wish to be covered, but they’d rather save money for retirement than spend it on premiums, especially when they’d still have to pay for most of what they need anyway.

You’ll recognize Chuck because he’s likely to be:

• In his late 50s or early 60s — too young for Medicare

• Showing a few minor health conditions

• Working as a truck driver or other contracted position

• Earning about $60K or more per year

Benefits Chuck is looking for:• A plan that will get him through

until Medicare• Help with costs of an unexpected

illness or accident• Premiums that cover only what he

needs so he can keep more money in his pocket

• Dental coverage


Assurant Health Access features and benefits


How Assurant Health Access plans work

• Patient Care – call for help with:– Finding a high-quality doctor in your network– Resolving billing and claims issues – Comparing quality and cost ratings for doctors and

facilities– Making the most of your health care plan

• Assurant Price Check– An accurate, guaranteed* online estimate for certain

common services, tailored to your plan and area – Know the cost of a service before you visit the doctor– For Assurant Health Access customers only – *Guarantee not available in GA. continued …


How Assurant Health Access plans work• Use your benefits

– Receive eligible services – Have us pay your providers directly– Receive negotiated network discounts even if plan limits

exceeded– Register at medco.com for tips on prescription savings

• Receive your cash payment (or have it paid to providers to take advantage of First Health Network discounts)

• Health Payment Advocates (HPA)– Use professional negotiators at HPA to reduce outstanding

bills or set up a payment plan


How it all works at the point of service

• Providers– No claim forms when client assigns benefits– Providers paid directly when client assigns benefits– Clients can find participating First Health Network

doctors at assuranthealth.com/FHN or by calling Patient Care

• Pharmacy– For all plans, client pays discounted rate at pharmacy– For Fundamentals and Enhanced

• Medco informs us of claim• Client receives benefit check 2-4 weeks later• Benefit can more than cover out-of-pocket expense


More for your moneyFirst Health Network • Save an average of 40% at more than

595,000 health professionals when you have us pay your providers

Retail health clinics • Save on office visits — as low as $65 per visit including labs (at Walgreens TakeCare clinics)

Medco® • Save an average of 30-40% on prescriptions

• Find lower cost alternatives

Outpatient lab services

• Save up to 60%

Discount card • Save on vision care, chiropractic care, alternative health and wellness, vitamins and more

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Discount card is an additional benefit; availability varies by state; card mailed separately.


Medco.com and My Rx Choices® prescription benefitsIn addition to discounts for all plans and cash

benefits for Fundamentals and Enhanced, all customers have access to Medco.com

• Online prescription management• Compare costs of prescribed drugs and suitable

substitutions• Check for drug interactions• Effortless auto refills on prescriptions• Extended payment plans for mail orders• Mobile app for convenience


Additional valuePatient Care Convenient access to independent advocates who

can compare prices of doctors and hospitals

Assurant Price Check Accurate, guaranteed1 online cost estimates for certain common services, tailored to the customer’s plan and area

Health Payment Advocates

Help negotiating payment plans or reductions on medical bills

Dedicated service team

Brings quick resolution to any questions or issues and suggests ways to save money

Benefits guide Helps new customers understand how to get the most from their plan

Welcome call Interactive call to welcome new customers, inform them about benefits and encourage them to learn how plan works

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1Guarantee not available in GA.


Patient Care advantages• Call Patient Care, your independent health

advocacy service, for personalized help navigating the health care system. Patient care can …– Answer questions about your benefits – Compare costs and quality ratings of doctors and hospitals– Schedule a doctor appointment for you – File your claims for you– Research and resolve claims issues– Help plan for non-emergency medical services, e.g.

• Colonoscopies• Hospital stays• MRIs• Knee surgery


Patient Care benefits to agents

You’ll call it Customer Care!• Offer another unique, customer-valued feature• Team of experts helps with customers’ post-sale

needs and questions, giving you more time to sell• No additional paperwork required—service is

automatically included• You spend more time selling • Customers can call 800.305.0377 Monday

through Friday, 7 a.m. to 9 p.m. CT


Assurant Price Check guaranteed pricingWith Assurant Price Check, your customers can visit AssurantPriceCheck.com at their own convenience and …

• Get accurate, guaranteed cost estimates for certain common services from network doctors

• Choose their doctor and know before their appointment what certain services will cost

• Get details that are specific to them, down to their plan and ZIP code• Gain valuable knowledge that will help them navigate the health care system with

confidence

Assurant Price Check is available only to Assurant Health Access customers!

Assurant® Price Check GuaranteeCustomers will not be responsible for any cost that exceeds the quoted price range, provided they receive services for the procedure code shown, from the doctor listed, and for which their First Health Network discounts apply. This price guarantee is good for services received up to 30 days after the date Assurant Price Check provides pricing.* Assurant Price Check is not insurance. It is a price estimate of what you would be charged after your network discount is applied. Assurant Price Check is not a guarantee of Assurant Health Access plan benefits. The program is subject to change.

*Guarantee is not available in Georgia.


Assurant Price Check example search


HPA capabilities

HPA expert negotiators work to:• Negotiate bills of about $300 and higher• Reduce amount owed by policyholder

• Establish payment plan to ease financial burden• Review final bill for accuracy of charges (including

verifying network discounts, questionable charges)

• Identify charitable or financial assistance programs


How Health Payment Advocates works

• No money or credit card information is exchanged between policyholder and HPA

• The policyholder drives the type of conversation between HPA and the provider

Assurant Health Access benefit levels

28 Assurant Health Access28 Assurant Health Access28


The Assurant Health Access portfolio

Value• For access to health care and Assurant Health

discounts, choose the affordability of Value.– Access to network and prescription discounts– Benefits for preventive care and unexpected illnesses

and injuries– Sickness and wellness benefits– Benefits for office visits

FundamentalsEnhanced


Benefit details - ValueEveryday Needs• Office Visits

– $50 per office visit– 2 visits maximum per calendar year

• Discounts on prescription drugs• Allergy Shots and Immunizations

– $10 per immunization and $10 per allergy shot

– $100 per calendar year maximum

Outpatient Medical Events• $1,000 per calendar year maximum• Laboratory Services

– $100 per surgical pathology test– $15 per other laboratory service

• Radiology Services– $130 per mammogram– $300 per CT scan– $450 per MRI scan– $250 per PET scan– $50 per other radiology service, including

x-ray and ultrasound• Physical Medicine Services

– $25 per occupational therapy, physical therapy and speech therapy visit

• $25 per other outpatient event not listed

Hospitalization and Surgical• Inpatient and Outpatient Surgery

– Includes surgical benefits for both inpatient and outpatient surgery. Benefit amounts paid are at least 100% of 2010 Medicare Physician Fee Schedule rates. See surgical schedule (Form 30353) for details.

• Anesthesia– $200 per anesthesia event– 1 event maximum per calendar year

• Ground and Air Ambulance– $100 per ground transportation– $1,000 per air transportation– 2 trips maximum per calendar year for all

ambulance transportation• Emergency Room or Urgent Care

– $150 per visit– 1 visit maximum per calendar year

• Inpatient Hospital Confinement– $1,000 per day for sickness– $2,000 per day for injury– $200,000 maximum per calendar year for

all inpatient confinements• Lifetime Maximum

– $1 million



ValueFundamentals• Fundamentals will help you pay for doctor visits,

prescriptions and hospital charges for both preventive care and sicknesses.

• It includes everything in Value plus:– Cash benefits for prescriptions– Benefits for two more office visits per year– Increased benefits for unexpected illnesses and injuries

Enhanced


Benefit details - Fundamentals

• Office Visits– 4 visits maximum per

calendar year

• Prescription Drugs – $10 per generic

prescription– $25 per brand prescription– $750 maximum per

calendar year for all prescriptions

• Anesthesia– 2 event maximum per

calendar year

• Emergency Room or Urgent Care– $250 per visit

• Inpatient Hospital Confinement– $2,000 per day for sickness– $4,000 per day for injury– $500,000 maximum per

calendar year for all inpatient confinements

• Lifetime Maximum – $2 million

Fundamentals includes all of the benefits of Value PLUS:



ValueFundamentalsEnhanced• For a higher level of insurance benefits but still no

deductible, choose Enhanced. • It includes everything in Fundamentals plus:

– Higher cash benefits for brand name prescriptions– Higher cash benefits for each office visit– Higher level benefits for unexpected illnesses and

injuries(surgery, hospital, ambulance, ER…)


Benefit details - Enhanced

• Office Visits– $75 per office visit– 4 visits maximum per calendar year

• Prescription Drugs – $35 per brand prescription

• Outpatient Medical Events– $3,000 per calendar year maximum

• Inpatient and Outpatient Surgery– Benefit amounts paid are at least

150% of 2010 Medicare Physician Fee Schedule rates. See surgical schedule (Form 30354) for details.

• Anesthesia– 3 event maximum per calendar

year

• Ground and Air Ambulance– $1,500 per air transportation

• Emergency Room or Urgent Care– $400 per ER visit and $100 per

Urgent Care visit– 1 visit maximum each per

calendar year• Inpatient Hospital Confinement

– $3,000 per day for sickness– $6,000 per day for injury– $1 million maximum per calendar

year for all inpatient confinements• Lifetime Maximum

– $3 million

Enhanced includes all of the benefits of Fundamentals PLUS:

Examples of how Assurant Health Access pays benefits


Sickness benefits to make clients healthyTake Care Clinic for strep throat

$65 Negotiated rate, including lab

$5 Generic amoxicillin $70 Total related charges

Medical costs:

Value Fundamentals Enhanced

Total related charges

$70 $70 $70

Fixed-benefit office visit

$50 $50 $75

Fixed-benefit generic Rx

- $10 $10

Total fixed benefit paid

$50 $60 $85

Customer pays (receives) balance

$20 $10 ($15)

Customer must assign benefits to provider to get network discount.Discount amounts based on Assurant Health claims data. Results may vary.


Broken arm (radius)

Value Fundamentals

Enhanced

Total related charges

$1,790

$1,790 $1,790

Total fixed benefit paid

$585 $785 $1077

Remaining balance

$1205 $1005 $713

HPA @ 20%* -$241 -$201 -$143

Customer pays $964 $804 $570

With an Accident Fixed

Benefit plan this customer would have

received $700 in additional cash benefits

*Discount amounts based on Assurant Health claims data. Results may vary.


Heart attack with valvotomyValue Fundamen

talsEnhance

d

Total charges $51,145 $51,145 $51,145

ER $150 $250 $400

Office visit $50 $50 $75

Inpatient hospital $4,000 $8,000 $12,000

Surgery $2,308 $2,308 $3,462

Anesthesia $200 $200 $200

Outpatient labs (20)

$300 $300 $300

Generic Rx (25) $0 $250 $250

Brand Rx (5) $0 $125 $175

Total fixed benefits paid

$7,008 $11,483 $16,862

Remaining balance

$44,137 $39,662 $34,283

HPA @ 20%* -$8,827 -$7,932 -$6,857

Customer pays $35,310 $31,730 $27,426

Medical costs:

Customer must assign benefits to provider to get network discount.*Discount amounts based on Assurant Health claims data. Results may vary.

$735 ER

$100 Office visit

$54,800 Inpatient hospital 4 days

$5,775 Surgery

$1,000 Anesthesia

$525 Outpatient lab tests (20)

$1,900 Generic Rx (25)

$925 Brand Rx (5)

$65,760 Total expenses

-$14,615

Network discount*

$51,145 After discount


Heart attack with valvotomy

Value Fundamentals

Enhanced

Total charges $51,145

$51,145 $51,145

Total fixed benefits paid

$7,008

$11,483 $16,862

Remaining balance

$44,137

$39,662 $34,283

HPA @ 20%* -$8,827

-$7,932 -$6,857

Customer pays $35,310

$31,730 $27,426

Customer must assign benefits to provider to get network discount.*Discount amounts based on Assurant Health claims data. Results may vary.Critical Illness rate based on $30k, 10 year term for 50-year-old male in FL.

$30K of Critical

Illness coverage would have

covered most out-of-pocket expenses for

just $63/month!

OR customer could work with HPA on a payment plan for the balance.


Neoplasm of frontal lobe

Value Fundamentals

Enhanced

Total charges $30,575

$30,575 $30,575

Total fixed benefits

$6,665

$9,755 $13,955

Remaining balance

$23,910

$20,820 $16,620

HPA @ 20%* -$4,782

-$4,164 -$3,324

Customer pays $19,128

$16,656 $13,296

With $25K of Critical Illness

coverage, this customer wouldn’t have out-of-pocket

expenses she can’t cover

*Discount amounts based on Assurant Health claims data. Results may vary.

Assurant Health Access affordable rates


Affordably priced within reach

Selling Assurant Health Access


Easy selling process• Only a few medical questions to answer• Instant decision in most cases• Simplified rating

– Not gender rated– Not area rated– No height or weight restrictions– Not rated for risk class– No smoker status– Very broad age bands– Based on age of primary applicant

• One-time, $25 processing fee • Simplified underwriting process improves placement• Effective date is either the 1st or 15th of the following

month• Payment by recurring monthly credit card available


Short application

Iowa application shown. Application and questions may vary by state.


Edelivery makes policy delivery easy

Your clients may choose electronic delivery of their policy information

• Clients receive materials more quickly• Clients receive access to policy materials online• Save paper to help the planet


Not yet available

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HIAssurant Health Access available

Wide availability


Create customized coverage for clients

• Assurant provides integrated solutions allowing you to add supplemental products to clients’ Assurant Health Access plans– Add accident and dental benefits with no additional

medical questions or underwriting– Add critical illness plan with short separate application

• Help your clients fill gaps in coverage with supplemental plans


Dental Term Life — Critical Illness

Accident Medical Expense

Accident FixedBenefit

Assurant Supplemental Coverage provides added value for clients


Sell on EASE: all 3 options + Supplemental


Assurant Health Access exclusions

Maintenance care and therapies:• Routine hearing care, artificial hearing devices, cochlear implants, auditory prostheses, routine vision

care, vision therapy, surgery to correct vision, routine foot care and foot orthotics• Routine dental care, unless you choose the dental insurance optionCosmetic services and procedures:• Services including chemical peels, plastic surgery and medications• Any correction of malocclusion (irregular tooth contact), protrusion, hypoplasia (abnormality in dental

enamel) or hyperplasia (abnormality) of the jawsReproductive-related procedures or concerns:• Diagnosis and treatment of infertility• Maternity, pregnancy (except complications of pregnancy), routine newborn care, surrogate

pregnancy, routine nursery care and abortion• Sterilization and contraceptive procedures, drugs or devicesQuality of life concerns:• Inpatient treatment of chronic pain disorders• Storage of umbilical cord stem cells or other blood components in the absence of sickness or injury• Genetic testing, counseling and services• Treatment, services and supplies related to sex transformation, gender dysphoric disorder and gender

reassignment; treatment of sexual dysfunction or inadequacy; or restoration or enhancement of sexual performance or desire

• Treatment for smoking cessation and hair loss• Cognitive enhancement• Prophylactic treatment, services and surgery


Assurant Health Access exclusions, cont.Prescription drug benefits do not include and will not provide benefits for:• Over-the-counter products• Drugs not approved by the FDA• Drugs obtained from sources outside the United States• Take-home drugs dispensed at an institutionThis plan also will not provide benefits for:• Any amount in excess of any maximum benefit or for non-covered events and associated complications• Durable medical equipment and personal medical equipment• Treatment undergone outside the United States• Treatment of behavioral health or substance abuse• Treatment, services, supplies, diagnosis, drugs, medication, surgery or medical regimen related to controlling weight,

obesity or morbid obesity• Treatment for snoring or sleep disorders• Experimental or investigational treatments; homeopathic treatments; alternative treatments, including acupuncture;

spinal and other adjustments, manipulations, subluxation and services; massage therapy• Telehealth and telemedicine (including but not limited to treatment rendered through the use of interactive audio,

video or other electronic media)• Illness or injury caused by war or while in the military; commission of a felony; or influence of an illegal substance• Illness or injury caused or aggravated by suicide, attempted suicide or self-infliction• Treatment or services due to injury from hazardous activities, such as extreme sports, whether or not for

compensation, including, but not limited to, hang-gliding, parachute or bungee jumping, rock or mountain climbing• Services ordered, directed or performed by a health care practitioner or medical provider who is an immediate family

member• Treatment used to improve memory or slow the normal process of aging• Home health care, hospice care, skilled nursing facility care, inpatient rehabilitation services, custodial care and

respite care• Sickness or injury arising out of or as the result of any work for wage or profit that is eligible for benefits under

Workers’ Compensation, employers’ liability or similar laws


Assurant Health Access exclusions, cont.Treatment for behavioral modification or behavioral (conduct) problems; learning disabilities;

developmental delays; attention deficit disorders; hyperactivity; educational testing, training or materials; memory improvement; cognitive enhancement or training; vocational or work-hardening programs and transitional living

• Growth hormone stimulation treatment to promote or delay growth• Treatment for TMJ and/or CMJ and certain jaw/tooth disorders• Services incurred due to a pre-existing condition for the first 12 months the plan is in forcePre-existing conditions (varies by state):A pre-existing condition is a sickness or injury and related complications for which any of the following

occurred during the 12-month period immediately prior to the effective date of your Assurant Health Access plan:

• You sought, received or were recommended to receive medical advice, consultation, diagnosis, care or treatment;

• You were prescribed prescription drugs;• You experienced signs or symptoms significant enough that either:— the signs or symptoms should have or would have allowed a health care provider to diagnose the

condition; or— the signs or symptoms reasonably should have or would have caused an ordinarily prudent person to

seek diagnosis or treatmentWe will not pay benefits for charges incurred due to a pre-existing condition or its complications until you

have been continuously insured under the plan for 12 months. After the 12-month period, benefits are paid for a pre-existing condition as long as the covered event occurs while the plan is in force.

Exclusion for Value only:• Charges for dispensation or fulfillment of prescription drugs

Thank you!

Assurant Health is the brand name for products underwritten and issued by Time Insurance Company, Milwaukee, WI.

J-78881 (Revised 1/2012)

Assurant Health Access plans have limitations and exclusions. A list is available at assuranthealth.com.

having access pays ® assurant health access sm for agent use only not for use in az

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