Limited/ Supplemental Plans (Sample)

Mini-Medical, Limited, & Supplemental Medical Plans

Many employers are implementing Mini-Medical/Limited Medical/Supplemental Benefit Plans that have 2 or 3 levels of plan coverage offered:

• Basic
• Standard
• Preferred Plans

They are also offering optional benefits to provide their employees alternatives and "selection" opportunities based upon the employees need to meet their family specific needs. Many of the options offered are dependent upon the number of total eligible employees to be offered the plans.

Niche Benefits is presenting - AS EXAMPLES ONLY – an offering that was made available, through a large brokerage, to a multi-state employer in 2003 and 2004. (This employer had recently experienced a 42% rate increase and knew its employees could not afford the benefit program that it had in place and decided to replace their current coverage.) They chose to offer the Mini-Medical/Limited Medical/Supplemental Benefit Plan designed by Niche Benefits. They understood that these plans should not be used to replace comprehensive health coverages wherever possible. However they considered the serious issue of no benefit coverage for their employees or to provide coverage they could afford.

KEY POINTS when reviewing the examples below - any of the benefit levels can be increased or decreased or additional ones added based upon the level of income of the targeted workforce in respect to premium offered and affordability by the employee:

1. With and Without Employer contribution
• Premium is reduced by 10%-20% with employer contribution
2. Participation requirements - 5 or more employees
3. No Pre-Existing Condition Exclusions
4. No Networks
5. No Deductibles
6. No Co-Payments
7. COBRA Administration Included
8. Effective dates – weekly, bi-weekly or monthly
9. Enrollment – Internet, Call Center or paper
10. Billing – electronic, Internet or paper
    

Please remember when reviewing the information below - the benefit designs can be changed as determined by the Broker/Client.

Examples

THE EMPLOYEE has the ability to choose their own doctor and medical facility to obtain treatment for accidents or illness. Benefits and can be paid directly to the covered employee who is then responsible for paying their healthcare provider, unless the healthcare provider accepts assignment for payment. At each visit to a healthcare provider, the employee presents their ID card - there is an 800 telephone number on the back of the card where the healthcare provider can call and verify benefits and assignment. Claims incurred are paid within 7 to 10 days of receipt - either to the Provider or to the covered employee.

The Plans presented and others that can be designed are made available to meet the anticipated disposal income of the employee and to meet their family budget. Please see the Frequently Asked Questions that will provide information that assists employees in making their decision as to which Plan is most appropriate for them.

PLANS FOR MOST STATES
- Example ONLY -
OTHER PLANS CAN BE DESIGNED BASED UPON BROKER/CLIENT DIRECTION

To all Employees: We are very excited to introduce a new package of HEALTH BENEFIT PLANS.

The PLAN provides immediate first dollar coverage with no deductibles & no coinsurance requirements. This plan is fully insured with no pre-existing condition limitations & limited network restrictions (Network use is required for Prescription Access & Discounted Health Services). Benefits are paid directly to the insured who is responsible for paying their healthcare provider, unless your healthcare provider accepts assignment of benefits. The first step in maintaining good health is having the ability to choose any family physician or medical facility for treatment.  In addition, a PPO - national network can also be attached to the benefit plan - resulting in hugh savings to the covered person (s)..

With all plans a valuable Pharmaceutical Card & Discounted Health Services Program can be added.

IMPORTANT NOTICE

This is a Benefit Plan highlight sheet & is not intended to be a complete or legal description of the program of benefits. Complete information is available immediately upon request before you enroll through your employer and will also be provided to you in the certificate of insurance or member benefit booklets for the various programs in which you may voluntarily choose to participate. This program is not intended to replace, nor do we recommend that it replace any comprehensive program of insurance in which you currently participate, or are considering participation in.

Also offered are exciting optional/ancillary benefit plans which can also be changed.

These coverages, are only examples, may be purchased with participation in one of the medical coverage options.

Short Term Disability - 13, 26 or 52 week benefit
Up to $500 per week for the covered employee only, after a 7 day waiting period for sickness or accident, not to exceed 66-2/3% of salary, excluding bonuses and overtime. Disability due to pregnancy or childbirth is covered.

Vision Benefit - Up to $300 per year per person for covered vision expenses. Benefit is paid at 80% (beneftis can be changed upon request).

Dental Benefit - Annual Maximum Benefit: $1,000.00 per covered member (benefits can be changed upon request)

• Annual Deductible: $100 per covered member
• 80% Benefit: Type One Service Exams
• 80% Benefit: Type Two Service Cleanings, X-rays, Fillings, and Extractions
• 50% Benefit: Type Three Services Oral Surgery, Crown, Bridge Work, and Dentures, Root Canal, Periodontics and Endodontic.
• Additional $500 lifetime max for Orthodontia Services. Paid at 50%
  

There are any number of other optional benefits such as Life, Long Term Care, Critical Care Illness and so forth.

CRITICAL ILLNESS COVERAGE:

Many employers are concerned because the Mini-Medical Plans do not cover the fully comprehensive coverages and have turned to offering, as an option, Critical Care Illness Plans to their employees. There are any number of critical care illness plans available in the marketplace and the one offered would be the most appropriate per the employer requirements.

Please click here to have us contact you about Limited Supplemental Plans.