Signature Gap Insurance Product Training
Signature Gap Insurance
Product Training
CurrentHealthcareLandscape
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Risinghealthcarecostsandhealthinsurancereformshaveshakenthingsupforemployers.Asaresult,manyofyourclientsareraisingtheiremployees’out-of-pocketcostsbymovingtohighdeduc7blehealthplans(HDHPs).
Changesinthemarket
Source: PwC 2015 Health and Well-being Touchstone survey
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Risingcontribu7ontocoverage
1 The Kaiser Family Foundation and Health Research & Educational Institute, Employer Health Benefits 2014 Annual Survey
This cost-shi7ing trend has lowered employer costs, but employees are now le7 open to greater financial risks.
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Due to the increases in the cost of care, more and more employees may be skipping or waiCng to seek treatment. When employees do so, they might risk long-term health issues that could cost more over Cme.
Risingcostsmeangreaterliabilityforemployees
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Percentage of consumers with employer-based insurance who took the following acCons in the last 12 months due to cost of care.
Theeffectsofcost-shiGingonemployeehealthcarechoices
Source: PwC Health Research Institute 2015 consumer survey
WhyyourclientsneedGapinsurance
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Your clients are faced with difficult decisions each year on how to offer affordable healthcare coverage, without subjecting their employees to financial risk. What are the most common ways you reduce your employer costs? • Raising deductibles • Offering higher co-pays • Increasing employee out-of-pocket maximums
ClientChallenges
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How do employers keep the negative results of deductibles, offering higher co-pays or increasing OOP maximums from impacting their employees? Further, if employees delay seeking appropriate medical care due to the cost, this may negatively impact productivity and ultimately the company’s bottom line.
Howtopreventemployeefinancialrisk
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The Kemper Benefits Signature Gap insurance plan works with an employer’s current medical coverage to help fill the gaps in their existing primary coverage, while maintaining employee benefits. Address your clients’ needs by offering them the option to enhance their protection and increase their peace of mind.
Whatisagapplan?
SignatureGapInsurance:AbePersolu7on
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Ournew,enhancedKemperBenefitsSignatureGapsolu7onhelpsfillintheholesleGbehindbyyourclients’primarycoveragewhenhospitalconfinedwithflexiblebenefits:
KemperBenefitsSignatureGapInsurance
• AbroadrangeofInpa7entHospitalConfinementBenefitamounts
• Moreoutpa7entcoverageamountop7ons
• Flexiblebenefitmaximumscombinedwithdeduc7blechoices
• Physicianofficevisitbenefitrideravailable
• Guaranteedissue
• Canbeofferedasvoluntaryoremployer-paid
• 5enrolledlivepar7cipa7onrequirement*
*Varies by state
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BroadRangeofInpa.entHospitalConfinementbenefitannualmaximumamounts
• In-pa7entHospitalConfinementBenefit1$1,000-$7,000perperson
1ThemaximumInpa7entHospitalBenefitplusdeduc7bleselectedmaynotexceedtheInsuredPerson’stotalIn-Networkout-of-pocketexposureundertheemployer’smedicalplan.Inmostinstances,theemployerwillselectaGapbenefitmaximumthatislessthanthattotalexposure.
Benefitsataglance
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Outpa.entCoverageAnnualMaximum
• Outpa7entcoveragebenefit2 PerPerson: 20%-70%oftheInpa7entmaximum
PerFamily: Upto2xtheperpersonmaximum
2TheperpersonOutpa7entBenefitPeriodMaximumselectedbytheemployermaynotexceed50%oftheIn-HospitalBenefitPeriodMaximum.PlansissuedwithanOutpa7entBenefitMaximumgreaterthan$2,500mustincludeaminimumGapBenefitPeriodDeduc7blethatmeetstheCompany’scurrentunderwri7ngguidelines.
Benefitsataglance
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PhysicianOfficeVisitBenefitRider
PhysicianOfficeVisitBenefitAnnualMaximum
• PhysicianOfficeVisit(POV)Benefit3PerVisit:$10-$50($10increments)
PerFamily:8,10or12visits
3.PhysicianOfficeVisit(POV)BenefitnotavailablewithHSAcompa7bleplans.
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FlexibleAnnualBenefitMaximumsCombinedwithDeduc.bleChoices
• Tradi7onalBenefitPeriodDeduc7bles
Perinsuredperson: None,$250,$500,$750,$1,000 or$1,250
AppliestoInpa7ent&Outpa7entBenefitRiderbenefits
• Plantailoredtofitemployerneeds
Benefitsataglance
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HSACompa.bleBenefitPeriodDeduc.bleMinimum4
• Individual Coverage (Employee only) $1,350
• Family Coverage $2,700
Benefitsataglance
4TobeHSACompa7ble,theminimumIndividualandFamilyDeduc7blesrequiredbytheIRSmustbeissued.The2016and2017minimumrequireddeduc7bleis$1,300/$2,600.TheDeduc7blemustapplytoboththeInpa7entandOutpa7entBenefitsandmaynotbewaivedforAccidents.ThePhysicianOfficeVisitBenefitRidermaynotbeincluded.
Plan Details
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KemperBenefitsSignatureGapInsurance
ProductDescrip7on
Thisisanrenewable,limitedbenefit,groupmedicalexpenseGapproductthatprovidesbenefitsthatsupplementexis7ngemployergroupmedicalplans.Itcoverscertainpor7onsoftheout-of-pocketexpensesthatemployeesandtheirfamiliesincurundertheirMedicalPlan(coinsurance,copays,deduc7bles)uptothemaximumannualbenefitselectedbytheemployer.Itisdesignedtohelpfillgapsinprimarycoverage,suchascopays,coinsuranceordeduc7bles.Thisproductdoesnotpay100%ofout-of-pocketexpenses.Expensesmustbecoveredbytheinsuredperson’smedicalplantobecoveredunderthisproduct.
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ProductFeatures
• Benefitsarepayablefor“CoveredCharges,”whicharedefinedastheinsuredperson’smedicalplandeduc7ble,copaymentsorcoinsurance.
• Allplansincludeinpa7entandoutpa7entbenefits• Pregnancyiscoveredsameasanysickness• Usestheprimarymedicalplan’sEOB(explana7onofbenefits)asabasisfordeterminingwhatiscovered
• PlansmayincludeaGapdeduc7bleop7onifelectedbythegroup• Designedtobeexemptfromthehealthcareaccess,portabilityandrenewabilityrequirementsofTitleI(HIPAA)relatedtoemployergrouphealthplans
• IncludesHSAcompa7bleop7ons
• Guaranteedissue(subjecttoeligibilityrequirements)
• Par7cipa7onrequirementof5enrolledlives
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ProductFeaturesandBenefitsAllbenefitop7onsareelectedattheemployergrouplevel.Benefitsarepayableiftheinsuredpersoniscoveredbyamedicalplanandcoveredchargesareincurred.Coveredchargesarethededuc7bles,copaymentsandcoinsuranceamountsthattheinsuredpersonisrequiredtopayunderhisorhermedicalplan.Eachbenefitissubjecttotheterms,condi7ons,limita7ons,exclusions,benefitperiodmaximumsandbenefitperioddeduc7bleincludedinthepolicy. Benefit BenefitOp.on BenefitPeriodMaximums
Inpa.entHospitalBenefit PerPerson $1,000-$7,000
Outpa.entBenefitRider PerPersonPerFamily
20%-70%oftheInpa7entmaxUpto2Xtheperpersonmax
PhysicianOfficeVisit(POV)Benefit
PerVisitPerFamily
$10-$50($10increments)8,10or12visits
Tradi.onalBenefitPeriodDeduc.ble
PerInsuredPerson
None,$250,$500,$750,$1,000or$1,250
Deduc.bleOp.ons(onlyavailablewithTradi7onalDeduc7bleplans)
NoDeduc7ble;appliestoInpa7ent&Outpa7entBenefitRiderbenefits
HSACompa.bleBenefitPeriodDeduc.bleMinimum
IndividualCoverage(Employeeonly)Familycoverage
$1,350$2,700
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Inpa7entHospitalBenefit
BenefitsarepayableiftheinsuredpersonishospitalconfinedundertheregularcareandaPendanceofaphysicianforatleast15hoursduetosicknessorinjuryandtheexpensesarecoveredbyandappliedtotheinsuredperson’smedicalplandeduc7ble,copaymentsorcoinsurance(coveredcharges).Coveredchargesfortreatmentinahospitalemergencyroomandtransporta7onbyambulancetoahospitalduetosicknessorinjuryarealsocoveredunderthisbenefitiftheinsuredpersonishospitalconfinedwithin24hoursofthetreatmentortransport.
Coveredchargesforhospitalconfinementoftheinsuredperson’snewbornchildrenarepayablefromthemomentofbirthun7ldischargedfromthehospital.BenefitsaresubjecttotheIn-HospitalMaximumBenefitshownintheScheduleofBenefits.ThehospitalconfinementmustbeginaGertheinsuredperson’seffec7vedate.In-HospitalMaximumBenefit
• $2,000-$7,000perinsuredperson,perBenefitPeriodHSAInpa.entMaximumBenefit
• $2,000-$5,000perinsuredperson,perBenefitPeriodNote:TheIn-HospitalBenefitMaximumplusdeduc7bleselectedmaynotexceedtheinsuredperson’stotalin-networkout-of-pocketexposureundertheemployer’smedicalplan(deduc7ble+coinsuranceandco-pays).Inmostinstances,theemployerwillselectaGapbenefitmaximumthatislessthanthattotalexposure.
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Outpa7entBenefitRider
Benefitsarepayableforcoveredchargesforoutpa7enttreatmentduetoaninjuryorsickness.CoveredchargesaresubjecttotheOutpa7entMaximumBenefitshownintheScheduleofBenefits.CoveredchargesmustbeginaGertheinsuredperson’seffec7vedate.
Thisbenefitincludescoveredchargesfortreatmentinahospitalemergencyroomandtransporta7onbyambulancetoahospitalduetosicknessorinjuryiftheinsuredpersonisnothospitalconfinedwithin24hoursofthetreatmentortransport.Italsoincludescoveredchargesforoutpa7entdurablemedicalequipmentreceivedbytheinsuredperson.
Thisbenefitdoesnotincludeanyexpensesincurredforoutpa7entprescrip7ondrugsoranexamina7onofaninsuredpersonbyaphysicianinthephysician’sofficeorurgentcarefacility.
Outpa.entMaximumBenefit• PerInsuredPerson:20%-70%ofselectedIn-HospitalMaximumBenefitper
BenefitPeriod• PerFamily:27mesthePerInsuredPersonOutpa7entMaximumBenefitNote:TheperpersonOutpa7entBenefitPeriodMaximumselectedbytheemployermaynotexceed50%oftheIn-HospitalBenefitPeriodMaximum.PoliciesprovidingOutpa7entBenefitMaximumsinexcessof$2,500mustincludeaGapplandeduc7ble.Theoutpa7entbenefitsareinlieuofanyinpa7entbenefit.Theoutpa7entbenefitdoesnotincludecoverageforanyexpensesincurredforanexamina7on.TheintentoftheOutpa7entBenefitRideristocovertreatment,suppliesandothernon-physicianrelatedoutpa7entcharges,whiletheOutpa7entPhysicianOfficeVisitBenefitRidercoversthephysician’sservicesfortheexamina7onoftheinsuredperson(officevisit).
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Outpa7entPhysicianOfficeVisit(POV)BenefitRider*
Benefitsarepayableforcoveredchargesforaninjuryorsicknessforanexamina7onof
theinsuredpersonbyaphysicianinthephysician’sofficeorurgentcarefacility.CoveredchargesaresubjecttotheOutpa7entPhysicianOfficeVisitMaximumBenefitshownintheScheduleofBenefits.Benefitsarenotpayableforanyotherserviceorsupplyprovidedinthephysician’sofficeorurgentcarefacility,includingbutnotlimitedto,chargesforx-raysandlaboratoryservices.
Outpa.entPhysicianOfficeVisitMaximum• PerInsuredPerson:$10,$20,$30,$40or$50perphysicianofficevisit• PerFamily:Uptwoamaximumof8,10,or12visitsperfamilyperbenefitperiodNote:TheintentofPhysicianOfficeVisitBenefitRideristocoverthephysician’sservicesfortheexamina7onoftheinsuredperson(officevisit),whiletheOutpa7entBenefitRidercoverstreatment,suppliesandothernon-physicianrelatedoutpa7entcharges.Benefitsarenotpayableforanyotherserviceorsupplyprovidedinthephysician’sofficeorUrgentCareFacility,including,butnotlimitedto,chargesforx-raysandlaboratoryservicesundertheOutpa7entPhysicianBenefitRider.BenefitPerioddeduc7blesdonotapplytothisRider.ThisriderisnotavailablewithGapplansissuedtosupplementaHighDeduc7bleHealthPlanthatrequiresHSAcompa7bility.
*POVRidernotavailablewithHSAcompa7bleplans
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Deduc7bleOp7ons
Tradi.onalPerPersonBenefitPeriodDeduc.ble• PerInsuredPersonperBenefitPeriod:None,$250,$500,$750,$1,000or$1,250
Note:BenefitsarepayableforanInsuredPersonaGertheyhavesa7sfiedthe“perInsuredPerson”deduc7ble
HSACompa.bleIndividualCoverage/FamilyCoverageBenefitPeriodDeduc.ble
• IndividualCoverage(EmployeeOnly):$1,350• FamilyCoverage:$2,700 Note:Ifoneormoredependentsarecoveredundertheemployee’scer7ficateofinsurance,theen7reFamilyCoverageDeduc7blemustfirstbemetbeforeanybenefitswillbepaidforanyinsuredperson.TheFamilyDeduc7blemaybesa7sfiedbyoneormoreinsuredpersons.Thistypeofdeduc7bleisrequiredforHighDeduc7bleHealthPlans(HDHP)thatareHSAcompa7ble.TobeHSAcompa7ble,theminimumIndividualandFamilyDeduc7blesrequiredbytheIRSmustbeissued.Thededuc7blemustapplytoboththeInpa7entandOutpa7entBenefits.
Deduc.blesapplyto:• BoththeInpa7entHospitalBenefitandtheOutpa7entBenefitRider
Deduc.blesdonotapplyto:• Outpa7entPhysicianOfficeVisitBenefitRiderBenefits
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