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John Blue and John Green have sore throats, so they both decide to go to the doctor’s office to obtain an official diagnosis.
Official
Diagnosis:
Strep
Throat
Strep Throat – $+3
Physical & Wellness Visit – $64
Stitches – $304
Flu Shot – $+25
Tetanus Shot – $+78
Appendectomy – $6,083
Annual Premium - $1566*
TOTAL OOP COST:
$7,783
Strep Throat – $321
Physical & Wellness Visit – $252
Stitches – $2,283
Flu Shot – $25
Tetanus Shot – $81
Appendectomy – $13,036
Annual Premium - $0
TOTAL OOP COST:
$15,998
Grand total:
with an LBM Plan
without an LBM Plan
Over $8,000 in Cost Savings!!!John Green is green with envy of the money that
John Blue saved with his LBM plan!
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$0
$4,000
$8,000
$12,000
$16,000
$20,000
John GreenJohn Blue
1 National Ambulatory Medical Care Survey: 2009 Summary Tables, table 12 National Ambulatory Medical Care Survey: 2009 Summary Tables, table 93 Summary Health Statistics for U.S. Children: National Health Interview Survey, 2010, table 144 Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2010, table 375 Burns, R., Mehrotra, A. and Weinick, R. (2010.) Many Emergency Department Visits Could Be Managed At Urgent Care Centers and Retail Clinics. Health A�airs, Volume 29 (Issue 9), p. 1630-1636. Retrieved from http://content.healtha�airs.org/content/29/9/1630.full.
The Limited Bene�t Medical Plans are underwritten by National Guardian Life Insurance Company* (NGL) under group policy form series NGRPHIP 5/11, et al and NGRPTL 5/11, et al, respectively. Product not available in all states.
Every e�ort has been made to ensure the accuracy of this brochure. The information applies to most states, however state laws do vary. The laws of your state may a�ect the program. This brochure is not a legal document. The contractual terms and conditions of coverage are set forth in the group policies. In the event of a discrepancy, the policies would be the determining factor. Insurance products are provided through NGL and administered by ASRM, LLC. NGL reserves the right to change the premiums it charges for its plans.VSP Access Plan discounts from Vision Service Plan. 24-hour Nurse Helpline and Online Wellness Services from Coverdell and Company, Inc. The suppliers of these services are not a�liated with NGL, which is not responsible for the content of the services and cannot be held liable for any services provided or not provided by these suppliers.*National Guardian Life Insurance Company is not a�liated with The Guardian Life Insurance Company of America, a.k.a. The Guardian or Guardian Life.
How Valuable is a Limited Benefit Medical Plan?
| Limited Benefit Medical Plans
*Premium amount and projected savings are based upon the voluntary premium rate and the benefit amounts of NGL-AlwaysCare Fixed Indemnity Plan 3.
DISCLAIMER: This document is not intended to provide medical advice. The costs provided are based on the national average for those services. In-network costs reflect national average costs minus national average discounts for selected services. Out-of-pocket (OOP) costs may vary based on location and use of network providers. Benefit reimbursement
amounts may vary by plan.
Key FeaturesGuaranteed issue • Available for as few as 10 enrolled (may vary by state) • No pre-existing condition exclusions •
No deductibles • No out-of-network penalties • Employees can choose their own physician •
Access to a Multiplan PPO Network • Point-of-service prescription drug benefit •
COBRA Eligible and Administration
startJohn Blue and John Green, two of Randy’s Roofing employees, recently received enrollment materials
for their review and consideration.
John Green’s Cost with no Plan:
Physician Visit – $114 (Actual Cost) = $114
Strep Test – $80 (Actual Cost) = $80
Prescription - $127 (Actual Cost) = $127
Total OOP = $321
$50
$100
$150
$200
$250
$300
$350
John Blue’s Cost With LBM:
Physician Visit – $66 (In-network cost) - $75 (Benefit) = $+9
Strep Test – $46 (In-network cost) - $40 (Benefit) = $6
Prescription - $75(In-network cost) - $75 (Benefit) = $0
Total OOP = $+3
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John Green’s Cost with no Plan:
Physician Visit and Physical - $188 (Actual Cost) = $188
Wellness Screening - $64 (Actual Cost) = $64
Total OOP = $252
John Blue’s Cost With LBM:
Physician Visit and Physical - $109 (In-network cost) - $175 (Benefit) = $+66
Wellness Screening - $37 (In-network cost) - $35 (Benefit) = $2
Total OOP = $+64
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+50
0
50
100
150
200
250
300
Wanting be proactive with taking preventive measures for their overall health and wellbeing, John Blue and John Green both decide to go to the doctor’s office for a physical and wellness visit. During this appointment, they will be screened for high blood pressure, high cholesterol and diabetes.
Wellness Visit
John Blue and John Green both go to the emergency room to get stitches for deep cuts they sustained during a flag football game, a non-work related accident.
ER Visit:
A Flag Football Game
Ends in Stitches
John Green’s Cost with no Plan:John Blue’s Cost With LBM:
Emergency Room Visit and Care - $1160 (In-network cost) - $500 (Benefit) = $660
MRI - $644 (In-network cost) - $1000 (Benefit) = +$356
Total OOP = $304
$0
$500
$1000
$1500
$2000
$2500
Emergency Room Visit and Care - $1,468 (Actual Cost) = $1,468
MRI - $815 (Actual Cost) = $815
Total OOP = $2,283
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John Green’s Cost with no Plan:John Blue’s Cost With LBM:
Immunization – $25 (In-network cost) - $50 (Benefit) = $ +25
Total Cost = $+25
It is flu season and Randy’s Roofing does not have a sick day policy, so any time taken off will be without pay. As a preventive measure, John Blue gets a flu vaccination from his in-network physician, while John Green decides to go to his local drug store pharmacist.
Preventive Care
$0
$5
$10
$15
$20
$25
$30
$35
$40
$45
$50
Immunization – $25 (Actual Cost) = $25
Total Cost = $25
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John Green’s Cost with no Plan:John Blue’s Cost With LBM:
Physician Visit – $21 (In-network cost) - $75 (Benefit) = $+54
Immunization – $26 (In-network cost) - $50 (Benefit) = $+24
Total Cost = $+78
Physician Visit – $36 (Actual Cost) = $36
Immunization – $45 (Actual Cost) = $45
Total Cost = $81
John Blue and John Green step on a rusted nail while helping a friend to repair a fence. They both go to an urgent care facility to get a tetanus shot.
Urgent Care
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John Green’s Cost with no Plan:John Blue’s Cost With LBM:
Emergency Room Visit and Tests - $2,511 (In-network cost)- $465 (Benefit) = $2046
ER Physician Services - $250 (In-network cost) - $0 (Benefit) = $250
Hospital Services - $7,917 (In-network cost) - $2,550 (Benefit) = $5,367
In-Patient Surgery - $1,087 (In-network cost) - $1,000 (Benefit) = $87
Anesthesia Services - $537 (In-network cost)- $200 (Benefit) = $337
Total Cost = $6,083
Emergency Room Visit and Tests - $3,179 (Actual Cost) = $3,179
ER Physician Services - $316 (Actual Cost) = $316
Hospital Services - $7,917 (Actual Cost) = $7,917
In-Patient Surgery - $1,087 (Actual Cost) =$1,087
Anesthesia Services - $537 (Actual Cost) = $537
Total Cost = $13,036
After a night of battling fever and chills, vomiting, diarrhea and severe abdominal pain, John Blue and John Green decide to go to the emergency room to find out the source of their symptoms. The attending physician diagnoses them both with acute appendicitis, which requires emergency surgery and a three day hospital stay.
Appendectomy
Out-of-pocketThermometer
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in
Joh
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$0
$2,600
$5,200
$7,800
$10,400
$13,000
0
$20
$40
$60
$80
$100
Extras
24 hour Helpline VSP Vision Care Access
Online Wellness Improvement Service
LBM plans provide employees and their dependents
with basic medical coverage.
Key Advantages of Limited Benefit Medical Plans
Access to CoverageIn-network Discounts
Reimbursement Benefits for Covered Service
startThe open enrollment period has begun and Randy’s Roofing is now offering a
Limited Benefit Medical plan.
John Blue and John Green, two of Randy’s Roofing employees, recently
received enrollment materials for their review and consideration.
Review the open enrollment materials and write down the questions he had for the insurance representative
Evaluate his family’s previous healthcare needs to determine which plan will best meet their needs
Assess the value of the plans based on premiums and benefits
John Blue decided to take the time to:
John Green never even took his
packet home.
Should John
Enroll in
Limited Benefit
Medical?
Based on his review, evaluation and assessment, he decided that it would be beneficial to enroll in the LBM plan. He now has access to basic insurance coverage, a network of physicians while receiving a fixed amount of payment for certain named and commonly used medical services.
John Green decided that he would rather take his chances and self-pay if any medical issues arose.
Nah...I’ll take my chances.
Yes!I definitely
see the value!
In 2009 there were ONE BILLION physician office visits in the United States. 1
FACT:
FACT:
The most frequent reason for physician office visits is a general medical examination. 2
FACT:
92.1 % of children have had contact with a healthcare professional in the past year. 3
FACT:
PPO networks can save an additional 15% or more on healthcare services.
FACT:
82.2% of adults have had contact with a healthcare professional in the past year. 4
FACT:
About 17% of all visits to hospital emergency departments nationally could potentially be treated at retail medical clinics or urgent care centers for an estimated savings of $4.4 billion. 5
COULD BE TREATED AT URGENT CARE
OF HOSIPTAL VISITS
NOTE: The AlwaysCare Limited Benefit Medical Plan is not Affordable Care Act (ACA) compliant; it does not meet the minimum level health insurance requirements. As a fixed indemnity plan, this is not health insurance. This plan provides a set amount
reimbursement for the completion of covered services.
LBM INFOGRAPHIC 042413
