Underwritten by National Guardian Life Insurance Company and administered by Merchants Benefit Administrators.FOR AGENT TRAINING USE ONLY. NOT FOR DISTRIBUTION TO CONSUMERS.

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Why purchase a limited benefit medical plan?

• An affordable way for your clients to get the health care they need

• Helps cover the anticipated cost of everyday health care services with set-dollar benefits

• Association benefits provide access to discounted prescriptions, vision, hearing, and lots

more services.

Target Clients

• Not eligible for group coverage or need to wait for Open Enrollment

• Don’t want to pay for high-cost ACA plans, but want some coverage

• Students, recent grads, pre-Medicare retirees

THESE PLANS PROVIDE LIMITED BENEFITS. Make sure your clients know this is not a major medical plan and does not satisfy the requirements of minimum

essential coverage under the Affordable Care Act. They may be subject to a tax penalty.

NGL PrimeCare Plan Highlights

• Guaranteed Issue

• No Pre-ex limitations

• No waiting period – benefits start right away

• First-dollar benefits – no deductibles or copays

• Access to two national provider networks for ultimate savings

• No SSN required

• Benefits are paid on top of other coverage – no coordination of benefits

• Automatic renewals – no need to reapply

National Small Business Association Benefits

PrimeCare is made available through a membership in NSBA

• Outlook Vision: 10% to 50% off the regular retail price of eyeglasses,

contact lenses, sunglasses, and corrective surgery, including Lasik, RPK, and more

• Outlook Rx: discounts of 10% to 50% off the pharmacy’s standard price

• EPIC Hearing: 30% and 60% savings on name-brand hearing aids

• BenefitHub Discounts & Rewards: A multitude of savings, discounts, and cashback

rewards on retail, entertainment and travel purchases

• Consumer Medical Bill Solutions: negotiates medical bills to achieve savings of

25% - 45% of the total billed charges

Plan DetailsPlan Levels Standard Select Premium

Inpatient Benefits

Hospital Confinement

Sickness Confinement per Day - up to 60 days per calendar year $600 $800 $1,200

Accident Confinement per Day - up to 30 days per calendar year $1,200 $1,600 $2,400

ICU Illness & Accident per Day - up to 15 days per calendar year $1,500 $2,000 $2,500

Mental Illness Confinement per Day - up to 10 days per calendar year $100 $100 $100

Alcoholism & Substance Abuse per Day - up to10 days per calendar year $100 $100 $100

Operating Room 1 Hospital Surgical Discharge/CY $1,000 $1,500 $2,000

Inpatient and Outpatient Benefits

Surgery (IP & OP Surgery)Surgical Schedule Maximum per Procedure - 1 per calendar year $1,250 $1,500 $2,000

Anesthesia per Session - 1 per calendar year $200 $200 $200

Nursing Private Duty Nursing/Home Health Care - up to 5 days per calendar year $100 $100 $100

Plan DetailsOutpatient Benefits Standard Select Premium

Physician Office Visits

Routine Physician Office Visit Daily Benefit $75 $75 $75

Number of days per calendar year 7 7 8

Consultation Benefit - 1 per calendar year $100 $100 $100

Wellness

Annual Physical Daily Benefit - 1 per calendar year $100 $100 $100

Wellness Screenings Conducted During Physical - 1 per calendar year $35 $35 $35

Immunizations Daily Benefit - up to 5 days per calendar year $50 $50 $50

Emergency RoomIllness ER Visit Daily Benefit Facility Expense - up to 3 days per calendar year $50 $50 $50

Accident ER Visit Daily Benefit Facility Expense - up to 2 days per calendar year $500 $500 $500

Diagnostic Laboratory &

Radiology

Magnetic Resonance Imaging (MRI) Daily Benefit - 1 day per calendar year $1,000 $1,000 $1,000

CT Scan Daily Benefit - 1 day per calendar year $300 $300 $400

X-Rays and Mammograms Daily Benefit - up to 5 days per calendar year $75 $75 $75

Diagnostic Laboratory Test Daily Benefit $40 $40 $40

Number of days per calendar year 6 6 8

Cardiovascular

EKG/ECG Daily Benefit - 1 day per calendar year $50 $50 $50

Echo Cardiograms - 1 day per calendar year $50 $50 $100

Cardiac Stress Test Daily Benefit - 1 day per calendar year $200 $200 $300

Therapeutic & Rehabilitative

Care

Physical, Occupational and Speech Therapy Daily Benefit - up to 6 days per calendar year $50 $50 $50

Oncology/Dialysis Daily Benefit - up to 6 days per calendar year $50 $50 $50

Outpatient Surg. FacilityHospital Outpatient or Freestanding Facility Daily Benefit N/A $500 $500

Number of days per calendar year N/A 1 2

Ambulance 1 Transport to Emergency Room - 1 day per calendar year N/A $300 $300

PrimeCare PPO Networks

• PrimeCare uses a Passive PPO Network. That means members receive the same benefit whether they use

a network or non-network provider. Members can maximize their benefits by receiving services at a

discounted rate from contracted network providers.

• Two provider networks to maximize savings – First Health and First Access

• More than 6,400 hospitals, over 154,000 ancillary facilities; more than 1 million physicians and health care

professionals with locations across all 50 states

• Using network doctors and hospitals stretches benefit dollars

• In-network doctors and hospitals have agreed to provide services at discounted rates – out-of-pocket costs

will be less

• Network doctors are carefully selected to promote quality outcomes

• No paperwork – network doctors and hospitals file claims

• Online provider directory pcproviderlookup.com 866-531-4449 for personal assistance.

First Health Network Average Savings

Family Practice 60,000+ 37%

Internal Medicine 65,000+ 40%

Pediatrics 36,000+ 32%

Radiology 35,000+ 43%

Emergent/Urgent Care 22,000+ 37%

Surgery 38,900+ 52%

First Access is a “wrap network” providing increased coverage with over 450,000 practitioners and 55,000 facilities with average savings of 22%.

Top First Health Network HospitalsBarnes-Jewish Hospital, St. Louis, MO Brigham & Women's Hospital, Boston Cedars-Sinai Medical Center, Los Angeles Cleveland ClinicDuke University Hospital, Durham, NCHospital of the University of Pennsylvania-Penn PresbyterianJohns Hopkins Hospital, Baltimore, MD Massachusetts General Hospital, Boston Mayo Clinic, Phoenix, AZMayo Clinic, Rochester, MN Mount Sinai Hospital, New YorkNew York-Presbyterian Hospital, NY Northwestern Memorial Hospital, ChicagoNYU Langone Medical Center, New YorkStanford Health Care-Stanford Hospital, CA UCLA Medical Center, Los AngelesUCSF Medical Center, San FranciscoUniversity of Michigan Hospitals and Health Centers, Ann ArborUPMC Presbyterian Shadyside, Pittsburgh

NGL PrimeCare Out-of-Pocket Examples

Network DoctorNon-network

Doctor

Your office visit $125.00 $125.00

Provider discount $50.00 $0.00

Total charge with

discount applied$75.00 $125.00

Plan pays $75 $75

Your total responsibility $0.00 $50.00

Out-of-pocket costs are less with network providers

Network HospitalNon-network

Hospital

Your office visit $7,500.00 $7,500.00

Provider discount $2,800.00 $0.00

Total charge with

discount applied$4,700.00 $7,500.00

Plan pays $4,600.00 $4,600.00

Your total responsibility $100.00 $2,900.00

Example 2 – Hospital Stay

Examples only. May not be specific to member’s plan of benefits.

Example 1 – Doctor Office Visit

NGL PrimeCare Rates and Commissions

Monthly Premiums

Member $ 256.01 $ 300.58 $ 344.78

Member + Spouse $ 494.78 $ 588.82 $ 682.07

Member + Child/Children $ 477.57 $ 568.05 $ 657.76

Member + Family $ 763.65 $ 913.42 $ 1,061.90

One-time $25 application fee (optional $0.00)

Commissions are level for the life of the policy. Commissions are paid weekly on new business and monthly on renewals.

NC rates are slightly higher.

Approved States as of 4.15.20

Alabama Kentucky OregonArizona Louisiana PennsylvaniaArkansas Massachusetts (P) Rhode IslandDelaware (P) Michigan South CarolinaFlorida Mississippi Tennessee (P)Georgia Nebraska TexasIllinois Nevada Virginia Indiana North Carolina West Virginia Iowa Ohio Wisconsin Kansas Oklahoma

P = pending cert approval

Eligible Ages

Primary applicants

Ages 18 – 64 at time of application

• Dependent Children up to age 26

• No child-only plans

• Renewable to age 65

• No Health Questions

Exclusions & Limitations

• intentionally self-inflicted injuries

• work-related Injury or Sickness

• mental or nervous disorders,

• alcoholism or substance abuse

• eye examinations for glasses

*Not a comprehensive list of exclusions. Please refer to the policy certificate for a complete list of exclusions and limitations.

• hearing examinations or hearing aids

• dental care or treatment

• reading or interpreting the results of any diagnostic tests

• cosmetic surgery

• care or treatment outside the US

There are no Pre-Existing Condition Exclusions

Some exclusions are:

Enrollment

Options are the 1st or 15th of the month

Must apply by 25th for 1st

Must apply by 10th for 15th

Same date every month EFT, Visa, MasterCard, or Discover

Initial Payment

Drawn at time of application

Reoccurring Payment Form of Payment

Permits both e-signature and voice verification file upload. 30-day free look period with full refund.

Enrollment Process

Select a plan level.

Enrollment Process

Choose a state and confirm plan level.

Enrollment Process

Three Simple Verification Options

1. Read and record voice verification and then upload the voice file.

2. Send a verification link via text or email

3. Read and record voice verification and then insert verification code

Simple Text Verification - Customer View on cell phone

Simple Text Verification - Agent View on Enrollment Screen

Important Contact Information

Benefits, Billing and Eligibility: 844-4175080Provider Locator Assistance: 866-531-4449Provider Locator Website: www.pcproviderlookup.comNSBA Benefits: go to NSBA.net (Access Code is NSBA)Claims Customer Service: https://mbaadmin.com/contact-us/

Select Member Services – Limited Medical

All claims with itemized bills including diagnosis, should be mailed to:Merchants Benefit Administration, Inc. Attn: MBA Limited Benefit Medical PO BOX 1245Elk Grove Village, IL 60007-1245

How to get contracted

Contracting@AHCPsales.com

877-228-8773

Call centers will need to complete a due diligence questionnaire.