Offered Exclusively Through

Seniors Choice is the premier group retiree medical plan for employees and retirees age 65+ which originates where Medicare ends.

The Basics Employer Options Underwritten by Guarantee Trust Life in

Glenview, IL Administered by MBA MBA, Inc. owner/distributor

SC Benefit Design Optional Benefits “How Deductibles Work” SC Part D Eligibility TEFRA Prospects Enrollment

Today’s Discussion

The Seniors Choice Plan Design

Basic Plan F Design Base Plan Benefits

• No Lifetime Maximum• Part A & B Deductible Coverage• Coverage for Excess Charges

Included• Skilled Nursing up to 100 Days• Foreign Travel included

The Seniors Choice Plan Design Cont.

$10 – Office Visit, Lab and X-ray Co-pay $10- Durable Medical Equipment $20 – All other outpatient services $100 – Emergency Room Co-pay

(waived if admitted) Excess charges are covered (up to 15%

above MAC) No Co-pay plan is also available

Deductible Options

Multiple Deductible Options◦From $0 to $4,000 All deductible options include the Medicare Part B deductible ($147)

Sponsor can choose one or as many deductibles as desired

Non-traditional Deductible

Example Deductible• Enrolled in SC $500 deductible plan option• Member incurs $1,000 in physician services

Member Out of Pocket Calculation

Physicians Services $1,000

Subtract Medicare Part B Deductible ($147)

Balance after Part B Deductible $853

Subtract 80% of Claim Paid by Medicare ($682.40)

Remainder Owed (Member pays this amount) $170.60

Part B Deductible (Member pays this amount) $147

Member Total Out-of-Pocket $317.60Remaining Annual Deductible Calculation

Seniors Choice Annual Plan Deductible $500

Subtract Out-of-Pocket amount paid by member which includes the Medicare Part B Deductible

($317.60)

Remaining Annual Plan Deductible $182.40

Optional Benefits

Comprehensive Wellness Benefit◦ Up to $250 per calendar year

Private Duty Nursing Benefit◦ $100 per 8 hour shift; 30 shifts per calendar year.

At Home Recovery Benefit◦ Certified by a doctor◦ Approved by Medicare

Additional Skilled Nursing Coverage ◦ From 101 days to 365 days

Enhanced Benefits EPIC Hearing Service Plan

Included with all plans National network of local ear physicians

and audiologists Testing, evaluations and hearing aid

fittings by licensed audiologists Savings of 35% to 65% on brand name

hearing aids Toll free telephone support No Administrative forms or paperwork

Enhanced BenefitsOutlook Vision Services

Outlook Vision Services◦Included with all plans◦Discounts on eye exams at approved locations

◦Up to 50% off eyewear◦Up to 50% discount on mail order contact lens replacement

◦Providers within a 15 minute drive for 85% of the U.S. population

Part D Late Enrollment PenaltyA Penalty will be assessed to anyone

who:1. Did not join a Medicare drug plan

when they were first eligible for Part A and/or

Part BOR

2. Went without creditable prescription drug coverage for 63 days or more

Penalty will be for ALL fully uncovered months

Calculate number of fully uncovered months:

Example: Uncovered from 5/16/06 - 12/31/08 =

31 months

Penalty is 1% for each number of fully uncovered

months: Example: 31 months x 1%

= 31%

Multiply penalty percent by current national base beneficiary premium*

Example: (2012): $31.00 x 31% = $9.61

Cost of Standard Part D plan premium + $9.61

(late enrollment penalty) = Part D total monthly premium

The penalty will be added to the standard premium of any Part D

plan for which the member enrolls. The member will have to pay the penalty each month as

long as he/she has the Medicare prescription drug

coverage.

*The current national base beneficiary premium is set by CMMS (Medicare) and is subject to change each calendar year.

Previous Years: [2011: $32.34] [2010: $31.94] [2009: $30.36] [2008: $27.93] [2007: $27.35] [2006: $32.20]

Plan Highlights

Always Guaranteed Acceptance Full takeover of pre-existing conditions Enhanced Benefits Optional Benefits Part D Coverage Gap coverage

Eligibility for Seniors Choice Group Retiree Medical Plans

Enrollee Qualification◦Currently Age 65 or over◦Enrolled in Medicare Parts A & B◦SC grandfathers any individual who has been employed by the sponsoring entity

Group Sponsorship Requirement

A group of 1 life may sponsor SC – Sole proprietors such as :• Lawyers• Dentists• Doctors• Insurance Agents• Real Estate Agents

Tax Equity and Fiscal Responsibility Act (TEFRA)

Employers with 20 or more FT/PT employees

20 or more weeks in the current or preceding year

The 20 weeks do not have to be consecutive

The requirements are based on the number of employees, not the number of individuals covered under the medical plan.

Seniors Choice Prospects

Groups of Under 20 employees◦Age 65 and over FT Employees TEFRA does not apply thus Medicare is primary

Premiums are generally higher for employees age 65 and over

Can raise the average age of group

Seniors Choice Prospects Continued

Groups with 20 or More Employees

◦Must comply with TEFRA regulations

◦Employees eligible for the employer sponsored group plan are ineligible for SC

◦Employees not eligible for the employer sponsored group plan are eligible for SC

Why Choose SC over a Traditional Medicare Supplement or MA Plan?

Tax benefits for premium contribution SC is always guaranteed issue Section 125 POP eligible Portable Extensive Part D Plan Open Enrollment Every December Enhanced Benefits Included

Example

Number EES 1010

Number of EES 65+ 1

Group Premium w/65 $5,500

Group Premium w/o/65

$4,000

Seniors Choice Premium w/Rx for 65 yr. old

$4,000 + $450 = $4,450

Monthly Savings = $1,050

How To Enroll In Seniors Choice

• Sponsoring Employers Must:– Complete Employer Trust

Participation Agreement– Employer may sponsor one or as

many deductibles as they desire• If voluntary, the Optional Prescription

Drug Benefit is elected by the enrollee

• Enrollee and/or Spouse Must:– Complete Enrollment Form– Make check or money order

payable to “Seniors Choice”– Make copy of Medicare I.D. card

and Medical I.D. card, if applicable

Remember . . . This is Group Retiree Medical Insurance All Agents and Brokers must be

appropriately licensed where the employer is domiciled

Any and all Marketing Materials utilized in connection with SC must first be approved in writing by Merchants Benefit Administration, Inc. prior to use