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Q – I am an employee. I don’t understand this insurance plan.
A – The “Insured” HRA helps reduce the employer’s and the employee’s cost for medical insurance. The “Insured” HRA is secondary insurance plan that co- ordinates with your employer’s high deductible major medical plan. This plan pays part of your major medical deductible directly to the health care provider.
Q – I am an employee. How do I file claims with the “Insured” HRA insurance plan?
A – Your part is easy. All you have to do is to show the health care provider your “Insured” HRA insurance card. Upon enrolling in our plan, you will receive a blue plastic insurance card holder so that you can keep your major medical and “Insured” HRA insurance cards in one place. Health care providers will normally file the claim for you since they are going to receive the insurance benefit.
Q – I am the spouse of an employee. When I go to the doctor, the primary insured’s ID # is not completely shown on my insurance card. Does the health care provider need the primary insured’s full social security number in order to accept this coverage and file my claim?
A – You do not need the primary insured’s full social security number; just the information on the card, the primary insured’s name and 4 digit I.D. number.
Q – I am an employee. I get bills from my health care provider and Explanation of Benefits statements from my major medical carrier saying I owe a large deductible. What’s up with that?
A – You have a secondary insurance plan that pays part of your deductible directly to the health care provider. Show the health care provider your “Insured” HRA insurance card and ask them to file the claim. If they have questions, need assistance or want to verify coverage ask them to call the number on your “Insured” HRA insurance card. The health care provider will credit you with payments from the major medical insurance company and the “Insured” HRA insurance company. Then you will be billed for your part.
Q – I am an employee. My doctor’s office says they don’t understand the “Insured” HRA and do not know how to bill for this insurance plan. Who can I refer them to or what should I tell them?
A – If the health care provider or you have questions call the number on your “Insured” HRA insurance card. We will be glad to assist. Explain to the health care provider that you have a secondary insurance plan that pays part of your deductible directly to them. The process is simple! Just show them the billing information on your “Insured” HRA insurance card and ask them to bill the insurance company for payment. The insurance company’s address and contact information is on the insurance card.
Q – I am an employee and my health care provider is requiring that I file claims for my insurance and pay them up front. What do I do?
A – Explain to the health care provider that you’re “Insured” HRA insurance plan pays part of your deductible directly to the health care provider. Once this is understood, most health care providers will file the claim because they want to receive the benefit check from the insurance company. The claims filing process is easy. The health care provider can ask questions and verify your benefits by calling 1-888-888-2519. If the health care provider will not file the claim and requires you to pay them up front, you can mail the major medical Explanation of Benefits (EOB) and a billing statement indicating a zero balance to the insurance company listed on your insurance card. The insurance company will then pay the benefits to you. The insurance company address and contact information is on the “Insured” HRA insurance card.
Q – I am an employee and want to know what is NOT covered.
A – Every treatment covered by the major medical plan is an eligible expense under the “Insured” HRA except the professional fee of a physician in a doctor’s office or medical clinic and outpatient prescription drugs. Usually this is a non-issue as many major medical plans apply a copay for these services.
Q – I am an employee. What if my family and I are transferred to another state but remain with my current employer; are we still covered by the “Insured” HRA? What if my family is visiting out of state or evacuated due to natural disaster like a hurricane. Will
we have coverage with the “Insured” HRA?
A – Yes – Your coverage is provided anywhere your major medical plan is accepted.
Q – I am an employee and want to know how to use my health plan on weekends when your claims department is closed.
A- Many insurance companies are closed at night and on the weekends. Show the health care provider your primary and secondary insurance cards. On the back of the “Insured” HRA insurance card we explain that benefits are paid to the health care provider and how they should file the claim.
Q – I am the HR manager for our company. My agent has shown me the “Insured HRA”. Is this a new concept and who are the underwriters for this plan?
A – The “Insured” HRA was developed over 12 years ago. Over 1600 groups in 26 states are insured by this plan. The sky rocketing cost of group health coverage in the last few years has made the “Insured” HRA more popular than ever. The “Insured” HRA is underwritten by three Insurance Companies:
Q – I am the HR manager for our company. Explain the Insured HRA and what is covered.
A – The “Insured” HRA plan is a secondary medical insurance plan. Combining this product with a high deductible major medical plan frequently saves groups 10% to 20% or more without reducing benefits. Every treatment covered by the major medical plan is an eligible expense under the “Insured” HRA except the professional fee of a physician in a doctor’s office or outpatient facility and outpatient prescription drugs. This becomes a non-issue because many major medical plans provide coverage for the professional fee and outpatient prescription drugs by requiring the insured to pay a copay.
Q – I am the HR manager for our company. Next week we are enrolling our employees with the “Insured” HRA coverage. What is the best way for me to get an overview of how this plan works, how to handle the enrollment, and how to submit additions, changes and terminations?
A – Your agent should be able to answer all of your questions. You can learn more about the “Insured” HRA by watching the webinar video on our web site www.premiumsaverplan.com. MWG Marketing is always available at 1-800-
800-1397 if you need assistance. It is easy to enroll your employees by using the XL Spreadsheet provided by your agent. Employee applications are not required. We strongly recommend the agent conduct an employee meeting to explain a few key points. Ask your agent to show your employees the power point presentation that explains the “Insured” HRA and the claims process. The agent should distribute the Claims Guide and the blue plastic insurance card holders for employees and their spouse. The card holder will assist in keeping the major medical and “Insured” HRA insurance cards in one place. Send adds, changes and terminations to the email address on your groups welcome letter.
Q – I am the HR manager for our company. How do our employees file claims and receive benefits?
A – The employee’s part is Easy! Health care providers will ask for the primary and secondary insurance cards. All the employee needs to do is to show the health care provider their “Insured” HRA insurance card along with their major medical insurance card. The “Insured” HRA pays part of the employee’s deductible directly to the health care provider. Health care providers will normally file the claim since they are going to receive the insurance benefit. If the employee chooses to file the claim, the employee should send the major medical Explanation of Benefits (EOB) and the health care provider’s itemized bill (form UB92 or HCFA 1500) to the insurance company. The address and contact information is listed on the “Insured” HRA insurance card. Claim forms are not required.
Q – I am a health care provider and I don’t understand this insurance plan. What is it?
A – The “Insured” HRA is a secondary insurance plan that is designed to offset an employer’s high deductible major medical plan. Claims should be filed to the “Insured” HRA as a secondary payer claim including the primary payer remittance information. Benefits are paid directly to the provider.
Q – I provide billing services for a health care provider who performs additional medical services within the context of a doctor’s office visit and for a local hospital. How do I bill for services?
A – Submit a secondary payer claim through our clearinghouse i-Plexus or your clearinghouse. The “Insured” HRA is administered by Morgan-White Administrators on behalf four different insurance companies. The Electronic Payer Identification Numbers for each of these payers can be found at www.morganwhite.com and on some insured’s insurance cards. If there are problems submitting claims through our clearing house you can contact the insurance company for assistance or bill the insurance company by mail. Simply mail the Major Medical Remittance Advice and your itemized bill (form HCFA 1500 or UB92) to the insurance company. Claim forms are not required. The address and contact information for the insurance company is on the insurance card.
Q – I am a health care provider and I don’t know what this patient’s benefits are. How do
I find this out?
A – Call the number on the patient’s “Insured” HRA insurance card. We will be glad to assist.
Q – I am a health care provider and there isn’t a complete ID # on the card.
A – All we need is the information on the card; the primary insured’s name and the 4 digit I.D. number.
Q – I am an agent. Is the “Insured” HRA a new concept?
A – The “Insured” HRA was developed over 12 years ago. Over 1600 groups in
26 states are insured by this plan. The sky rocketing cost of group health coverage in the last few years has made the “Insured” HRA more popular than ever. Here are a few examples of what our agent partners have said about our “Insured” HRA plan…
“The best product I have ever sold”
“…revolutionary”
“…I have tried to find a product like this for many years.”
Q – I am an agent. Explain the Insured HRA and what is covered.
A – The “Insured” HRA plan is a secondary medical insurance plan. Combining this product with a high deductible major medical plan frequently saves groups 10% to 20% or more without reducing benefits. Every treatment covered by the major medical plan is an eligible expense under the “Insured” HRA except the professional fee of a physician in a doctor’s office or outpatient facility and outpatient prescription drugs. This becomes a non-issue because many major medical plans provide coverage for the professional fee and outpatient prescription drugs by requiring the insured to pay a copay.
Q – I am an agent. Who is MWG Marketing? Who are the underwriters for the “Insured” HRA?
A – MWG Marketing developed this concept 12 years ago. They are experts in marketing this plan and they are your backdoor marketing department. The “Insured” HRA is underwritten by three Insurance Companies:
Q – I am an agent. Explain your selling strategy?
A – Most employers today are very interested in reducing the cost of their medical coverage. The cost of group health coverage has skyrocketed over the last few years. At the same time the economy has struggled. This sets the stage for our “Insured” HRA plan. Combining this product with a high deductible major medical plan frequently saves groups 10% to 20% or more without reducing benefits.
Q – I am an agent. Why should I show the employer the “Insured” HRA instead of a typical HRA?
A – A Traditional HRA results in employers shouldering all claims risk…and with claims being unknown, cash flow can quickly become a major concern. The “Insured” HRA eliminates all employer financial risk and cash flow concerns, guarantees savings to the penny, and pays brokers full group like commission. The “Insured” HRA is exactly what brokers and employers have been looking for.
Q – I am an agent. What type of group should I be looking for?
A – Groups of 50 or more are an excellent prospect, but you can offer the coverage to employer groups of 5 or more. We accept any group that has major medical coverage with 5 or more enrolled except personal injury attorneys. The higher the group’s major medical rates, the better this concept works. We do not rate up groups because of health issues or high major medical rates. This is one reason the “Insured” HRA works best with groups that have health problems and high rates. If the employee’s major medical renewal rate is $350 or higher there is a good chance that the “Insured” HRA plan will save the employer a significant amount of premium. We suggest that you quote all new groups and all renewal groups, even those that do not receive a rate increase. Why not help every group reduce the cost of their medical coverage?
Q – I am an agent. How important is the high deductible major medical plan? What should I look for?
A – Extremely Important! The key to making this concept work and saving the employer a lot of premium is to drive down the major medical cost as much as possible by finding the “best value” in a high deductible / high coinsurance major medical plan. We recommend combining the “Insured” HRA with a major medical plan with a deductible of $5,000 or more that has a doctor’s office and prescription drug copay. Try to find a plan that drives down the employee renewal rate by $100 or more. Example- If the employee renewal rate is $449, try to find a high deductible plan where the employee rate is $349 or less. The “Insured” HRA is not HSA compatible.
Q – I am an agent. How do I sell this product to prospective clients?
A – Make sure you understand the cost objectives and benefit plan design the employer wants to achieve. Provide MWG Marketing with accurate information on the Quote Request Form so they can run meaningful illustrations. We recommend creating 2 or 3 proposals that fit the employer’s plan design and cost objectives. The proposals make it easy for the employer to see the savings and benefits compared to their current plan and to select the best plan.
Q – I am an agent. What do I need to know before I present the “Insured” HRA to a client?
A – The best way to make sure you are ready to present the “Insured” HRA is to watch the webinar video and the frequently asked questions video on our web site www.premiumsaverplan.com. MWG Marketing will assign a Product Specialist to personally train you and assist you with every quote. Your Product Specialist will be glad to participate in a Go-To-Meeting with you and the employer. They will be glad to train other agents or support personnel in your office.
Q – I am an agent. How do I explain this product to employees?
A – New group and new hire training is very important. We recommend the agent conduct a group meeting to explain the “Insured” HRA and answer questions. Make sure you…..
It is a good idea to leave the power point, extra claims guides and insurance card holders with the employer for use in training new employees or employees that missed the “Insured” HRA meeting. Make sure that all employees in all locations receive this information.
Q – I am an agent. Is there a website where employees, clients and health care providers can visit that explains everything?
A – Go to premiumsaverplan.com. This web site contains a video that explains the “Insured” HRA plan and a video that answers Frequently Asked Questions.
Q – I am an agent. Will the “Insured” HRA cover out-of-network charges?
A – The “Insured” HRA pays the same for in or out-of-network charges. This is an advantage for the insured since most medical plans increase the deductible and coinsurance for out of network charges. The “Insured” HRA does not increase your deductible or co-insurance. We design the “Insured” HRA with a benefit amount to fit in-network risk, not the higher out-of-network risk. Going out of network could result in charges that exceed the “Insured” HRA benefit amount. The insured is always better off going in-network.
Q – I am an agent. How do I design the “Insured” HRA to match the employer’s cost and benefit objectives? What plan designs are available?
A – Make sure you understand the employer’s cost and benefit objectives? You need to determine what deductible and coinsurance levels the employer wants and how much they want to reduce their cost. Most groups will want to maintain their current deductible and coinsurance levels. Some employers will want to raise the employee’s deductible and coinsurance amount in order to increase their savings. A few employers will want to improve their benefits by lowering the employee’s deductible and coinsurance amount even though it means less savings. The “Insured” HRA offers a wide range of plan design options. Employers can design “Insured” HRA plans with employee deductibles from $250 to $3,000, a wide range of coinsurance options and benefit amounts up to $9,500 per insured person.
Q – I am an agent. Can a group have more than one “Insured” HRA plan design?
A – Groups with 10 or more employees can offer their employees 2 plan designs. Groups with 25 or more employees can offer their employees 3 plan designs. We recommend finding the best value in a high deductible major medical plan and then designing 2 or 3 “Insured” HRA plans to fit underneath that match the employer’s cost and benefit objectives.
Q – I am an agent. The Product Specialist told me the “Insured” HRA gives deductible credit for first year groups. What is this and what is the best way to receive credit?
A – All “Insured” HRA plans have a deductible the employee pays before benefits are paid. The employer selects the employee deductible amount. During the first year of the plan the “Insured” HRA gives Deductible Credit for the amount of deductible the insured person has incurred with their major medical carrier prior to the “Insured” HRA effective date. The best way for employees to receive credit is for the agent to send a Deductible Incurred Report from the major medical carrier to the “Insured” HRA insurance company with the initial enrollment.
Q – I am an agent. Why don’t you offer 4th quarter roll over deductible credit and “cap” family deductibles and coinsurances like some of the major medical carriers?
A – The “Insured” HRA is sold with a wide range of major medical carriers and plan designs. We have made great advances with this product, but it does not have every feature of a major medical plan. We will continue to make every effort to make the “Insured” HRA the best product we can deliver to meet the needs of our agents and their groups.
Q – I am an agent. How do I get appointed?
A – Contact your MWG Marketing Product Specialist. They will send you a contracting link or they can send you a contract by email.
Q – I am an agent. How do I get a quote?
A – Simple, no census is required. Just fill out a one page Quote Request form available from MWG Marketing on our web site premiumsaverplan.com. Make sure the information is accurate so that the proposal will be meaningful.
Q – I am an agent. How do I enroll a new group?
A – Easy. We do not require employee applications. Just use the XL spread sheet provided by MWG Marketing to send enrollment information, the completed group application, a copy of the proposal selected and a check for the first month’s premium. Subsequent billing payments can be made by bank draft or check.
Q – I am an agent. What is the best way for the group or for me to communicate with the Insurance Company to insure the administration works smoothly?
A – For day to day issues like billing, policy issue, claims, agent appointment or commission it is best to communicate by email directly to the department that handles that issue. Your Product Specialist will provide you with the departmental email list. If you need special assistance contact our customer service department or your Product Specialist at MWG Marketing.
Q – I am an agent. Are HIPAA forms necessary?
A – The Health Insurance Portability and Accountability Act requires insurance companies to obtain a written authorization from a member prior to releasing any health information to a third party. The insurance company can only share private information with individuals listed on the HIPAA Authorization.
Q – I am an agent. Can I get all of the employees to sign a HIPAA Authorization form electronically at enrollment?
A – HIPAA specifically prohibits anyone from asking for blanket authorizations.
Q – I am an agent. What if my clients need help with a claim issue?
A – If the insured person needs claim assistance, the agent should: