HealthValu

When one size does not fit all.

Affordable Health Insurance Options for Direct Wholesale Network Members

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SBU is pleased to offer a comprehensive medical benefits package to the Pastors and staff of Direct Wholesale Network, LLC.
SBU HealthValu Plan No pre-existing condition exclusions Guaranteed issue Unlimited lifetime benefits No deductible for hospital benefits Primary care physician copay $10 Specialist office visit copay $10 PPO plan Utilizes national PHCS Network Underwritten by ACE American Insurance Company: an A+ rated company Catstrophic Major Medical Wrap Up to $1 million per year in coverage Unlimited lifetime benefits

SBU also offers the following ancillary benefits to the Pastors and staff of the Direct Wholesale Network, LLC.
Dental Vision Life & Disability Insurance Long Term Care Medicare Supplemental & Medicare Advantage Plans

SBU HealthValu vs. BlueCross BlueShield

SBU HealthValu
$507 per Pastor: $399 ACE HealthValu + $108 Companion Life Catastrophic Major Medical Wrap

BlueCross BlueShield
$905.31 per Pastor

PPO Network: PHCS

PPO Network: BCBS

Fully underwritten, no medical questions asked Deductible: $0 Coinsurance: 100% of plan benefits Copay: $10 Unlimited lifetime maximum Number of physicians nationally: 568,000 Our Plan provides First Dollar coverage, and the Catastrophic Major Medical Wrap is what gives us the unlimited lifetime maximum

Without medical underwriting, rates could increase due to existing health issues Deductible: $1000 Coinsurance: 90% of negotiated rate Copay: $20 Unlimited lifetime maximum Number of physicians nationally: 500,000 The insured has to pay $1000 out-of-pocket plus 10% coinsurance ($3000 total) to be covered at 100%

Summary For an example group of 786 members, our SBU HealthValu plan provides savings of $313,072 per month or $3,756,864 per year over BlueCross BlueShield plans.

Difference in Exclusions
SBU HealthValu Exclusions BlueCross BlueShield Exclusions

Substance Abuse and Mental Health Suicide

Covered Covered

Every medical plan has exclusions. Typically, most people dont realize the limitations. We have compared the ACE exclusions to BCBS, and we feel that the Substance Abuse, Mental Health, and Suicide exclusions werent a major factor for Direct Wholesale Network.

How much coverage do my employees need?

In a perfect world, your employees would have 100% coverage for all their medical expenses. But within the reality of todays world, the question is how much you and they can afford. Lets look at some statistics.

85% of insured individuals incur less than $6,000 per year in medical expenses. Less than 5% of insured individuals incur over $16,000 per year in medical expenses. Concentration of Health Care Spending in the U.S. Population, 2007
Percent of Total Health Care Spending
100% 80% 60% 40% 20% 0% Top 1% Top 5% Top 10% Top 15% Top 20% Top 50% Bottom 50%
( $44,482) ( $15,806) ( $8,716) ( $5,798) ( $4,064) ( $786) (<$786)

Percent of Population, Ranked by Health Care Spending

Note: Dollar amounts in parentheses are the annual expenses per person in each percentile. Population is the civilian non-institutionalized population, including those without any health care spending. Health care spending is total payments from all the sources (including direct payments from individuals, private insurance, Medicare, Medicaid, and miscellaneous other sources) to hospitals, physicians, other providers (including dental care), and pharmacies; health insurance premiums are not included.

Source: Kaiser Family Foundation calculations using data from the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2007.
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Comparing Your Insurance Plan Options

Typical Coverage by Insurance Plan Type

Comprehensive $16K
95% of Insureds incur less than $16,000 in Medical Expenses

Medical Expenses

$6K $4K $1K First Dollar HealthValu Combining ACE & Companion Life $250 High Deductible Plan $1,000 ded

85% of Insureds incur less than $6,000 in Medical Expenses

70% of Insureds incur less than $2,000 in Medical Expenses

Types of Insurance Plans

Key Employee Out-of-Pocket Expenses Expenses covered by Insurance Plan

Source: Kaiser Family Foundation calculations using data from the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2007.
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How HealthValu Pays

Illustrative Claim Scenarios (HealthValu Advantage100 Plan)
Low Annual Utilization
HealthValu Advantage100 4 Physicians Visits - $125 each 1 Lab workup - $75 each* Class I 2 Generic Prescriptions 2 Brand Prescriptions - $75 each 1 Emergency room visit - $1,000 each* Annual total Medical Cost Employee Pays $40 $0 $ 20 $40 $0 $1745 $100
$1745 $100

Medical Expenses $1745 Employee Pays $100

Moderate Annual Utilization

HealthValu Advantage100 6 Physicians Visits - $125 each 1 Lab workup - $75 each* Class I 6 Generic Prescriptions 6 Brand Prescriptions - $75 each 1 Emergency room visit - $1,000 each* 1 Broken nger (Dr Ofce) - $3000 each* Annual total Medical Cost Employee Pays $60 $0 $ 60 $150 $0 $600 $5,335 $870

Medical Expenses $5,335 Employee Pays $870

$870 $5,335

Major Annual Utilization

HealthValu Advantage100 6 Physicians Visits - $125 each 1 Lab workup - $75 each* Class I 6 Generic Prescriptions 6 Brand Prescriptions - $75 each 1 Emergency room visit - $1,000 each* 1 Broken nger (Dr Ofce) - $3,000 each* Five day hospitalization - With three days in ICU and Surgery Performed (Total charge $60,000 PPO discounted rate $36,000)* Annual total Medial Cost Employee Pays $60 $0 $ 60 $150 $0 $600 $0 $65,335 $870

Medical Expenses $65,335 Employee Pays $870

$870

$65,335

If the hospitalization was the result of a Critical Illness as described, the employee would receive $5,000 cash to offset the remaining bills plus living expenses.

*Charges repriced as in-network.

Catastrophic Major Medical Wrap

How does it work?
Companion Catastrophic Major Medical Wrap insurance will provide the major medical wrap coverage which ensures that any claim that reaches $100k in a single year is covered at 100% up to $1 million per year, with unlimited lifetime coverage.

How much does it cost?

The cost of the ACE HealthValu plan is $399 per pastor per month, and the Companion Catastrophic Major Medical Wrap is an additional $108 per per pastor per month, bringing the monthly total to $507 per pastor. There is a 1% chance that a pastor or dependent will have a claim that exceeds $100k in one year. The Catastrophic Major Medical Wrap will cover the cost of that claim at 100% up to $1 million per year, with an unlimited lifetime benefit.

How does it act like Major Medical?

The Catastrophic Major Medical Wrap makes the ACE HealthValu plan a creditable major medical plan like any other (such as BlueCross BlueShield).
$1 million

Medical Expenses

Key ACE HealthValu

$100,000

Catastrophic Major Medical Wrap

Summary
This program will save an estimated $3,756,864 per year for an example group of 786 members. Over a 5-year period, this program could save that example group $18,784,320, making it a true legacy program.

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