National General Group Health Options National With General

National General Group Health Options National. With General Benefits Solutions Gordon Marketing Self-funded Program Big-business benefits for the small to mid-size business Employer

Agenda: Who is National General? Self Funding National Footprint Reference Based Pricing Underwriting and Retention 51+

Introduction: • Donald Worrall • • District Sales Manager (Milwaukee) NSM for 10 years Milwaukee Houston Milwaukee Office Handles: Wisconsin, Iowa, Minnesota, North/South Dakota, and our MGA channel

National General Overview: § $5+ billion of 2019 GWP § “A-” rating from A. M. Best § 8, 500+ employees § § § 49, 900 independent A&H agents & brokers are contracted nationally P&C segment includes: Auto, Home, Commercial Vehicle A&H segment includes: Small Group Self Funding and Individual Medical Solutions Consistent 20% Growth § Higher in A&H §

Our History We have a long track record of success • Northstar Marketing can trace our roots back to 1896 • Time Insurance (1892) John Alden Fortis Assurant Health Nat Gen • Marketing small group self-funded plans for over 15 years • Started in Massachusetts, Washington, Colorado

Growth of Level Funded Block 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 12/31/2016 12/31/2017 12/31/2018 # of Groups Today

What its like to work with us! New Business Sales • Dedicated Sales Professionals that are IN OFFICE • • • Sales Strategies and Product Updates Quote Generation and Plan Changes Handhold your groups through the underwriting process Negotiation for best possible pricing Assistance with final submission paperwork 24 -48 Hour Quote Turnaround Policy 48 Hour Underwriting Turnaround Time 3 -5 Business Days for Underwriting Approval 3 -5 Days for Group Activation (ID Cards)

Self Funding for Small Groups

Self-Funding Overview Get out of the ACA • Self-Funding follows federal ERISA guidelines, which govern stop loss insurance vs state regs which govern health insurance • Self Funding vs Level Funding • They are, at the core, the same product. Just funded differently. • SF – There are fixed costs (admin/stop loss) and variable costs (claims) Hard to predict cash flow, especially in smaller groups. • LF – Monthly cost is the same, regardless of claims activity • Because Self Funding is Stop Loss Insurance, we are able to underwrite. • Community Rating • Low-Risk Groups pay too much • High-Risk Groups pay too little • Majority of groups are not high risk – think the 80/20 rule • Once implemented, a Level Funded Group and a Fully Insured Group operate the same!

The Mechanics of Our Quote Annualized Claims Fund 4 -Tier Composite Rates Fixed Cost “Max Funded” for 12 months Maximum/Total Cost

Unique Program Features Group Size: • • Most Markets – 2 -400 Depending on State • 5 -400 • 51+ or 101+ Product Options: • • • Traditional Advantage Reference Based Pricing Network Options: • • • Aetna Signature Administrators Cigna OAP A few local network options Participation: • • 50% of eligible OR 75% after valid waivers For an Additional Cost: 25% of eligible OR 50% after valid waivers

Unique Program Features Industry Agnostic: • • We will write ANY type of group with an Employer/Employee Relationship Including Non-ERISA groups; Churches, Schools, Municipalities Integrated HRA Capabilities: Free COBRA Admin and POP Plans: Niche Markets: • • • 1099 s Allowed (no restrictions) Carve Outs Allowed Multi-Location Specialty Aggressive Commissions: • • Comp starts at 7% for traditional, 8% for RBP Always flexible! (go up or down for a 1: 1 reflection on premium) Custom Plan Designs: • Maybe our #1 differentiator!

Custom Plan Designs • Deductible options range from $500 to $7900 • Platform Options • Coinsurance options: 100%, 90%, 80%, 70% and 50%* (not all networks) • Network Options • ER copay options • Out of Pocket Options • • Multiple office-visit copay options ($35/$40/$60) First-dollar diagnostic x-ray and lab options • Spec Options • Prescription Copay Options 100, 000 different potential options. • $6, 500 -$100, 000 • Sales sets this

Product Platforms

Product Platforms • Traditional (All Markets) • Aetna and Cigna OAP PPO Networks • In and Out-of-Network Coverage • Typically 20 -50% below fully insured ACA (heavily market dependent), prior to medical underwriting • Advantage (All Markets) • Same network options as traditional, but no OON coverage (-5% to -7% vs traditional) • Core Value (39 states) • No networks with this plan. Reimbursements based on a % of Medicare (-15 to -30% vs traditional)

Reference-Based Pricing: Core Value

What is Reference Based Pricing (RBP) § RBP uses Medicare reimbursement rates as a reference § Payment is consistent regardless of what the doctor or facility charges § The amount we reimburse providers is call the Maximum Allowable Amount (MAA) § Because reimbursements are based on Medicare, rather than pre-negotiated discounts, there are NO NETWORKS associated with this plan. § Go anywhere!

Balance Billing and the Member Advocacy Program

Balance Billing • Most providers accept our payment, but…. There may be balance billing • If this happens, the member should contact our Member Advocacy Team (MAT) • Once notified, the MAT follows this procedure; 1) Call the provider and try to get them to accept payment. 2) Attempt to negotiate the price down 3) Ultimately, pay the balance bill • MAT will also assist with; • • • Finding friends of the program Answer benefit questions Claim status updates Billing Questions Facilitate provider negotiations in cases of balance billing

Balance Billing EOB Insert

Underwriting and Account Management

Underwriting Practices <51 Enrolled: • For groups of <51 enrolling, we require Individual Medical Applications • • Nat Gen App Preferred Online Apps Accepted Include; • Formfire, Easy. App, Ease. Central, Nat Gen Proprietary • Rates are based on; • • • Demographics Location Industry/SIC Plan Design Health Status If any of these change prior to enrollment, the rates will change!

Underwriting Specifics: Important to know, underwriting in group is different than in IM/STM. We’re pricing for risk, not excluding it. • NO PRE-X in Nat Gen Group Plans. • Rating for known conditions (start inexpensive and increase price based on risk, like the “old days”) • How do you know a group is “healthy”? Generally, you don’t! Get a quote from us first! Groups normally need to see the rates to fill out apps. • Don’t do too much field underwriting yourself, ask your rep! • Low Risk Conditions: No or Minimal Rating • • HBP, Cholesterol, GERD, Acne, Depression, Allergies, Generous Build Chart, Smoking (no rating) • Medium Risk Conditions: It Depends! • Pregnancy, Diabetes, Previous Cancers (could be low/no risk too), Some Heart Conditions • High Risk Conditions: High Rating or Declines • • Hep C, Ongoing Cancers, Transplants, AIDS, MS Injectable Meds • Humira, Enbrel, Copaxone

Account Management Provide Superior Service Work with You to Retain Business +

1 Allied Portal Encourage Employers to Use the Allied Portal View the following: • Plan Information and Documents (SPD, SBCs, ID Cards etc) • Eligibility: Search and verify employee information and plan selection • Reporting Monthly Invoices Claim Summary Report (claim detail by member) Census Report Claim Fund Summary Report • Search Providers and Obtain Drug Formulary

Call the Account Support Team 2 Have a Question – Please Call or Email!! Staffed to handle service related inquiries: • • Billing Eligibility Claims Reporting and Fees Call 888 -659 -1959 or email ngbsselffunded@ngic. com Encourage Members to Call Allied for Claims and Benefit Questions

Dedicated Account Manager 3 Reissues Work with you to retain business • Explain Increase • Review Census Changes • Provide options, if applicable • Determine if rate relief is available • Provide support in presenting to the employer Service Escalations • Routed to AM from Inbound team when appropriate

Online Underwriting w/ Fitness Tracker • Takes away burden of paper apps • Easy process – do it on a computer or smart phone – Happy to set up a demo for your agency • Up to a 5% credit on full premium if 100% of members connect their fitness tracker (Fitbit/Garmin/Apple. . etc) – First in industry to try this – Trackable fitness a data point of underwriting risk?

Quote and Sales Process <51 Enrolling

Quoting – What do we need? <51 Enrolling: • Census • Group Information (Name/Zip) • Plan Design or Renewal – if possible • Quote Everything! Don’t pick and choose. • Groups won’t fill out apps, and they likely won’t be “interested” without seeing the quote first.

Prescreens <51 Enrolling: - IMQs Always Required - Typically a 48 hour turnaround time - We may come back with questions on ambiguous or incomplete information - The more information, the better Strategy: - Even if underwriting isn’t asking, for groups we’re competitive on, we may ask questions on information not provided, in order to get the best rate possible. - IE; individual writes that they had a heart attack. We may come back and ask if they had stents or a bypass. This results in a lower (and more accurate) rate. - Please share renewal/competitor info, our actuaries will review to see if we can provide a better offer.

Submission • Once we have a firm prescreen, rates are locked in (subject to census, plan, or effective date changes) • Submission Checklist; • ACH or Check (ACH preferred) • Signed Quote • Master App • Self Funded Docs Signed • NY Pool Forms • 3 -5 day turnaround to approve a group • Will accept a submission 3 business days after the effective date. • 3 -5 days after approval, Temp ID cards are available

Our Value Proposition: Dedicated Sales and Post-Sale Service Uniquely positioned to assist inexperienced agents More experience than our competition Move your block, we’ll pay you more, and save many of your clients significant dollars. • Niche Markets • Robust online portal • Unique underwriting methodology • •

Questions? Donald Worrall District Sales Manager 414. 999. 2000 Donald. Worrall@NGIC. com