Module 08 — The Brochure Call: Step by Step

YOU:

All right, so I figured what we'd do today is I'd go ahead and share my screen with you. I'm going to go over all the benefits from start to finish, make sure it's a good fit for what we're looking for, and kind of talk next steps from there. So can you see my screen here?

YOU:

All right, so first thing we're going to take a look at here is — this is going to be the main health insurance brochure that we look at here today. First thing you'll notice is that we offer this plan as a fixed benefit health and income protection plan. So we not only offer this as health insurance, but we also call it income protection. The reason we call it income protection is because any unused benefits will actually be paid back to you as a policyholder when it comes to claims. I'll show you some examples as we come through here.

YOU:

Now if we go to the top of our next page here, you'll notice we have a lot of different plan options we can pick and choose from. No matter what levels we choose, they all come with the same $5 million lifetime maximum. So what that means is our policyholders are going to be guaranteed renewable — we're not going to kick the option to claim like a car insurance company might do to you.

YOU:

First thing we have here: your calendar year max benefit per insured person. You can see we have an option of a quarter million, half a million, and a million dollars per person per calendar year. Right now we've got you set on the half a million. The reason we do it this way is just in case — God forbid — let's say you jump on the plan and two months in, end up having a heart attack. Well, let's say you're having a real rough year and just a couple months later you end up coming down with some form of cancer. We just want to make sure you have plenty of money to take care of whatever you need.

YOU:

Next, we have our different benefit levels: Gold Value, Gold Plus, or Gold Preferred — also known as our one unit, two unit, or three unit plan. People always ask what a unit is. I like to tell people it's kind of like a bronze, silver, gold tier. Our Gold Value or one-unit plan is our entry-level plan. Gold Preferred or three-unit is our best plan. The one we're looking at today is going to be our most popular version — the Gold Plus, or two-unit plan. Same one I've got for myself and my family.

YOU:

And then over here under your confinement deductible — these are going to be confinement deductibles only. What that means is our deductibles are only applicable if we stay more than 24 hours in the hospital. So even if we go in at 10am but we're out by 8pm, we're still not paying a deductible. It's only if they keep you more than 24 hours. So you're not paying any kind of crazy deductible for things like doctor visits, prescriptions, outpatient surgery, cancer treatment — there's no deductible there. The deductible we're looking at is $5,000.

YOU:

Next thing we'll take a look at is our First Day Hospital Admission Benefit. What this is, is the insurance company telling us they're going to give us $2,000 just to get us checked into the hospital. A lot of people use this benefit to help pay down or negotiate that deductible. So you can really look at it as more like a $3,000 deductible. The reason they do it this way instead of just saying you have a $3,000 deductible is because this puts a lot more power back into your hands as a policyholder when it comes time to negotiating.

YOU:

Typically what I recommend is that in your hospital stay, someone's either going to come to your room or mail you a bill saying you owe $5,000. You can tell the hospital: "Look, I'll pay $25 payments a month for the next X years" — or — "I'll give you $2,000 in one shot and we call it even." More often than not, we're seeing hospital systems go ahead and negotiate those deductibles down. One of the biggest issues hospitals face right now is actually collecting on deductibles. But worst case, it's really more like having a $3,000 deductible.

YOU:

Next thing we'll look at is your hospital confinement. I tell people to think of this like an all-inclusive resort — because when you pay for an all-inclusive resort, you're paying for the food you're eating and the room you're staying in — your room and board. According to the Kaiser Family Foundation, the national average for hospital confinement is right at $2,800 a day. That's the reason we don't typically go with the value plan — you'd be pretty upset if you paid $3,000 for the deductible and then you're out of pocket an extra $1,300 for every day you're in the hospital. So with the Plus plan, we're paying $3,000 per day. In that same example of them charging $2,800 — not only do we cover your hospital confinement, but that extra $200 left on top would actually be paid back to you as a policyholder. That's how the income protection works.

YOU:

You'll also notice we're paying a little bit more for the first few days — because typically the first few days in the hospital while they're stabilizing you, they charge a little more. And we pay a little bit more for ICU rooms. On average we're seeing ICU range anywhere from $3,200 to $3,300 a day — and we're paying $4,000 for those.

YOU:

Next we have your outpatient hospital or ambulatory surgical center when we're having surgeries performed. Are you familiar with these types of places? Perfect. These are those privately owned freestanding buildings popping up all over the major cities that perform day surgeries. If we go in for a surgery requiring general anesthesia — like a knee or elbow surgery where they put you to sleep — we're going to pay $3,000 for your facility fee. If it's surgery not requiring general anesthesia — local anesthesia, something more minor like a cyst removal — we'll pay $1,500 for those facility fees.

YOU:

Next is your outpatient radiation therapy, chemotherapy, or immunotherapy benefit — all of our cancer treatment. I'll tell people even our value plan will oftentimes have enough coverage here. Good example: my dad had prostate cancer about five or six years ago. When he was going in for treatment, he was going to the most expensive facility in North Texas, right here in Plano — and every day they charged him $700. Even the value plan would have had plenty of coverage. But with the Plus plan, we're paying $1,500 a day to make sure we're getting the best doctors and hospitals no matter where we are.

YOU:

Here's a real one. This client was in Florida, went to Florida Cancer Specialists, and had radiation done in January. Total bill that day was $587. There's a $230.45 discount for being in the PPO network, bringing the charge down to $356.54. Now look at the client's total payable benefit — $2,250. That's actually a Preferred plan client. We paid the provider $356.54 — and the net benefit, or excess indemnity, was $1,893.46. We actually cut that client a check for $1,893.46 for that day of radiation. Over 28 treatments, they got 28 similar checks totaling just shy of $60,000 in overages. Not only was all their cancer treatment completely covered, but the excess $60,000 was paid back to them as policyholders. Does that make sense?

YOU:

Back over here, next is professional services. First is your inpatient healthcare practitioner benefit — actual doctors you see while in the hospital. Your nurses and staff are usually rolled into the confinement charge; doctors typically bill separately and tack on an extra $50 to $100 a day. We're paying $120 for that. Next is the surgical benefit — we pay one times, two times, or three times the current surgical schedule. The schedule the insurance company uses is the Medicare schedule of benefits based in Dallas, Texas — which has the second highest healthcare costs in the nation. So whatever Dallas Medicare would pay for a surgery, we pay double that. Give you an example: if you're going in for a $12,000 surgery and the fee schedule says Medicare pays $6,000 — we pay $12,000 for that same surgery. Surgery is completely covered, and the excess $2,000 would be paid back to you. Same thing for your surgeon assistant and anesthesia.

YOU:

Next we'll look at all of our outpatient benefits. First is your physician benefit. We get a total of 16 office visits per person per calendar year — $120 for the first eight visits. No crazy deductibles to meet first, no copays, no coinsurance — just $120. My own personal example: my doctor typically bills $180 every time I see him. He's in network with the Aetna First Health PPO network, so that $180 comes down to $95. The insurance pays the $95 to the office, and the extra $25 comes back to me as a policyholder. I'm actually making $25 when I see my doctor — versus the $35 copay I was paying on my old Blue Cross plan. If I need to go more than eight times, the plan pays $60. So in that case, insurance gets billed $185, network brings it to $95, we pay $60, and I'd pay $35 at the time of service. Of those 16 visits, if I need to see a chiropractor, the first five visits also pay $120. For therapy visits, we get an additional 16 visits at $60.

YOU:

Next is your radiology benefit for MRI, PET scans, CT scans, nuclear testing — the outpatient version. We're paying $480 for these. Now, one thing I always like to point out: if your doctor recommends any kind of imaging, the best thing to do is just call me. We have our in-house American Ally Advocacy program. One of the bigger functions they do is pre-pricing procedures — surgery, CT scans, MRIs — and they try to help pre-negotiate those services to keep within the benefits. They can also help negotiate bills on the back end.

YOU:

Quick example on that: a couple years ago I was in a car accident in Dallas. My doctor said everything looks good but wanted a CT scan of my brain just to be sure. The place he wanted to send me was going to charge $1,900. I called the advocacy team, told them I'm in Plano and need a brain CT scan. They found a place right around the corner charging $192 for the exact same service. I saved nearly 90% right off the bat, and the scan was completely covered plus I got a little money back. Imaging is one of those things where prices vary wildly from one facility to the next — always call ahead with the advocacy team.

YOU:

Same thing for X-rays, EKGs, ultrasounds, sonograms — we pay $160 for those. Minor surgery at a specialist or physician's office, like a mole removal — $200. Lab work — $80. Both LabCorp and Quest Diagnostics are in the network. 93% of all labs in the US go through one of those two. They both get network discounts first, then we add the $80 on top. In the South I usually recommend Quest — they average 70–75% discounts. LabCorp is better up North. In-office injections like cortisone or allergy shots — $20.

YOU:

Next is your Emergency Room Department benefit. This is one of the really cool benefits on our plan — as far as I know, no other insurance has something like this. In the event you end up in the emergency room, we're going to pay $100 for your facility fee plus an additional $100 for professional services just to get you checked in. So we're paying $200 to get you seen in the ER — and we still don't charge the deductible unless you stay more than 24 hours. The plan also comes with Urgent Care benefits — four visits per person per calendar year at that same $200. CareNow, Concentra, CitraCare, places like that. If you need a fifth or sixth visit, it starts dipping into your regular office visits at the $120 rate.

YOU:

Now there are a couple extra add-ons included in the price I gave you. The first one is the Enhanced Accident Plan. This kicks in an additional $10,000 in ground or air ambulance — stacked on top of the base plan's $500 ground and $1,000 air. So really it's like having $10,500 ground or $11,000 air. My personal favorite benefit on the accident portion is the Accidental Injury Benefit — up to an additional $4,000 for things like a broken bone, needing stitches, a car accident. This pays on top of all the other benefits. The plan also comes with a $100,000 Accidental Death Benefit — like a little life insurance policy. And a $300 a day hospital income benefit for up to 30 days if we're confined from an accident. Plus some more specific benefits like loss of limbs down toward the bottom.

YOU:

Next is your prescription benefits. We're paying $10 for each generic prescription. Most of your generic prescriptions run $4 to $20 — most common blood pressure medication, lisinopril, is $4. Most common Type 2 diabetes medication, metformin, same thing, $4. So $10 should have you covered there. For brand name prescriptions, we pay $20. I always say what your doctor always tells you — if you can get on the generic, get on the generic. Some brand names are extremely expensive. But if you do have a brand name prescription you have to be on, just call me. We work with several pharmaceutical discount programs. I had a guy on Ozempic — $923 a month — we got it down to $50. Had someone's brand name Zoloft, $382 a month, down to $15 direct from the manufacturer. Not saying it works every time, but always worth looking into.

YOU:

Next is preventative care benefits. This is one of two things with a waiting period — 60 days from when the policy starts until we have access. But after that initial 60 days, for mammograms we pay $250. Basic 2D mammograms typically run $100–$150, 3D around $150–$250. Mammograms also fall in the imaging category, so it's always best to call us before scheduling so we can call around and find the best price. Are you currently due for any colonoscopies? Just let me know when you are — we'll go over that benefit. For all other preventative care — physicals, annual lab work — that's covered as well.

YOU:

So to kind of wrap up here — the policy comes with a $5 million lifetime maximum. The reason I bring that up is to say that the policies are guaranteed renewable till you're 65, and we don't jack up your rates like a car insurance company would if you had a major claim.

Then there's going to be the free telehealth. The reason it says free is because it's actually unlimited and doesn't dip into any of your 16 doctor visits. You can use this to call in simple prescriptions if someone is sick, or if you were traveling and needed something, you could use this service as well.

Our plans come with no copays, no coinsurance, and the only time you would have a deductible with us is if you stayed in the hospital for more than 24 hours.

Then we are part of the First Health PPO network, which is one of the largest in the country — but we can search for your doctors in just a moment.

The last thing is going to be the Critical Illness that also comes included with the policies. This is going to be set at $30,000 for the adults and $10,000 per child. This is going to be a check that will be mailed directly to you if you get a heart attack, stroke, or cancer — to help pay for things like your mortgage or medical bills if need be.

YOU:

Let's check your doctors and hospitals. Go to firsthealthlbp.com/LocateProvider/CustomPage — I'll pull that up on my screen right now. Enter your zip code and I can show you what's in network near you. Or give me your doctor's name or hospital and I'll search directly. Who do you see for your primary care?

Note

Benefits pay the same in or out of network — this step is about showing the client they likely have good providers nearby and that the network discount works in their favor.

YOU:

Now what about your prescriptions? Let's check them on GoodRx.com so we know exactly what you'd be paying. Tell me what medications you're taking and I'll look them up right now.

Note

Pull up GoodRx.com. Search the medication. Show the cash pricing at nearby pharmacies. Compare to what they're currently paying. If brand name, mention the pharmaceutical discount program options.

YOU:

So that's everything that I had for you.... was there an effective date that you had in mind?

The Close

"Was there an effective date that you had in mind?" assumes forward momentum — it's not "do you want to sign up?", it's "when do you want to start?" If you've done your job through the call, this is the natural next step, not a pitch.

RESOURCES — Click to Download

Optimum Health Saver Brochure

Enhanced 24-Hour Accident Plan Brochure

Critical Illness Brochure

Specified Disease Brochure

Dental + Vision Brochure

Module 08 Complete

You now have the complete brochure call script. Practice it out loud until it is natural. Proceed to Module 09 for objection handling after the presentation.