Today, we hope to provide you with useful resources. We will discuss supplemental products offered by Allstate. The goal of these products is to give your clients additional support. With these offerings, you can help clients enhance their coverage, so even those with bronze or catastrophic plans can feel like they have a gold plan.

The webinar will be recorded and emailed to you afterward. Flyers for the products Phil will discuss are available in the handouts section on your right. If you miss downloading them, they will also be included in the email. We will have a Q&A session, so feel free to submit questions via chat, send them privately, or wait until the Q&A portions after the slideshow and after Phil walks through the Allstate website and quoting tool.

I’ll hand it off to Phil now.

Thank you, Halle, and thanks to Thomas and the team at URL for putting this together. I also want to thank the agents on the call. For those who have worked with us before, thank you. If you haven’t, I hope you’ll hear something today that encourages you to consider these options for your clients.

We’re here today to talk about our health product, Health Access, and our supplemental products. Supplemental products help people afford to use their health insurance.

All of our products are individually based. We offer group list billing with a minimum of two employees, billed monthly to an employer. Here in Pennsylvania, we have the fixed benefit indemnity plan called Health Access, along with accident, dental, and hospital expense plans to help people use their insurance. For seniors, we offer senior dental and senior indemnity products. We recently launched a guarantee issue senior indemnity plan up to age 74, expected to be approved soon in Pennsylvania.

This year, changes are being driven by potential repeal of enhanced subsidies, stricter income verification, and uncertainty around auto-enrollment from bronze to silver plans and minimum premium responsibilities. Many clients will struggle to afford ACA plans, which is why these supplemental options are important.

The Health Access plan allows clients to use any provider or the network. This permanent health plan covers clients up to age 65. It is a fixed benefit plan (FB), with a preexisting condition exclusion during the first 12 months. After that, preexisting conditions are covered. Rates are guaranteed for three years. This plan has never had rate increases, which is rare in the health plan industry. There may also be premium savings compared to ACA plans.

Health Access is a fixed benefit indemnity plan, also known as a limited benefit plan. It should be sold with supplemental products to create a “circle of protection” for the customer. Clients should not rely on this plan alone, as they would be underinsured. There is no upfront deductible, and the plan pays first in cases of injury or sickness. Benefits start immediately, though preventive services are limited. There is no maximum benefit, but note that Pennsylvania does not offer child-only plans under this product.

Ideal candidates are clients who pay too much for insurance and rarely use it. They can save money and cover future out-of-pocket expenses. Clients with ongoing medical conditions are not a good fit and are better suited for ACA plans.

The plan pays first, unlike major medical insurance, which requires the client to pay first. Supplemental products can pay second if needed.

We offer several benefit levels. The richest plan is the Plus Plan, which pays $2,000 just for a hospital admission, up to three times a year, and $6,000 per day for ICU stays. The plan includes options like Metal Gap, which helps cover out-of-pocket costs under a metallic ACA plan. Guarantee issue products are also available, requiring no more than four health history questions.

Surgery benefits are divided into Tier One (more expensive) and Tier Two (less expensive) procedures, with outpatient surgery covered as well. Additional benefits include anesthesia, outpatient surgical facilities, and reimbursement for hospital visits. Observation stays are covered at $1,500 per day, even if the client is not formally admitted. Ground and air ambulance services are also covered.

Clients can use any provider or the network. In-network visits are generally more cost-effective. First Health Network is comprehensive and includes major centers of excellence like Johns Hopkins, Sloan Kettering, Cleveland Clinic, Mayo Clinic, and MD Anderson.

A drug benefit is available for a $7 monthly upcharge, covering up to 800 generic medications with zero copay, including birth control. Virtual urgent care is included. This benefit covers preexisting conditions immediately, even if the underlying Health Access plan excludes them for the first 12 months.

Clients will receive an ID card with the network logo and an explanation of benefits (EOB) each time a claim is paid. Primary applicants must be 18–64, and children are covered up to age 26. Coverage continues until age 65. Health Access is approved in multiple states that touch Pennsylvania.

Exclusions differ from ACA plans, so clients should read the brochure carefully. The plan is month-to-month, allowing cancellation if clients obtain other insurance, such as employer-sponsored coverage. Coverage can begin any day of the month, and agents can quote 90 days into the future. Payment options include automatic draft or credit card (Visa, MasterCard, Discover). The initial payment can be set before the start date to avoid double payment.

The Allstate Health website provides brochures, flyers, and claim forms for supplemental products. This plan is intended for clients who cannot afford ACA coverage, dislike narrow networks, or are concerned about high out-of-pocket costs. Health Access pays set dollar amounts, allows use of any doctor or hospital, has no lifetime limits, and includes guarantee issue, Metal Gap, and comprehensive plan options.

Agents should note that clients have limited options if ACA coverage is unaffordable: religious sharing plans, no insurance, or one of these supplemental plans. Claims transparency is important; clients should understand the process and avoid surprises, which is a key advantage of Health Access.

So, first things first, because we don’t cover preexisting conditions in the first 12 months, every time your customer submits a claim, we’re going to be requesting doctor records. And if you’ve ever sold life insurance, you know these things don’t come back overnight. Here’s how it works: we get notified of the claim, and we mail or email your customer a letter asking them to provide the physicians they’ve seen and medications they’ve taken over a certain period—usually about 12 months, maybe a bit longer. If they don’t return that letter, we’re basically stuck; we can’t pay the claim, and they could end up in collections. That’s why it’s super important to tell customers upfront what to expect. If you don’t, your phone will ring with someone upset, thinking their claim was denied, when really they just never responded.

Alright, moving on to our supplemental products, I think this will make a lot more sense once we look at a sample quote. These products can be attached to other plans, but everything I’m talking about can also stand alone. You could pair Trio Med with an access plan, or even with an ACA plan sold through Penny Marketplace. What’s cool about Trio Med is that it gives your customer a per-accident benefit and an equal amount of critical illness benefit. And the plan comes with an AD&D benefit as well. Everything is guarantee issue, so if your customer breathes air and has a credit card, they can get it.

Here’s how Trio Med works. There are three levels of benefit. Accident medical expense (ME) and critical illness (CI) are equal. So let’s say your customer buys a $5,000 per accident benefit. That means they get $5,000 every time they have a covered accident. They would also get $5,000 if they’re diagnosed with one of 15 critical illnesses, which are divided into three categories. So, in a really unlucky month, they could get $5,000 for a cancer diagnosis, another $5,000 if they have a stroke, and another $5,000 for a heart attack. That’s money they could use for out-of-pocket costs, or to have loved ones stay nearby during treatment.

There are higher critical illness levels too, and while right now they’re simplify issue, by this Friday everything is guarantee issue. One important note: accident claims aren’t meant to make money. If you buy a $5,000 benefit and your accident only costs $4,000, we’ll pay the lower amount after a $250 deductible. Customers just need to seek treatment within 30 days of the accident, with follow-up care within 26 weeks. This product is great for people worried about hitting their out-of-pocket on an ACA plan, or for families with active kids in high school sports who might be prone to injuries.

Trio Med reimbursement works like this: it doesn’t coordinate with other accident plans. The customer gets the lesser of the bill charges, the network discounted rate (we often use Highmark as an example), or usual and customary charges. Most people are happy with this; I don’t get calls about underpaid claims. The critical illness benefit pays upon diagnosis, has no waiting period, and no network restrictions. The primary gets 100% of the benefit, spouses 50%, and children 25%. Eligibility ages are similar to our fixed benefit indemnity plan. There are some limitations and exclusions, like intercollegiate sports, but interscholastic (high school or younger) sports injuries are covered.

We also have Hospital Expense Protection. This requires answering three health questions, so it’s not guarantee issue. Plan C, the richest option, pays $5,000 once per year plus $150 per day for the first 10 days of hospitalization, whether sickness or injury. There are add-ons for ICU, office visits, radiology, lab work, and an air ambulance benefit. It can work as a standalone or as an attachment to a fixed indemnity or ACA plan.

Dental plans are copay-based and use the Aetna network nationwide. Some plans have a $3,000 annual maximum and a six-month wait for major services, while others have no waiting period or max. Using in-network providers is critical; out-of-network reimbursement is much lower. Vision plans are offered through Avis and Guardian Life and accepted at most major chains.

For pricing and claims, accident and Trio Med plans reimburse based on bills or network rates. If a customer has no primary insurance, they just submit an itemized bill, and we calculate from there. Short-term medical and Hospital Expense Protection plans exclude certain preexisting conditions, like heart attacks, stroke, cancer, or diabetes. The products are month-to-month, can be added or canceled with a few days’ notice, and some renew automatically until age 65 or beyond.

We also offer inexpensive life insurance—simplify issue, 10-year term with a five-year rate guarantee. For example, a 38-year-old could get $100,000 of coverage for $28 a month. This pairs nicely with a hospital wrap, prescription benefits, and the association membership.

The quoting website is really straightforward. You go through the back office, click “Quote & Enroll,” and you can quote single or multiple products. Customers sign via PIN text or e-signature, which takes about a minute. In our example, a 38-year-old female could bundle hospital protection, Trio Med, dental, vision, prescription coverage, association membership, and life insurance for around $389 a month.

A few important things from questions we got during the session: dental allowances can be used in or out of network, but out-of-network benefits spend faster; tiered benefits automatically apply based on the procedure; claim payments go to the provider or customer depending on who submits; and if you’re unsure about preexisting conditions, sometimes it’s better to go with an ACA plan to make sure the customer has the right coverage.

In short, these products give flexibility, guarantee issue options, and ways to fill coverage gaps. Customers can pick and choose what fits their needs, and agents should make sure expectations are clear upfront so there’s no confusion when claims come in.