Hello my name is ____ and I am calling on behalf of (company) because you are now eligible for health benefits with them! Do you have a few minutes to go over what your benefits are, or do you need to schedule some time? 

(now is good) ok great,  I just need to let you know that this call is recorded. It acts as your verification for what you decided to opt-in or out of.  1st l need to verify your information on the enrollment platform.

(schedule time)  If they need to schedule time, use Meet Paddy to schedule A day and the time that you will be available or someone else on the team is for a callback.

Employees may or may not have been informed of HealthWorx, if you know there has been communication to them simply see if they need a refresher. 

Eligibility

If they are not Medicare eligible and earn at least 464 a paycheck they are eligible for this benefit and will automatically be enrolled.

Do they have health insurance?

If so they will still benefit from the plan and it will not interfere with their existing coverage no matter what type it is. If they do not then this plan is even more beneficial.

Plan summary

Low Co-pays for Primary, Specialist & Urgent Care visits, discounts on prescriptions preventative care and telemedicine covered at 100%, the whole family is able to utilize telemedicine and prescription discounts without being dependants. There’s also a wellness program including Health Risk Assessments, Chronic Condition Management, Nutrition Planning, Individual consultations as well as group sessions.A hospital benefit that gives $2000 if admitted to the hospital, a built in Accident plan pays them directly for any injuries you may have. AND a $25,000 TERM life insurance that lasts until age 65 or when they leave their (Employer).

How their Insurance plan works with it

If their copays are higher with their insurance then they can use this plan, if they are admitted to the hospital, the hospital funds can help with out of pocket costs like deductibles.

Do they get federal and state taxes taken out of their paycheck?

If yes: Their paycheck increases 

If no: Medicare and social security still will be. So they’ll be seeing some savings and still have access to the great benefits of HealthWorx for little to no cost. 

How it works is the cost of the plan is $464 and this will be deducted BEFORE taxes are taken out. So they are paying taxes on a lower amount, then after taxes on the same check a tax free health subsidy of $424 will be added back onto their check.Since less taxes are taken out their take home pay is increased. Does that make sense? If needed see example.

They will be receiving an email directly from Worxsitehr that includes a welcome kit including your Digital ID Card that they can use at ANY provider since they are not confined to a network!

Example:

Let’s say their check is $1,000, before taxes $500 is deducted, so now they are only paying taxes on $500 instead of a $1,000. Then on the same check, after taxes $460 is added back onto their check. So there’s about a $40 difference but their tax savings will be greater than that so it results in an increase in their take-home pay.

With three unique plans available to choose from, you should be able to find a plan that works for you. To find more about your plans, view the benefits guide.

Providence Advantage Premium

myprovidence.com

Are they familiar with how copays, deductibles or max out of pockets work?

Do they currently have health insurance?

How it works:

Copays are a fixed dollar amount that is paid to a health care provider for a covered service at the time care is provided. Generally if there is a copay, paying any additional towards the deductible does not apply. 

A deductible is the dollar amount that an individual or a family pays for covered services before the plan pays any benefits in that calendar year. After the deductible is met then coinsurance kicks in, coinsurance pays a percentage of the covered services until the out of pocket max is met.

An out of pocket max is the total amount that is paid from the individual or a family during a calendar year. Once the out of pocket max is met, the insurance then pays for all other covered services at 100%.

Does that make sense to them?If more than one plan is offered what type of coverage are they looking for? i.e. healthy more concerned with cost savings vs. unhealthy need great coverage.

Plan Summary

Copays: $10 for virtual primary & Mental health care

$20 for primary care & naturopath

$40 for Specialists/urgent care

$20 for Mental health, Chiropractic & acupuncture visits

Prenatal office visits are covered in full

Deductible: $5,500 if 2 or more are enrolled then $11,000

Out of pocket max: $7,500 if 2 or more are enrolled then $15,000

In network Coinsurance: 20%

Out of network Coinsurance: 40% but if the provider charges more than what is reasonable then any billing charges above that may be applied

Network Info

Are they concerned about keeping their current doctor? Would they like assistance with seeing if they are in network?

ProvidenceHealthPlan.com/findaprovider or call 1-800-878-4445 for a list of network providers.

Prescription Summary

Most common generic drugs $0-$10 copay

Some generic but mostly brand names $40-$75 copay

Speciality drugs are only covered through participating specialty pharmacies for 50% of the drug cost up to $200For a list of all participating pharmacies visit ProvidenceHealthPlan.com

Vision Summary

Vsp Choice network 800-877-7195

Are they using vision currently? Want details? 

Adult annual exams- $10

Lenses- Covered in full unless progressive then a $50 copay

Frames for adults- $130 allowance then 20% discount off balance

Contacts- $130 allowance

Vision benefits for children under the age of 19

Annual exam - Covered in full

Frames - Otis & Piper frames covered in full or $150 allowance 

Contacts- Covered in full

Providence Advantage Plus

myprovidence.com

Plan Summary

Copays: 

$10 for virtual primary & mental health care

$75 for primary care & naturopath

$100 for Specialists/urgent care

$75 for Mental health, Chiropractic & acupuncture visits

Prenatal office visits are covered in full

Deductible: $8,000 if 2 or more are enrolled then $16,000

Out of pocket max: $9,100 if 2 or more are enrolled then $18,200

In network Coinsurance: 50%

Out of network Coinsurance: 50% but if the provider charges more than what is reasonable then any billing charges above that may be applied

Network Info

Are they concerned about keeping their current doctor? Would they like assistance with seeing if they are in network?

ProvidenceHealthPlan.com/findaprovider or call 1-800-878-4445 for a list of network providers.

Prescription and Vision benefits are identical across all plans, see the summary of these in the providence advantage premium script.

Providence Connect - Narrowest Network

myprovidence.com

Plan Summary

Copays: 

$10 for virtual primary & mental health care

$50 for primary care & naturopath

$100 for Specialists/urgent care

$100 for Mental health, Chiropractic & acupuncture visits

Prenatal office visits are covered in full

Labs & X-rays:50% after deductible is met

Deductible:$5,500 if 2 or more are enrolled then $11,000

Out of pocket max:$9,100 if 2 or more are enrolled then $18,200

In network Coinsurance:50%

Out of network Coinsurance:50% but if the provider charges more than what is reasonable then any billing charges above that may be applied

Network Info

Are they concerned about keeping their current doctor? Would they like assistance with seeing if they are in network?

ProvidenceHealthPlan.com/findaprovider or call 1-800-878-4445 for a list of network providers.

Prescription Summary

Most common generic drugs $0-$10 copay

Some generic but mostly brand names $40-$75 copay

Speciality drugs are only covered through participating specialty pharmacies for 50% of the drug cost up to $200

For a list of all participating pharmacies visit ProvidenceHealthPlan.com

Prescription and Vision benefits are identical across all plans, see the summary of these in the providence advantage premium script.

Principal Dental Insurance

Are they in need of dental insurance?

Will they utilize major services?

There are 2 plans to choose from a low plan and a high plan.

The low plan has a $50 deductible, a $750 annual maximum benefit. It pays 100% of preventative services, 80% for basic but Major services are not covered.

The High plan has a $50 deductible $1500 annual maximum benefit. It pays 100% of preventative services, 80% for basic and 50% for Major services.

Examples of basic and major services:

Basic: Fillings, simple tooth extractions

Major: Periodontal cleaning, crowns, dentures

Willamette Dental

The Willamette Dental plan requires you to access care at a Willamette Dental Group facility. This plan does not limit you to an annual benefit maximum like most traditional dental plans. Services at a Willamette Dental Group facility are covered at a flat copay amount so you know exactly what your cost will be, for instance for all preventative services there is a $20 copay, a fill is $25 copay and a crown is a $350 copay. There is Orthodontic Coverage available for adults and children too!NOTE, ON THE SPOT IF SOMEONE IS UNSURE IF THERE IS A FACILITY IN THEIR AREA YOU CAN ALSO GOOGLE WILLAMETTE DENTAL FACILITIES IN THEIR CITY

How comfortable are you with handling surprise medical expenses or if you suddenly need to go to the doctor? 

Comfortable - GREAT - With these Benefits you’ll be able to use other people’s money to help reduce your out of pocket expenses so you can KEEP what’s yours…

Not Comfortable - I hear you! With these benefits, you’ll have a low cost way to protect your hard earned money….So the next few benefits we’ll be reviewing with you can help you with situations like these - putting money back in YOUR pocket when a medical need takes place. With Wellfleet, you’ll enjoy a low cost benefit, hassle-free claims, Wellfleet Pays YOU so you have cash on hand to take care of your needs.

Are they familiar with how an accident benefit works?

How it works:

The companies name is Wellfleet, and they work directly with them, not hospitals or doctors. Wellfleet pays them set benefit amounts directly for any injuries big or small. The claims process is very easy - we are also here to help! Are they interested?

Plan summary:

If they have an injury and are seen for it they will be paid. For example: You tweak an ankle really bad and you’re not sure it’s broken so you go to urgent care, get an x-ray, get sent home with crutches and have a follow-up visit. You didn’t end up breaking your ankle but just for getting some needed care you will be paid a total of $650 with this plan.

In addition the plan comes with a $50 wellness benefit, just for having a preventative service done like an annual physical, well child visits, mammograms.

How does it pair well with their current insurance?

This amount would completely cover the copays for the visits and leave plenty of funds left over to help with any out of pocket expenses incurred for the x-ray and crutches!

Do they have any family history of critical illnesses?

How it works:

Wellfleet will pay them directly a lump sum benefit when diagnosed with something major like cancer, heart attack, stroke. Are they interested?

Plan summary:

This product is guaranteed issue and pays a lump sum benefit of up to $30K - this means that Wellfleet doesn’t need to ask any questions about their health. It does have a pre-existing clause which means if there is a condition that is being advised or treated for in the past 12 months, and that condition plays a part in the Critical illness, then the benefits will not be paid out unless the plan is in force for 12 months treatment free.

Plan Details:

Health Screen rider is included, pays $50 a year for over 50 types of health screenings like biopsys, immunizations, and blood tests.

How it works with their plan:

If something major like this were to happen treatment would likely begin right away. This plan pays as soon as you are diagnosed which would help pay your out of pocket max, relieving the financial burden to concentrate on healing.

Are they in need of any life insurance?

Do they know how life insurance works?

How it works:

Guaranteed issue Term life insurance pays out a death benefit in the amount to a beneficiary in the event of their death. The length of the term is it’s expiration date, for instance if it’s a 10 year term then the policy would expire after it is in force for 10 years.

Plan summary (20 yr up to age 65) (10 yr up to age 75):

Guaranteed issue means no health questions and benefit amount available to choose from is anywhere from $10k to $100k. With HealthWorx (if they opted in), they already have a small TERM life insurance plan that can help with burial expenses, but if more coverage is needed this would be a viable option. Would they like a quote?

Plan details:

Eligibility requirements: 18-75 for the 10 year term and up to age 65 for the 20 yr

Riders Included: acceleration benefit, which allows a portion of the policy amount to be used, if diagnosed with a terminal illness.

Spouses or children allowed: yes up to 15k for spouse and 10k for children

Review their plans on the summary page and read the acknowledgment box, the ask for permission to electronically sign.