2. Purple Cow 2012
Value Proposition
1
More VALUE…
Purple Cow gives you all 3 of today’s major
employee benefits in 1 package, designed
to provide multiple layers of protection:
Group Life: P50,000 – P1,000,000
Group Accident: P50,000 – P1,000,000
Group Health: P10,000 – P200,000
You can get MORE benefits for ALL of your staff
3. Purple Cow 2012
EB Primer
3
What are the most common EB?
• Paid vacations, 75%
• Health insurance, 61%
• Paid sick leave, 59%
• Disability insurance, 41%
• Education reimbursement, 39%
• Pension plan, 30%
• Life insurance, 29%
• Dental insurance, 24%
- Small Business Poll on Compensating Employees (NFIB, US: 2003)
All 4 insurance benefits are offered by Purple Cow
4. Purple Cow 2012
EB Primer
4
What makes Insurance ‘sulit?’
• LIFE INSURANCE provides you with instant cash
in the event of death or total and permanent disability;
(.25% of population between 18-65)
• ACCIDENT INSURANCE provides you with instant
cash in the event of accidental death or disablement;
(10% of inpatient & outpatient cases)
• HEALTH INSURANCE (medical insurance or HMO)
protects you from losing money in the event of sickness
or accident. (10% inpatient / 300% outpatient)
Insurance saves you from losing your money
5. Purple Cow 2012
Benefits
1
3 Major Employee Benefits (per IC)
LIFE – ACCIDENT – HEALTH
LIFE (worldwide) HEALTH (nationwide)
1. LIFE INSURANCE 3. MEDICAL HMO
* Terminal Illness Rider * 8,205 affil. MD, 383 hospitals, 428 clinics
* Total & Perm. Disability Income
4. Opt. DENTAL HMO
ACCIDENT (worldwide) * Basic 10: 790 dentists, 659 clinics
2. PERSONAL ACCIDENT 5. Opt. Annual Physical Exam
a. Accidental Death * Basic 5: mobile or clinic
* Murder
b. Accidental Disablement
6. Health & Wellness Program
* up to 2x/yr; tailored to utilization report
* Assault
6. Purple Cow 2012
Benefits
2
Benefits Summary
LIFE – ACCIDENT – HEALTH
1. Life = 5x MBL 13. Access to Big 5 Hospitals & Healthway
2. Terminal Illness = up to 50% of 5x MBL 14. 100% Pre-Existing Conditions coverage
3. Total & Perm. Disability Income = 5x MBL 15. 100% Congenital Conditions coverage
4. Accidental Death = 5x MBL 16. 100% Special Procedures coverage
5. Murder = 5x MBL 17. Benefits on top of Philhealth
6. Accidental Disablement = __% of 5x MBL 18. Pooled Employee utilization
7. Assault = __% of 5x MBL 19. Separate Dependent utilization
8. Medical = HMO buffet of benefits 20. Opt. Dental = HMO buffet of benefits
9. Combined inpatient & outpatient limits 21. Opt. APE = choice of mobile or clinic
10. Max. Benefit Limits per disability per year 22. Health & Wellness Program (up to 2x/yr)
11. HMO patient for no-cash-out 23. Same benefits for Dependents
12. Private patient for reimbursement (HMO rate) 24. Access through Social Media
7. Purple Cow 2012
Benefits
7
3a. Medical HMO (nationwide)
ASIANLIFE (8,205 affil. MD, 383 hospitals, 428 clinics) TERMS & CONDITIONS
1. Traditional HMO buffet of benefits 1. Instant rates, regardless of size
2. Combined inpatient & outpatient limits 2. No franchising required
3. Max. Benefit Limits per disability per year 3. No utilization report required
4. HMO patient for no-cash-out 4. No individual applications required
5. Private patient for reimbursement (HMO rate) 5. Minimum group size = 10
6. Access to Big 5 hospitals & Healthway 6. Minimum mode of payment = monthly
7. 100% Pre-Existing Conditions coverage 7. Pooled Employee utilization to spread risk
8. 100% Congenital Conditions coverage 8. Split Dependent utilization to reduce cost
9. 100% Special Procedures coverage 9. Buy now, pay later
10. Benefits on top of Philhealth 10. 1st year Virgin promo rate, if applicable
+Principals 18yo-65yo; Dependents 30dy-22yo / 18yo-65yo +Same rates for Dependents in 2012
Medical HMO benefits are covered on top of Life & Accident benefits
8. Purple Cow 2012
Benefits
8
3b. Medical HMO…
PRE-EXISTING CONDITIONS (Dreaded) PRE-EXISTING CONDITIONS (Non-Dreaded)
1. Blood dyscrasias 1. Asthma, pleural effusion or other chronic airway obstruction conditions
2. Benign / malignant new growths 2. Benign cyst / tumor and malignant conditions
3. Chronic cardiac / cardio-vascular diseases 3. Chronic gynecologic conditions
4. Collagen / connective diseases 4. Hemorrhoids and other chronic colonic and ano-rectal illnesses
5. Diseases of the immune system 5. Diseased tonsils requiring surgery, cataracts & other opthalmo-otolaryngologic conditions
6. Chronic hepatobiliary diseases 6. Pathological abnormalities of nasal septum and turbinate
7. Neuro-surgical / neurological conditions 7. Sinus condition requiring surgery
8. Chronic pulmonary diseases 8. Chronic neurologic conditions
9. Chronic genito-urinary diseases 9. Calculus cholecystitis / cholelithiasis and/or urolithiasis
10. Chronic gynecological conditions 10. Chronic conditions of the genitourinary system
11. Chronic gastrointestinal conditions 11. Polyps, ulcers, liver cirrhosis and other chronic gastrointestinal diseases
12. Endocrine abnormalities 12. Endocrine illnesses
13. Antibiotic / chemotherapy-resistant diseases / bactemia / septicemia 13. Seizure disorders
14. Chronic opthalmo-otolaryngologic diseases 14. Moderately to far advanced tuberculosis
15. Chronic musculo-skeletal diseases 15. Chronic musculo-skeletal malignancies
16. Pathological / accidental fractures 16. Malignancies of the blood and bone marrow
17. Illnesses / injuries necessitating the use of isolation room / ICU or other IC facilities 17. Hypertension, coronary artery disease / myocardial ischemia, cerebrovascular accident and other
chronic cardiac diseases
18. Accidental injuries
19. Second and third degree burns 18. Collagen / connective tissue diseases
20. Surgical procedures requiring application / use of prosthesis for immediate treatment 19. Diseases of the immune system
21. PEC (except congenital ones) subject to the provision on ‘PEC’ in this Agreement [waived] Dreaded & Non-Dreaded PEC are covered 100% up to MBL
9. Purple Cow 2012
Benefits
9
3c. Medical HMO…
SPECIAL PROCEDURES or NEW MODALITIES OF TREATMENT
1. Lithotripsy 11. Sclerotherapy
2. Arthroscopic procedures 12. Physical & speech therapy
3. Laparoscopic procedures 13. Angiography
4. Laser therapy (excludes use for correcting vision) 14. Nuclear technologies
5. Nuclear / radioactive isotope scans 15. Thallium scintigraphy
6. Cost of artificial limbs, joint prosthesis and heart 16. CT scan / MRI
valve prosthesis 17. Pulmonary perfusion scan
18. Endoscopy
7. Other new modalities of treatment for conditions with
established etiologies and used as alternatives to 19. Bone densitometry scan
conventional or traditional procedures
20. Anti-nuclear anti-body (ANA)
8. Dialysis 21. C-reactive protein (rheumatic & complications)
9. Chemotherapy 22. Lupus cell exam
10. Radiation oncology / therapeutic radiology 23. Sleep therapy
Special Procedures or New Modalities of Treatment are covered 100% up to MBL
10. Purple Cow 2012
Benefits
10
3d. Medical HMO…
EXCLUSIONS
1. Expenses that should be taken care of by any government programs such as Philhealth 13. Illnesses / injuries attributable to the plan member’s own misconduct / gross
negligence / immoral habits, and willful and unnecessary exposure to danger or
2. Services rendered or supplies provided free of charge health hazards
3. Additional hospital charges and/or professional fees resulting from a plan member taking
14. Self-inflicted injuries including, but not limited to, any form of suicide attempt
a room accommodation more than his R&B limit (excesses and/or incremental costs)
4. Maternity and maternity-related conditions and/or complications except those benefits that 15. Sexually transmitted disease, AIDS, rehabilitative treatment for alcoholism and
may be provided by the (optional) Maternity benefit drug abuse
5. Sterilization of either sex or reversal of such, artificial insemination, sex change, 16. Acquisition of prosthetic appliances, artificial aids, durable equipment, surgically
consultation/confinement regarding fertility implanted devices and external prosthetic devices except those that are explicitly
covered and enumerated in the ‘Special Procedures or New Modalities of Treatment’
6. Non-recommended confinement, convalescent / domiciliary / custodial care, rest cures provision of this agreement
7. Dental-related cases except those that may be provided by the Dental Benefits and to the 17. Organ transplant-expense relating to organ donation of the donating party/parties
extent that are necessary for the repair or alleviation of damage caused solely by accidental
injury sustained (and not caused by the plan member) 18. Executive check-ups, unless explicitly provided in the master policy, and/or
confinements purely for diagnostic purposes, as well as non-recommended
8. Circumcision, cosmetic / aesthetic procedures except re-constructive surgery to treat
confinements
functional defects due to a covered disease and/or accidental injury
9. Psychiatric disorders, psychosomatic conditions, treatment for any mental or nervous 19. Take-home medicines, unless optional ‘Reimbursement of Prescribed Medicines’
disorders, illness / injury / condition / complication arising from the plan member’s excessive benefit is provided, and vaccines, except for first doses of either anti-venom, anti-
alcohol intake and/or use of regulated/prohibited drugs rabies or anti-tetanus used for emergency treatment
10. Illnesses and/or injuries arising from the plan member’s participation in brawls, riots, 20. Medico-legal fees including the cost of Medical Certificates that a plan member
commission of a crime, violation of ordinances, or the like may require for any purpose it may serve him or her
11. Illnesses / injuries resulting from conditions of war or sustained from combat-related 21. Congenital disease / deformity that is evident to the plan member at birth and/or
activities can be clinically determined to be congenital [waived]
22. Medical / surgical procedures and/or diagnostic tests that are experimental in
12. Illnesses / injuries resulting from the plan member’s active participation in hazardous nature and/or not generally accepted by the medical profession such as, but not limited
activities such as, but not limited to, bungee jumping, hang-gliding, scuba diving, to, iridology, chiropractic services, and acupuncture
mountain/wall climbing, and professional sports
11. Purple Cow 2012
Competitive Advantages
2
Why Purple Cow?
2 Ways to Access Healthcare:
You can see an HMO doctor for free,
or your own doctor for reimbursement
at the HMO rate – each time you avail.
(Unlike most HMO plans)
You can see your own doctor, cheaper
12. Purple Cow 2012
Competitive Advantages
3
Why Purple Cow?
3 Major Employee Benefits in 1 Plan:
You get Group Life, Accident & Health
(medical HMO, optional dental HMO,
optional APE, and Wellness) – all in 1 plan.
(Unlike most HMO plans)
You get all the Employee Benefits you will ever need
13. Purple Cow 2012
Competitive Advantages
6
Why Purple Cow?
100% Pre-Existing Conditions:
You get 100% coverage up to MBL for
Pre-Existing Conditions such as cancer,
hypertension, diabetes & asthma.
(Unlike most HMO plans)
You are covered for dreaded & non-dreaded diseases
14. Purple Cow 2012
Competitive Advantages
7
Why Purple Cow?
100% Congenital Conditions:
You get 100% coverage up to MBL for
Congenital Conditions such as mitral valve
prolapse, rheumatic heart disease & hernia.
You are covered for most HMO plans) since birth
(Unlike medical conditions
15. Purple Cow 2012
Competitive Advantages
8
Why Purple Cow?
100% Special Procedures:
You get 100% coverage up to MBL for
Special Procedures such as arthroscopy,
laparoscopy, chemotherapy, P/T & MRI.
You are covered for most HMO plans) of treatment
(Unlike newer modalities
16. Purple Cow 2012
Competitive Advantages
9
Why Purple Cow?
Benefits on Top of Philhealth:
Your HMO limits are on top of Philhealth,
so you won’t be needing as much MBL:
Benefits = Philhealth + MBL (not just MBL).
(Unlike most HMO plans)
You get full HMO benefits on top of Philhealth benefits
17. Purple Cow 2012
Competitive Advantages
19
Why Purple Cow?
Medical HMO Network:
You can get inpatient and outpatient
treatment from 8,205 affiliated doctors,
383 hospitals, and 428 clinics nationwide.
(unlike some HMO plans)
You can go to MMC/ SLMC/ CSMC/ AHMC/ TMC/ Healthway
18. Purple Cow 2012
Summary
1
♠ What’s in it for…Employees?
EE Features EE Benefits
A complete Employee Benefits package You get more financial security from
that can make you financially secure Purple Cow than from any other HMO
Life INS, Accident INS, Medical HMO, You won’t need to get any more
Optional Dental HMO & Optional APE insurance benefits for yourself
Nationwide Medical & Dental networks, You can use any accredited hospital
inclusive of all major hospitals & clinics or clinic for medical or dental treatment
Choice of doctor as a Private Patient for You can see your own doctor and get
insurance reimbursement at HMO rates reimbursed the HMO doctor’s rate
100% Pre-Existing, 100% congenital, You are covered for existing illnesses,
& 100% Special Procedures coverage natal conditions, & special procedures
Employee Benefits on top of Philhealth You get full HMO + Philhealth benefits
Access to benefit information through You can take charge of your own
C3 on www.purplecow.ph & Facebook health, and know before you go
1 health card for every employee You can avail anytime, anywhere
