PPO AGENTS

No, you will not want to change any of your existing distribution networks because…

PPO AGENTS is a targeted National Marketing Organization, offering you unique, niche-specific products that will help you diversify and increase your income — by attracting and keeping, self-employed clients.

Generally, you are self-employed if any of the following apply to you.

You carry on a trade or business as a sole proprietor or an independent contractor.

You are a member of a partnership that carries on a trade or business.

You are otherwise in business for yourself (including in a part-time business or as a gig worker).

Learn more here.

 CLICK HERE for the 11 simple questions.

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P.S.  For experienced agents/brokers this next part goes without saying…

Why it is important that clients be honest when answering the 11 questions (and about being self-employed)? 

Retroactive Rescission:

The PPO company verifies the truthfulness of these answers, especially for large claims.

If a member misrepresents their eligibility or health status, the PPO plan may be rescinded retroactively.

This means coverage would be canceled as if it never existed, leaving the member responsible for all past medical bills.

Financial Burden:

Facing a health issue can be stressful enough.

A retroactive rescission could result in significant financial hardship for the member, potentially jeopardizing their business or personal finances.

By carefully reviewing eligibility and health questions with potential members, you can:

Ensure a Smooth Enrollment Process:

Understanding eligibility upfront helps avoid application delays or denials.

Protect Your Clients:

By explaining the consequences of misrepresentation, you help members make informed decisions and avoid potential financial setbacks.

Maintain a Positive Client Relationship:

Transparency builds trust and strengthens your relationship with your clients.

Remember, the online application is a legal document.

By clearly explaining the eligibility requirements and underwriting questions, you can help your clients avoid a potentially devastating financial situation.

Encourage your clients to be honest and transparent during the application process.

If they have any pre-existing conditions or concerns about eligibility, you can guide them towards alternative plan options that may be a better fit.

The level-funded PPO can be offered at a lower monthly premium than the marketplace HMO because of two key features:

1. **Underwriting:** Unlike HMOs in the marketplace, this plan allows underwriting, which means they can assess applicants’ health risks through a questionnaire. This allows them to accept only healthy individuals, leading to lower overall claim costs and lower premiums.

2. **Data-driven cost control:** The plan leverages anonymized member data to two ends:
* Selling it to data analytics companies generates revenue, reducing plan costs.
* It allows them to identify areas for cost savings and potentially negotiate better rates with healthcare providers.

Group Plan via LLC Membership:

This plan operates as a level-funded group health plan offered through a Limited Liability Company (LLC).

By becoming a member of the LLC, individuals gain access to the group plan benefits.

There is a Joinder Agreement that is signed as a part of the Member becoming a Working Owner of the LLC.

Each member receives a unit of the LLC, essentially becoming a *working owner.  

(*Members complete activities via their Personal Health Dashboard. Activities such as periodically watching a health related video, completing surveys or filling out questionnaires.)

This unique structure allows the plan to offer group plan rates to self-employed individuals who wouldn’t qualify otherwise.

Established Level-Funded Approach: This level-funded PPO is built on a well-established strategy.

Millions of Americans across various sectors, including private companies, public institutions, and unions, rely on level-funded group health plans.

This widespread use demonstrates their acceptance as a reliable and cost-effective approach to health insurance.

Once your clients understand the benefits – even if in some cases where a PPO may cost them a bit more than an HMO – they are going to love you!

While price is important, your clients should consider the value of choice.

Unlike HMOs, our Nationwide PPO plan allows your clients to visit any in-network doctor or specialist without a referral. Or even out of network at a reduced level of coverage.

This flexibility is crucial if they develop a future health concern or need to see a specialist quickly.

You are offering your client peace of mind knowing they have options when they need them — which is priceless.

Even with a small tax credit/subsidy, joining the PPO is a strategic move.

It provides nationwide access to top-tier medical centers, ensuring quality care during unexpected health challenges.

Health conditions can change unexpectedly.

Imagine facing a major illness like cancer or heart disease.

PPOs allow nationwide access to top-tier centers of excellence medical centers.

These “centers of excellence” specialize in complex treatments.

Encourage your clients to join now — while healthy and they still can — before a health crisis necessitates access to specialized care.