Family Monthly Deductible

The Facts:

Employees can no longer afford the high deductibles being offered by Fully Insured Carriers for themselves and their dependents.
Employees budget for their expenses on a monthly basis and usually do not have extra funds in the case of a medical crisis situation.
Traditional plan designs have become increasingly complicated, hard to understand and unaffordable.
Most plans today have maximum out-of-pocket expenses that are limitless, confusing and impossible to budget.

At Entrust, we created the Family Monthly Deductible (FMD) provision to better meet the insurance needs of employees and their dependents while providing simple and real protection to the employee family budget. Employees understand and appreciate knowing that in the event of a medical crisis – they know exactly how much they will have to pay.

Why choose a Family Monthly Deductible (FMD)?

Employer Advantages

The FMD offers lower monthly premiums.
The FMD manages excess claims utilization resulting in better control of plan costs.
The FMD offers true maximum out of pocket amounts.
The FMD creates better employee participation spreading the risk to stabilize costs.
The FMD has saved 20 – 48% compared to the cost of traditional PPO plans.

Employee Advantages

An FMD is budgetable tool for the employee and/or family.
The FMD plans are more affordable.
The FMD engages employees/patient’s as healthcare consumers.
The FMD protects the entire family budget with lower deductible expenses.
No monthly medical expenses – no monthly deductible.
The FMD is more affordable for patients in any circumstance.

Most traditional plans reward the 15% who receive 85% of the claims and penalize the 85% who receive 15% of the claims.

The FMD treats everyone most equitably.

At Entrust, we believe if you duplicate what hasn’t worked to your satisfaction in the past you will only get what you got! Therefore, our successes with our clients result from creative shifting of the benefit paradigm.

Family Monthly Deductible (FMD) vs.

Calendar Year Deductible (CYD) Premium Equivalents

From an underwriting standpoint, the Family Monthly Deductible rates are much lower than a Calendar Year Deductible thereby making plan premiums for employee coverage and for their dependents much more affordable. Only Entrust approved Stop Loss Carriers are experienced at giving maximum credits for the FMD plan designs. At Entrust, our systems are designed to specifically adjudicate claims based upon this deductible concept.

The following are examples of deductible premium equivalents:

FMD Premium Equivalents	CYD Premium Equivalents
$ 300 FMD	$ 750 - $1,250 CYD
$ 500 FMD	$ 1,250 - $2,000 CYD
$1,000 FMD	$ 2,000 - $3,000 CYD

Example Procedure and Average Costs Comparison FMD vs. CYD (examples assume 100% co-insurance after deductible is met)

With the Family Monthly Deductible the covered family (one or more covered persons) can pre-determine, budget and; therefore assume a realistic amount of economic liability during a calendar month time frame that assures a predetermined max family deductible exposure. The FMD amount is much lower than an individual family member, calendar year accumulation provision. The following are some examples of medical events and associated out of pocket costs:

Event	Example Cost	$500 FMD	$2,000 CYD
Event	Example Cost	Patient Out-of-Pocket	Patient Out-of-Pocket
Complicated delivery of baby	$17,500	$ 500	$ 4,000 *
Car accident of family	$23,000	$ 500	$ 6,000 **
Appendectomy surgery	$ 4,500	$ 500	$ 2,000

* Mom and Baby both meet deductible. ** Family 3x’s

Plan Design and Funding Mechanisms Offering the FMD eliminates complicated and confusing plan designs that lead to employee/patient frustration and dissatisfaction. Eliminating the unknown financial responsibility and the stress of balance billing from providers gives employees piece of mind and more disposable monthly income. At Entrust, the FMD can be the main platform of the plan design. Coupled with varied proprietary funding mechanisms; the client can choose a traditional self funded approach or an approach that functions like fully insured products.