Great customer experiences that deliver:
Driving outcomes that provide employees with financial security during a difficult time
Employees today expect a simple digital way to get their benefits.
Prudential has risen to this challenge with our market-leading claim experience and high-touch support.
A deeper dive into our products
Accident Insurance
Critical Illness Insurance
Hospital Indemnity Insurance
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Flexibility
Efficiency
Value
• Comprehensive and competitively priced products • Evolving product suite to incorporate emerging medical trends • Claims analytics inform strategic plan design and pricing
• Deep benefits administration partnerships, powered by our PruExchange data framework • Plan setup and enrollment APIs support faster implementations • API integrations simplify the billing process
Simplify the experience
Better benefits
I’ve never filled out a claim form for anything and I don’t understand half of the questions on this 10-page form.
Solution
Simplify the claims process
No paper or electronic forms
Easy digital claims
Ongoing claims consultation and monitoring
Claims integration with Disability, Absence, and Medical Auto-pay eligible claims
Learn More
Simplify the Experience
Do Less Work
I ran up my credit card bill because my medical plan didn’t cover prescription copays and ride service to physical therapy.
Provide benefits that can protect employees from unexpected expenses
Less work
Maximize the Benefit
Market-leading claim experience: About as simple as ordering a pizza
1
Tell us what happened and when?
2
Tell us who provided treatment?
3
Give us permission to get the information we need about the service
Helps promote employee peace of mind by providing extra financial insurance protection
Monitor claim data from other coverages
Verification of benefit eligibility
Auto-pay of eligible claims and consultation to identify additional benefits
Medical Insurance TPA
Prudential Disability
30% of Disability claims are from an employee also enrolled in Supplemental Health
1 Option available to customers with more than 1,000+ eligible lives who offer self-insured medical.
1053971-00002-00
Group Accident, Hospital Indemnity and Group Critical Illness Insurance coverages are limited benefit policies issued by The Prudential Insurance Company of America, a Prudential Financial company, Newark, NJ. Prudential’s Group Accident, Hospital Indemnity and Group Critical Illness Insurance coverages are not substitutes for medical coverage that provides benefits for medical treatment, including hospital, surgical and medical expenses, and they do not provide reimbursement for such expenses. The Booklet-Certificate contains all details, including any policy exclusions, limitations, and restrictions, which may apply. If there is a discrepancy between this document and the Booklet-Certificate/Group Contract issued by The Prudential Insurance Company of America, the Group Contract will govern. A more detailed description of the benefits, limitations, and exclusions applicable are contained in the Outline of Coverage provided at time of enrollment. Please contact Prudential for more information. Contract provisions may vary by state. Contract Series: 83500 and 114774.
These policies provide disability income and accident insurance only. They do NOT provide basic hospital, basic medical, or major medical insurance as defined by the New York State Department of Financial Services.
IMPORTANT NOTICE – THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS.
This coverage is not health insurance coverage (often referred to as “Major Medical Coverage”).
This type of plan is NOT considered “minimum essential coverage” under the Affordable Care Act and therefore does NOT satisfy the individual mandate that you have health insurance coverage.
• True-digital claims submission with no forms needed or medical records to submit • Work directly with medical providers to fully adjudicate claims • Maximized benefits: Ongoing claim consultation and monitoring, and Accident and Hospital Indemnity benefit bundling
Employees guided digitally with only needed questions
Employees don’t have to submit medical documentation
Proactive prompts for non-medical-related benefits (e.g., travel and lodging)
Benefit reminders
30%
Wellness Benefit
TM
Provide Greater Transparency
“I’m dealing with a scary medical situation and I forgot I had coverage.”
Remove the guesswork
Only shows the benefits for which the employee is eligible under the employer’s plan
“Cart” function allows employee to review all claim data before submission*
Help Employees Stay Healthy
Sonya’s Journey
Dave’s Journey
Jesse’s Journey
*Future capability.
Reporting shows employers claim data and benefit utilization
Speed
Benefit bundling helps employees get more of their benefits faster
Meet Jenn Young, healthy, and active. She fractured her leg. Even with health insurance, it was a huge expense she just didn’t count on.
Jenn submits:
Prudential pays an Initial benefit bundle:
More services provided?
Jenn just submits proof of treatment for additional services:
1 Notice of Claim
Fracture X-ray
Medical appliance (crutches)
Physical therapy (1)
Physician follow up visit (1)
Emergency room visit
Ambulance 1 more physician follow-up 7 more physical therapy visits No new Notice of Claim
Choice
• Wide range of benefit amounts & flexibility with coverage limits • Guaranteed issue coverage • Broad wellness benefit option
Ease
• Claims integration with Disability, Absence, and Medical • Auto-pay of eligible supplemental Health claims using information from Disability or Absence claim • Easy and intuitive, paperless claim filing process
• Broad wellness benefit option • Spouse benefit amount up to 100% of employee benefit • Dependent children automatically covered • Guaranteed issue coverage
• No waiting periods between separate covered conditions • Standard 180-day recurrence period at 100% benefit • Auto-pay of eligible Supplemental Health claims uses information from Disability or Absence claim
• 80+ Possible covered conditions • National cancer institute evaluation benefit • Diagnosis based contract language
80+ covered conditions
Alzheimer’s Disease Benign Brain Tumor Cancer in Situ Coma Heart Attack Invasive Cancer Major Organ Failure (MOF) (Includes bone marrow or stem cell transplant) Paralysis of Limbs Renal (Kidney) Failure Skin Cancer Stroke Third Degree Burns Severe Coronary Artery Disease
Childhood Conditions Autism Cerebral Palsy (for children age 5 or younger) Cleft Palate/Cleft Lip for newborn children Congenital Heart Disease Cystic Fibrosis (for children age <5–17> or younger) Down Syndrome for Newborn Children
Acute Respiratory Distress Syndrome Adrenal Hypo-Function (Addison’s Disease) Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease) Aplastic Anemia Arteriosclerosis Blindness Brain Aneurysm Cancer Death Cerebral Palsy Chemotherapy Cleft Palate/Cleft Lip Coronary Artery Bypass Graft Crohn’s Disease Cystic Fibrosis Deafness Diphtheria Encephalitis Huntington’s Chorea Infectious Disease (including COVID-19) Internal Cardioverter Defibrillator Legionnaires’ Disease Liver Failure Loss of Hands and Feet
Loss of Speech Malaria Meningitis (Bacterial) Multiple Sclerosis Muscular Dystrophy Myasthenia Gravis Necrotizing Fasciitis Occupational HIV and Hepatitis Infection Osteomyelitis Pacemaker Placement Parkinson’s Disease Persistent Vegetative State Polio Post-Traumatic Stress Disorder Rabies Sepsis Sickle Cell Anemia Skin Cancer Spina Bifida Systemic Lupus Erythematosus Systemic Scleroderma Terminal Illness Tetanus Transient Ischemic Attack Traumatic Head Injury Tuberculosis
Childhood Conditions (cont.) Gaucher disease type 2 or type 3 Glycogen Storage Disease (type IV) Infantile Tay Sachs Disease Muscular Dystrophy (for Covered Persons ages <5–17> or older) Niemann Pick Disease Pompe Disease Premature Infant and Neonatal Intensive Care Unit (NICU) Sickle Cell Anemia (for children age 5 or younger) Spina Bifida Type 1 Diabetes Zellweger Syndrome
Standard Covered Conditions
Conditions Typically Covered at 10%-25% Cancer in situ Skin cancer
OPTIONAL COVERAGE–benefits available for the following conditions
Covered Conditions under Infectious Disease Anthrax Bacterial Cerebrospinal Meningitis Cholera COVID-19 Diphtheria Encephalitis Legionnaire’s Disease Lyme Disease Malaria Methicillin-Resistant Staphylococcus Aureus (MRSA) Necrotizing Fasciitis Osteomyelitis Pertussis (whooping cough) Rabies Rocky Mountain Spotted Fever Tetanus Tuberculosis Typhoid Fever Myasthenia Gravis Systemic Lupus Erythematosus Scleroderma
• Admission and confinement benefits payable five times per year per covered person • Guaranteed issue coverage • Broad wellness benefit option
• No waiting period • Auto-pay of eligible Supplemental Health claims uses information from a Disability or Absence claim
• New benefits added to standard plan offering • No pregnancy elimination period • Benefits for newborns
New benefits added to standard plan for Hospital Indemnity
• Benefits for newborns • Hospital Admission • ICU Admission • Hospital Confinement • ICU Confinement
• High Risk Pregnancy benefit • Premature Infant and NICU benefit • Pandemic benefit • Quarantine benefit • Observation benefit
Jesse was seriously injured in a bike accident.
Jesse underwent advanced diagnostic tests.
Jesse updated his provider information. Prudential gathered information needed to cover additional services.
Completely recovered, Jesse takes a ride on his favorite bike path.
He required extensive rehabilitation.
An ambulance rushed him to the hospital.
Jesse submitted his claim on his phone from his hospital bed.
He had to use crutches.
The doctor diagnosed a concussion.
He was admitted to the hospital for treatment.
Jesse had surgery for his broken thigh bone.
He was evaluated for multiple injuries.
An unexpected accident can impact your employees' financial health
Meet Jesse, Aged 33
Broken thigh bone & anesthesia: Benefit pays $6,100
Transportation to hospital by ambulance: Benefit pays $300
Emergency room visit: Benefit pays $150
Medical testing: Benefit pays $200
Physical rehabilitation ($25 x 10 visits): Benefit pays $250
Injury concussion: Benefit pays $400
Medical equipment: Benefit pays $100
Hospital stay (2 additional days @ $200/day): Benefit pays $400
*Out-of-pocket expenses include medical and non-medical expenses. Names/situations identified in this document are for example/hypothetical/illustrative purposes only. Actual benefits may vary.This coverage is not health insurance coverage (often referred to as “Major Medical Coverage”).This type of plan is NOT considered “minimum essential coverage” under the Affordable Care Act and therefore does NOT satisfy the individual mandate that you have health insurance coverage.Group Critical Illness Insurance coverage is a limited benefit policy issued by The Prudential Insurance Company of America, a Prudential Financial company, Newark, NJ. Prudential’s Critical Illness Insurance is not a substitute for medical coverage that provides benefits for medical treatment, including hospital, surgical, and medical expenses, and it does not provide reimbursement for such expenses. The Booklet-Certificate contains all details, including any policy exclusions, limitations, and restrictions, which may apply. If there is a discrepancy between this document and the Booklet-Certificate/Group Contract issued by The Prudential Insurance Company of America, the Group Contract will govern. A more detailed description of the benefits, limitations, and exclusions applicable are contained in the Outline of Coverage provided at time of enrollment. Please contact Prudential for more information. Contract provisions may vary by state. Contract Series: 114774.©2020 Prudential Financial, Inc. and its related entities. Prudential, the Prudential logo, and the Rock symbol are service marks of Prudential Financial, Inc. and its related entities, registered in many jurisdictions worldwide. VB2S_FL_GI8_01
Hospital Insurance
Prudential paid Jesse for his fracture benefit and automatically paid an initial benefit bundle for additional treatment related to his accident. No proof of treatment was required.
Initial Benefit Bundle:
Diagnostic testing
Medical equipment
$150
$600
$100
$250
Simplifying Fracture Claims
Click to submit
Click to reset
Accident Coverage
Source: NCHS, National Hospital Ambulatory Medical Care Survey, 2018, https://www.cdc.gov/nchs/data/nhamcs/web_tables/2018_ed_web_tables.pdf. *Includes injuries such as fractures, intracranial, open wounds, foreign bodies, and burns. Excludes sprains and strains, superficial injuries, and med/surg complications.
Prudential covers about 80% of all injuries*
Click to update
Scenario is hypothetical in nature.
80%
Dave experienced chest pains at work.
Treatment completed. Dave returned home.
They ordered food, not wanting to impose on friends for meals.
Dave participated in cardiac rehab therapy.
Completely recovered, Dave returned to work.
EMTs rushed him to the hospital.
His wife stayed at a local hotel.
Prudential paid David for his claim related to his second diagnosis.
Dave went home to recuperate.
Dave suffered another heart attack at home.
While in the hospital, his doctor recommended treatment out-of-state at a cardiac care center.
Heart attack initial diagnosis: Benefit pays $30,000
Lodging cost ($100 x 5 days): Benefit pays $500
Heart attack second diagnosis: Benefit pays $30,000
An unexpected illness can impact your employees' financial health
Meet Dave, Aged 53
Prudential paid Dave's benefit and he didn't need to wait for treatment to begin.
Dave submits his Critical Illness claim from his hospital bed.
His wife drove him to the cardiac care center where he received treatment.
Transportation ($0.50 x 200 miles round trip): Benefit pays $100
Prudential paid Dave's benefit based on his initial diagnosis and he didn't need to wait for treatment to begin.
Diagnosis-Based Plans
Critical Illness Coverage
Source: Prudential Book of Business 2021.
Prudential’s standard plan covers the 13 conditions that comprise approximately 87% of critical illness incidence:
• Invasive Cancer • Heart Attack • Major Organ Failure • Stroke • Cancer-Non-Invasive (Cancer in Situ-Other than Skin Cancer) • Renal Failure • Alzheimer's disease
• Severe Coronary Artery Disease • Coma • Paralysis of Limbs • Third Degree Burns • Benign Brain Tumor • Skin Cancer
87%
Dave will be out of work for some time and submits his Short-Term Disability claim to Prudential.
Prudential is notified of Dave's heart attack and consults with him on initiating a claim for benefits.
Prudential will use information from an employee's Disability claim to determine potential eligibility for a supplemental health benefit. We will make direct outreach to notify them and offer consultation to help initiate the claim.
Proactive claim notification and consultation
Sonya goes into labor and her husband rushes her to the hospital.
Sonya and her baby remained hospitalized for two additional days.
With the extra money, Sonya recieved from her hospital benefit, Sonya took a couple of extra weeks of unpaid maternity leave to bond with her new baby.
She’s admitted to the hospital.
After laboring for 8 hours, Sonya delivered a healthy baby boy.
Sonya returned home.
Sonya used her benefits to pay some of the out-of-pocket medical and non-medical expenses.
Sonya submits her Supplemental Health claim to Prudential right from her hospital bed.
Prudential paid her benefit and worked with her medical provider to fully adjudicate her claim.
Hospital admission: Benefit pays $1,500
Newborn Benefit 2 days @200/day: Benefit pays $400
A hospital stay can impact your employees' financial health
Meet Sonya, Aged 30
Sonya’s doctor quickly delivered the baby via an emergency C-section.
Hospital Confinement 2 additional days @$200/day: Benefit pays $400
Source: NCHS, National Hospital Ambulatory Medical Care Survey, 2018, https://www.cdc.gov/nchs/data/nhamcs/web_tables/2018_ed_web_tables.pdf.
Prudential covers about 80% of all hospital admissions
Hospital Indemnity Coverage
She received a total of $2,300 in benefits for her Hospital stay
Sonya goes into labor and her husband rushes her to the hospital
Prudential reaches out to remind Sonya of her Hospital Indemnity benefit and consults to help her submit her claim.
While in the Hospital, Sonya contacts Prudential and submits her Disability claim.
Source: NCHS, National Hospital Ambulatory Medical Care Survey, 2015, https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf.
Rewarding Wellness Made Easy
Helping Employees to Stay Healthy
50
+
covered exams to help employees get their annual benefit
• Easily submit claims by phone or online • Auto adjudication of wellness claims under $100 across all products
• Mass upload of wellness event participants • Benefit reminders throughout the year • COVID testing and evaluation
We make it simple:
• Wellness benefit automatically applied across all eligible products
Onboarding
Weeks 3 - 5
Weeks 1 - 2
Weeks 6 - 9
Welcome call with Onboarding Specialist
Confirm good order of case details
Initiate setup for data exchange
Enrollment prep
Enrollment event
Prudential to load and audit enrollment files
Participant setup
Generate and provide first bill
Admin call and first bill walkthrough
Enrollment summary available
Deliver Master Contract and Certs
Deliver Welcome Letter to participants
Billing the way you want it
Employee Enrollment
Clients BenAdmin system
Ongoing full enrollment file
“Pay-as-Deduct”
Payroll deductions for Prudential products
Prudential
Prudential Self Service Portal
FROM
TO
Manual, time-consuming process
Automated, simpler approach
Review/ Revisions
Payroll Company
"Pay-as-Deduct"
Employee
Employer
System function
Platform Integration
What to expect during the Welcome Call
Introductions • Roles and Responsibilities Initial Discovery • Confirmation of sold products, services, and rates • File exchange requirements • Establish contacts for further discovery Implementation Approach and Next Steps • Project Plan and Key Implementation project milestones • Initial Marketing recommendations for Enrollment • Schedule working sessions for: - Enrollment Strategy - Plan Design and Rates - Billing Structure - Claims Structure - Data Exchange Coordination (file layouts)
Sam's Journey
Sam suffered serious injuries in a car accident.
She remained in the hospital for 5 more days.
Sam contacted a garage to get her car repaired.
She paid her auto insurance deductible.
Completely recovered, Sam rented a car and returned to work, confident that her savings won’t be drained.
EMTs rushed her to the hospital.
She was admitted to the Intensive Care Unit (ICU).
She used some of her benefits to pay for everyday expenses and get back on the road.
Unable to cook, she arranged for food delivery.
Sam returned home to recuperate.
Sam’s claim was paid within 5 days. She didn’t need to coordinate benefits with her medical plan.
She stayed for 2 additional days.
An unexpected hospital stay can impact your financial health
Hospital Indemnity Insurance benefits are simple to understand and easy to use.
Sam was seriously injured in a car accident on her way to work and was rushed to the hospital. Although she had a good medical plan, Sam was smart to sign up for Hospital Indemnity Insurance from Prudential, so she didn’t need to dip into her savings.
Meet Sam, Aged 30
Hospital Indemnity Insurance provided Sam with: Benefits regardless of what her medical plan may cover Guaranteed coverage regardless of her health Lump sum benefit paid directly to her to use however she likes Ability to take the plan with him if she changes jobs or retires
The following medical services were covered under her policy, and Sam only had to submit one claim to Prudential.
Hospital and ICU admission: Benefit pays $2,000
ICU confinement: Benefit pays $800
Hospital confinement: Benefit pays $1,000
