Transcript Optional Benefits

®
UnitedHealthcare
Underwritten By Golden Rule
Strengthen your product portfolio with
affordable health insurance plans
This presentation currently excludes the marketing states of:
CT, DE, GA, KS, KY, LA
Not For Consumer Use
36256-0606 All Gen 21 States and Georgia
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Today’s Agenda
 Evolution of Golden Rule, A United Healthcare Company
 Product Portfolio and Competitive Rate Comparisons
 Network Size and Strength
 Ease of Doing Business
 Value Added Benefits
 Setting Ourselves Apart From the Rest
 E-Store: Online Quoting and Application Submission
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
2
Why Golden Rule?
3
 Leader in the individual and family market
 Experience and expertise spans 60 years
 Pioneer of consumer driven health care solutions
 Strong financial ratings*
 Rated A by A.M. Best
 Rated A+ by Standard & Poor
*These ratings are an indication of financial strength and stability
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
3
Resolving Claims
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Over 3.5 million claims processed in 2006!
Over 14,000 claims processed per work day
Over 2.2 million dollars paid out per work day!
90% are processed in 10 working days or less!
99% benefit accuracy rate!
Actual health claims results 2006
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
4
Rate Reduction for New Business
5
% Population >= 5% rate decrease
93.47%
% Population >= 10% rate decrease
35.49%
% Population >= 15% rate decrease
15.23%
Pennsylvania
5% - 23%
Oklahoma
5% - 12%
Michigan
Up to 19%
South Carolina
Up to 7%
Illinois
5% – 15%
Texas
5% – 20%
Indiana
5% - 14%
Tennessee
14% - 15%
Maryland
10%
Nebraska
5%
Missouri
5%
Arizona
5% - 19%
Ohio
5% - 18%
Iowa
5% - 7%
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Top States By 2007 Production
1
FL
2
GA
3
TX
4
OH
5
MI
6
MO
7
AZ
8
CO
9
PA
10
WI
11
MD
12
CT
13
VA
14
SC
15
NC
16
AL
17
LA
18
IL
19
TN
20
OK
Most
Competitive
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Product Portfolio
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UnitedHealthcare, Underwritten by Golden Rule
Our goal is to provide you with a choice
Today we’re positioned to be your
of health plans designed to fit your
go-to-carrier for all plan types in
clients’ needs at a price they can afford.
the individual health market!
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Health Savings Accounts (HSA)
Qualified HSA Plans give clients the option
to establish a Health savings Account:
 HSA 100® – Our comprehensive HSA
 HSA Saver – More limited benefits and priced
20-40% less
®
Optional Benefits Available with HSA Plans
$5 Million Lifetime Maximum Benefit
Term Life Benefit
Enhanced Preventive Care Benefits
Package
HSA Hospital Indemnity Rider
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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HSA 100
Who does the HSA 100® fit?
 Those who are willing to trade low deductible health insurance for
higher deductible plans
 Those interested in saving money on premium
 Those who prefer comprehensive coverage
Comprehensive Coverage
• 100% after the deductible for all covered expenses including:
 Doctor office visits
 Rx coverage
 In hospital patient services
 Out patient services
 Preventive mammogram, Pap Smear, PSA Testing
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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HSA Saver
®
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HSA Saver – our most affordable HSA plan
 Priced 20-40% less than HSA 100®
 Limited Coverage
• Outpatient doctor visits - not covered
• Outpatient Rx – not covered
• Outpatient X-ray and lab –
Same deductible
choices as HSA 100
(covered if within 14 days of surgery or confinement)
 Coverage provided for the more costly expenses
• Inpatient hospital
• Inpatient Rx
• Outpatient surgery, MRI, CAT Scan, chemotherapy, radiation treatment,
hemodialysis
 Coverage provided for Preventive
• Mammogram, Pap Smear, PSA Testing
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Monthly Base Premium
Comparison
11
®
HSA Saver (catastrophic)
vs.
®
HSA 100 (comprehensive)
Dublin, OH
430
Husband & Wife,
aged 40
Golden Rule
Golden Rule
HSA 100®
HSA Saver®
$5,800 Ded;
100%
$5,800 Ded;
100%
$156.86
$122.55
21% Savings
Premium based on preferred health status, Rx copay. Premium based on January 07 effective date.
Each plan has its own benefit design and other characteristics not presented here.
Not For Consumer Use
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Exante Bank
•
•
•
•
•
•
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Wholly owned subsidiary of UnitedHealth Group
Crediting 4% interest rate*
FDIC insured account balances
Investment opportunities
HSA pre-paid debit card or checkbook
Easy online account management
Prompt customer service
Exante Bank
866-234-8913
* Rate as of 6/1/06; subject to change
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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High Deductible Plans
• High Deductible Plans (non-HSA qualified)
 Plan 100® – our simplest plan
 Plan 80 – similar to Plan 100 but with 80/20 coinsurance
SM
 Saver 80 – our most affordable plan
SM
Optional Benefits Available with High Deductible Plans
$5 Million Lifetime Maximum Benefit
Term Life Benefit
Prescription Drug Card Benefit
First-Dollar Accident Benefit
Enhanced Preventive Care Benefits
Package
Maternity Benefit
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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High Deductible Plans
®
• Plan 100 * - our simplest plan
 Choose a Plan Deductible
• 1,500, $2,500, $3,500, $5,000
 100% after the deductible
• Doctor office visits
• Rx coverage
• Preventive care
• In hospital patient services
• Out patient services
 Max of two deductibles per family, per calendar year
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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High Deductible Plans
• Plan 80SM* - similar to Plan 100® but with 80/20 coinsurance
 15 - 25% less premium than Plan 100
 80/20 to $15,000 coinsurance, then 100%
 Same deductibles as Plan 100
• Saver 80SM – our most affordable plan
 30 - 40% less premium than Plan 100
 80/20 to 15,000 coinsurance, then 100%
 Limited Coverage
• Outpatient doctor visits - not covered
• Outpatient Rx – not covered
 Coverage provided for the major (catastrophic) expenses
Hemodialysis, radiation, chemotherapy, and organ transplant drugs
Surgeon, assistant surgeon and facility fees
CAT Scans, MRIs
Emergency room fees
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Plan 80
Deductibles
$1500
$2500
$3500
$5000
Saver 80
Deductibles
$500
$1000
$1500
$2500
$3500
$5000
Monthly Base Premium
Comparison
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Husband & Wife, aged 35 with
two children
Sarasota, FL 342
Golden Rule
Plan 100
Plan 80
Saver 80
$2500 Deduct
$2500 Deduct
$2500 Deduct
100%
80 / 20%
80 / 20%
$262.79
$228.39
$175.97
$1500 Deduct
$1500 Deduct
$1500 Deduct
100%
80 / 20%
80 / 20%
$323.39
$279.17
$213.65
Premium based on preferred health status, Rx copay. Premium based on January 08 effective date.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
33% Savings
34% Savings
Copay Plans
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• Copay Plans
 Copay SelectSM – our most benefit rich plan with excellent preventive care
benefits
 Copay SaverSM – our most affordable copay plan
Optional Benefits Available with Copay Plans
$5 Million Lifetime Maximum Benefit
Term Life Benefit
Prescription Drug Card Benefit Buy-Up
(Copay Select only)
Two Additional Doctor Office
Visits (Copay Saver only)
Maternity Benefit
First-Dollar Accident Benefit
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
SM
Copay Select
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SM
Copay Select - Our benefit-rich copay plan with excellent
preventive care
 $35 doctor office copays regardless of deductible!
• Copay is unlimited
• General practitioner, specialist, urgent care
• Covers history and exam
 Core plan benefits remain the same regardless of
deductible!
 Includes Rx copays regardless of deductible!
Copay
Select
SM
Deductibles
$500
$1000
$1500
$2500
$5000
• Generic - $15 copay (no deductible)
• Name Brand - $100 per person deductible
 $30 preferred
 $60 non-preferred
• Annual maximum of $3,000 per insured (Optional Prescription
Drug Benefit Buy-Up)
 Preventive care not subject to the plan deductible!
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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SM
Copay Select Preventive Care
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• Preventive Care Doctor Office Visit
• History and exam - $35 copay
• X-ray and Lab - 80% / 20% (not subject to deductible)
• $300 annual maximum per person
• Child Immunizations (ages 0-18)
• Vaccine - 80% / 20% (not subject to deductible)
• Separate $300 annual maximum per person
• Preventive mammogram, pap smear, PSA testing
• 80% / 20% (not subject to deductible)
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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SM
Copay Saver
Copay SaverSM – our most affordable copay plan
 Priced 20-30% less
 $35 doctor office copay
• Limited to 2 per person, per calendar year
• Optional buy-up to total of 4 visits
 $15 copay for Generic Rx (Brand name drugs not covered)
 Preventive Mammogram, pap smear, PSA testing: 80 / 20%
 X-ray and lab are covered if performed within 14 days of a
surgery or confinement
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Monthly Base Premium
Comparison
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Copay SelectSM (comprehensive) vs. Copay SaverSM (catastrophic)
Husband & Wife, aged 35
with two children
Golden Rule
Copay Select
Austin, TX 787
Golden Rule
SM
Copay Saver
SM
$5,000 Ded;
80 / 20%
$5,000 Ded;
80 / 20 %
$351.26
$273.69
Premium based on preferred health status, Rx copay. Premium based on January 08 effective date.
Each plan has its own benefit design and other characteristics not presented here.
Not For Consumer Use
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
22% Savings
Optional Benefits
22
To Enhance Plans
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
22
Enhanced Preventive Care
Benefits Package
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This optional benefit is available with all plans except Copay SelectSM.
No waiting period
$300 annual max on covered expenses
PSA testing, pap smear, mammography
$35 copay per doctor office visit
Doctor office x-ray and lab covered at 100%
Well care visits
Child (0-18) immunizations
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Prescription Drug Card
Benefits
Prescription Drug Card Benefit:
This optional benefit is available only with Plan 100® and Plan 80
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SM
 Generic: $15 copay
 Name-Brand Preferred: $30 copay
 Name-Brand non-preferred: $60 copay
• Name brand copay is after a $100 per person, calendar year deductible
• $3,000 annual maximum
(If generic is available, name brand is reimbursed at generic price)
Prescription Drug Card Benefit Buy-Up
SM
This optional benefit is available only with Copay Select .
 Eliminates the $3,000 annual drug maximum
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Maternity Benefit
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This optional benefit is available with all plans except HSA plans
This benefit helps cover the costs for
routine pregnancy or delivery:
• Client pays 20%
• Golden Rule pays 80%
• Graded benefit with a maximum of $7500
Years
Covered Annual Maximum
1&2
$2,500
3&4
$5,000
5+
$7,500
*Not available in AR, MD, NC, VA
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Optional Benefits
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$5 Million Lifetime Maximum Benefit*
Available with all plans
•Upgrades coverage to $5,000,000 per person
Term Life Benefit**
Available with all plans
•Decreasing term life benefit
•Benefit payout based on primary insured’s age at the time of death
Two Additional Doctor Office Visits
This optional benefit is available only with Copay SaverSM
• Increases the number of copay doctor office visits from 2 to 4
per person, per year
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Optional Benefits
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First Dollar Accident Benefit
This optional benefit is available will all plans except HSA plans.
• Upfront coverage for unexpected injuries
• Treatment of an injury within 90 days of an accident
• Benefit choice of $500 or $1,000
• Plan deductible must be greater or equal to the
benefit amount selected
*Not available in VA
**Not available in NC
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Preferred Network
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UnitedHealthcare
ChoicePlus
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
28
UnitedHealthcare Choice Plus
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Expansive national network*
Owned by UnitedHealth Group
Choice of network providers at all times
Offers significant provider discounts**
Average network discount of 45%
Leverage strength of UnitedHealth Group
Strength in numbers
*UnitedHealthcare Choice Plus Network is not offered with Golden Rule Health plans in all states.
**Discounts vary by provider, geographic location, and service provided
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Preferred Network Discounts*
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Sample doctor visit EOB
45%
Discount*
$125.00
$68.69
.
.
*Discounts vary by provider, geographic location, and service provided
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
30
Preferred Network Discounts*
31
Sample lab work EOB
90%
Discount*
$34.39
$357.75
.
.
*Discounts vary by provider, geographic location, and service provided
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Update: Network
3232
Top 10 Health Plans Accepted by Office-Based Physicians
Health Plan
Physicians Accepting
UnitedHealth
64.8%
Blue Cross Blue Shield
64.3%
Humana
52.3%
Aetna
43.4%
Cigna
39.6%
Wellpoint
38.3%
Wellcare
37.7%
Medicare
27.3%
Healthnet
17.8%
Sierra
10.5%
Source: SK&A Information Services, October 2007
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Golden Rule
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Eligibility and
Underwriting
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Underwriting
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• It’s a new day – the UnitedHealthcare way!
• Sound pricing data from actuaries on treatment and
prescription costs
 Opportunity to issue apps with fewer riders
 Looking closely at plan design and deductible size
• Initiated auto-issue through E-Store*
 Issue applications in 48 hours or less
 Application matches certain underwriting criteria
*Actual health underwriting results February 2006 - not all applicants qualify
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
34
Rate Classes
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(Broker Guide page 24)
• Preferred
.90 = 61%
 Preferred H&W chart (Broker Guide page 25)
 No history of high blood pressure
 No medical exclusionary riders longer than one year
• Standard I 1.00 = 35%
• Standard II 1.25 = 4%
 Expanded height and weight table, to help accept more
cases (Broker Guide page 25)
Guidelines button
 Male 6’0” aged 45 max considered weight
• Was 257lbs
• Now 279lbs
 Female 5’6” aged 45 max considered weight
• Was 205lbs
• Now 228lbs
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
on the rating
software will help
determine which
health class
status to quote
Rate Classes
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(Broker Guide page 24)
 Elimination of the Tobacco Rate Class
• Relative tobacco surcharge based on Issue Age & Rate Class
Issue Age
Preferred
Standard I
Standard II
Under 40
1.20
1.35
1.60
40-54
1.30
1.55
1.80
55+
1.50
1.65
1.90
 Elimination of Motorcycle Exclusion
• 20% individual rating in lieu of an exclusion rider will be applied
during underwriting
• Added in underwriting if applicant has driven a motorcycle in
the past 24 months
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Clearance Periods
•
•
•
•
•
•
•
Atrial fibrillation – 2 years
Cancer – depends on type
Colon cancer – 5 years
Prostate cancer – 2 years
Epilepsy – 1 year since last seizure
Hyperthyroid –6 months
Gastric Bypass – 5 years and stable weight for at least
12 months
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Riders
Increased deductible rider
 Example: Controlled hypertension
 Increase overall deductible by $400
 Premium remains the same
 Hypertension is considered a covered expense
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Riders
Option Two: Temporary Rider
 Placed on a condition for a specific period
 Usually one to two years
 Premium remains the same
 Condition is not covered during rider period
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Preliminary Evaluation*
Broker Service Center: 800-474-4467
Select prompt 1 for underwriting assistance
• Necessary information needed to effectively prescreen
 Age and gender
 Diagnosis and date
 Prescribed treatment, medications, and dosages
• Quick Response Prescreen
• Specialty Team
 Refer to underwriting manual
 Confer with underwriter
 Advise of underwriting opinion
*No guarantee of coverage. Final decision is up to underwriting at time of submission
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Service Standards
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• We issue 83% of all applications*
• 61% of applicants receive preferred rating class*
• We handle all underwriting requirements
 Amendments
 HBQ questionnaires
 APS (when medical histories are unclear or complex)
 MIB reports
• Underwrite at time of application / telephone
• Certificates are mailed to you / I.D. cards are mailed to your client
Actual 2006 health underwriting results
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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What Your Clients Can Expect
• Each individual listed on the application is underwritten
separately
• Effective date of choice
• Premium modes:
 Monthly bank draft (EFT)
 Direct quarterly billing
• Submit premium at time of application
 Premium is refunded if non-issue
• 12-month initial rate guarantee*
• I.D. cards for certificates or policies are mailed directly to client
*Subject to benefit or location change
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Golden Rule E-Store
43
ESTORE
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
43
E-Store Overview
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 Available to all appointed brokers
 Offers convenient online access
 Creates a professional web
presence
 Can reduce operating expenses
 Fast and efficient
 Can help grow your business
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
44
E-Store Features
45
 Online quoting and application submission
 Quote archiving and application tracking
 Simple navigation to support your Golden Rule business
Print all forms and brochures needed to write Golden
Rule plans
Check correspondence for lapses and re-rate
notification
Status of pending applications
Download quoting software
Network link for checking doctors and hospitals
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
45
E-Store Online Quoting
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E-mail customized quote directly to client
• View quote
• Complete app and apply online
Broker Assisted Application
• Assist client in completing majority of the app
• E-mail completed app to client for review and electronic
signature
• Client submits to Golden Rule
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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On E-Store’s “My New Business” and “My Block of
Business” sections you’ll find:
 Tracking by app number, name, paid to date, plan name, current billed
premium, and more.
 Information on health class, ratings, riders, and premium.
 Details on dependents.
Visit
www.goldenrulehealth.com/broker
for full details.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
48
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Update: E-Store improvements
• My Book of Business
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
4949
5050
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
5151
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
5252
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
5353
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Golden Rule
54
Resources & Training
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
54
Resources
• Broker Service Center
 (800) 474-4467
 [email protected]
• E-Store
 www.goldenrule.com
• National Key Broker Sales Manager
 Annette Dahlke
• (800) 232-5432 Ext. 12312
• (920) 661-2312 Direct line
• [email protected]
• Webinars
 https://goldenrule.webex.com (no WWWs)
 www.goldenrule.com/OnDemand/OnDemand.shtml
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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56
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
57
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Why Choose Golden Rule?
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1. Our commitment to YOU… and the individual health insurance
market
2. Best in Class Broker support
3. UnitedHealthcare brand recognition and leadership
4. Full range of health plans to fit your clients’ needs and budgets
5. Ease of doing business
6. Competitive rates!
7. Strength of network for claims repricing
8. Fast and flexible underwriting
9. E-Store technology
10. Continued training opportunities
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
58