Transcript It`s time for a change…

It’s time for a change…
The company behind the change…

Philadelphia American Life Insurance Company (PALIC)
has a history dating back to 1904 and is now part of the
New Era Life family of insurance companies

Over $300,000,000 of annually premium income.
 Over $120,000,000 of Health Premium annually
Philadelphia American Life Company is licensed in 47
….states.

The man behind the company
Dr. Bill Chen, our president, and CEO, earned
his doctorate in theoretical statistics from
Purdue University in 1970 and became a
Fellow in the Society of Actuaries in 1978. He
has spent nearly 30 years in the life and health.
insurance industry.
He has been honored by numerous
organizations including Ernst and Young, Merrill Lynch Regional
and was recognized as Entrepreneur of the Year in 1994 by Inc.
Magazine.
For a growing number of American's, the
days of $20 co-pays are coming to an end.
It’s a new world of Defined Benefit plans and
supplemental benefits.
Now, WE are required to be more pro-active
in controlling our medical expenses AND be
equally pro-active in the management of our
personal health.
The Key to Controlling Healthcare Costs is
More Than Co-Pays and Deductibles
It’s about providing the “right”
plan at the right time to help
guide personal decisions.
Welcome to Health Saver Plus 1
Your Guide to the Next Generation
of Affordable Health Insurance
In today’s market where health insurance is often
unavailable or unaffordable, Health Savers Plus 1
can help provide you and your family with peace of
mind by proving health insurance benefits you can
afford.
The idea is that affordable, quality healthcare is
achievable if you the consumer, have the basic
knowledge and willingness to make informed
decisions by discussing treatment plan and costs
with the healthcare professional of your choice.
www.vimo.com/hospital
77002
Hip replacement
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Access the best
quality
healthcare at
the lowest
possible cost.
Welcome to
Health Saver
Plus 1
Your Guide to the
Next Generation
of Affordable Health
Insurance
Key Features Include
• $5,000,000 Lifetime Maximum
• Choose from three benefit options
 Pick your Base Plan Deductible
.
 Calendar Year Benefit Maximum Level
 Number of Benefit Units to fit your needs
• Use any Doctor or Hospital you choose
“Without Penalty”
Three Calendar Year Deductibles
.\
1st Choose a deductible you can afford
1. $ 1,000
2. $ 2,500
3. $ 5,000
2nd Choose an Annual Maximum Benefit
.
Maximum Covered Benefits Per Covered
Person per Calendar Year
Maximum Number of Days Per Covered
Persons
Annual
Maximum
Annual
Maximum
Annual
Maximum
$100,000
$250,000
$1,000,000
30
60
180
Hospital Indemnity Benefits – Facility Fees
.
3rd Pick the number of Benefit Units
Select The Number of Benefit Units
1 Unit 2 Units
3 Units
Daily Indemnity Benefit For Hospital Confinement
$1,500
$3,000
$4,500
Confinement in a Hospital Intensive Care Unit (ICU)
(Up to 20 days per Calendar Year
$2,250
$4,500
$6,750
Daily Indemnity Benefit For Hospital Confinement For Mental
Illness, Alcohol and/or Substance Abuse
$ 750
$1,500
$2,250
Daily Indemnity Benefit For Hospital Confinement in a
Rehabilitation Facility or Skilled Nursing Facility
$ 750
$1,500
$2,250
Daily Indemnity Benefit For Outpatient Radiation or
Chemotherapy
$ 750
$1,500
$2,250
Daily Indemnity Benefit for Outpatient Hospital or
Ambulatory Surgical Center services when surgery is
performed
$1,500
$3,000
$4,500
Outpatient Benefits
.
CALENDAR YEAR DEDUCTIBLE
$500 per insured
Calendar Year Maximum
$2,000
Units
1 Unit
Outpatient Office Visit
$
Other Outpatient Services (per test)
• MRI, CAT Scan or Nuclear testing
• Other diagnostic testing or X-rays
• Laboratory testing
• Injections
$ 175
40
10
5
25
5
2 Units
$
50
3 Units
$
75
$ 350
80
20
10
$ 525
120
30
15
$
10
$
15
$ 20
$
30
Generic Prescription (per prescription filled)
$
Brand Name Prescription (per prescription filled)
$ 10
Well Care Maximum
$ 50 per visit up to
$150 per calendar year
Professional Services
.
Surgical Procedure: The plan will pay this benefit if any
Covered Person undergoes a surgical procedure when
performed in a Hospital or in an Ambulatory Surgical Center
due to a eligible Accident or Sickness. The reimbursement
schedule is the Medicare RBRVS (Resource-Based Relative
Value Scale) per procedure based on your providers location.
Inpatient Pathologist / Radiologist: The plan will pay this
benefit if any Covered Person undergoes an Inpatient
Pathologist / Radiologist procedure as a result of a Covered
Accident or Sickness. The reimbursement schedule is the
Medicare RBRVS (Resource-Based Relative Value Scale) per
procedure based on your providers location.
1 Unit
2 Units
3 Units
1 X the
Current
RBRVS
Schedule
2 X the
Current
RBRVS
Schedule
3 X the
Current
RBRVS
Schedule
1 X the
Current
RBRVS
Schedule
2 X the
Current
RBRVS
Schedule
3 X the
Current
RBRVS
Schedule
Assistant Surgical Services
We will pay 20% of the amount
listed in the fee schedule
Anesthesia Benefit for covered services
We will pay 25% of the amount
listed in the fee schedule
Inpatient Physician Hospital Visit per visit
Emergency Ambulance for each trip due to a covered injury
or Sickness that results in a hospital confinement.
$50
$100
$250.00 per trip
$150
Professional Services (Texas Only)
.
Texas Only
1 Unit
2 Units
3 Units
Surgical Procedure:* The plan will pay this benefit if any
Covered Person undergoes a surgical procedure when
performed in a Hospital or in an Ambulatory Surgical
Center due to a eligible Accident or Sickness.
1 X the
Policy fee
schedule
2 X the
Policy fee
schedule
3 X the
Policy fee
schedule
Inpatient Pathologist / Radiologist:* The plan will pay
this benefit if any Covered Person undergoes an Inpatient
Pathologist / Radiologist procedure as a result of a
Covered Accident or Sickness.
1 X the
Policy fee
schedule
2 X the
Policy fee
schedule
3 X the
Policy fee
schedule
Assistant Surgical Services
We will pay 20% of the amount
listed in the fee schedule
Anesthesia Benefit for covered services
We will pay 25% of the amount
listed in the fee schedule
Inpatient Physician Hospital Visit per visit
Emergency Ambulance for each trip due to a covered
injury or Sickness that results in a hospital confinement.
$50
$100
$150
$250.00 per trip
* The reimbursement schedule for 1 unit is similar to what is payable under Medicare’s Physician
..fee schedule for surgeries. You may acquire up to three units based on plan selected
Medical Plan Comparison
.
Hospital
Indemnity
Major
Medical
Pays based on
Define Benefit
Schedule
Pays based on
Expense Incurred
Deductible is
Applied Against
Eligible
Benefits
Deductible and
Co-Payment is
Applied Against
Eligible Expenses
PHCS Network Composition Summary By MSA
Health Saver Plus 1
Prostate Cancer
3 Day Hospital Stay
3 Units @ a Daily Hospital Benefit of $4,500
Inpatient Hospital
Hospital Bill
3 days
Eligible
Benefit Deductible
$1,000 Deductible
2 Units @ a Daily Hospital Benefit of $3,000
3 Units
Payable
Out of
Pocket
Eligible
Benefit Deductible
$1,000.00
2 Units
Payable
Out of
Pocket
$8,000.00
$9,215.17
$17,215.17
$13,500.00
$1,000.00 $12,500.00
$4,715.17
$9,000.00
$2,530.00
$4,104.81
$4,104.81
($1,574.81)
$2,736.54
$2,736.54
($206.54)
55845
$650.00
$820.96
$820.96
($170.96)
$547.31
$547.31
$102.69
55845
$2,394.00
$1,026.20
$1,026.20
$1,367.80
$684.14
$684.14
$1,709.86
88305-26
88309-26
88331-26
86850-26
86901-26
86900-26
80061-26
83735-26
80048-26
85025-26
83735-26
$480.00
$495.00
$408.00
$7.26
$13.31
$8.47
$26.02
$13.31
$18.15
$10.89
$13.31
$175.74
$327.78
$282.12
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$175.74
$327.78
$282.12
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$304.26
$167.22
$125.88
$7.26
$13.31
$8.47
$26.02
$13.31
$18.15
$10.89
$13.31
$117.16
$218.52
$188.08
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$117.16
$218.52
$188.08
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$362.84
$276.48
$219.92
$7.26
$13.31
$8.47
$26.02
$13.31
$18.15
$10.89
$13.31
$36.00
$21.75
$21.75
$14.25
$14.50
$14.50
$21.50
$110.00
$110.00
$110.00
$200.00
$150.00
$150.00
$150.00
$150.00
$150.00
$150.00
$150.00
$150.00
($40.00)
($40.00)
($40.00)
$50.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$10.00
$10.00
$10.00
$100.00
Totals
$24,848.89
$20,859.36
$1,000.00 $19,859.36
$4,989.53
$13,906.25
$1,000.00 $12,906.25
$11,942.64
Re-priced @ 20% PHCS
Re-priced @ 30% PHCS
Re-priced @ 40% PHCS
$19,879.11
$17,394.22
$14,909.33
Surgery
55845
Assistant Surgery
Anesthesia
Pathology Bills
Radiology bills
74000-26
Hospital Visits
$19.75
($2,465.14)
($4,950.03)
$7,936.47
$4,487.97
$2,003.08
PHCS Physician & Hospital Network*
•
•
•
•
Inpatient services 10% to 50%
Outpatient services 10% to 40%
Ancillary services 15% to 55%
Physician services 23% to 46%
* PHCS Network is not available in MA, MD and WV
Imaging Network
Over 3,200 outpatient radiology facilities
• Save an average of 40% to 75% less than the usual costs
for MRI, CT and PET scans
Lab Services
10% to 80% savings on regular retail pricing of blood test with
over 3,000 certified labs nationwide.
Pharmacy Discounts
Access to over 60,000 participating pharmacies nationwide.
• Average savings 31% generic drugs and 13% off brand
...name prescriptions
Medical Discount Plan
Only $19.95/ month for you
and your family
Other Great Services Include
•
•
•
•
•
My eWellness – web-based health & wellness
eDocAmerica – online access to physicians
NurseLine – 24 hour Registered Nurse Advisor Help Line
Discounts on Chiropractic Services and Durable Medical
Discounts on Diabetic Supplies
Discount listed above are for illustrative purposes only please
refer to Careington’s brochure NEL-DMP or the membership
booklet for more details about the Discount Medical Plan.
- This Is Not Insurance -
Critical Illness Rider
Provides immediate cash for your customers when
they are diagnosed with a covered medical crisis.
They can use the money for:
• Treatment not covered by HSP1 including deductible and
…..expenses
in excess of the coverage selected.
• Non-medical expenses like travel, childcare, and spouse’s
…..time off from work.
• Expensive alterations to your home or vehicle for special
…..needs.
• Or, any way you choose. There are NO restriction on how
…..you spend your money.
Critical Illness Rider
A Lump-sum Benefit is paid upon the diagnosis of:
Covered Illness
% Benefit Paid
Heart Attack
100%
Stroke
100%
Cancer (Internal Cancer)
100%
End Stage Renal Failure
100%
Major Organ Transplant
100%
Non-Invasive Carcinoma In-situ
25%
Coronary Artery Bypass
25%
If a partial benefit is paid the remainder of the benefit will be payable
upon the diagnosis of another covered Critical Illness.
Critical Illness Rider
MONTHLY RATES
Issue Age
$10,000
NTU
Under 30 $
$20,000
TU
NTU
6.40
$30,000
TU
$
9.00
NTU
$
$40,000
$50,000
TU
NTU
TU
NTU
TU
9.60
$ 13.50
$ 12.80
$ 18.00
$ 16.00
$ 22.50
3.20
$
4.50
$
5.80
$
8.70
$ 11.60
$ 17.40
$ 17.40
$ 26.10
$ 23.20
$ 34.80
$ 29.00
$ 43.50
30 - 39
$
40 - 44
$ 11.20
$ 17.90
$ 22.40
$ 35.80
$ 33.60
$ 53.70
$ 44.80
$ 71.60
$ 56.00
$ 89.50
45 - 49
$ 12.60
$ 21.40
$ 25.20
$ 42.80
$ 37.80
$ 64.20
$ 50.40
$ 85.60
$ 63.00
$ 107.00
50 - 54
$ 20.80
$ 37.40
$ 41.60
$ 74.80
$ 62.40
$ 112.20
$ 83.20
$ 149.60
$ 104.00
$ 187.00
55 - 59
$ 23.40
$ 44.50
$ 46.80
$ 89.00
$ 70.20
$ 133.50
$ 93.60
$ 178.00
$ 117.00
$ 222.50
60 - 64
$ 35.70
$ 71.40
$ 71.40
$ 142.80
$ 107.10
$ 214.20
$ 142.80
$ 285.60
$ 178.50
$ 357.00
$10,000 Benefit Amount
0 - 26
Per Dependent Child
$
1.40
Family Term Life Rider
ACTUAL AGE
AT DEATH
INSURED INDIVIDUAL’S
DEATH BENEFIT*
INSURED SPOUSE’S
DEATH BENEFIT**
18-29
$ 50,000.00
$ 10,000.00
30-34
$ 40,000.00
$ 10,000.00
35-39
$ 30,000.00
$ 10,000.00
40-44
$ 20,000.00
$ 10,000.00
45-49
$ 15,000.00
$ 7,500.00
50-54
$ 10,000.00
$ 5,000.00
55-59
$ 7,500.00
$ 3,750.00
60-64
$ 5,000.00
$ 2,500.00
* Death Benefit is based on Insured’s attained age.
** Spouse’s Death Benefit is based on Insured’s attained age
ACTUAL AGE
AT DEATH
CHILDREN’S
DEATH BENEFIT
0 -14 days
$ 0.00
15 days to 6 month
6 months—age 17
$ 500.00
$ 3,000.00
Monthly Rates
Insured Only
$10.00
Insured & Children
$12.50
Family
$15.00
Enhanced Accident Expense Plan
.
BENEFIT SUMMARY
1 Unit
2 Units
Accidental Injury Benefit
$ 2,000.00
$ 4,000.00
Accidental Death Benefit
$ 50,000.00
$ 100,000.00
Ground or Air Ambulance
$ 5,000.00
$ 10,000.00
$ 150.00
$300.00
$ 500.00
$ 1,000.00
$ 1,000.00
$ 2,000.00
$ 5000.00
$ 10,000.00
$ 10,000.00
$ 20,000.00
$ 5000.00
$ 10,000.00
$ 10,000.00
$ 20,000.00
Hospital Income Benefit
Dismemberment Benefits
Loss of Finger or Toe
Single Loss Benefit
Multiple Loss Benefit
Loss of Hand, Arm, Foot, Leg
Single Loss Benefit
Multiple Loss Benefit
Loss of Site
Single Loss Benefit (One Eye)
Multiple Loss Benefit (Both Eyes)
Enhanced Accident Expense Plan
.
Optional Accident Disability
Income Benefit
1 Unit
Monthly Benefit
$ 1,000.00
Two Benefit Period To Choose From
12 Months
24 Months
Only Two Occupational Classes
Type 1
Type 2
2 Units
$ 2,000.00
Monthly Bank Draft Rates
Issue Ages for Accident Plan
Issue Ages for Accident Disability Rider
ACCIDENT PLAN
0-75
18-64
1 Unit
2 Units
Insured
$23.00
$31.05
Insured & Spouse
$44.28
$56.93
Insured & Children
$53.48
$69.00
Family
$74.75
$94.88
Child Only
$16.10
$20.13
ACCIDENT DISABILTY INCOME RIDER
1 Unit
2 Units
Type 1 - 12 months
$10.35
$20.70
Type 1 - 24 months
$13.23
$26.45
Type 2 - 12 months
$19.55
$39.10
Type 2 - 24 months
$26.45
$52.90
Underwriting
Simplified Issue
Application
It’s time for a change…
Simplified Issue Application
.
Simplified Issue Application
.
Simplified Issue Application
.
Simplified Issue Application
.
Underwriting
“Made Easy”
It’s time for a change…
Underwriting Tip -1
To help you ensure we are receiving accurate information from
the applicant, you might let them know that a representative
from the home office will call and review the application and
their prescription history that you are about to review with them.
You might tell them as your agent you are going to:
• “Ask them a series of questions about their medical history and ask
them what medications they have taken in the last 12 months. These
will be the same questions that the Company will ask you on a
recorded phone call when they process your application.”
It’s time for a change…
• Please be as thorough as possible to ensure consistency between
their application and the recorded quality assurance call. This will
help in getting their application processed in a timely manner.
Underwriting Tip - 2
Explain to the applicant how we handle Pre-existing
Conditions to ensure they understand how it works
What is a Pre-Existing Condition?
“A condition for which treatment was rendered or
recommended by a Physician or for which drugs or
medicine was prescribed within 12 months prior to a
covered Person’s Effective Date.
New Business
Flow Chart
Paper
Application
Fax
Application
Reviewed For
Processing
YES
E-APP
Checked for
Legibility
No
Yes
It’s time for a change…
Missing
Forms
All Forms
Ask For
another Fax
or
Original
App To Be
Mailed
Manually Key
Into System
Contact
Agent
LSP
Policy System
Underwriter’s
Desk
IntelliScript
Pre-Screen
QAC
Underwriter
Review
Decline
NO
APS or
Other
Requirement
No Requirements or
After Review of new
information
Conditional
Offer
YES
+ Issue Policy
+ Draft Premium
IntelliScript
Prior
2007
2008
2009
2010
Quality Assurance Call
1. The Quality Assurance Desks will be open from 8:00 am to 5:00 pm
CST Monday thru Friday.
2. The purpose of this call is to allow the applicant to add any
information that may have forgotten to disclose to the agent
3. A “Thank You ” email is sent from the home office upon receipt of
the application to let the applicant know that we will be calling them
and if they have not heard from us we invite them to call the toll free
number to complete the call.
How Do I Get Quick Issue
Let your client know what underwriting will be expecting
• Let them know about the Quality Assurance Call and
how important it is.
• Let them know that we will be ordering an RX history
showing prescriptions they have had filled and the doctor’s name.
• Make sure you charge the correct rate ups. If they are not on
the application, you will find them located in the Underwriting
Guide –This relates specifically to question 13!
How Do I Get Quick Issue
Stress The Importance of Question #13
In the last 12 months, other than conditions listed on the
application, has any applicant had any medical or surgical
advice or treatment or including prescriptions or operations
or been advised to have medical tests or surgery that has not
yet been performed, or is awaiting medical tests?
If YES-you will need to refer to the Underwriting guide to
determine if any action is necessary.
WHAT ABOUT CONDITIONS NOT ON THE APPLICATION?
The application ask about common conditions, but not all
medical conditions! Please use the UW Manual if conditions
are disclosed but not asked on the application. Question 13
ask about “Other” conditions.
ANEMIA-
Within 2 Years since recovery = 2 Points
Between 2-5 years since recovery = 1 Point
More than 5 years = STD
Otherwise = DEC
GASTRIC BYPASS SURGERYWithin the last 12 months = 2 Points
1 Year-3 Years-full recovery = 1 Point
More than 3 years, full recovery = STD
With Complications = DEC
How Do I Get Quick Issue
Get complete information
• If the Rx history and the Quality Assurance Call are
...consistent with the information on the application-you
can expect QUICK turnaround
……..
• If information is developed through any of these
.. sources that is not consistent with the application, an
APS may be ordered which may delay issue several
weeks.
…
……..
…….
• Getting complete information, avoids underwriting …
…requiring the agent to go back later which may cause
…you to have to “Resale” the program
Underwriting Made Easy
Get quick answers to your Underwriting Questions?
[email protected]
Tobacco Rate
My client stopped smoking five years ago. He smoked 2 packs a day but now only smokes an
occasional cigar once or twice a week, can I quote him the non-tobacco rate?
Thanks
Successful Agent
Underwriting Made Easy
In Summary-Explain to the client
• How Pre-Existing Condition’s are applied
• How the surgical schedule works with the based on the
number of units they selected
• The application process including the Quality Assurance
Call
......
• How important complete medical and prescription history
is in completing the application.
Underwriting is always available to help at
[email protected]
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