“Critical Care” An Insurance Solution For Today’s Health Care Reality.
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Transcript of “Critical Care” An Insurance Solution For Today’s Health Care Reality.
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AIM States
GoldenCare USA StatesAIM/GOLDENCARE MAP
AIM 1-800-672-7202 GoldenCare USA 1-800-842-7799
www.AIMforLTC.com/ACSIA
The Big Picture on “Critical Care”
• The Need Is Real and Not Widely Recognized
• “Critical Care” Is EASY to explain and the risk is relevant to most people
• Qualifying for coverage is reasonable – most get approved
– Great place to pivot when there’s an LTCi decline
• Underwriting Turn Around Time is Short – 3 days on average (No APS)
Bottom Line: Your Business Pipeline Fills Up Fast and You Get Paid Quickly
GTL State Approval List Alabama Alaska Arkansas Arizona Colorado Delaware Idaho Illinois Indiana Kansas
Kentucky Louisiana Maine Maryland Michigan Mississippi Missouri Montana Nebraska Nevada
Tennessee Texas Washington Washington DC West Virginia Wisconsin Wyoming
New Jersey New Mexico North Carolina North Dakota Ohio Oklahoma Oregon South Carolina Indiana South Dakota
Times Have Changed, the NeedIs Real and Most are Unaware!
Today, with early detection, prevention and advances in medical treatments, the odds of surviving a life altering critical condition are better than ever.
The Facts
1 in 2 will be diagnosed with cancer during their lifetime1
Every 40 seconds someone in the U.S. has a stroke.2
In 2010, 785,000 Americans had a new coronary attack 470,000 had a recurrent attack3
1United States Cancer Statistics (USCS). Centers for Disease Control and Prevention site, 2011 Cancer of All Sites - SEER Stat Fact Sheet. 2011 2Stroke Facts. Centers for Disease Control and Prevention 2011. 3Roger V, Go, A, Lloyd-Jones, D, et al. Heart disease and stroke statistics—2011 update. American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
Survival odds today 86% of hospitalized heart attack
patients survive (higher for first heartattacks)1
80% of stroke patients survive the initialevent.1
– 35% recover completely or with minor impairments.2
The survival rate for kidney failure is 60% to 90%.3
50-90% for major organ transplants (including the heart, lungs, liver, and kidneys)4
1 “Why do I need critical illness insurance?”.essentialbenefits.ca. Essential Benefits. 2 Feb. 2011. Web. 2010. 2 “Cancer Facts and Figures 2011”. American Cancer Society. n.d. Sep. 2011 3 “Acute Kidney Failure”. merckmanuals.com. The Merck Manuals Online Medical Library. 16 Feb. 2011. Web. 2010. 3. “Organ Transplantation”. FAQs.org. Health. n.d. Web 16 Feb. 2011.
For many, it may be too much More than 50% of bankruptcies are caused by excess medical
expenses1
79% of these people had health insurance!1
Half of the foreclosures in America are due to debt from medical causes2
About 1.5 million homeowners are currently in danger of losing their homes due to illness related expenses.2
1 Himmelstein, David U. et. al. “Medical Bankruptcy in the United States, 2007: Results of a National Study Clinical Research Study”. Harvard U. n.d. Web.16 Mar. 2011. 2 Robertson, Egelhof & Hoke. “Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures”. August 2008. Web. Oct. 2011. 3
Health Insurance Doesn’t Cover As Much As It Used To
• Most Medical plans provide coverage for hospital and medical expenses arising from a critical illness
• Many expenses are not covered such as: – medical co-pays
– transportation to treatment centers
– Lodging
– Childcare
– What about other expenses like paying your mortgage?
Could your client’s nest egg withstand the potential financial impact of a critical illness?
Triggering DiagnosesCOVERED CONDITIONS:
• Cancer
• Cancer In-Situ
• Heart Attack
• Coronary Artery Bypass Surgery
• Stroke
• Alzheimer’s Disease
• Kidney Failure
• Major Organ Transplant
• Paralysis
• Coma
Straightforward Benefit AccessBased on a Medical Diagnosis, Pays CASH!
• With no restrictions! • CASH can be used for…
– Loss of income– Rehabilitation expenses– Alternative treatment options– Travel and lodging for treatment plans– Lifestyle changes– Mortgage loans & debt payments– Child care expenses
“Critical Care” Stands apart from typical Critical Illness
Policies
• Covers Alzheimer’s Disease• Increased benefits for care received in ALFs and NHs• Coverage availability up to age 84
“Critical Care” Stands apart from typical LTCi
• Trigger benefits sooner – based on diagnosis not ADLs• Underwriting – easier and MUCH faster• Higher issue rates – get paid more often!
Select a Monthly Base Benefit• Options: $500 to $3,000 per month in $250
increments– Dependent coverage is $500 per month
• Benefit is increased when care is received in an LTC facility:– 100% when in a Nursing Home– 50% when in an Assisted Living Facility
Example: $2,000 monthly base benefit at home:
$3,000 per month for an ALF (50% of the base benefit)
$4,000 per month for a NH (+100% of the base benefit)
NOTE: The Full Monthly Base Benefit = Nursing Home Benefit
Deriving The Lifetime Maximum BenefitCalculating the Lifetime Maximum Benefit:
• “Full Monthly Base Benefit” (Nursing Home Benefit) x the benefit period x 3
Example: If the selected monthly base benefit = $2,000 the, “Full Monthly Base Benefit” is $4,000 (Nursing Home Benefit)
Lifetime Maximum Calculation: $4,000 monthly Nursing Home benefit x 24 month benefit
period x 3 = LT Max of $288,000
This is the maximum the policy will pay under any circumstance with this monthly base benefit
Coverage Limits By Diagnosis
• Cancer 100% of your chosen benefit period• Cancer In-Situ 3 months• Heart Attack 3 months• Coronary Artery Bypass Surgery2 months• Stroke 100% of your chosen benefit period• Alzheimer’s Disease 100% of your chosen benefit
period• Kidney Failure 100% of your chosen benefit period• Major Organ Transplant 100% of your chosen benefit period• Paralysis 100% of your chosen benefit
period• Coma 3 months
Example A : Lifetime Maximum – Multiple Claims at Home
24 mo BP, $2,000/Mo Base Benefit, $4,000 NH Benefit, $288,000 LT Max
Note: Full Base Benefit = Nursing Home Benefit
Initial Claim:Client diagnosed with a Stroke
Policy pays 100% of BP for Stroke = 24 months
24 months at $2,000/mo = $48,000
Lifetime Maximum:$288,000 -$48,000$240,000 remains
3 years later:Client is diagnosed with Cancer
Policy pays 100% BP for Cancer = 24 months
24 months at $2,000/mo = $48,000
Lifetime Maximum:$ 240,000 -$ 48,000$192,000 remains
6 years later:Client diagnosed with a second Stroke
Policy pays 100% BPfor Stroke = 24 months
24 months at $2,000/mo = $48,000
Lifetime Maximum:$192,000-$ 48,000 $144,000 remains
Example B: Lifetime Maximum – Claims at home and in the Nursing Home
24 mo BP, $2,000/Mo Base Benefit, $4,000 NH Benefit, $288,000 LT Max
Note: Full Base Benefit = Nursing Home Benefit
6 years later:Client is diagnosed with a second Stroke Stays in NH
Policy pays 100% BP for Stroke= 24 months
24 months in NH at $4,000/mo = $96,000
Lifetime Maximum:$144,000 -$ 96,000$48,000 LT Max Remains
Initial Claim:Client diagnosed with a Stroke. Stays home
Policy pays 100% BP for Stroke = 24 months
24 months at $2,000/mo = $48,000
Lifetime Maximum:$288,000 -$ 48,000$240,000 LT Max Remains
3 years later:Client is diagnosed with Cancer – Stays in NH
Policy pays 100% BP for Cancer = 24 months
24 months in NH at $4,000/mo = $96,000
Lifetime Maximum:$240,000-$ 96,000$144,000 LT Max Remains
NOTE: TIAs or Strokes are acceptable but will be limited to the CancerCare Plus Policy
Opportunity for LTCi Declines:Circled LTCi declines (in red) are acceptable with Critical Care
APPLICATION: United Of Omaha for Nebraska
Opportunity for LTCi Declines:Circled LTCi declines (in red) are acceptable with Critical Care
Diabetes with +50 units of Insulin is acceptable but will be limited to the Cancer Care Plus Policy
Cancers are fine but are limited to the Cardiac Care Plus Policy.
Being on ANY form of Disability is acceptable
APPLICATION: United Of Omaha for Nebraska
Directly from United of Omaha’s Underwriting Guide
Field Declines for LTCi but not for “Critical Care”
Amputation due to disease Anorexia
Arrhythmia RA with more than 10mg of Prednisone
Asperser's Syndrome Atrial Fibulation with History of Stroke or TIA
Bell’s Palsy Blindness, not adapted
Buerger’s Disease Prostate Cancer, Stage IV
Any Cancer < 2 years Charcot Marie Tooth
Narcotic Use Compression Fractures
Continued:Field Declines for LTCi but not for “Critical Care”
Crest Syndrome Epstein Barr
Hemophilia Hydrocephalus
Neuropathy Pick’s Disease
Polyneuropathy Quadriplegia Sjogren’s
Spina Bifida Multiple Strokes or TIA’s
Systemic Lupus
Underwriting
• Only 5 knock-out questions– No Height or Weight questions
• Every application will have a drug prescription history check
• No APS• Average underwriting turnaround time – 3 days• In rare circumstances, phone, face-to-face at or
medical records may be needed to clarify a condition – at the underwriter's discretion
Rate Book Page
• One page for each plan
• A block of rates for each Benefit Period
• Rates are annual
• 1.5 Factor for tobacco use
• $25 Policy Fee
Steps to Rating – 60 Year Old
• Step 1: Choose Plan A, B or C – we’ll use Plan A
• Step 2: Choose Benefit Period – we’ll use 12 Month Benefit Period
• We’ve narrowed it down to one block of rates!
Sample: Plan A, 12 Month Benefit Period
Step 3: Choose Monthly Base Benefit – we’ll choose $1,500 – Annual
Premium = $1,023.30
Step 4: Select a Monthly Modal Factor = ($1,023.30 x .09) = $92.10/mo
Sample Rates 12 month Plans (A,B and C) $1,500 per month Benefit
Base Plan - $1,500 ALF - $2,250 NH - $3,000
Plan A Plan B Plan CAge Critical Care Cancer Care Cardiac Care
50-54 $50.63 $28.43 $22.97
55-59 $69.44 $39.29 $33.56
60-64 $92.00 $51.90 $48.63
65-69 $118.44 $64.64 $68.72
70-74 $145.37 $77.86 $91.51
Company History
• Located in Glenview, IL• Founded in 1936 by the
Holson family• Mutual life insurance
company• Licensed in 49 states plus
Puerto Rico• More than 1.5 million
policyholders• Manufacturer of niche
insurance products
The GTL Difference
• Agents have instant access to whoever they need to speak to… no automated phone system
• Fast and efficient underwriting…90% of business issued in 3 days or less
• Claims are paid directly to the policyholder or beneficiary…so they can use the money however they like
– If insured passes away during claim – benefit payments continue to the beneficiary– If insured recovers during claim, benefit payments continue