it’s time for a change…. the company behind the change… philadelphia american life insurance...
TRANSCRIPT
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 companyDr. 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.
It’s time for a change…
RETHINK the way you view healthcareRETHINK the way you view healthcare
Empowered healthcare is the Mission.. Empowered healthcare is the Mission..
Think PreventionSmart and healthy lifestyle choices
Think ControlTake control over personal
healthcare decisions
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.
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.
For a growing number of American's, the days of $20 co-pays are coming to an end.
The Key to Controlling Healthcare Costs is More Than Co-Pays and Deductibles
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.
It’s about providing the “right” plan at the right time to help guide personal decisions.
Welcome to Health Saver Plus! 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 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 your treatment plan and costs with the healthcare professional of your choice.
Welcome to Health Saver Plus! 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 Number of Benefit Units to fit your needs Calendar Year Benefit Maximum
• Use any Doctor or Hospital you choose “Without Penalty”
Three Calendar Year Deductibles To Choose From.Maximum of three Deductibles per policy
Three Calendar Year Deductibles To Choose From.Maximum of three Deductibles per policy1. $ 1,000
2. $ 2,500
3. $ 5,000
1. $ 1,000
2. $ 2,500
3. $ 5,000
Maximum Covered Benefits Per Covered Person per Calendar Year $100,00
0$250,000
$1,000,000
Maximum Number of Days Per Covered Persons 30 60 180
Choose Your Maximum Benefit Level.
Hospital Indemnity Benefits – Facility Fees .Select The Number of Benefit Units To Fit Your Needs
1 Unit
2 Units
3 Units
Daily Indemnity Benefit For Hospital Confinement $1,000
$2,000 $3,000
Confinement in a Hospital Intensive Care Unit (ICU) (Up to 20 days per Calendar Year $1,50
0$3,000 $4,500
Daily Indemnity Benefit For Hospital Confinement For Mental Illness, Alcohol and/or Substance Abuse $
500$1,000 $1,500
Daily Indemnity Benefit For Hospital Confinement in a Rehabilitation Facility or Skilled Nursing Facility $
500$1,000 $1,500
Daily Indemnity Benefit For Outpatient Radiation or Chemotherapy $
500$1,000 $1,500
Inpatient Physician Hospital Visit per visit $ 50 $ 100 $ 150
Daily Indemnity Benefit for Outpatient Hospital or Ambulatory Surgical Center services when surgery is performed
$1,000
$2,000 $3,000
Emergency Ambulance for each trip due to a covered injury or Sickness that results in a hospital confinement.
$250 per trip
Professional Services.
* 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
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
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
Sample of Common Surgeries .
CPT DESCRIPTION19307 mastectomy, modified radical
27130 total hip arthroplasty
29881 knee arthroscopy/surgery
33533 coronary artery bypass, arterial, single
93510 left heart catheterization
45380 colonoscopy and biopsy
47562 laparoscopic cholecystectomy
50590 lithotripsy, fragmenting of kidney stone
58150 total hysterectomy
66984 cataract surg w/intraocular lens, 1 stage
Sample Fee Schedule Comparisonby State
Policy Fee Schedule (1 Unit) 100.00%Alabama 87.00%Arkansas 85.00%Arizona 93.68%Colorado 93.59%Georgia - Atlanta 97.03%Iowa 86.41%Illinois - Chicago 105.66%Illinois - Rest of the state 92.96%Indiana 90.50%Louisiana - New Orleans 97.82%Michigan - Detroit 107.11%Michigan - Rest of the state 94.80%Missouri - St. Louis 94.78%Mississippi 88.18%Nebraska 85.49%Ohio 95.76%Oklahoma 86.99%Pennsylvania - Philadelphia 106.03%Pennsylvania - Rest of the state 94.60%South Carolina 88.38%Tennessee 89.06%Wisconsin 89.36%
Outpatient Benefits .CALENDAR YEAR DEDUCTIBLE $500 per insured
Calendar Year Maximum $2,000
Units 1 Unit
2 Units
3 Units
Outpatient Office Visit $ 25 $ 50 $ 75
Other Outpatient Services (per test)• MRI, CAT Scan or Nuclear testing• Other diagnostic testing or X-rays• Laboratory testing• Injections
$ 1754010
5
$ 350802010
$ 525120
3015
Generic Prescription (per prescription filled) $ 5 $ 10 $ 15
Brand Name Prescription (per prescription filled) $ 10 $ 20 $ 30
Well Care Maximum $ 50 per visit up to $150 per calendar year
Receive Benefits From Three Pools
.
Patient Protection and Affordable Care Act
Hospital Indemnity
Pays based on Define Benefit Schedule
Deductible is Applied Against
Eligible Benefits
Major Medical
Pays based on Expense Incurred
Deductible and Co-Payment is Applied
Against Eligible Expenses
Medical Plan Comparison .
Inpatient Hospital 6 days Eligible Benefit Deductible Payable Out of Pocket
Hospital Bill $25,469.71 $18,000.00 $1,000.00 $17,000.00 $8,469.71
Pathology Bills81003 $9.00 $9.66 $9.66 -$0.6680053 $33.00 $45.42 $45.42 -$12.4285025 $9.00 $33.42 $33.42 -$24.4284132 $11.25 $19.74 $19.74 -$8.4980053 $33.00 $45.42 $45.42 -$12.4280074 $25.00 $204.63 $204.63 -$179.6382247 $10.00 $21.57 $21.57 -$11.5782248 $10.00 $21.57 $21.57 -$11.5785651 $8.00 $15.24 $15.24 -$7.2485025 $9.00 $33.42 $33.42 -$24.4284132 $11.25 $19.74 $19.74 -$8.4980053 $33.00 $45.42 $45.42 -$12.4285025 $9.00 $33.42 $33.42 -$24.42
Radiology Bills 71020 $47.00 $26.91 $26.91 $20.0972193 $255.00 $141.36 $141.36 $113.6474160 $270.00 $154.26 $154.26 $115.7474020 $57.00 $32.91 $32.91 $24.0976705 $130.00 $70.98 $70.98 $59.02
Hospital Visits $286.00 $150.00 $150.00 $136.00$225.00 $150.00 $150.00 $75.00$225.00 $150.00 $150.00 $75.00$210.00 $150.00 $150.00 $60.00$210.00 $150.00 $150.00 $60.00$175.00 $150.00 $150.00 $25.00
Totals $27,770.21 $19,875.09 $1,000.00 $18,875.09 $8,895.12
Health Saver Plus Diverticulitis 6 day stay $1,000 Deductible 3 Units
PricingOur most economical plans (Male/Female age 40 with 2 children)
1) Family Rate 1 Unit / NTU $1,000 Deductible with a …..$100,000 Annual Maximum $ 196.02
2) Family Rate 2 Units / NTU $2,500 Deductible with a …..$250,000 Annual Maximum $ 317.99
Our most popular plan (Male/Female age 40 with 2 children)
4) Family Rate 2 Units / NTU $1,000 Deductible with a …..$1,000,000 Annual Maximum $ 500.96
Rate does not include a one time $30.00 non-refundable application fee
3) Family Rate 2 Units / NTU $1,000 Deductible with a …..$250,000 Annual Maximum $ 435.62
Enhanced 24 Hour Accident Expense Insurance Plan
withAccident Disability Income
Benefit
Enhanced 24 Hour Accident Expense Insurance Plan
withAccident Disability Income
Benefit
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
Hospital Income Benefit $ 150.00 $300.00
Dismemberment Benefits
Loss of Finger or Toe Single Loss Benefit Multiple Loss Benefit
$ 500.00$ 1,000.00
$ 1,000.00$ 2,000.00
Loss of Hand, Arm, Foot, Leg Single Loss Benefit Multiple Loss Benefit
$ 5000.00$ 10,000.00
$ 10,000.00$ 20,000.00
Loss of Site Single Loss Benefit (One Eye) Multiple Loss Benefit (Both Eyes)
$ 5000.00$ 10,000.00
$ 10,000.00$ 20,000.00
Enhanced Accident Expense Plan .
Optional Accident Disability Income Benefit 1 Unit 2 Units
Monthly Benefit $ 1,000.00 $ 2,000.00
12 Months 24 Months
Two Benefit Period To Choose From
Type 1 Type 2
Only Two Occupational Classes
Monthly Bank Draft Rates Issue Ages for Accident Plan 0-75Issue Ages for Accident Disability Rider 18-64 ACCIDENT PLAN 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
It’s time for a change…
Underwriting
Simplified Issue Application
Simplified Issue Application .
Simplified Issue Application .
Simplified Issue Application .
It’s time for a change…
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.”
• 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.
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.
Underwriting Tip - 2
New BusinessFlow Chart
It’s time for a change…
FaxApplication
PaperApplication
LSPPolicy System
Reviewed ForProcessing
MissingForms
ContactAgent
All Forms
Checked forLegibility
Ask Foranother Fax
orOriginal
App To BeMailed
No
YES
Yes
Manually KeyInto System
E-APP
UnderwriterReview
APS orOther
Requirement
ConditionalOffer
No Requirements orAfter Review of new
information
Decline
YES
NO
+ Issue Policy + Draft Premium
Pre-Screen
QAC
IntelliScript
Underwriter’s Desk
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.
• 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
Let your client know what underwriting will be expecting
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.
How Do I Get Quick Issue
Stress The Importance of Question #13
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 SURGERY-
Within the last 12 months = 2 Points 1 Year-3 Years-full recovery = 1 Point More than 3 years, full recovery = STD With Complications = DEC
• 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
How Do I Get Quick Issue
Get complete information
Underwriting Made Easy
[email protected] 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?
ThanksSuccessful Agent
Get quick answers to your Underwriting Questions?
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
Online Services
1. How to register Online as a new agent
2. Access to Downloading the eApp
3. Check the status of your pending
business
4. Download a copy of your application
5. Get a copy of your commission
statement
6. See your latest commission check
The following slides will provide you with the following information
Register Today Atwww.neweralife.com
Download The eApp
Manage Your Agent Profile
SalesForms
Online Applications
CommissionStatement
Pending Business
Online Applications
Medicare Supplement
Health Saver Plus
Manage Your Agent Profile
SalesForms
Online Applications
CommissionStatement
Pending Business
Online Applications
Medicare Supplement
Health Saver Plus
Select either the Health Saver Plus or theEnhanced 24 Hour Accident Expense Plan
Manage Your Agent Profile
SalesForms
Online Applications
CommissionStatement
Pending Business
Online Applications
Medicare Supplement
Health Saver Plus
Manage Your Agent Profile
SalesForms
Online Applications
CommissionStatement
Pending Business
Online Applications
Medicare Supplement
Health Saver Plus
Now You Can Login To Online Agent Service
Atwww.neweralife.com
Manage Your Agent Profile
SalesForms
Online Applications
CommissionStatement
Pending Business
Online Applications
Medicare Supplement
Health Saver Plus
Dave Collett
Download a copy of your completed Application
Manage Your Agent Profile
SalesForms
Online Applications
CommissionStatement
Pending Business
Online Applications
Medicare Supplement
Health Saver Plus
Use 60000Demo as your agent number while you are familiarizing yourself with the eApp otherwise it will assume a life application