the nuts & bolts of critical care - goldencare agents · the survival rate for kidney failure...

e-Seminar Series Part 1

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The Nuts & Bolts ofCritical Care

Tom RandallNational Marketing Director

GOLDENCARE USA

1For Agent Use Only

Today’s Presentation…

� Quick Bird’s-Eye View

� Why Traditional Critical Illness is Hot

� Cross-over of LTCi Claims

� The “Nuts & Bolts” of Critical Care

� UW Highlights & Differences from LTCi

� The Simple Critical Care Application

� EASY Calculation of Rates

2For Agent Use Only

Great For Uninsurable/Declined LTCi Clients

� Simple 5 question, “Yes-No” application with 90%+ issue rate

– No Height/Weight -- No APS

– No Telephone Interview -- No Cognitive

� Easier access to benefits – 1st day coverage

– NO 2 of 6 ADL’s, NO 90 day pre-cert – Diagnosis Trigger & pays no matter what

� Pays up to 100% extra for ALF and NH

Lifetime Level Renewals

3For Agent Use Only

Great For Uninsurable/Declined LTCi Clients

� Covers where LTCi won’t

– Heart Attack

– Bypass Surgery

– Kidney Failure or Organ Transplant

– Cancer

� No special CE or Partnership training required

The best alternative in the industry!

(Maybe better?)

4For Agent Use Only

State Approvals As Of May 15th

� Alabama

� Alaska

� Arkansas

� Arizona

� Colorado

� Delaware

� Hawaii

� Idaho

� Illinois

� Indiana

� Iowa

� Kansas

� North Carolina

� North Dakota

� Ohio

� Oklahoma

� Oregon

� South Carolina

� South Dakota

� Tennessee

� Texas

� Washington

� West Virginia

� Wisconsin

� Wyoming

� Kentucky

� Louisiana

� Maine

� Maryland & DC

� Michigan

� Mississippi

� Missouri

� Montana

� Nebraska

� Nevada

� New Jersey

� New Mexico

5For Agent Use Only

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.

6For Agent Use Only

The Facts

� More than 75% of healthy individuals over the age of 40 will become critically ill at some point.1

� 1 in 2 will be diagnosed with cancer during their lifetime2

� Every 40 seconds someone in the U.S. has a stroke.3

� In 2010, 785,000 Americans had a new coronary attack 470,000 had a recurrent attack4

1 Mueller, E., & Spencer, L. (2012) Critical Illness Plans: Addressing Your Client’s Needs. Healthcare Reform Magazine, March 3, 2012. www.healthcarereformmagazine.com/article/ critical-illness-plans-addressing-your.html 2United States Cancer Statistics (USCS). Centers for Disease Control and Prevention site, 2011 Cancer of All Sites - SEER Stat Fact Sheet. 2011 3Stroke Facts. Centers for Disease Control and Prevention 2011. 4Roger V, Go, A, Lloyd-Jones, D, et al. Heart disease and stroke statistics—2011 update. American Heart Association Statistics Committee and Stroke Statistics Subcommittee.

7For Agent Use Only

Improving Survival Odds

� 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. 4“Organ Transplantation”. FAQs.org. Health. n.d. Web 16 Feb. 2011.

8For Agent Use Only

Surviving a Critical Illness Comes at a Cost

� Most Medical plans provide coverage for hospital, doctor and other medical expenses arising from a critical illness

� Many expenses are not covered such as:

– Medical co-pays & deductibles

– Transportation & lodging

– Out of network / experimental treatment

– Loss of income

– Everyday expenses – child care, mortgage, etc.

The American Cancer Society estimates that 65% of the cost of cancer treatment is not covered by traditional health insurance.1

1 American Cancer Society Website, 2012 http://www.cancer.org

9For Agent Use Only

For Many, the Cost May Be Too Much

� Nearly 2/3 of all bankruptcies filed in the U.S. are a direct result of overwhelming medical expenses… and,

… 79% of these people had health insurance!1

� Half of the foreclosures in America are due to debt from medical causes.2

� 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 Clinical Research Study.” Harvard U. n.d. Web.16 Mar. 2011 2Robertson, Egelhof & Hoke. “Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures”. August 2008. Web. Oct. 2011.

Could your client’s nest egg withstand the potentialfinancial impact of a critical illness?

10For Agent Use Only

WHAT CAUSES CLAIMS?

1Fifth Intercompany Report prepared by the society of Actuaries, November, 2011 2American Association for Critical Illness Insurance study conducted by Gen Re, 2011

Similar claim causes in both policies!


Critical Care -A New Concept To Solve An Old Problem

It’s a blend of both Critical Illness and LTCi benefits


First-Day CASH Triggering Diagnoses

COVERED CONDITIONS:

� Cancer

� Cancer In-Situ

� Heart Attack

� Coronary Artery Bypass Surgery

� Stroke

� Alzheimer’s Disease

� Kidney Failure

� Major Organ Transplant

� Paralysis

� Coma


Straightforward Benefit Access

� With first-day CASH, you have control of the funds:

– Traditional health insurance co-pays or deductibles

– 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 CI Policies

� Covers Alzheimer’s Disease

� Allows multiple claims

� Increased benefits when residing in an ALF or NH

� Applications up to age 84


� Trigger benefits sooner – based on diagnosis, not ADLs

� Underwriting – easier and MUCH faster

� Higher issue rates – so you get paid more often

Critical Care Stands Apart from Typical LTCi


Let’s Think About This…

1 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project

� Odds of having cancer is around 50%

� Odds of heart attack or bypass surgery between 33-47%

� The Alzheimer’s Association tells us that at age 85, 50% will develop


Why Should LTCi Agents Offer It?

� 49% of LTCi claims dollars are for Alzheimer’s– Average industry claim is 659 days1

� A two year Critical Care plan will provide sufficient benefits to exceed average industry claim

1 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project


“Critical Care”Designing A Plan


Choose One of Three Plans


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: $3,000 monthly base benefit at home:

� $4,500 per month for an ALF (+ 50% of the base benefit)

� $6,000 per month for a NH (+ 100% of the base benefit)


Benefit Period Selection

� For All Other Covered Conditions You Choose Period

– Cancer, Stroke, Alzheimer’s, Kidney Failure, Organ Transplant, & Paralysis

– Benefit Period Options = 6, 12, 18, or 24 Months (The same for all)

� Some Conditions Have A Pre-Set Benefit Period

– Cancer In-Situ, Heart Attack & Coma = 3 Months

– Coronary Artery Bypass Surgery = 2 Months

� Built-In Restoration of Policy Benefit Periods

– Not “One-and-Done” – Allows for multiple claims

– Benefit Period fully restores 12 months after the last payment of benefits (with the exception of Alzheimer’s & Paralysis)

– Subject to the Lifetime Maximum Benefit


Deriving The Lifetime Maximum Benefit

Calculating the Lifetime Maximum Benefit:� “Full Monthly Base Benefit” (Nursing Home Benefit) x the benefit period x 3

Example: If the selected monthly base benefit = $3,000 the, “Full Monthly Base Benefit” is $6,000 (Nursing Home Benefit)

Lifetime Maximum Calculation:

� $6,000 monthly Nursing Home benefit x 24 month benefit period x 3 = LT Max of $432,000

This is the maximum the policy will pay under

any circumstance with this monthly base benefit


Only One Optional Benefit To Worry About

Optional Return of Premium Rider

� Very Inexpensive – Only 10% - 25% Additional Premium

� Returns premiums (less claims paid) if insured dies before the first policy anniversary which follows their 80th birthday


An Example of the Power of Critical Care

Initial Claim:Client diagnosed with a Stroke and stays home

Policy pays 100% of BP for Stroke = 24 months

24 months at $3,000/mo = $72,000

Lifetime Maximum:$432,000 -$ 72,000$360,000 Lifetime Max. remains

3 years later:Client is diagnosed with Cancer

Policy pays 100% BP for Cancer = 24 months

6 months in home at $3,000/mo= $18,000… then,18 months in NH at $6,000/mo = $108,000… Total = $126,000

Lifetime Maximum:$ 360,000 -$126,000$234,000 Max. remains

6 years later:Client diagnosed with a 2nd Stroke and stays in NH

Policy pays 100% BPfor Stroke = 24 months

24 months in NH at $6,000/mo = $144,000

Lifetime Maximum:$ 234,000-$144,000 $ 90,000 Lifetime Max. remains

24 mo BP, $3,000/Mo Base Benefit, $6,000 NH Benefit, $432,000 LT Max

Note: Full Base Benefit = Nursing Home Benefit


Critical Care

Gives You an Underwriting Advantage Over LTCi!


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 GuideField Declines for LTCi but not for “Critical Care”

Amputation due to disease Anorexia

Arrhythmia RA with more than 10mg of Prednisone

Asperger's Syndrome Atrial Fibrillation with History of Stroke or TIA

Balance/Walking Problems Bell’s Palsy

Blindness, not adapted Buerger’s Disease

Prostate Cancer, Stage IV Any Cancer < 2 years

Cardiomyoapathy Chronic Pain

Compression Fractures Congestive Heart Failure


Continued:Field Declines for LTCi but not for “Critical Care”

COPD (Past Mild) CREST Syndrome

Disability Dizziness

Epstein Barr Fraility

Heart Transplant Hemophilia

High Blood Pressure (uncontrolled) Hydrocephalus

Major Depression Multiple Falls

Narcotic Pain Medication Use Neuropathy

Pick’s Disease Polyneuropathy

Quadriplegia Sjogren’s Syndrome

Spina Bifida Strokes or TIA’s (multiple)

Systemic Lupus


“Critical Care”

The Application


Underwriting

� Only 5 knock-out questions

� Every application will have a drug prescription history check

� No Automatic APS

� Very fast underwriting turnaround time

� In rare circumstances, phone, face-to-face at or medical records may be needed to clarify a condition – at the underwriter's discretion


Three Plans, Three Underwriting Opportunities


Underwriting Questions



Med List – Attach a Sheet if Necessary.


“Critical Care”

Calculating Rates


Simple, Color-Coded Medication Guide


Simple Rate Worksheet Page



� Applicant Plan

� Spouse’s Plan

� Dependents’ Plan(s)

� Sub-Total Annual Premium

� Optional ROP (10-25%)

� $25 Policy Fee

� Modal Premium


Rate Book Page

� One page for each plan

� A block of rates for each Benefit Period

� Rates are annual

� Modal Factors List

� 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 = $929.64 + $25.00 annual policy fee = $954.64

Step 4: Select a Monthly Modal Factor = ($954.64 x .09) = $85.92/mo

MICHIGAN RATE FACTORS


Full List of Webinars!www.goldencaretraining.com/schedule

GREAT F/Up Webinar:

Mark Randall Presenting…

Wed. (6/18) 9:00-9:30 a.m. Central

“Critical Care Marketing Concepts”

www.A2agent.com


� Superior Product Designs

� Personalized Consumer Websites

� LTC CEO Software

� CareOptions Online (COOL)

� Top GoldenCare Agent Website

� Live Webinar Training

� Recorded Webinar Training

� GoldenCare Rewards Program

Why GoldenCare USA?

GoldenCare USA ~ 800-842-7799

If You’re Not Yet Appointed… the Next Step Is Up To YOU!

We Can Be Your BEST Partner in the Industry!

� Proven Consumer Presentation

� Top LTCi Illustration Software

� Expert, Personalized Quotes

� Multi-Company Product Compares

� Full App Scrubbing/UW Support

� Spend-down & Inflation Calculators

� LTCi Waiver/Disclaimer Form

� Cost Surveys, Tax Guide & MORE!


GoldenCare USA ~ 800-842-7799

www.goldencareagent.com www.goldencaretraining.com

*Want a PDF of today’s slides? Email: [email protected]

Everyone who attends this webinar receives

AT LEAST 50 Reward Points!*

PLUS… one lucky attendee earns

500 Reward Points!

* Limit 1 Reward Code Per Agent Per Unique Training Topic.

THANK YOU FOR ATTENDING!

the nuts & bolts of critical care - goldencare agents · the survival rate for kidney failure...

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