uhone broker guide

8/4/2019 Uhone Broker Guide

1/28

Golden Rule Insurance Company, a UnitedHealthcare company, is the

underwriter and administrator o these plans.

Not For Consumer Use All the inormation in this guide is condential.

Updated March 2011

Broker Guide

Feb 25 2011 09:25:55


2/282 Note: All the inormation in this guide is condential.

1 Discounts vary by provider, geographic area, and type o service.2 For automated convenience, the IVR System o the above Customer Service Center number is available: 5:00 a.m. to 9:00 p.m. Eastern (M-F);

Saturday 5:00 a.m. 4:55 p.m. Eastern time.

Important Contact Inormation

By Golden Rule Insurance Company, a UnitedHealthcare Company

UnitedHealthOne is the brand name o the UnitedHealthcare amily o companies that oer individual and amily

health insurance products. Golden Rule Insurance Company is the underwriter and administrator o these plans.

UnitedHealthcare is an operating division within UnitedHealth Group, the largest single health carrier in the United

States. UnitedHealthcare provides a ull spectrum o consumer-oriented health benets plans and services to

individuals, public sector employers, and businesses o all sizes, including more than hal o the Fortune 100 companies.

UnitedHealthcare Choice Plus network Big Network & Big Savings

Available across the country.

Over 5,200 hospitals.

Over 700,000 physicians.

Network discounts of up to 50%!1

Broker Contact Inormation

Broker Service center:

(800) 474-4467

HourS of operation:

8:00 a.m. to 6:00 p.m. Eastern (M-TH)

8:00 a.m. to 5:00 p.m. Eastern (F)

new BuSineSS fax:

(317) 713-7875

For submission of:

Applications & Applicant medical documentationLicenSing fax:

(618) 943-5239

For submission of:

Licenses & Appointment Renewal Fees

e-Store:

www.UHOne.com/Broker

Quote and submit applications

Preliminary Evaluation

Broker Education events

Business reports including pending andexisting business

emaiL:

In E-Store click on Contact Us

Client Contact Inormation

cuStomer Service2:

(800) 657-8205

HourS of operation:

8:00 a.m. to 6:00 p.m. Eastern (M-F)

new BuSineSS appLicationS:

Mail To: Golden Rule Insurance Company

HEALTH APPLICATION

PO Box 68994

Indianapolis, IN 46268-0994underwriting maiLing addreSS:

7440 Woodland Drive

Indianapolis, Indiana 46278-1719

rSa medicaL:

(866) 665-6025

High Blood Pressure (HBP) Questionnaires

cLient underwriting interviewS

for verification:

(800) 307-4217

premium payment maiLing addreSS:

P. O. Box 740209

Cincinnati, OH 45274-0209

Feb 25 2011 09:25:55


3/28Note: All the inormation in this guide is condential.

Important Contact Inormation

Contents

Product Offerings

Rules or Eligibility

How to Prepare for Accurate Quoting and

Application Submission

Review Unacceptable Conditions

Rate Class Charts

What to Expect From Our Underwriting Process

Underwriting Actions

Preliminary Evaluation (Underwriting Guidance)

E-Store Online Quoting & Application

E-Store Features

Premium Modes and Payment Information

Single-Payor Options for Multiple

Individual Plans

Underwriting Appeals

Frequently Asked Questions

State Product Availability Chart

Notes

2

3

4

5

6

7-10

11-14

15

16-17

18

19

20

21

22

23

24

25

26-27

T A B L E O F C O N T E N T S

Feb 25 2011 09:25:55



Product Offerings*

Plan Type

copay pLanS

More Traditional Plans

Higher Premiums,

Lower Deductibles

HeaLtH SavingS

account pLanS

Market-Leading Plans

High Deductible Plan plus

Savings Account

HigH deductiBLe pLanS

Simple-to-Understand

Plans Lower Premiums,

Higher Deductible

SHort term HeaLtH pLanS

1-11 Month Plans

dentaL pLanS

May Be Ideal For

Anyone who prefers the

convenience o copay

benets or routine health-

care expenses. Families with children who

have regularly scheduled

doctor ofce visits.

Adults who want copay

benets or preventive care

and prescription drugs.

Those interested in

trading low deductible

health insurance or a

higher deductible plan

to save money on

monthly premiums.

Persons interested in more

control over how their

health-care dollars are spent.

Families interested in one

calendar-year deductible

per amily.

Anyone willing to

take responsibility or

routine health-care

expenses in exchange

or lower premiums.

Anyone seeking lower-cost

protection rom unexpected

accidents and illnesses.

Early retirees needing

a bridge to Medicare.

College students

Benet waiting period

Medicare gap

Best for network dentist

Best for non-network dentist

Plan Name

Copay SelectSM

More comprehensive

HSA 100More comprehensive

HSA 70SM

More aordable

Plan 100More comprehensive

Plan 80SM

More aordable

Saver 80SM

Even more aordable

Short TermSM Value

Short TermSM Plus

Short TermSM Copay

UnitedHealthcare

Dental PremierSM

UnitedHealthcare

Dental ValueSM

Out-o-Pocket**

Lower

Lower

Higher

Lower

Higher

Higher

Higher

Lower

Lower

Premium Cost

Higher

Higher

Lower

Higher

Lower

Lower

Lower

Higher

Highest

Higher

Lower

* Varies by state.

** Out-of-pocket exposure is deductible, coinsurance, and copays.

Under all plans, additional expenses may be incurred that are not eligible or reimbursement by the insurance.

Feb 25 2011 09:25:55


5/28Note: All the inormation in this guide is condential.

Rules or Eligibility

Foreign Residence and Travel

U.S. citizens that have been overseas for less than 12 months are eligible for coverage.

Within the rst six months of coverage if an applicant or policyholder intends to travel to a destination where war

exists or war is imminent we will not issue coverage. Coverage will not be issued to oreign-born applicants thatintend to return to their native country.

Individuals that have not been in the United States for 12 consecutive months will not be considered for coverage.

(This does not include adopted children.)

If your clients travel internationally, International Medical Group (IMG) provides specic coverage and may be

reached at (800) 628-4664.

Age

Eligible from birth up to age 64 for individual health. Please note: There are no pre-existing condition exclusions

or children under the age o 19.

No age restrictions on dental.

Short term eligibility up to 64 .

Other Coverage

Golden Rule maintains specic guidelines regarding other medical coverage. Generally, well issue our plans in

addition to only the ollowing types o coverage:

Student accident insurance.

Accident-only plans.

Dread disease policies (e.g., cancer).

Coverage through Medicaid.

Feb 25 2011 09:25:55


6/28

Track Application

Complete and

Submit Application

Create Quote

Submit Preliminary

Evaluation

(i necessary)

Establish Rating Class

Determine Heightand Weight

6 Note: All the inormation in this guide is condential.

1. Determine clients eligibility by reviewing Rules or Eligibility (pge 5).

2. Review the listing oUcceptble Coditios (pges 7-10).

Some conditions present an increased risk we are unwilling to accept. An

automatic decline will likely result or any individual with one or more o

theses conditions. I surgery is pending or serious ailments exist without

a diagnosis, a decline will also likely occur. Everyone has the right to

apply or coverage, and clients who appear unacceptable may apply i

they choose.

3. Determie ccurte height d weight o each applicant.

4. Establish the proper rating class or your client by reviewing our Rte

Clss Chrts d Defitios (pges 11-14). Accurate height andweight or each applicant is important and will drive the rating class o

the applicant. Medical conditions, previous insurance, and tobacco use

may also be actors in determining your clients rating class and will vary

by state. Please utilize the proper state chart.

5. Complete a Prelimiry Evlutio i there are conditions present that

could aect underwriting (pge 18).

6. Quotes. When quoting through E-Store, several options are available for

you. Quoting is easy and fast; simply click on Quoting and Applications.

Generate a quote and email it to your client, or you may create and add

your client as a new prospect, and then create a quote. You may also email

the quote, brochure, and application (pge 19).

Quotes can be obtained by utilizing E-Store, our software, calling our

Broker Service Center, or your broker account executive.

7. Submittig pplictio. Your client may submit their application

online. The most efcient application submission is the utilization o

our online process. You may submit your clients application by mailing

a paper application to us, or axing a paper application to our New

Business department (cotct io listed o pge 2).

8. Trckig pplictios. Ater submission o an application and or 30 days

ollowing the nal outcome, you may check under New Business. Thirty-

one (31) days ater issue you may track your business under My Business.

Review Unacceptable

Conditions

Determine Eligibility

How to Prepare for Accurate Quoting and Application Submission

Quoting and

Application Submission

Flow Chart

Feb 25 2011 09:25:55


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BACK DISORDERS

Disabled

Pending Surgery

CANCER/TUMORS

Bladder Cancer (5-year clearance)

Brain Cysts (Present or within 2 years or with

ater-eects)

Brain Tumor (Benign within 2 years or with ater-

eects. Will not consider malignant brain tumor)

Breast Cancer (2-year clearance i cancer-ree and not

in lymph nodes. 5-year clearance i local or regional

metastasis. Declined i distant metastasis)

Cancer Present

Cervical Cancer (Present. If cured will consider)4

Colon Cancer (5-year clearance)

Giant Cell Carcinoma

Hodgkins Disease

Kidney Cancer (5-year clearance)

Leukemia

Leukoplakia

Lymphoblastoma

Lymphocytic Interstitial Pneumocystitis

Lymphoma

Lymphosarcoma

Lung Cancer (10-year clearance)

Malignant Melanoma

Multiple Myeloma

Ovarian Cancer (7-year clearance)

Polyposis

Prostate Cancer (2-year clearance)

Reticulum Cell SarcomaSkin Cancer Squamous Cell (Present)

Stomach Cancer (5-year clearance)

Testicular Cancer (5-year clearance)

Tongue Cancer (5-year clearance)

Uterine Cancer (10 years without hysterectomy*)

*Total hysterectomy and no metastasis, can consider

DIGESTIVE SYSTEM

Alcoholic Pancreatitis (Chronic or recurrent)

Crohns Disease (Present will not consider)

1 attack and unoperated but recovered

2-year clearance

2 or more attacks/unoperated but recovered

4-year clearance

2 or more attacks/operated/recovered

2-year clearance

Cirrhosis or Fatty Liver

Colon Polyps (Present)

Colostomy or Ileostomy

Cystic Fibrosis

Diverticulitis (Present)

Enlarged Liver

Esophageal Varices

Hepatitis (Chronic or recurrent)

Hepatitis C Always declined

Hepatitis A Can consider with a 6-month

clearance, no meds, and normal Liver Functions Test

Hepatitis B Can consider with a 12-month

clearance, no meds, and normal Liver Functions Test

Gastric Bypass (Declined unless 5-year clearance and

stable weight or at least 12 months)

Gluten Intolerance

Ulcerative Colitis (I surgically corrected, we

can consider)

EAR/EYE

Menieres Disease (Declined i condition is progressing

or having problems with equilibrium)

Optic Neuritis (Declined i present or diagnosed

within 1 year with no etiology)

Retinal Hemorrhage

Sjogrens Syndrome

Review Unacceptable Conditions

Note: All the inormation in this guide is condential.Feb 25 2011 09:25:55


8/28

ENDOCRINE

Addisons Disease

Adrenal Hyperplasma

Diabetes Mellitus (May be able to consider

Gestational Diabetes)Discoid Lupus (chronic) (Within 2 years)

Hyperinsulinemia

Systemic Lupus

FEMALE DISORDERS

Unless pending surgery, can consider most emale

disorders with riders. Check Cancer Listing.

GENERAL IMPAIRMENTS

Abnormal Lab Values with no etiology

Assistive Devices (Canes/walkers/etc.)

Chronic Fatigue (I present)

Disabled

DWI/DUI First Oense 2-year clearance

2 or more decline

Epstein Barr Syndrome (Present decline 1-year

clearance rom recovery can consider)

Lyme Disease (1-year clearance I given antiobiotics

beore testing, will still require clearance)

Nursing Home Conned

Organ Transplant Recipient

Parotid Gland Removal within 3 years

Pregnancy (Current)

Polyarteritis

Protein C Deciency

Sarcoidosis (Present or within 5 years)

Sleep Apnea (Decline unless surgically corrected and

1-year clearance)

Spinal Meningitis (6-month clearance rom recovery)

Workers Comp Benets (If released from care can

consider cannot consider i legal case is still pending)

GENITOURINARY SYSTEM

Hydronephrosis (Present)

Kidney Dialysis

Kidney Infections can be considered unless chronic*

Kidney Stones Bilateral (Present in both kidneys)Kidney Transplant

Nephrosclerosis

Nephrosis

Nephrotic Syndrome

Neurogenic Bladder

Polycystic Kidney Disease

Renal Artery Stenosis

*Other kidney problems we can consider: duplication of kidney,

born w/o kidney

HEART CIRCULATORY

Aneurysms (Anywhere in the body)

Angina

Angioplasty

Aortic Stenosis

Aplastic Anemia

Arterial Blockage (Anywhere in the body)

ArteriosclerosisAtrial Fibrillation (2-year clearance)

AV Malormations

Bicuspid Aortic Valve

Bradycardia (Heart rate under 45)

Bruits Present (Sounds of turbulent blood ow)

Buergers Disease1

Cardiac Debrillator Implanted

Cardiac Hypertrophy

Cardiomyopathy

Cerebral Hemorrhage

Congenital Deects2

Congestive Heart Failure (CHF)

Corarctation o Aorta

Coronary Artery Disease (CAD)

Coronary Bypass

Coronary Insufciency

Coronary Occlusion

Coronary Spasms


Review Unacceptable Conditions Continued

Feb 25 2011 09:25:55


9/28

Coronary Thrombosis

Cytomegalovirus (CMV) (I present)

Deep Vein Thrombosis (Still on blood thinners)

Diastolic Murmurs or Systolic Murmurs Grade 3-6

Ejection Fraction of less than 50%Endarterectomy

Endocarditis (Within 5 years)

Heart Attack (Myocardial Inarction)

Heart Bypass Surgery

Hemochromatosis

Hemorrhagic Diathesis (Hemophilia)

High Blood Pressure (If present and Standard II build)

Intermittent Claudication (Narrowing o leg

arteries Ischemia)

ITP (Idiopathic Thrombocytopenia)

Kawasaki Disease (Present or within 6 months

o recovery)

Let Bundle Branch Blockage (LBBB)

Lown-Ganong-Levine Syndrome (I symptomatic)

Mitral Insufciency

Mitral Regurgitation (Trace or Trivial Regurgitation is

considered with MVP)

Mitral Stenosis

Myocarditis (Within 6 months)Obstructive or Stenotic Murmurs

Pacemaker

Pericarditis (If Viral, 2-year clearance. If due to Heart/

Lung problems or multiple attacks, would

be declined)

Peripheral Vascular Disease

Pulmonary Hypertension

Pulmonary Stenosis

Raynauds Disease

Rheumatic Heart Disease

Sick Sinus Syndrome

Sickle Cell Anemia

Stroke

Tachybrady Syndrome

Tetralogy o Fallot3

Thalessemia Major

Transient Ischemia Attacks (TIA)

Transposition o the Great Arteries

Valve Replacements

Ventricular Contractions

Ventricular Fibrillation

Ventricular Paroxysmal Tachycardia

Von Willebrands Disease (If present)Wolfe-Parkinson-White Syndrome (If symptomatic)

MUSCULAR/SKELETAL

Ankyslosing Rheumatoid Spondylitis (Inammation

o spine and large joints)

Cerebral Palsy

Muscular Dystrophy

Myasthenia Gravis

Osteomyelitis (Present)

Pagets Disease

Paraplegic

Parkinsons Disease

Pathological Fractures

Polymyalgia Rheumatica

Psoriatic Arthritis

Quadriplegic

Rheumatoid Arthritis (5-year clearance with

no treatment)Spina Bida

Tourettes Syndrome (We can consider if under the

age o 20 well adjusted, and no Obsessive Compulsive

Disorder must attend regular school)

NERVOUS SYSTEM

Alcohol/Substance Abuse Treatment (5-year

clearance rom date o last treatment {not including

AA} i only one oense)

Alzheimers Disease

Autism

Bipolar (Manic Depression)

Downs Syndrome

Epilepsy (1-year clearance since last seizure)

Eating Disorders (Anorexia/Bulimia with present or

ongoing treatment; ater treatment, weight must be

stable or 2 years)



10/28

1 Obstruction of small and medium arteries and veins by inammation triggered by smoking.2 Patent ductus arteriosus (present), dextrocardia, atrial septal defect, atrioventricular canal defect, Ebsteins Anomaly, Eisenmengers complex, hypo-

plastic let heart syndrome, pulmonary atresia and stenosis, and truncus arteriosus.3 Combination o heart deects consisting o large ventricle septal deect/displacement o aorta/narrowing o outlaw rom right side o heart/thickening

o right ventricle wall.4 I cured by hysterectomy more than 2 years ago, may consider w/o rider.

Huntingtons Chorea

Hydrocephalus

Multiple Sclerosis

NeuropathyRetardation (Severe)

Schizophrenia

Seizure or Convulsive Disorder (Unknown etiology

unless last seizure was a long time ago and current EEGs

are normal Usually 2 years)

Suicide Attempt (Within 5 years, 2 or more attempts

need 10-year clearance Thoughts o suicide 1-

to 2-year clearance/ideations o suicide 2- to

5-year clearance)

Turners Syndrome

RESPIRATORY SYSTEM

Asbestosis

Bronchitis Chronic

C.O.L.D. (Chronic Obstructive Lung Disease)

C.O.P.D. (Chronic Obstructive Pulmonary Disease)

Emphysema

Lung Cyst or Abscess (Present)Pulmonary Embolisms

Pneumonia (Present)

Tuberculosis (Present)

SEXUALLY TRANSMITTED DISEASES

AIDS

HIV Positive

THYROID/GOUT DISORDERS

Graves Disease (Present and under treatment less than

6 months can consider on a case-by-case basis.

Treatment over 6 months can consider/rider)

Hyperthyroid (Case by case less than 6 months decline

more than 6 months, we can consider with rider)

Thyroid with goiter or pending surgery


Review Unacceptable Conditions Continued

Feb 25 2011 09:25:55


11/28


12/28

Defnition o Rating Classes

Preerred I Designed for applicants who fall within the Preferred I and II height and weight guidelines. Additionally,

these applicants have been covered by health insurance within the past 63 days.

Preerred II Designed for applicants who fall within the Preferred I and II height and weight guidelines and are in

good health. These applicants do not have current or prior insurance coverage within the past 63 days.

Stdrd I Designed or applicants whose height and weight place them in the Standard I chart, or applicants with

ongoing medical conditions.

Stdrd II Designed or applicants whose height and weight place them in the Standard II chart.

Please note: Some states do not use Preferred I rating class. A rating class may be adjusted depending upon discovery during our underwriting process.


Rate Class Chart or the Following States Continued

Tobacco Rate-Up

Tobacco use adds a surcharge to the premium rate. The tobacco surcharge varies by age and rating class.

Feb 25 2011 09:25:55


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14/28

Defnition o Rating Classes

Preerred Designed for applicants who fall in the Preferred height and weight guidelines and are in good health.

Stdrd Designed or applicants whose height and weight place them in the Standard chart or applicants with ongoing

medical conditions.

Tobcco Those applicants who are currently or have used tobacco products within the last 12 months.

Please note: A rating class may be adjusted depending upon discovery during our underwriting process.


Rate Class Chart or the Following States Continued

(Kansas and New Mexico)

Stdrd Helth Clss Height/Weight Chrt

Male Ages 18 to 45 Age 46 and over

Height Standard Acceptable Standard Acceptable

4 10 88-161 162-180 88-174 175-1864 11 90-165 166-184 90-178 179-190

5 0 92-169 170-188 92-182 183-195

5 1 94-173 174-193 94-186 187-200

5 2 96-177 178-197 96-190 191-204

5 3 99-182 183-203 99-196 197-210

5 4 102-187 188-209 102-202 203-216

5 5 104-192 193-215 104-207 208-222

5 6 107-198 199-220 107-213 214-228

5 7 110-202 203-225 110-217 218-232

5 8 113-207 208-231 113-223 224-238

5 9 116-212 213-236 116-228 229-244

5 10 119-218 219-244 119-235 236-252

5 11 122-224 225-249 122-241 242-258

6 0 125-230 231-257 125-248 249-266

6 1 128-235 236-262 128-253 254-272

6 2 132-242 243-270 132-260 261-279

6 3 135-248 249-277 135-267 268-286

6 4 139-256 257-286 139-276 277-296

6 5 143-264 265-294 143-284 285-3046 6 147-272 273-303 147-293 294-314

6 7 151-280 281-312 151-301 302-322

6 8 155-287 288-320 155-309 310-332

6 9 158-295 296-328 158-317 318-340

6 10 162-302 303-336 162-324 325-349

6 11 166-310 311-345 166-333 334-357

7 0 170-317 318-253 170-341 342-366

Stdrd Helth Clss Height/Weight Chrt

Female Ages 18 to 45 Age 46 and over

Height Standard Acceptable Standard Acceptable

4 10 80-149 150-167 80-155 156-1744 11 82-153 154-171 82-159 160-178

5 0 84-155 156-176 84-162 163-182

5 1 86-159 160-180 86-166 167-186

5 2 88-163 164-184 88-170 171-190

5 3 90-168 169-189 90-175 176-196

5 4 92-173 174-194 92-180 181-202

5 5 94-178 179-200 94-185 186-207

5 6 97-182 183-205 97-190 191-213

5 7 99-186 187-209 99-194 195-217

5 8 102-191 192-215 102-199 200-223

5 9 105-196 197-220 105-204 205-228

5 10 108-202 203-227 108-210 211-235

5 11 111-206 207-232 111-215 216-241

6 0 115-212 213-239 115-221 222-248

6 1 118-217 218-244 118-226 227-253

6 2 121-222 223-251 121-232 233-260

6 3 124-230 231-258 124-239 240-267

6 4 127-236 237-266 127-246 247-276

6 5 130-244 245-274 130-254 255-284

6 6 134-250 251-282 134-261 262-293

6 7 137-258 259-290 137-269 270-301

6 8 141-265 266-298 141-276 277-309

6 9 144-273 274-306 144-284 285-317

6 10 148-280 281-313 148-291 292-324

6 11 152-286 287-321 152-298 299-333

7 0 155-295 296-328 155-306 307-341

Feb 25 2011 09:25:55


15/28

What to Expect From Our Underwriting Process

Depending upon the complexity of the medical

conditions o the individuals submitted on the application,

underwriting will usually reach a decision in 2-30 days.

Our underwriting process may involve one or more phone

calls to your clients to discuss their medical conditions.

Please notify your client that they may receive a phone call

to obtain and veriy medical inormation.

We may order information from the Medical Information

Bureau and an attending physician statement rom

a physician. Periodically some physicians require an

individualized release or medical records rather than

accepting the release contained on the application. When

this occurs, the receipt o the records is delayed, and

thereore, the nal decision cannot be made until the

inormation is received. Once we receive the inormation

requested we will make an underwriting decision. Each individual is underwritten separately and therefore

one or more o the applicants may be issued coverage

while others may not.

You may check the progress of pending applications by

visiting E-Store, and checking under My Business, located

under My Business on the home page.

All issued applications will be sent to you unless you notify

us that you want the coverage documents sent directly to

your clients.

Once issued, plans and ID cards are mailed separately; plans

are mailed rom us and ID cards are sent by a vendor.

Depending upon the state or product selected, an

association ee may be required in addition to monthly

premium. These ees range rom $4 to $40 per month

depending on your clients choice o FACT membership

level (Basic, Choice, and Elite). The membership provides

an array o purchase discounts or travel, entertainment,

and medical needs. (See What is FACTon page 24.)



16/28


Each individual on an application is underwritten separately. Underwriting actions are based on the inormation on the

application as well as inormation we obtain during underwriting. I coverage cannot be issued as applied or, we will

consider a rate-up. I a rate-up can not be utilized, an exclusion rider may be applied. I a rider cannot be applied,

only then is the application declined. This decision process can vary state by state, but generally ollows this process.

Issue as Applied

Medical Rate-Up*

Rider Non Medical

Increased Deductible, Rx Card

Rider Medical/Avocation

Limited Duration/Indenite

Decline

Unacceptable Risk or too

many riders.

No rate-ups

No riders

Used when the condition is

well controlled

Ongoing costs are relatively low Applicant can qualify for a preferred

health class even with a rate-up

Rate-ups in 10% increments

Additional information page 17

Well controlled condition

Ongoing medical costs are too high for

a rate-up

May apply increased medical deductible**

May apply increased drug deductible onCopay plan**

May remove drug copay card**

Preferred health class rating will not

be applied

Can exclude a specic ailment, body

part, or system

Limited duration or indenite

exclusionary period

Avocation rider excludes activity or hobby

Additional information page 17

Unacceptable conditions

Potential serious condition or

undiagnosed ailment

4 or more medical riders on one person*Not available in KS, KY, NM, and NV

**On an individual basis


16 Note: All the inormation in this guide is condential. Feb 25 2011 09:25:55


17/28

I a client has a condition that increases risk, Golden Rule may issue coverage with a modication rather than decline

coverage. Common modications include:

Rte-Up I a condition is well-controlled with prescription medication(s), diet, and/or routine ofce visits, a premium

rate-up may be used. The amount o the premium rate-up will vary by the ongoing costs o the treatment. Any premium

increase applies only to the applicant with the condition; other covered amily members will not be aected by the rate-up.

Icresed Prescriptio Drug Crd Deductible I a condition is well-controlled, a prescription drug deductible

increase may be used. The increased deductible amount will vary by the expected ongoing prescription costs. This

increased deductible can only be used with plans containing the prescription drug card benet.

Icresed Medicl Deductible I a condition is well-controlled, a medical deductible increase may be used. The

increased deductible amount will vary by the expected ongoing costs. This increased deductible is typically used with plans

that do not contain the prescription drug card benet.

Exclusio o the Prescriptio Crd Medical history and/or prescription drug use may prohibit the issuing o the

prescription drug card.

Medicl Riders Exclude coverage or specied conditions or body parts. Medical riders may be temporary (up to 10

years in length) or indenite. Common riders include:

asthm/allergies Excludes Outpatient treatment only. This rider may exclude any outpatient diagnosis or treatment

o allergies and asthma. This includes, but is not limited to, evaluation, testing, treatment, therapy, and medication

thereore, and any complications.

Bck Disorders Two separate riders may apply:

1. The rst option excludes coverage or any injury to, disease o, or disorder o the spinal column, including the

vertebrae, intervertebral discs, spinal cord, nerves, surrounding ligaments and muscles, treatment or operation

thereore and complications thererom.

2. The other option excludes loss as a result o outpatient diagnosis or treatment o any injury to, disease o, or disorder

o the spinal column, including the vertebrae, intervertebral discs, surrounding ligaments and muscles. This includes,

but is not limited to, ofce visits or outpatient consultations with a doctor, chiropractor, or other medical practitioner

or medical proessional, spinal adjustments, physical therapy, X-rays, and other diagnostic tests.

Cholesterol/Lipids Excludes Outpatient treatment only. This rider may exclude outpatient treatment or elevated

cholesterol, hyperlipidemia, or hypertriglyceridemia, including testing, dietary counseling, ofce visits, and medication.

Psychologicl/Psychitric Disorders.Two separate riders may apply, depending on the condition and severity.

1. The rst option excludes any outpatient diagnosis or treatment o psychiatric and/or psychological disorders.

This includes, but is not limited to, evaluation and/or testing, treatment, counseling, therapy, and/or medicationthereore and complications thererom.

2. The other rider option excludes any treatment or any type o psychological or psychiatric disorder. This includes

any treatment or substance abuse as well as complications that may occur.

Note: Medical riders may be reviewed or removal ater the policy/certifcate has been in orce or 12 consecutive months.

Note: State variations may prevent some o the underwriting actions noted above.

Note: All the inormation in this guide is condential.

Underwriting Actions Continued

Feb 25 2011 09:25:55


18/28

Preliminary Evaluation (Underwriting Guidance)

To assist the application process, we have two options or obtaining underwriting guidance. You may call the broker

service center or use our preliminary evaluation orm on E-Store. By utilizing our preliminary evaluation, inormation

is transmitted directly to our underwriting team who will review and provide a response to you regarding your

applicants eligibility.

Go to www.UHOne.com/broker and login.

Select Services > Preliminary Evaluation.

Click on the Create New Evaluation Form > New Form button.

Fill out the form and click submit.

Track your evaluation responses from the main evaluation screen.

Receive an answer in as little as 2-4 hours.



19/28

E-Store Online Quoting and Application System

Please visit our online E-Store at www.UHOne.com/broker.

This site provides a quick and simple approach to quotes, quoting submission, and tracking. In order to use this site,

registration is required.

1) Click on Register Now on home page.

2) Your National Producer Number (NPN) is your broker identication number with us. Input that number where required.

3) You will be required to choose a security question and provide an answer or added security.

4) Choose a password and enter where prompted.



20/28

E-Store Features

The home page is your

link to all the tools

available on E-Store.

The tabs listed across

the top o the page

provide easy navigation

throughout the site.

Quoting &

Application

Instant Quote

Applications

in Progress

Prospect List

My Business

Prospect List

My New Business

My Existing

Business

Lapse Notications

Re-Rate

Notications

Licensing &

Compensation

Compensation

Statements

More tools

coming...

My Account

Broker

Inormation

Security &

Admin Settings

Sales Tools &

Broker Training

Supplies & Forms

Preliminary Evaluation Tool

Add Quoting Link to

Your Website

On Demand Webinars

Scheduled Health Webinars



21/28

Premium Modes and Payment Inormation

A minimum o one months premium must accompany an application and will be processed at time o application approval.

First year premiums are guaranteed for the rst 12 months.* We may adjust the premium rates after the rst 12 months. The

type o plan, age, and gender o covered persons, type, and levels o benets, time the coverage has been in orce, and their

place o residence are actors that may be used in establishing rate classes.

Modes or Initial Payment:

For the premium payment submitted on an electronic application we are able to accept Visa, MasterCard, or Electronic

Funds Transer (EFT) rom a checking account as long as authorization is included with the application.

For paper applications we can also accept a personal check.

Please note that payment will be processed upon issue if paying by EFT, credit or debit card. If paying by personal check,

payment will be processed immediately upon receipt o application.

Modes or Ongoing Premium Payment:

eLectronic fundS tranSfer (eft) montHLy

Your clients may set up direct automatic payments rom their checking or savings accounts. To setup Electronic Funds Transer

(EFT), please include appropriate banking inormation with the application.

Applicants may select the date of the month the payment is transferred to us, however it must be within 10 days after

the due date.**

If no date is selected, the transfer will automatically occur on the premium due date.

Please note that plans set up with Electronic Funds Transfer (EFT) generally stay in force longer due to the automatic

payment method.

no billig ee is ssocited with this choice.

eLectronic fundS tranSfer (eft) QuarterLy

Your clients also have the option to set up EFT on a quarterly basis ter their coverage has been issued.

Contact Client Services at (800) 657-8205 to change the payment option to quarterly EFT once coverage has been issued.

Or go to www.UHOne.com, click on the Customers tab, click on Download Health Insurance Forms, and obtain an EFT

authorization orm and submit it to us or processing.

direct BiLL montHLy or QuarterLy

Your clients may elect to have bills mailed to them monthly or quarterly.

A bill will be sent two weeks in advance of the premium due date.

There is a $10 per pper-miled-ivoice billig ee ($120 annually or monthly direct bill and $40 annually or quarterly bill).

*Subject to address change or benet change.

**TN and TX exception.

2Note: All the inormation in this guide is condential.Feb 25 2011 09:25:55


22/28

Single Payor Options for Multiple Individual Plans

Business Checks Accepted

Monthly Bill Option

EFT Option

Eective Dates

Documents Required

E-Store Capable

Fees

EFT

Monthly Individual Bill

List Bill

Optimal Use

Employer Payor

Yes

Yes

Yes

Applicants may have dierent

eective dates

Employer Payor agreement must be

signed (located on E-Store under broker/

orms or in booklet # 39203-G-0410)

Yes, only ater all policies are issued

- 0

- $10 per policy/certicate per month

- N/A

Small groups


23/28

Underwriting Appeals

Our underwriting process is thorough and complete and our underwriting decisions are nal. Applicants may appeal

an underwriting outcome i they believe the decision was based on outdated or incorrect medical inormation.

The applicant may submit a request to review an underwriting decision by writing or calling our Client Services

department and providing the updated or corrected inormation.

Tobacco

A tobacco surcharge is automatically

added when an applicant indicates

they use tobacco. The surcharge

assessed ranges rom 1.12 to 1.90

depending upon the individuals age

and rate class.

Removal o this surcharge only occurs

i the insured has been smoke ree

or a minimum o 12 consecutive

months. The insured must submit a

new application along with the ee

or a urinalysis to veriy no presence

o tobacco. Fees range rom $60 to

$83 depending on the state. Medical

history and claims will be reviewed

upon receipt o the new application,

in addition to the urinalysis to make

the determination.

Motorcycle

A motorcycle surcharge (20%) will

be added to the base premium o

an applicant i that applicant holds

a valid motorcycle license. This

surcharge will be added at the time

o issue. Several states do not have asurcharge and instead simply exclude

the applicant while on a motorcycle:

CO, KS, KY, LA, NV.

I the insured has not held a valid

motorcycle license in the last 24

months this surcharge may be

removed. A signed request must be

submitted by the insured stating

they no longer hold a valid license

or a motorcycle and no longer ride

motorcycles, and have not done so in

the last 24 months.

HIPAA Health InsurancePortability and

Accountability Act

In some states we oer HIPAA coverage

or your clients. The ollowing criteria

must be met in order to qualify*:

1. The client does not have any other

health insurance coverage (or it will

be involuntarily terminated soon).

2. The client has been insured by

creditable coverage (as denedbelow) or the last 18 months or

more with no lapse in coverage o

more than 63 days.

3. The clients most recent coverage

was under a group health plan (as

dened below) , a governmental

plan, or a church plan.

4. The clients most recent coverage was

not terminated due to nonpayment

o premiums, raud or intentionalmisrepresentations.

5. The client is not eligible or any

coverage under a group health plan (as

defned below), Medicare, or Medicaid.

6. The client accepted and exhausted

any group continuation o coverage

(including COBRA) that was oered

to themorThe client was not

oered group continuation o

coverage (including COBRA).

Creditable coverage includes group or

individual health insurance coverage,

Medicare, Medicaid, Armed Forces

coverage, Indian or tribal coverage,

state risk pool coverage, public

health coverage, and Peace Corps Act

coverage. A plan is NOT creditable

coverage i it: a) provides coverage

only or accidents, disability, or liability;

b) is credit-only insurance; or c) is a

secondary to other insurance.

Generally, a group health plan is any

coverage existing in connection with

employment. Included are: employer-

sponsored plans (so long as at least one

employee participates); coverage o an

employee under an individual policy

o insurance that is part o a plan, und,

or program established or maintained

by an employer that provides medical

care to employees or their dependents;

coverage o a business owner so long

as at least one employee other than

the business owner and the business

owners spouse also participates in the

plan; and coverage o partners in a plan

maintained by the partnership.

2Note: All the inormation in this guide is condential.

* Check specic application packets for state variations.

Feb 25 2011 09:25:55


24/28

Frequently Asked Questions

How do I obti oresidet ppoitmets?

You will need to submit an application, a copy of your current resident license, and an appointment fee. Call (800) 474-4467 for

assistance or obtain the required orms at www.UHOne.com and click on Brokers.

Where do I x licesig iormtio?

Licensing inormation should be axed to our Lawrenceville, IL, oice at (618) 943-5239.

Must I crry Errors d Omissios isurce to be ppoited with Golde Rule?

No, it is not required, but we reserve the right to require it in the uture, and we recommend it or your

own protection.

How do I obti curret iormtio bout Golde Rule pls?

Go to www.UHOne.com/broker or the most current inormation.

How do I kow i my supplies re curret?

Get the latest supplies from our E-Store website. If you are still unsure if you have the correct supplies, call us at (800) 474-4467.

How do I obti prelimiry evlutio o cliets isurbility?

We have an online tool that assists you in determining coverage eligibility. Please refer to page 18.

Where do I x pplictios?

(317) 713-7875

Is premium required with the pplictio?

At least one months premium is required with the application. Premium paid by EFT (checking account or credit card) will not be

processed until policy is issued. Paper checks will be deposited immediately upon receipt.

Wht re the optios or pymet?

For the irst premium payment, Visa, MasterCard, Electronic Funds Transer (EFT) via E-Store, check, or money order is accepted.

For ongoing payments, your clients can setup automatic payments rom a checking or savings account each month, or we can bill

the client directly on a monthly or quarterly basis. Fees may apply.

Why do you oer List Bill d Employer Pyor optios i employer cot py or premiums?

These are simply a convenience or the employer or other third party to aid in collection and submission o employees individual

premiums to Golden Rule. See page 22 or more details.

How do I keep trck o my cliets pls oce theyre issued?

You will ind reports on your issued business on E-Store under My Business.

Wht is aCT?

FACT is the Federation o American Consumer and Travelers, an independent association. In some states, in order to be eligible,

applicants or health plans are required to become members o FACT because they are association group plans. The membership

cost varies per month and can be paid with the applicants monthly premium. For this monthly ee the applicant receives

consumer and travel discounts rom FACT. Visit the FACT website at http://usafact.orgto obtain more inormation.



25/28

Visit E-Store or current product brochures, applications, and rates

M Benet can be added to Long Term Health Product

S Benet is a Stand-Alone Product

D Benet can be added to a Dental Stand-Alone Product

2Note: All the inormation in this guide is condential.

PRODUCTS anD PaYMEnT OPTIOnS OERED In THE OLLOWInG STaTESUpdated 8/23/10

State Product Availability Chart

State

AK

AL

AR

AZ

CA

CO

CT

DC

DE

FLGA

IA

IL

IN

KS

KY

LA

MD

MI

MO

MS

MT

NC

ND

NE

NH

NM

NV

OH

OK

PA

SC

SD

TN

TX

UT

VA

WI

WV

WY

Long TermHealth ProductsAvailable

X

X

X

X

X

X

X

X

XX

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Short TermProductsAvailable

X

X

X

X

X

X

X

XX

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Dental

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

S

Vision

M, D

M, D

M, D

D

M, D

M, D

M, D

M, D

M, D

M, D

M, D

M, D

M, D

M

M, D

M, D

M, D

M, D

M, D

D

D

M, D

M, D

M, D

M, D

M, D

M, D

M, D

M, D

M, D

M, D

D

M, D

M, D

Continuity

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

EmployerPayor

X

X

X

X

X

XX

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

ListBill

X

X

X

X

X

XX

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

PRODUCTS PaYMEnT OPTIOnS

Feb 25 2011 09:25:55



Notes

Feb 25 2011 09:25:55


27/282Note: All the inormation in this guide is condential.Feb 25 2011 09:25:55


28/28

Visit E-Store twww.UHOne.com/broker

or Call Broker Services at (800) 474-4467.

Mke sure you re usig curret brochures,pplictios, d rtes or your stte!