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e-Seminar Series Part 1
Welcome! If you can see this screen, dial in
to 866-299-7945, then 8754# and you’re all set!
GREAT NEWS!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.
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
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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!
11For Agent Use Only
Critical Care -A New Concept To Solve An Old Problem
It’s a blend of both Critical Illness and LTCi benefits
12For Agent Use Only
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
13For Agent Use Only
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
14For Agent Use Only
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
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� 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
16For Agent Use Only
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
17For Agent Use Only
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
18For Agent Use Only
“Critical Care”Designing A Plan
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Choose One of Three Plans
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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)
21For Agent Use Only
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
22For Agent Use Only
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
23For Agent Use Only
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
24For Agent Use Only
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
25For Agent Use Only
Critical Care
Gives You an Underwriting Advantage Over LTCi!
26For Agent Use Only
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
27For Agent Use Only
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
28For Agent Use Only
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
29For Agent Use Only
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
30For Agent Use Only
“Critical Care”
The Application
31For Agent Use Only
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
32For Agent Use Only
Three Plans, Three Underwriting Opportunities
33For Agent Use Only
Underwriting Questions
34For Agent Use Only
Underwriting Questions
35For Agent Use Only
Underwriting Questions
36For Agent Use Only
Underwriting Questions
37For Agent Use Only
Underwriting Questions
Med List – Attach a Sheet if Necessary.
38For Agent Use Only
“Critical Care”
Calculating Rates
39For Agent Use Only
40For Agent Use Only
Simple, Color-Coded Medication Guide
41For Agent Use Only
Simple Rate Worksheet Page
42For Agent Use Only
Simple Rate Worksheet Page
43For Agent Use Only
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
44For Agent Use Only
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
45For Agent Use Only
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!
46For Agent Use Only
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
47For Agent Use Only
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
48For Agent Use Only
� 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!
49For Agent Use Only
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!