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Physicians Mutual Vista Care Choices Long Term Care Insurance Larry E. Pike, CLU, ChFC, LTCP, CSA Regional Sales Manager May 24, 2006.

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Presentation on theme: "Physicians Mutual Vista Care Choices Long Term Care Insurance Larry E. Pike, CLU, ChFC, LTCP, CSA Regional Sales Manager May 24, 2006."— Presentation transcript:

1 Physicians Mutual Vista Care Choices Long Term Care Insurance Larry E. Pike, CLU, ChFC, LTCP, CSA Regional Sales Manager May 24, 2006

2 Physicians Mutual Founded in 1902 Been Selling LTC for 29 years A+ rating from Weiss A rating from AM Best AA rating from S&P Surplus to Asset Ratio- 54.7%

3 Vista Care Choices

4 Product Highlights Monthly Benefit vs. Daily Benefit Calendar Day EP vs. Service Day EP NO Modal Factor $1000 Cash Payment at time of Claim Alternate Plan of Care Restoration of Benefits Return of Premium Options Shared Care Benefit

5 NO User-Id or Password Needed Run Quotes Download Software Download Forms Keep Current on Physicians Mutual

6 Long Term Care Underwriting Glenn Miller – Lead LTC Underwriter

7 Physicians Mutual Underwriting Philosophy In the Middle Experience “Look for ways to issue” Relationships Profit Center Board of Directors – Doctors Underwriting Committee

8 Pre-qualification Increase Predictability Save Money and Time Quick turnaround Multiple options to communicate: – –Phone 800-299-9409 –Fax: 402-633-5717

9 Pre-qualification The more you know about your client, the more we can help. Age Tobacco use Marital status Height/weight Medications All disclosed health conditions Details, details, details

10 Co-Morbidity Chart Easy to use Features 10 of the most common chronic health conditions Provides additional questions the agent can ask their client Used in the field or over the phone Available on our web stie

11 Long Term Care Combined Medical Conditions Quick Reference Chart Atrial Fib.. >6 mos. Stroke >4 yrs ago TIA >4 yrs ago Valvular Heart Disease Type 2 DM Under Control PVD >12 mo or CAD Carotid Stenosis <50% occl. BP Avg. > 170/100 Smoker in past 12 mos. CHF (EF>40%) Atrial Fibrillation diagnosed over 6 months Ago * DEC DEC IC IC IC DEC IC IC Stroke Over 4 years ago * DEC IC DEC ICDEC ICDEC Transient Ischemic Attack Over 4 years ago* DEC IC DEC ICDEC ICDEC Valvular Heart Disease * IC DEC IC Type 2 Diabetes * Controlled IC DEC IC DEC ICDEC Peripheral Vascular Disease over 12 months ago or Coronary Artery Disease * IC IC IC IC DEC IC DEC IC IC Carotid Stenosis Less than 50% occluded* IC DEC IC DEC IC Blood Pressure Averages over 170/100 * DEC DEC DEC DEC DEC Smoker within the past 12 months * IC DEC IC Congestive Heart Failure (with Ejection Fraction over 40%) * IC DEC DEC IC DEC IC IC DEC IC DEC=Decline. Do not submit an application. IC=Individual Consideration. An application will be entertained. (File development may result in an offer of reduced benefits, a substandard rating or a decline.) *See page below for questions you should ask your client regarding above conditions. To find out if your client has uninsurable complications/symptoms, ask questions below.


13 Underwriting rules 18-59 TI or APS’able condition 60-64 TI required, APS’s able condition or PE w/in last 3 years 65-69 TI and APS required 70-84 F2F and APS required

14 Cognitive Underwriting Under age 70 - Telephonic Interviews Over age 70 – Face-to-Face Interviews – MCAS Soft Signs

15 Here’s What You Can Expect Brochure Eliminates surprises during the underwriting process Answers many of the questions a client may ask. Sets realistic expectations

16 The Secret to LTC Underwriting The Four C’s Control Compliance Complication Co-morbids

17 The Good LTC Risk <70 Married, both applying Physically and socially active Compliant with Treatment Complete health disclosure

18 The Bad LTC Risk Dependent in ADL’s/IADL’s Impaired mobility Inactive/Frail Cognitive concerns Multiple medications Multiple health impairments

19 Top 5 Reasons for Decline Diabetes Cognitive Impairment Heart Disease Circulatory Disorders Musculoskeletal Disorders

20 The Good Diabetic Case Compliant with diet, medication, exercise, follow ups No increase in medications it the past 6 months HgbA1c < 8.0 Below Standard Maximum Weight

21 Bad Diabetic Case Noncompliance Obese Onset within 6 months, or recent medication change Complications – retinopathy, neuropathy, nephropathy, foot ulcers Hx of CVA or TIA

22 Anatomy of a Case Case Study #1 How do you think the agent did with app completion and field underwriting? Application 68 F High blood pressure and diabetes. All other health questions answered no No Medications listed

23 Case Study #1 Phone Interview Moved in with daughter 6 weeks ago Hydrocodone Insulin 40 units/day Lasix 80 mg day Two BP meds

24 Case Study #1 APS CHF x 8 years Stroke last year with residuals weakness and speech impairment Uses a walker Needs help with standing, bathing, dressing, medication, laundry, transportation, managing money Has received home health care for 7 years

25 Case Study #2 Application 70 yo M 5’7 170# Hytrin Prostate, Niacin Cholesterol All other health conditions answered no

26 Case Study 2# Phone Interview Declined by another carrier “too old” Skiing accident in ’95 Gym, treadmill, walks dogs

27 Case Study #2 APS 5’3 170# BPH with TURP Diabetes Subdural hematoma with craniotomy in ‘03

28 Case Study #2 APS continued 4-04 decreased concentration 1-05 moderate memory loss Rx Aricept

29 Case Study #3 Application 52 M, married, 6’4 310# Digoxin, Coumadin, Toprol – A Fib 2 BP Meds 3 Diabetes Meds Both knees replaced Quoted Standard

30 Case Study #3 Telephone Interview Pharmacist, knees replaced ’03, ’04, Atrial Fib, Diabetes, A1c 7.6 Treadmill 4x/week, chews tobacco

31 Case Study #3 APS Stress test 10 Mets, no ischemia 6-04 ER visit recurrent PAF 12-04 338# Sleep Apnea, CPAP

32 Case Study #3 Did we issue? If yes at what benefits and rate class?

33 Underwriting Guide Use Height/Weight Chart to determine weight class/eligibility Check uninsurable medication list Check Co-Morbidity Chart Check Medical Impairment section for handling of disclosed health If in doubt, speak with an underwriter

34 Questions?

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