Presentation on theme: "PART 1: General Market Explanation PART 2: UA Coverage Solutions Form UASM-1 R02 2002 Agent Training Presentation."— Presentation transcript:
PART 1: General Market Explanation PART 2: UA Coverage Solutions Form UASM-1 R Agent Training Presentation
Part 1: General Market Explanation Medicare Review Medicare Supplement Long Term Care Life Insurance Insurer Selection
In 1966 the Federal government started this hospital/medical insurance program to help protect persons age 65 and over. In year 2000, 13% of the US population was over 65 and Medicare eligible. — Administration on Aging; August Medicare Overview By the year 2030, Medicare will pay for the health care of nearly 20% of the population. Rethinking Medicare by Tom Curry, MSNBC; May 2, 2000.
Medicare consists of two parts — A & B: Medicare Today Medicare Part A Hospital Room & Board. Other Costs Associated with Confinement. Skilled Care in a Nursing Facility. Medicare Part B Medical insurance
MEDICARE PART A — HOSPITAL MEDICARE PAYS: YOU PAY: Medicare Today 2002 Deductible:Most confinement $812 per costs after deductibleconfinement Days 61-90: All eligible $203 Daily remaining expenses Days :All eligible $406 Daily remaining expenses Days 151 on:Nothing All hospital costs
MEDICARE PART A — Skilled Nursing Facility MEDICARE PAYS: YOU PAY: Medicare Today Days 1-20: All eligible Nothing expenses after leaving the hospital — specific limitations Days :All eligible $ Daily remaining expenses Days 101 on:Nothing All costs
MEDICARE PART B — MEDICAL Part B covers: Doctor & surgeon fees, most lab tests & X-rays performed outside the hospital and outpatient treatment. Medicare Today MEDICARE PAYS -- generally pays 80% of “approved”charges -- YOU PAY $100 annual deductible 20% of “approved” charges 100% of charges above Medicare “approved” amounts
PART A — HOSPITAL INSURANCE 1st DAY 61st-90th DAY60 DAY 21st-100th DAY YEAR BENEFIT INPATIENT HOSPITAL INPATIENT HOSPITALLIFETIME RESERVE SKILLED NURSING PERIOD BEGANDEDUCTIBLECOINSURANCECOINSURANCEFACILITY COINSURANCE PART B — MEDICAL INSURANCE ANNUAL DEDUCTIBLECOINSURANCE COVERED SERVICESCOVERED SERVICES $ % of Approved Amount $ % of Approved Amount $ % of Approved Amount 1991-Now$ % of Approved Amount 1966$ 40.00$ 10.00$ 20.00$ $812.00$203.00$406.00$ per benefit period per day per day per day
PlansABCDEFGHIJ Core Benefits Skilled Nursing Home Part A Hospital Deductible Part B Deductible Excess Doctor Charges 100%80%100%100% Foreign Travel At-Home Recovery Prescription Drugs $1250$1250$3000 Preventive Care *Plans F & J are also high deductible plans. Standardized Med-Supp Plans
Hypothetical Example: Patient Liability after Medicare Need for Medicare Supplement PATIENT PLAN C PLAN FPLAN G LIABILITYPAYSPAYSPAYS PART A: Hospital Part A Deductible$ 812$ 812$ 812$ $2036,090 6,090 6,090 6, $40624,360 24,360 24,360 24,360 Additional Hospitalization20,000 20,000 20,000 20,000 3 units of $ SUBTOTAL:$51,442$51,442 $51,442 $51,442 SNF: 80 $ ,120 8,120 8,120 8,120 At-Home Recovery: 14 $40 560——560 PART A TOTAL:$60,122$59,562 $59,562$60,122 PART B: Outpatient Hospital Services & Medical PART B TOTAL:$12,591$8,325$12,591$11,638 $72,713 UNPAID $67,887 $72,153 $71,760 Plans covering excess charges are not applicable in PA and OH.
Insurance companies receive eligible Medicare Part B claims automatically from Medicare Part B administrators. Automatic filing virtually eliminates the need for customer claims filing. Not all Medicare Supplement insurers offer automatic filing. Companies offering automatic filing sometimes provide it only in limited areas. Federal law requires Medicare to file a small number of claims directly with insurers. Automatic Claims Filing
1. Can patients pick their primary-care physician? 2. What gets covered? Pre-existing conditions? Emergency-room visits? 3. How much will it really cost? Are there co-payments on prescriptions, routine doctor appointments and visits to specialists? 4. What if a patient wants to see someone not included in the plan? Managed Care ‘Freedom’? Questions Seniors should research in the case of HMOs:
5. How good are the HMO doctors? How many are board-certified? 6. Does the patient have access to any doctor in the HMO plan? 7. How convenient are the locations of HMO facilities and physicians? 8. What do current patients think of the HMO? Managed Care ‘Freedom’? Questions Seniors should research in the case of HMOs: (continued)
Initial Medicare Supplement policy selection is more critical than customers may realize. Only policies are standardized, companies are not. “First Year” Choices Choose a safe, strong, proven company — once. Research, understand and choose the best coverage for you — once. Qualify for coverage — once. Health status can change and qualifying for a different policy (an upgrade) may not be possible later.
36% of all 65 year old men and 50% of all 65 year old women will eventually require nursing home care. - Long Term Care Planning, A Dollar and Sense Guide, The average cost of a nursing home stay in 1990 was about $72 a day. - Who Buys Long Term Care Insurance? Profiles & Innovations in a Dynamic Market, HIAA This figure has now risen to a cost ranging from $ per day, depending on location. - University of Maryland Center on Aging Partnership for Long Term Care, updated 8/7/01. Long Term Care Need
Life insurance is purchased mainly to buy additional financial protection for families. Most policies sold cover people age Life Coverage Ordinary life is the most widely used form of life insurance protection and it is broken into two types... whole life (permanent) and term insurance. The most common minimum amount of an individual policy is $10,000.
When a loved one dies many bills may remain and the family will need to find the money to pay them. Life insurance coverage bought now can help to cover these costs. Life Coverage This type of Life insurance is generally for ages Provides quick access to pay final expense costs Protects loved ones from financial burden during a difficult time Options can include varying face amounts, cash and loan values and living benefits (continued)
Most annuities are available for ages Annuities are purchased for the purpose of producing periodic income at regular intervals for a specific time frame, such as 10, 20, 30 years or even life. Annuities Annuities help assure protection against the possibility of outliving one’s financial resources. Typically annuities are intended to provide additional retirement income.
Choose the right company. Examine the company behind the product... financial stability, leadership experience, industry ratings and rankings. Life/Health Insurer Selection Match coverage needs to budget. The bottom line... what good is an insurer if you can’t depend on them when you need protection?
Medicare Supplement Long Term Care Cancer Life Coverages United American Review Part 2: UA Coverage Solutions
Source: HIAA Source Book of Health Insurance Data, 2000 Growth in the Medicare Supplement Market Millions Predicted Number of People Age 65
Growth in the Medicare Supplement Market in 2000, the number of Medicare beneficiaries was approximately 40 million. The number of Medicare beneficiaries is expected to increase 77% during to an estimated 75 million. Annual out-of-pocket spending for elderly Medicare beneficiaries is expected to climb from $3,142 in 2000 to $5,248 in Source:
Policy Forms MS A MS B* MS C MS D MS F MS G Core Benefits Skilled Nursing Home Part A Hospital Deductible Part B Deductible Excess Doctor Charges 100% 80% Foreign Travel At-Home Recovery There are ten standardized Medicare Supplement insurance plans; of these, United American offers six. *Plan B provides both senior and underage disability protection. Benefits are identical (separate app/brochures); senior rates are age-banded and Underage Disability rates remain one rate all ages. (Some states require designated Medicare Supplement plans be available to persons eligible for Medicare due to disability.) Excess charges are not applicable in PA and Ohio. Plans F and G not available in PA and VT. Plans and benefits may vary by state. United American Insurance Company is not associated with or endorsed by Medicare, Social Security or any other governmental agency. UA’s ProCare Med-Supp Portfolio
Groups of 50 or more retired employees are eligible — including eligible spouses. 100% participation is required. Coverage is guaranteed issue. Lower, community rates will be offered. The full UA ProCare portfolio is available. United American’s ultimate customer service, “Automatic” Claims Filing PLUS ® (ACF PLUS ® ) is available throughout the Country (except in MA). UA Group Medicare Supplements
United American delivers... UA Policyholder Services Personal one-on-one Agent attention. Fast policy issue for fast protection. Automatic Payment Plan (Bank Draft) for premium payment, thereby eliminating unintentional lapse and providing non-stop protection. Easy-to-understand product brochures with clearly defined benefit descriptions. ACF Partners ®, which provides automatic filing (ACF PLUS ® ) of Medicare Part B claims and also includes discount health services. (ACF Partners not available in Connecticut, Kansas, Minnesota or Montana.)
Nationwide discount health services program with savings for: Chiropractic Dental Eye Care Hearing Aids Prescriptions Mail Order Pharmacy ACF Partners ® Up to 40% Up to 50% Up to 20% Up to 30% Save More $$
PLUS, “Automatic” Claims Filing: Virtually eliminates claims filing Direct provider payment Speeds claims processing Consolidated monthly claim statements Note: Federal law requires Medicare to file a small number of claims directly with insurers. ACF Partners ®
ACF Partners AK OR NV AZ TX LA AR MO KS NE IA MS AL GA FL IL IN OH KY WV VA PA HI CT NJ DE DC ACF Partners/ACF PLUS not available in MA and NY. MD WI CA ID MT WY WA UT CO NM OK SD ND MN TN SC NC MI NH VT ME RI ACF PLUS available ACF Partners ®
Dear Sirs, Thank you so much for the Partners membership card* for the discount benefit program. I have used the card several times, and it is hard to believe how much I have saved on prescriptions. It is well worth the fee. I recommend the company (United American) to friends and relatives as often as I have the opportunity. Sincerely, E. Clark, Georgia Policyholder Praise
Dear United American, I have been on Medicare and United American insurance for six months now. I am writing to inform you that, thanks to your agent in this area I chose your company. The service has been excellent and payments prompt. I will recommend your company to anyone who is 65 and anyone else who will listen. Again thanks. P.S. I save about 45 to 50% on drugs with the ACF Partners card*. Thanks again, J. Clemens, IA Policyholder Praise
Dear Sir, Thank you for being such a good insurance company. Whenever anyone asks, “What insurance do you have?” and I tell them United American, they immediately say, “well then, everything will be taken care of.” And it is. I never have a worry about a thing. Sincerely, M. Fry., CO Policyholder Praise
Dear Madam, I have been with you about 8 years and in that time I have never had a problem. As a matter of fact many times evidence of your payment (monthly statement) comes before the EOMB from Medicare. C. Cherney, North Carolina Policyholder Praise Mr. Mark McAndrew, Just a short note to thank you and your people for 16 years of wonderful, prompt service - never a problem. Yours truly, O. and J. Yonkers, New Hampshire
To: Subject: A thanks This may be a strange but as I was working around the house the other day, your TV ad came on and I just wanted to thank you for the great way this insurance company took care of my parents... my father and then my mother signed up with UA and recommended many others to this company, so I just wanted to say thanks and I will look into UA when I am ready for a supplemental coverage!! Sincerely, K. Rich, Florida Policyholder Praise
LTC Classic — Indemnity LTC Gold Series — Expense-Incurred Individual or Married Protection Issue Ages Long Term Care Plans* *Plans and benefits may vary by state
The Classic and Gold Series Plans offer these additional features: LTC Features Benefits for Alzheimer’s Disease — covers as any other sickness* Cognitive Impairment Lapse Protection Third Party Notification Guaranteed Renewable Protection Automatic Payment Plan Married couple rate *In most states, Alzheimer’s must be first diagnosed or treated after the policy is in force.
Choice of Daily Benefit Amount: $30 - $200 Choice of Benefit Periods: 1 year, 2 years, 4 years or Unlimited Choice of Elimination Periods: 0, 30, 100, 180 days Qualified Nursing Home Coverage for skilled, intermediate & custodial care Bed Reservation Benefit Restoration of Benefit Waiver of Premium Optional Benefit Inflation Rider Optional Non-forfeiture Benefit Rider LTC Classic Plans & benefits may vary by state. Policy Form LTCIN
Choice of Daily Benefit Amount: $30 - $200 Choice of Benefit Factors (or Maximum Benefit): 365 days, 730 days, 1460 days or Unlimited* Choice of Elimination Periods: 0, 30, 100, 180 days Qualified Nursing Home covers all levels of care: skilled, intermediate & custodial care Alternative Plan of Care Benefit Bed Reservation benefit Restoration of Benefit Waiver of Premium *Unlimited not available on HHC or HHCC Riders. Plans & benefits may vary by state. Policy Form LTCBOM LTC Gold Series
Optional Riders: LTC Gold Series Plans & benefits may vary by state. Home Health Care Home Health and Community-Based Care with: Alternative Care Hospice Care Adult Day Care Respite Care Benefit Inflation Rider Non-Forfeiture Benefit (where approved)
Miscellaneous Hospital Benefit: Good Sense Plan Plans & benefits may vary by state. Policy Form GSP1 Issue ages 0-63 Benefit amounts of $15,000 or $25,000 (less $500 deductible) Surgical Expense Benefit Radiotherapy Benefit Choice of Daily Hospital Room Benefit Daily Intensive Care Benefit – up to two times the daily room benefit
UA Cash Benefit Cancer Plan This is a supplemental cancer only insurance policy. Policy Form CANB Reasons To Buy UA’s Supplemental Cancer Coverage: Reason #1 Freedom To Choose How Money Is Spent No restrictions on the way the policyholder spends the benefit amount received... reconstructive surgery, choice of treatment plan or doctor, mortgage payments, travel expenses, income while not working, etc. It’s up to the policyholder to decide how best to spend the money.
UA Cash Benefit Cancer Plan Reasons To Buy UA’s Supplemental Cancer Coverage: Reason #2 Existing Coverage Doesn’t Matter Fact: The lump sum cash benefit amount is designed as a total cash payment. This frees the customer from having to forfeit any existing coverage. With UA’s Cash Benefit Cancer Plan there is no duplication of coverage. This is a supplemental cancer only insurance policy. Policy Form CANB
Reasons To Buy UA’s Supplemental Cancer Coverage: Reason #3 Liberal Qualification No physical exam is required to qualify — a few health questions will determine if you qualify for coverage. UA Cash Benefit Cancer Plan This is a supplemental cancer only insurance policy. Policy Form CANB
First diagnosis, cash benefit supplemental cancer policy Pays one-time cash payment of up to $10,000, $20,000, $30,000, $40,000, $50,000 Benefit payment upon written satisfactory proof according to the policy of diagnosed internal cancer or malignant melanoma Coverage for Individual, Single Parent and Family — issue ages 0-69 Policy pays in addition to any other existing coverage No hospitalization or treatment required to collect the full benefit amount due This is a supplemental cancer only insurance policy. Plan and benefits may vary by state. Policy Form CANB UA Cash Benefit Cancer Plan
Whole Life — Level or Increasing RT85 Renewable Term Life Joint Last Survivor 21-Pay UA Life Plans* *Plans and benefits may vary by state
Ages Level Benefit with 4 Payment Options - 10 Year Pay - 20 Year Pay - 15 Year Pay - Ordinary Life Graded Benefit— Offered where approved.** - Available on level and increasing benefit choices Increasing Benefit — Grows 5% each policy year for 20 years until it doubles. - Ordinary Life payment option only Living Benefit— Offered where approved. Whole Life* Policy Forms SWL & SWLGD *Plan and benefits may vary by state **Graded Benefit not approved in MA, MN, NC, NJ, PA, SC and WA.
Ideal protection for families just starting out and for those who need additional insurance coverage. * Plan and benefits may vary by state. Policy Form RT10 ** Graded Benefit not approved in MA, MN, NC, NJ, PA, SC & WA. RT85 Renewable Term Life* Available ages Immediate coverage with policy issue Graded Benefit - offered where approved Cash Benefit paid directly to beneficiary Living Benefit (where approved)
Whole Life, coverage for couples — Ages Plan and benefits may vary by state Policy Form JSWL Joint Last Survivor Level Benefit with 4 Payment Options - 10 Year Pay - 20 Year Pay - 15 Year Pay - Ordinary Life Increasing Benefit — Grows 5% each policy year for 20 years until it doubles. Ordinary Life payment option only. Offers Living Benefit where approved Beneficiary receives policy benefit upon death of survivor No premium increases ever
“Special needs” life insurance coverage from birth. Plan and benefits may vary by state. Policy Form URL-CBP 21-Pay Life Plan Available ages 0-79 Coverage for individuals, families and seniors Face amount increases 5% per year Optional child and Accidental Death Benefit Riders (Additional premium applies.)
United American will provide a complimentary Memorial Guide to each current or prospective policyholder. The Memorial Guide documents important information that aids families in making final preparations: vital statistics, military record, immediate family and special requests. This Guide allows seniors to assess their final expense needs and their level of preparation. Memorial Guide
Issue ages 0-80 Single Premium Tax-deferred growth Guaranteed interest rate at all times Optional maturity date 5 income options include monthly checks Plan may vary by state. Policy Form USPDA UA Lifestyle Annuity
1.Over 50 years of Life/Health insurance experience 2.Full range of Life and Health products —Medicare Supplement, Long Term Care, Cancer, Life (whole life, term, annuities) 3.One of the largest writers of individual Medicare Supplements (NAIC Final Med-Supp Experience Report 2/01) 4.Personal Agent service 5.Fast policy issue for fast protection 6.UA average Medicare turnaround times: claims processing — 3.56 days. 7. Timely policyholder communications 8.Freedom to choose physicians & facilities on all health coverage 9. Simple “Yes/No” applications 10.ACF Partners ® : discount health services program with “Automatic” Claims Filing 10 GREAT REASONS TO BUY UA COVERAGES United American Review
United American Insurance Company is not associated with or endorsed by Medicare, Social Security or any other governmental agency. Unless specified, these Medicare Supplement policies will not duplicate Medicare payments or pay expenses not Medicare eligible. These policies described herein have exclusions and limitations. This is a solicitation for insurance, and an agent representing United American Insurance Company may call you to provide costs and complete details. Pre-existing condition means an injury sustained or sickness manifesting itself prior to the policy effective date. Form UASM -1 R02
UNITED AMERICAN SECURITY FOR TODAY AND TOMORROW United American Insurance Company Headquarters McKinney, Texas