Presentation is loading. Please wait.

Presentation is loading. Please wait.

It’s time for a change…. The company behind the change… Philadelphia American Life Insurance Company (PALIC) has a history dating back to 1904 and is.

Similar presentations


Presentation on theme: "It’s time for a change…. The company behind the change… Philadelphia American Life Insurance Company (PALIC) has a history dating back to 1904 and is."— Presentation transcript:

1 It’s time for a change…

2 The company behind the change… Philadelphia American Life Insurance Company (PALIC) has a history dating back to 1904 and is now part of the New Era Life family of insurance companies Over $300,000,000 of annually premium income.  Over $120,000,000 of Health Premium annually Philadelphia American Life Company is licensed in 47 ….states.

3 The man behind the company Dr. Bill Chen, our president, and CEO, earned his doctorate in theoretical statistics from Purdue University in 1970 and became a Fellow in the Society of Actuaries in 1978. He has spent nearly 30 years in the life and health. insurance industry. He has been honored by numerous organizations including Ernst and Young, Merrill Lynch Regional and was recognized as Entrepreneur of the Year in 1994 by Inc. Magazine.

4 It’s time for a change… RETHINK the way you view healthcare

5 Empowered healthcare is the Mission.. Think Prevention Smart and healthy lifestyle choices Think Control Take control over personal healthcare decisions

6 It’s a new world of Defined Benefit plans and supplemental benefits. Now, WE are required to be more pro-active in controlling our medical expenses AND be equally pro-active in the management of our personal health. It’s a new world of Defined Benefit plans and supplemental benefits. Now, WE are required to be more pro-active in controlling our medical expenses AND be equally pro-active in the management of our personal health. For a growing number of American's, the days of$20 co-pays are coming to an end. For a growing number of American's, the days of $20 co-pays are coming to an end.

7 The Key to Controlling Healthcare Costs is More Than Co-Pays and Deductibles It’s about providing the “right” plan at the right time to help guide personal decisions.

8 Welcome to Health Saver Plus! Your Guide to the Next Generation of Affordable Health Insurance Health Savers Plus In today’s market where health insurance is often unavailable or unaffordable, Health Savers Plus can help provide you and your family with peace of mind by proving health insurance benefits you can afford. The idea is that affordable, quality healthcare is achievable if you the consumer, have the basic knowledge and willingness to make informed decisions by discussing your treatment plan and costs with the healthcare professional of your choice.

9 Welcome to Health Saver Plus! Your Guide to the Next Generation of Affordable Health Insurance

10 Key Features Include $5,000,000 Lifetime Maximum Choose from three benefit options. Pick your Base Plan Deductible Number of Benefit Units to fit your needs Calendar Year Benefit Maximum Use any Doctor or Hospital you choose “Without Penalty”

11 Three Calendar Year Deductibles To Choose From M aximum of three Deductibles per policy Three Calendar Year Deductibles To Choose From. M aximum of three Deductibles per policy 1.$ 1,000 2.$ 2,500 3.$ 5,000 1.$ 1,000 2.$ 2,500 3.$ 5,000

12 Maximum Covered Benefits Per Covered Person per Calendar Year $100,000$250,000$1,000,000 Maximum Number of Days Per Covered Persons 3060180 Choose Your Maximum Benefit Level Choose Your Maximum Benefit Level.

13 Hospital Indemnity Benefits – Facility Fees Hospital Indemnity Benefits – Facility Fees. Select The Number of Benefit Units To Fit Your Needs1 Unit2 Units3 Units Daily Indemnity Benefit For Hospital Confinement$1,000$2,000$3,000 Confinement in a Hospital Intensive Care Unit (ICU) (Up to 20 days per Calendar Year $1,500$3,000$4,500 Daily Indemnity Benefit For Hospital Confinement For Mental Illness, Alcohol and/or Substance Abuse $ 500$1,000$1,500 Daily Indemnity Benefit For Hospital Confinement in a Rehabilitation Facility or Skilled Nursing Facility $ 500$1,000$1,500 Daily Indemnity Benefit For Outpatient Radiation or Chemotherapy $ 500$1,000$1,500 Inpatient Physician Hospital Visit per visit$ 50$ 100$ 150 Daily Indemnity Benefit for Outpatient Hospital or Ambulatory Surgical Center services when surgery is performed $1,000$2,000$3,000 Emergency Ambulance for each trip due to a covered injury or Sickness that results in a hospital confinement. $250per trip

14 Professional Services Professional Services. * The reimbursement schedule for 1 unit is similar to what is payable under Medicare’s Physician..fee schedule for surgeries. You may acquire up to three units based on plan selected Assistant Surgical Services We will pay 20% of the amount listed in the fee schedule Anesthesia Benefit for covered services We will pay 25% of the amount listed in the fee schedule 1 Unit2 Units3 Units Surgical Procedure:* The plan will pay this benefit if any Covered Person undergoes a surgical procedure when performed in a Hospital or in an Ambulatory Surgical Center due to a eligible Accident or Sickness. 1 X the Policy fee schedule 2 X the Policy fee schedule 3 X the Policy fee schedule Inpatient Pathologist / Radiologist:* The plan will pay this benefit if any Covered Person undergoes an Inpatient Pathologist / Radiologist procedure as a result of a Covered Accident or Sickness. 1 X the Policy fee schedule 2 X the Policy fee schedule 3 X the Policy fee schedule

15 Sample of Common Surgeries Sample of Common Surgeries. CPTDESCRIPTION 19307mastectomy, modified radical 27130total hip arthroplasty 29881knee arthroscopy/surgery 33533coronary artery bypass, arterial, single 93510left heart catheterization 45380 colonoscopy and biopsy 47562 laparoscopic cholecystectomy 50590 lithotripsy, fragmenting of kidney stone 58150 total hysterectomy 66984 cataract surg w/intraocular lens, 1 stage

16 Sample Fee Schedule Comparison by State Policy Fee Schedule (1 Unit)100.00% Alabama87.00% Arkansas85.00% Arizona93.68% Colorado93.59% Georgia - Atlanta97.03% Iowa86.41% Illinois - Chicago105.66% Illinois - Rest of the state92.96% Indiana90.50% Louisiana - New Orleans97.82% Michigan - Detroit107.11% Michigan - Rest of the state94.80% Missouri - St. Louis94.78% Mississippi88.18% Nebraska85.49% Ohio95.76% Oklahoma86.99% Pennsylvania - Philadelphia106.03% Pennsylvania - Rest of the state94.60% South Carolina88.38% Tennessee89.06% Wisconsin89.36%

17 Outpatient Benefits Outpatient Benefits. CALENDAR YEAR DEDUCTIBLE$500 per insured Calendar Year Maximum$2,000 Units 1 Unit2 Units3 Units Outpatient Office Visit$ 25$ 50$ 75 Other Outpatient Services (per test) MRI, CAT Scan or Nuclear testing Other diagnostic testing or X-rays Laboratory testing Injections $ 175 40 10 5 $ 350 80 20 10 $ 525 120 30 15 Generic Prescription (per prescription filled)$ 5$ 10$ 15 Brand Name Prescription (per prescription filled)$ 10$ 20$ 30 Well Care Maximum$ 50 per visit up to $150 per calendar year

18 Receive Benefits From Three Pools Receive Benefits From Three Pools. Patient Protection and Affordable Care Act

19 Hospital Indemnity Pays based on Define Benefit Schedule Deductible is Applied Against Eligible Benefits Major Medical Pays based on Expense Incurred Deductible and Co-Payment is Applied Against Eligible Expenses Medical Plan Comparison Medical Plan Comparison.

20 Inpatient Hospital 6 daysEligible BenefitDeductiblePayableOut of Pocket Hospital Bill $25,469.71$18,000.00$1,000.00$17,000.00$8,469.71 Pathology Bills 81003$9.00$9.66 -$0.66 80053$33.00$45.42 -$12.42 85025$9.00$33.42 -$24.42 84132$11.25$19.74 -$8.49 80053$33.00$45.42 -$12.42 80074$25.00$204.63 -$179.63 82247$10.00$21.57 -$11.57 82248$10.00$21.57 -$11.57 85651$8.00$15.24 -$7.24 85025$9.00$33.42 -$24.42 84132$11.25$19.74 -$8.49 80053$33.00$45.42 -$12.42 85025$9.00$33.42 -$24.42 Radiology Bills 71020$47.00$26.91 $20.09 72193$255.00$141.36 $113.64 74160$270.00$154.26 $115.74 74020$57.00$32.91 $24.09 76705$130.00$70.98 $59.02 Hospital Visits$286.00$150.00 $136.00 $225.00$150.00 $75.00 $225.00$150.00 $75.00 $210.00$150.00 $60.00 $210.00$150.00 $60.00 $175.00$150.00 $25.00 Totals $27,770.21$19,875.09$1,000.00$18,875.09$8,895.12 Health Saver PlusDiverticulitis6 day stay$1,000 Deductible3 Units

21 Pricing Our most economical plans Our most economical plans (Male/Female age 40 with 2 children) 1) Family Rate 1 Unit / NTU $1,000 Deductible with a …..$100,000 Annual Maximum $ 196.02 2) Family Rate 2 Units / NTU $2,500 Deductible with a …..$250,000 Annual Maximum $ 317.99 Our most popular plan Our most popular plan (Male/Female age 40 with 2 children) 4) Family Rate 2 Units / NTU $1,000 Deductible with a …..$1,000,000 Annual Maximum $ 500.96 Rate does not include a one time $30.00 non-refundable application fee 3) Family Rate 2 Units / NTU $1,000 Deductible with a …..$250,000 Annual Maximum $ 435.62

22 Enhanced 24 Hour Accident Expense Insurance Plan with Accident Disability Income Benefit Enhanced 24 Hour Accident Expense Insurance Plan with Accident Disability Income Benefit

23 Enhanced Accident Expense Plan Enhanced Accident Expense Plan. BENEFIT SUMMARY1 Unit2 Units Accidental Injury Benefit $ 2,000.00$ 4,000.00 Accidental Death Benefit $ 50,000.00$ 100,000.00 Ground or Air Ambulance $ 5,000.00$ 10,000.00 Hospital Income Benefit $ 150.00$300.00 Dismemberment Benefits Loss of Finger or Toe Single Loss Benefit Multiple Loss Benefit $ 500.00 $ 1,000.00 $ 2,000.00 Loss of Hand, Arm, Foot, Leg Single Loss Benefit Multiple Loss Benefit $ 5000.00 $ 10,000.00 $ 20,000.00 Loss of Site Single Loss Benefit (One Eye) Multiple Loss Benefit (Both Eyes) $ 5000.00 $ 10,000.00 $ 20,000.00

24 Enhanced Accident Expense Plan Enhanced Accident Expense Plan. Optional Accident Disability Income Benefit 1 Unit2 Units Monthly Benefit $ 1,000.00$ 2,000.00 12 Months24 Months Two Benefit Period To Choose From Type 1Type 2 Only Two Occupational Classes

25 Monthly Bank Draft Rates Monthly Bank Draft Rates Issue Ages for Accident Plan 0-75 Issue Ages for Accident Disability Rider 18-64 ACCIDENT PLAN1 Unit2 Units Insured$23.00$31.05 Insured & Spouse$44.28$56.93 Insured & Children$53.48$69.00 Family$74.75$94.88 Child Only$16.10$20.13 ACCIDENT DISABILTY INCOME RIDER1 Unit2 Units Type 1 - 12 months$10.35$20.70 Type 1 - 24 months$13.23$26.45 Type 2 - 12 months$19.55$39.10 Type 2 - 24 months$26.45$52.90

26 It’s time for a change… Underwriting Simplified Issue Application

27 Simplified Issue Application Simplified Issue Application.

28

29

30 It’s time for a change… Underwriting “Made Easy”

31 It’s time for a change… Underwriting Tip -1 To help you ensure we are receiving accurate information from the applicant, you might let them know that a representative from the home office will call and review the application and their prescription history that you are about to review with them. You might tell them as your agent you are going to: “Ask them a series of questions about their medical history and ask them what medications they have taken in the last 12 months. These will be the same questions that the Company will ask you on a recorded phone call when they process your application.” Please be as thorough as possible to ensure consistency between their application and the recorded quality assurance call. This will help in getting their application processed in a timely manner.

32 Explain to the applicant how we handle Pre-existing Conditions to ensure they understand how it works What is a Pre-Existing Condition? “A condition for which treatment was rendered or recommended by a Physician or for which drugs or medicine was prescribed within 12 months prior to a covered Person’s Effective Date. Underwriting Tip - 2

33 New Business Flow Chart

34 It’s time for a change… Fax Application Paper Application LSP Policy System Reviewed For Processing Missing Forms Contact Agent All Forms Checked for Legibility Ask For another Fax or Original App To Be Mailed No YES Yes Manually Key Into System E-APP

35 Underwriter Review APS or Other Requirement Conditional Offer No Requirements or After Review of new information Decline YES NO + Issue Policy + Draft Premium Pre-Screen QAC IntelliScript Underwriter’s Desk

36 IntelliScript Prior 20072008 20092010

37 Quality Assurance Call 1.The Quality Assurance Desks will be open from 8:00 am to 5:00 pm CST Monday thru Friday. 2.The purpose of this call is to allow the applicant to add any information that may have forgotten to disclose to the agent 3.A “Thank You ” email is sent from the home office upon receipt of the application to let the applicant know that we will be calling them and if they have not heard from us we invite them to call the toll free number to complete the call.

38 Let them know about the Quality Assurance Call and how important it is. Let them know that we will be ordering an RX history showing prescriptions they have had filled and the doctor’s name. Make sure you charge the correct rate ups. If they are not on the application, you will find them located in the Underwriting Guide –This relates specifically to question 13! How Do I Get Quick Issue Let your client know what underwriting will be expecting

39 In the last 12 months, other than conditions listed on the application, has any applicant had any medical or surgical advice or treatment or including prescriptions or operations or been advised to have medical tests or surgery that has not yet been performed, or is awaiting medical tests? If YES-you will need to refer to the Underwriting guide to determine if any action is necessary. How Do I Get Quick Issue Stress The Importance of Question #13

40 WHAT ABOUT CONDITIONS NOT ON THE APPLICATION? The application ask about common conditions, but not all medical conditions! Please use the UW Manual if conditions are disclosed but not asked on the application. Question 13 ask about “Other” conditions. ANEMIA- ANEMIA- Within 2 Years since recovery = 2 Points Between 2-5 years since recovery = 1 Point More than 5 years = STD Otherwise = DEC GASTRIC BYPASS SURGERY- Within the last 12 months = 2 Points 1 Year-3 Years-full recovery = 1 Point More than 3 years, full recovery = STD With Complications = DEC

41 If the Rx history and the Quality Assurance Call are...consistent with the information on the application-you …….. can expect QUICK turnaround If information is developed through any of these.. … sources that is not consistent with the application, an …….. APS may be ordered which may delay issue several ……. weeks. Getting complete information, avoids underwriting … …requiring the agent to go back later which may cause …you to have to “Resale” the program How Do I Get Quick Issue Get complete information

42 Underwriting Made Easy healthunderwriting@neweralife.chealthunderwriting@neweralife.com Tobacco Rate My client stopped smoking five years ago. He smoked 2 packs a day but now only smokes an occasional cigar once or twice a week, can I quote him the non-tobacco rate? Thanks Successful Agent Get quick answers to your Underwriting Questions?

43 Underwriting Made Easy In Summary-Explain to the client How Pre-Existing Condition’s are applied How the surgical schedule works with the based on the number of units they selected The application process including the Quality Assurance...... Call How important complete medical and prescription history is in completing the application. Underwriting is always available to help at healthunderwriting@neweralife.com

44 Online Services

45 1.How to register Online as a new agent 2.Access to Downloading the eApp 3.Check the status of your pending business 4.Download a copy of your application 5.Get a copy of your commission statement 6.See your latest commission check The following slides will provide you with the following information

46 Register Today At www.neweralife.com

47

48

49

50 Download The eApp

51 Manage Your Agent Profile Sales Forms Online Applications Commission Statement Pending Business Online Applications Medicare Supplement Health Saver Plus

52 Manage Your Agent Profile Sales Forms Online Applications Commission Statement Pending Business Online Applications Medicare Supplement Health Saver Plus Select either the Health Saver Plus or the Enhanced 24 Hour Accident Expense Plan

53 Manage Your Agent Profile Sales Forms Online Applications Commission Statement Pending Business Online Applications Medicare Supplement Health Saver Plus

54 Manage Your Agent Profile Sales Forms Online Applications Commission Statement Pending Business Online Applications Medicare Supplement Health Saver Plus

55

56 Now You Can Login To Online Agent Service At www.neweralife.com

57

58 Manage Your Agent Profile Sales Forms Online Applications Commission Statement Pending Business Online Applications Medicare Supplement Health Saver Plus

59

60 Dave Collett

61 Download a copy of your completed Application

62 Manage Your Agent Profile Sales Forms Online Applications Commission Statement Pending Business Online Applications Medicare Supplement Health Saver Plus

63

64

65 Use 60000Demo as your agent number while you are familiarizing yourself with the eApp otherwise it will assume a life application


Download ppt "It’s time for a change…. The company behind the change… Philadelphia American Life Insurance Company (PALIC) has a history dating back to 1904 and is."

Similar presentations


Ads by Google