1. Hey Doc! Six ways Critical LifeEvents® supports the way consumers experience critical illlness today
Dr. Howard Fixler
Medical Director & Second Vice President, Long-term Care & Disability
Trustmark Voluntary Benefit Solutions
Dan Johnson
Vice President, Sales & Marketing
Trustmark Voluntary Benefit Solutions

2. Change leads to innovation
The questions…
The answers…
Classic plans
Why do CI plans need to change?
Why are a third of all CI claims in the industry getting denied?
What are the primary claims submitted?
CI plans aren’t keeping pace with medical practices
66% of denials are due to conditions not being covered or definition not being met
90% of all industry claims are for cancer, heart attack and stroke (94% for Trustmark)

3. Change leads to innovation
70% were interested in early identification coverage and typical plans don’t cover it
E.g., mini-stroke, skin cancer & tumors
64% were interested in early stage illness coverage where preventive measures are taken
E.g., artery obstruction repair and stroke prevention procedures
Critical LifeEvents®
Less than 50% would actually purchase a rider which covered those ‘Other Conditions’

4. Six ways Critical LifeEvents® supports an employee’s medical experience
1. Reflects current clinical practices
2. Covers earlier stages of diseases
3. Covers more conditions
4. Simplifies the claims process
5. Expands clinical diagnosis
6. Eliminates separation and modifies reocurrence periods

5. 1. Reflects current practices
Classic plans
Critical LifeEvents®
Heart attacks have to be diagnosed through enzymes in order to be paid.
Heart attacks are no longer diagnosed through enzymes alone, which expands the definition of what’s paid through Critical LIfeEvents.

6. Percutaneous Coronary Intervention
1. Reflects current practices
Percutaneous Coronary Intervention
Heart attack
10 minutes
Catheterization lab

7. REFLECTS CURRENT PRACTICES
Classic plans
Critical LifeEvents®
Stroke benefits are only paid if a 30-day neurologic deficit is present.
Strokes aren’t causing as many neurologic deficits because of early diagnosis and interventions, so a 30-day deficit doesn’t preclude the benefit.

8. ©American Heart Association, Inc. All rights reserved.
1. Reflects current practices
Why are strokes causing fewer 30-day impairments?
Earlier diagnosis
More designated stroke centers
Better diagnostics
Clot-busting intervention
©American Heart Association, Inc. All rights reserved.

9. Supportive neuroimaging
1. Reflects current practices
CLAIM CHECK ✓
$15,000 benefit
January 2016
March 2016
Critical LifeEvents®
Critical LifeEvents®
Clinical diagnosis of stroke – 50%
Stroke w/ 30-day impairment – 100%
$7,500 ✓
$7,500 ✓
Supportive neuroimaging

10. COVERS EARLIER STAGES OF DISEASES
Classic plans
Critical LifeEvents®
Contracts are limited and rarely cover the early stages of a disease.
Provides a benefit for the early identification and early stages of cancer, coronary artery disease and cerebral vascular disease.

11. 0% 10% 0% 10% 0% 10% 2. Covers earlier stages of diseases
Classic plans
Critical LifeEvents®
Melanoma in-situ
Melanoma in-situ
CANCER 0%
10%
Classic plans
Critical LifeEvents®
HEART ATTACK
Clinical diagnosis of coronary artery disease
Clinical diagnosis of coronary artery disease 0%
10%
Classic plans
Critical LifeEvents®
Mini-stroke (TIA)
Mini-stroke (TIA)
STROKE 0%
10%

12. 3. Covers more conditions
Classic plans
Critical LifeEvents®
Limited to established cancer
Heart attack
Stroke
Claim definition of in-situ vs. medical definition of in-situ
Covers cancer, heart attack & stroke more comprehensively
Early identification: 10% (TIA, melanoma & in-situ)
Early stages: 50%
Late stages: 100%
Benign tumors (brain, spinal cord or cranial nerve)
Myelodysplastic syndrome
Invasive basal cell skin cancer

13. 4. Simplifies the claims process
Classic plans
Critical LifeEvents®
In-situ I Invasive
Claims denied because the language is too restrictive
Stage 1 I Stage 2 I Stage 3 I Stage 4
Allows for high mortality cancers to be covered, even if the cancer is localized (i.e., pancreas, esophageal, liver, biliary tract, lung, head/neck, leukemia, lymphoma, multiple myeloma)
Conventional plans use the claim definition of in-situ, whereas Critical LifeEvents uses the medical definition of in-situ.

14. Located at site of origin; not affecting neighboring tissue
4. Simplifies the claims process
Classic plans
Pancreatic cancer
25%
(potential)
Critical LifeEvents®
Located at site of origin; not affecting neighboring tissue
Pancreatic cancer
100%
©Mayo Foundation for Medical Education and Research. All rights reserved.

15. 5. Expands clinical diagnosis
A diagnosis by a physician based on clinical evidence, which includes documentation of clinical exam, clinical impression, imaging studies or diagnostic test results. Clinical diagnosis must include recommendations for treatment.
Classic plans
Critical LifeEvents®
Focus on more rigid criteria.
Expands clinical diagnosis in all categories of illness (cancer, heart attack, stroke) to 50%

16. CLAIM CHECK ✓ 50% ✓ 50% ✓ 10% ✓ 10% ✓ 5. Expands clinical diagnosis
Classic plans
denied
Critical LifeEvents®
50% ✓
Clinically diagnosed heart attack
Clinically diagnosed heart attack
Classic plans
denied
Critical LifeEvents®
50% ✓
Clinically diagnosed stroke
Clinically diagnosed stroke
Classic plans
denied
Critical LifeEvents®
10% ✓
Mini-stroke (TIA)
Mini-stroke (TIA)
Classic plans
denied
Critical LifeEvents®
10% ✓
Initial diagnosis coronary artery disease
Initial diagnosis coronary artery disease

17. 6. Eliminates separation & modifies reoccurence periods
Classic plans
Critical LifeEvents®
Classic plans
Requires 90 days for new covered condition
Requires 12 months for reoccurring condition
In case of cancer progression, must be treatment-free for at least 12 months.
Requires no elimination period for a new covered condition
In case of cancer progression, a 30-day confirmation of ‘No Evidence of Disease’ is needed
Replenishing annual benefit

18. Six ways Critical LifeEvents® supports an employee’s medical experience
1. Reflects current practices
2. Covers earlier stages of diseases
3. Covers more conditions
4. Simplifies the claims process
5. Expands clinical diagnosis
6. Eliminates separation and modifies reocurrence periods

19. Dr. Howard Fixler Dan Johnson
Medical Director & Second Vice President, Long-term Care & Disability
Trustmark Voluntary Benefit Solutions
Dan Johnson
Vice President, Sales & Marketing
Trustmark Voluntary Benefit Solutions