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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 now part of the New Era Life family of insurance companies Over $300,000,000 of annually premium income.
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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.
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.
For a growing number of American's, the days of$20 co-pays are coming to an end. 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.
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.
Welcome to Health Saver Plus 1 Your Guide to the Next Generation of Affordable Health Insurance In today’s market where health insurance is often unavailable or unaffordable, HealthSavers Plus 1 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 treatment plan and costs with the healthcare professional of your choice.
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Access the best quality healthcare at the lowest possible cost.
Welcome to Health Saver Plus 1 Your Guide to the Next Generation of Affordable Health Insurance
Key Features Include • $5,000,000 Lifetime Maximum • Choose from three benefit options • .Pick your Base Plan Deductible • Calendar Year Benefit Maximum Level • Number of Benefit Units to fit your needs • Use any Doctor or Hospital you choose “Without Penalty”
Three Calendar Year Deductibles .\1st Choose a deductible you can afford • $ 1,000 • $ 2,500 • $ 5,000
Hospital Indemnity Benefits – Facility Fees 3rd Pick the number of Benefit Units .
Professional Services (Texas Only). *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
3 Units @ a Daily Hospital Benefit of $4,500 2 Units @ a Daily Hospital Benefit of $3,000
PHCS Physician & Hospital Network* • Inpatient services 10% to 50% • Outpatient services 10% to 40% • Ancillary services 15% to 55% • Physician services 23% to 46% • * PHCS Network is not available in MA, MD and WV • Imaging Network • Over 3,200 outpatient radiology facilities • Save an average of 40% to 75% less than the usual costs for MRI, CT and PET scans Lab Services 10% to 80% savings on regular retail pricing of blood test with over 3,000 certified labs nationwide. • Pharmacy Discounts • Access to over 60,000 participating pharmacies nationwide. • Average savings 31% generic drugs and 13% off brand ...name prescriptions • Other Great Services Include • My eWellness – web-based health & wellness • eDocAmerica – online access to physicians • NurseLine – 24 hour Registered Nurse Advisor Help Line • Discounts on Chiropractic Services and Durable Medical • Discounts on Diabetic Supplies Medical Discount Plan Only $19.95/ month for you and your family Discount listed above are for illustrative purposes only please refer to Careington’s brochure NEL-DMP or the membership booklet for more details about the Discount Medical Plan. - This Is Not Insurance -
Critical Illness Rider • Provides immediate cash for your customers when they are diagnosed with a covered medical crisis. • They can use the money for: • Treatment not covered by HSP1 including deductible and …..expenses in excess of the coverage selected. • Non-medical expenses like travel, childcare, and spouse’s …..time off from work. • Expensive alterations to your home or vehicle for special …..needs. • Or, any way you choose. There are NO restriction on how …..you spend your money.
Critical Illness Rider • A Lump-sum Benefit is paid upon the diagnosis of: If a partial benefit is paid the remainder of the benefit will be payable upon the diagnosis of another covered Critical Illness.
Family Term Life Rider * Death Benefit is based on Insured’s attained age. ** Spouse’s Death Benefit is based on Insured’s attained age Monthly Rates
Monthly Bank Draft Rates Issue Ages for Accident Plan 0-75 Issue Ages for Accident Disability Rider 18-64
Underwriting Simplified Issue Application It’s time for a change…
Underwriting “Made Easy” 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. It’s time for a change…
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
Paper Fax E-APP Application Application Reviewed For Checked for YES Processing Legibility No Yes It’s time for a change… Ask For another Fax All Forms Missing or Forms Original App To Be Mailed Manually Key Into System Contact Agent LSP Policy System
Underwriter’s Desk IntelliScript Pre-Screen QAC APS or Other Underwriter Requirement Decline Review No Requirements or After Review of new Conditional information NO Offer YES + Issue Policy + Draft Premium
Quality Assurance Call • The Quality Assurance Desks will be open from 8:00 am to 5:00 pm CST Monday thru Friday. • The purpose of this call is to allow the applicant to add any information that may have forgotten to disclose to the agent • 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.
How Do I Get Quick Issue • 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! Let your client know what underwriting will be expecting
How Do I Get Quick Issue 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. Stress The Importance of Question #13
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- 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
How Do I Get Quick Issue • 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 Get complete information
Underwriting Made Easy Get quick answers to your Underwriting Questions? healthunderwriting@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
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
