The Claim Experience Delivering on a Promise

1. The Claim ExperienceDelivering on a Promise Laurene A. PolignoneAssistant Vice President RLTC Claim Operations

2. Agenda • Claims Model • Goals & Objectives • Key Components • Process Flow • Voluntary Care Coordination • Discount Provider Program • Fast Facts • Performance • Marketing Materials

3. Goals and Objectives of Our Claims Model • Well positioned for future growth • Provide a superior policyholder experience • Enhance claims management throughout the life of a claim

4. Components of Claims Model Service Center Intake Unit Suite of supportive materials Policyholder Quality Assurance Discount Provider Program Voluntary Care Coordination

5. Claims Process Intake Specialist External Care Coordinator • Policyholder initiates claim • Reviews contract, gains understanding of needs • If policyholder shows claim potential, On-site assessment and plan of care ordered through care coordination vendor • If policyholder has “no” providers inplace a referral to CareScout is made • Acknowledge-ment letters forwarded to PH and producer • Contacts policyholder within 24 hours to schedule an on-site assessment • On-site assessment performed, plan of care developed in home, HIPAA authorization completed

6. Onsite Assessment and a Plan of Care • Face to face assessment in policyholder’s home • 1 ½ hour visit • Registered Nurse or Licensed Social Worker • Assess & review • Health and Medications • ADL’s • Cognition • Behavior & Emotions • Support Systems • Paid/Unpaid Caregivers • Environment • Develop needs based Plan of Care

7. Claims Process Provider Specialist Intake Specialist External Care Coordinator Care Manager • Policyholder initiates claim • Reviews contract, gains understanding of needs • If policyholder shows claim potential, On-site assessment and plan of care ordered through care coordinator vendor • If policyholder has “no” providers inplace a referral to CareScout is made • Acknowledge-ment letters forwarded to PH and producer • Contacts policyholder to schedule an on-site assessment • On-site assessment performed, plan of care developed, HIPAA authorization completed • Reviews on-site assessment and plan of care to determine appropriateness. • Determines benefit eligibility • Performs TQ certification • Sets monitoring frequency for care coordination • Determines provider eligibility • Communicates to policyholder in writing. If denied a call to the policyholder is made • Reviews weekly and monthly provider and facility invoices for payment

8. Voluntary Care Coordination Benefit Monitor Implement of Plan of Care Update Plan of Care

9. Implementation of the Plan of Care? • Assistance with Medicare eligibility (typically during the EP) to assist with wellness and apply days towards the EP • Provide community resource referrals • Meals on wheels • Personal response system • Elder Services • Access to local & National support systems • Alzheimer’s Association • American Heart Association • Facilitate coordination of services • Education • Disease management • Poly pharmacy review • Depression screening

10. Claims Process Benefit Specialist Provider Specialist Intake Specialist External Care Coordinator Care Manager • Policyholder initiates claim • Reviews contract, gains understanding of needs • If policyholder shows claim potential, On-site assessment and plan of care ordered through care coordinator vendor • If policyholder has “no” providers inplace a referral to CareScout is made • Acknowledge-ment letters forwarded to PH and producer • Contacts policyholder to schedule an on-site assessment • On-site assessment performed, plan of care developed, HIPAA authorization completed • Reviews on-site assessment and plan of care to determine appropriateness. • Determines benefit eligibility • Performs TQ certification • Sets monitoring frequency for care coordination • Determines provider eligibility • Communicates to policyholder in writing. If denied a call to the policyholder is made • Reviews weekly and monthly provider and facility invoices for payment

11. CareScout Discount Provider Program(CareScout) • Provides policyholders and their families with: • Direct access to a care advocate • Quality information and reports on more than 90,000 • nursing homes • assisted living facilities • hospice facilities • home health providers • Discounts ranging from 7% - 35% • more than 95% of the time • Average savings for families: • $7,400 per year (nursing homes) • $1,800 (assisted living facilities) • $1,800 per year (home health care agencies)

12. Discount Provider ProgramCareScout Sample Report John Hancock Life Insurance Company, Boston, MA 02117

13. Fast Facts • > $1.4 billion in claims paid • > $313 million claims paid in 2006 • > $7.3 billion in reserves • > 32,0000 policyholders with claims • > 13,000 policyholders received benefits in 2006 • 4.73% of claims denied in 2006

14. 2007 Cycle Time

15. Complaint, Appeal & Rescission Activity Baseof 11,000 active claims and 750 new arising claims each month

16. 2007 Customer Satisfaction Survey Results

17. Marketing Materials • Advantage Provider Program Brochure (LTC-3069) • Testimonial Brochure (LTC-3067) • Claims Experience Brochure (LTC-3068) • 5 Step Claims Process (LTC-3066) • Claims Testimonial DVD (LTC-3032) • FAQ’s (LTC-3217) • Claims Experience Flyer (LTC-3256)