UnitedHealthcare

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UnitedHealthcare

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Preventive mammogram, Pap Smear, PSA Testing. 10. Confidential property of UnitedHealth Group. ... Preventive Mammogram, pap smear, PSA testing: 80 / 20 ... – PowerPoint PPT presentation

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Title: UnitedHealthcare

1

UnitedHealthcare
Underwritten By Golden Rule

This presentation currently excludes the
marketing states of CT, DE, GA, KS, KY, LA
Strengthen your product portfolio with affordable
health insurance plans
Not For Consumer Use 36256-0606 All Gen 21 States
and Georgia
2
Todays Agenda

Evolution of Golden Rule, A United Healthcare
Company
Product Portfolio and Competitive Rate
Comparisons
Network Size and Strength
Ease of Doing Business
Value Added Benefits
Setting Ourselves Apart From the Rest
E-Store Online Quoting and Application
Submission

3
Why Golden Rule?

Leader in the individual and family market
Experience and expertise spans 60 years
Pioneer of consumer driven health care solutions
Strong financial ratings
Rated A by A.M. Best
Rated A by Standard Poor

These ratings are an indication of financial
strength and stability
3
4
Resolving Claims

Over 3.5 million claims processed in 2006!
Over 14,000 claims processed per work day
Over 2.2 million dollars paid out per
work day!
90 are processed in 10 working days or less!
99 benefit accuracy rate!

Actual health claims results 2006
4
5
Rate Reduction for New Business
Population gt 5 rate decrease 93.47
Population gt 10 rate decrease 35.49
Population gt 15 rate decrease 15.23
Pennsylvania 5 - 23
Michigan Up to 19
Illinois 5 15
Indiana 5 - 14
Maryland 10
Missouri 5
Iowa 5 - 7
Oklahoma 5 - 12
South Carolina Up to 7
Texas 5 20
Tennessee 14 - 15
Nebraska 5
Arizona 5 - 19
Ohio 5 - 18
6
Top States By 2007 Production
Most Competitive
1 FL
2 GA
3 TX
4 OH
5 MI
6 MO
7 AZ
8 CO
9 PA
10 WI
11 MD
12 CT
13 VA
14 SC
15 NC
16 AL
17 LA
18 IL
19 TN
20 OK
7
Product Portfolio
UnitedHealthcare, Underwritten by Golden Rule
Today were positioned to be your go-to-carrier
for all plan types in the individual health
market!

Our goal is to provide you with a choice
of health plans designed to fit your
clients needs at a price they can afford.

7
8
Health Savings Accounts (HSA)
Qualified HSA Plans give clients the option to
establish a Health savings Account

HSA 100 Our comprehensive HSA
HSA Saver More limited benefits and priced
20-40 less

Optional Benefits Available with HSA Plans Optional Benefits Available with HSA Plans
5 Million Lifetime Maximum Benefit Term Life Benefit
Enhanced Preventive Care Benefits Package HSA Hospital Indemnity Rider
9
HSA 100

Who does the HSA 100 fit?
Those who are willing to trade low deductible
health insurance for
higher deductible plans
Those interested in saving money on premium
Those who prefer comprehensive coverage
Comprehensive Coverage
100 after the deductible for all covered
expenses including
Doctor office visits
Rx coverage
In hospital patient services
Out patient services
Preventive mammogram, Pap Smear, PSA Testing

10
HSA Saver

HSA Saver our most affordable HSA plan
Priced 20-40 less than HSA 100
Limited Coverage
Outpatient doctor visits - not covered
Outpatient Rx not covered
Outpatient X-ray and lab
(covered if within 14 days of surgery or
confinement)
Coverage provided for the more costly expenses
Inpatient hospital
Inpatient Rx
Outpatient surgery, MRI, CAT Scan, chemotherapy,
radiation treatment, hemodialysis
Coverage provided for Preventive
Mammogram, Pap Smear, PSA Testing

Same deductible choices as HSA 100
11
Monthly Base Premium Comparison
HSA Saver (catastrophic) vs. HSA 100
(comprehensive)
Husband Wife, aged 40
Golden Rule Golden Rule
HSA 100 HSA Saver
5,800 Ded 100 5,800 Ded 100
156.86 122.55
Dublin, OH 430
21 Savings
Premium based on preferred health status, Rx
copay. Premium based on January 07 effective
date. Each plan has its own benefit design and
other characteristics not presented here. Not For
Consumer Use
12
Exante Bank

Wholly owned subsidiary of UnitedHealth Group
Crediting 4 interest rate
FDIC insured account balances
Investment opportunities
HSA pre-paid debit card or checkbook
Easy online account management

Prompt customer service Exante Bank 866-234-8913
Rate as of 6/1/06 subject to change
12
13
High Deductible Plans

High Deductible Plans (non-HSA qualified)
Plan 100 our simplest plan
Plan 80SM similar to Plan 100 but with 80/20
coinsurance
Saver 80SM our most affordable plan

Optional Benefits Available with High Deductible Plans Optional Benefits Available with High Deductible Plans
5 Million Lifetime Maximum Benefit Term Life Benefit
Prescription Drug Card Benefit First-Dollar Accident Benefit
Enhanced Preventive Care Benefits Package Maternity Benefit
14
High Deductible Plans

Plan 100 - our simplest plan
Choose a Plan Deductible
1,500, 2,500, 3,500, 5,000
100 after the deductible
Doctor office visits
Rx coverage
Preventive care
In hospital patient services
Out patient services
Max of two deductibles per family, per calendar
year

15
High Deductible Plans

Plan 80SM - similar to Plan 100 but with 80/20
coinsurance
15 - 25 less premium than Plan 100
80/20 to 15,000 coinsurance, then 100
Same deductibles as Plan 100
Saver 80SM our most affordable plan
30 - 40 less premium than Plan 100
80/20 to 15,000 coinsurance, then 100
Limited Coverage
Outpatient doctor visits - not covered
Outpatient Rx not covered
Coverage provided for the major (catastrophic)
expenses

Plan 80 Deductibles 1500 2500 3500 5000
Saver 80 Deductibles 500 1000 1500
2500 3500 5000

Hemodialysis, radiation, chemotherapy, and organ
transplant drugs
Surgeon, assistant surgeon and facility fees
CAT Scans, MRIs
Emergency room fees

16
Monthly Base Premium Comparison
Husband Wife, aged 35 with two children
Sarasota, FL - 342
Golden Rule Golden Rule Golden Rule
Plan 100 Plan 80 Saver 80
2500 Deduct 100 2500 Deduct 80 / 20 2500 Deduct 80 / 20
262.79 228.39 175.97
1500 Deduct 100 1500 Deduct 80 / 20 1500 Deduct 80 / 20
323.39 279.17 213.65
33 Savings
34 Savings
Premium based on preferred health status, Rx
copay. Premium based on January 08 effective
date.
17
Copay Plans

Copay Plans
Copay SelectSM our most benefit rich plan with
excellent preventive care benefits
Copay SaverSM our most affordable copay plan

Optional Benefits Available with Copay Plans Optional Benefits Available with Copay Plans
5 Million Lifetime Maximum Benefit Term Life Benefit
Prescription Drug Card Benefit Buy-Up (Copay Select only) Two Additional Doctor Office Visits (Copay Saver only)
Maternity Benefit First-Dollar Accident Benefit
18
Copay SelectSM
Copay SelectSM - Our benefit-rich copay plan with
excellent preventive care

35 doctor office copays regardless of
deductible!
Copay is unlimited
General practitioner, specialist, urgent care
Covers history and exam
Core plan benefits remain the same regardless of
deductible!
Includes Rx copays regardless of deductible!
Generic - 15 copay (no deductible)
Name Brand - 100 per person deductible
30 preferred
60 non-preferred
Annual maximum of 3,000 per insured (Optional
Prescription Drug Benefit Buy-Up)
Preventive care not subject to the plan
deductible!

Copay SelectSM Deductibles 500 1000 1500 2500
5000
18
19
Copay SelectSM Preventive Care

Preventive Care Doctor Office Visit
History and exam - 35 copay
X-ray and Lab - 80 / 20 (not subject to
deductible)
300 annual maximum per person
Child Immunizations (ages 0-18)
Vaccine - 80 / 20 (not subject to deductible)
Separate 300 annual maximum per person
Preventive mammogram, pap smear, PSA testing
80 / 20 (not subject to deductible)

19
20
Copay SaverSM

Copay SaverSM our most affordable copay plan
Priced 20-30 less
35 doctor office copay
Limited to 2 per person, per calendar year
Optional buy-up to total of 4 visits
15 copay for Generic Rx (Brand name drugs not
covered)
Preventive Mammogram, pap smear, PSA testing 80
/ 20
X-ray and lab are covered if performed within 14
days of a surgery or confinement

21
Monthly Base Premium Comparison
Copay SelectSM (comprehensive) vs. Copay SaverSM
(catastrophic)
Husband Wife, aged 35 with two children
Golden Rule Golden Rule
Copay SelectSM Copay SaverSM
5,000 Ded 80 / 20 5,000 Ded 80 / 20
351.26 273.69
Austin, TX - 787
22 Savings
Premium based on preferred health status, Rx
copay. Premium based on January 08 effective
date. Each plan has its own benefit design and
other characteristics not presented here. Not For
Consumer Use
22
Optional Benefits

To Enhance Plans

22
23
Enhanced Preventive Care Benefits Package
This optional benefit is available with all
plans except Copay SelectSM.
No waiting period
300 annual max on covered expenses
PSA testing, pap smear, mammography
35 copay per doctor office visit
Doctor office x-ray and lab covered at 100
Well care visits
Child (0-18) immunizations
Annual max does not apply
Primary care, OBGYN, etc.
Plan deductible is waived
Separate 300 annual max
23
24
Prescription Drug Card Benefits

Prescription Drug Card Benefit
This optional benefit is available only with Plan
100 and Plan 80SM
Generic 15 copay
Name-Brand Preferred 30 copay
Name-Brand non-preferred 60 copay
Name brand copay is after a 100 per person,
calendar year deductible
3,000 annual maximum
(If generic is available, name brand is
reimbursed at generic price)
Prescription Drug Card Benefit Buy-Up
This optional benefit is available only with
Copay SelectSM.
Eliminates the 3,000 annual drug maximum

24
25
Maternity Benefit
This optional benefit is available with all plans
except HSA plans
This benefit helps cover the costs for routine
pregnancy or delivery

Client pays 20
Golden Rule pays 80
Graded benefit with a maximum of 7500

Years Covered Annual Maximum
1 2 2,500
3 4 5,000
5 7,500
Not available in AR, MD, NC, VA
25
26
Optional Benefits

5 Million Lifetime Maximum Benefit
Available with all plans
Upgrades coverage to 5,000,000 per person

Term Life Benefit
Available with all plans
Decreasing term life benefit
Benefit payout based on primary insureds age at
the time of death

Two Additional Doctor Office Visits
This optional benefit is available only with
Copay SaverSM

Increases the number of copay doctor office
visits from 2 to 4 per person, per year

26
27
Optional Benefits
First Dollar Accident Benefit
This optional benefit is available will all plans
except HSA plans.

Upfront coverage for unexpected injuries
Treatment of an injury within 90 days of an
accident
Benefit choice of 500 or 1,000
Plan deductible must be greater or equal to the
benefit amount selected

Not available in VA Not available in NC
27
28
Preferred Network

UnitedHealthcare
ChoicePlus

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UnitedHealthcare Choice Plus

Expansive national network
Owned by UnitedHealth Group
Choice of network providers at all times
Offers significant provider discounts
Average network discount of 45
Leverage strength of UnitedHealth Group
Strength in numbers

UnitedHealthcare Choice Plus Network is not
offered with Golden Rule Health plans in all
states. Discounts vary by provider, geographic
location, and service provided
29
30
Preferred Network Discounts
Sample doctor visit EOB
45 Discount
68.69
125.00
.
.
Discounts vary by provider, geographic location,
and service provided
30
31
Preferred Network Discounts
Sample lab work EOB
90 Discount
34.39
357.75
.
.
Discounts vary by provider, geographic location,
and service provided
31
32
Update Network
32
Top 10 Health Plans Accepted by Office-Based Physicians Top 10 Health Plans Accepted by Office-Based Physicians
Health Plan Physicians Accepting
UnitedHealth 64.8
Blue Cross Blue Shield 64.3
Humana 52.3
Aetna 43.4
Cigna 39.6
Wellpoint 38.3
Wellcare 37.7
Medicare 27.3
Healthnet 17.8
Sierra 10.5
Source SKA Information Services, October 2007 Source SKA Information Services, October 2007
33
Golden Rule
Eligibility and Underwriting
33
34
Underwriting

Its a new day the UnitedHealthcare way!
Sound pricing data from actuaries on treatment
and prescription costs
Opportunity to issue apps with fewer riders
Looking closely at plan design and deductible
size
Initiated auto-issue through E-Store
Issue applications in 48 hours or less
Application matches certain underwriting criteria

Actual health underwriting results February 2006
- not all applicants qualify
34
35
Rate Classes (Broker Guide page 24)

Preferred .90 61
Preferred HW chart (Broker Guide page 25)
No history of high blood pressure
No medical exclusionary riders longer than one
year
Standard I 1.00 35
Standard II 1.25 4
Expanded height and weight table, to help accept
more cases (Broker Guide page 25)
Male 60 aged 45 max considered weight
Was 257lbs
Now 279lbs
Female 56 aged 45 max considered weight
Was 205lbs
Now 228lbs

Guidelines button on the rating software will
help determine which health class status to quote
36
Rate Classes (Broker Guide page 24)

Elimination of the Tobacco Rate Class
Relative tobacco surcharge based on Issue Age
Rate Class

Issue Age Preferred Standard I Standard II
Under 40 1.20 1.35 1.60
40-54 1.30 1.55 1.80
55 1.50 1.65 1.90

Elimination of Motorcycle Exclusion
20 individual rating in lieu of an exclusion
rider will be applied during underwriting
Added in underwriting if applicant has driven a
motorcycle in the past 24 months

37
Clearance Periods

Atrial fibrillation 2 years
Cancer depends on type
Colon cancer 5 years
Prostate cancer 2 years
Epilepsy 1 year since last seizure
Hyperthyroid 6 months
Gastric Bypass 5 years and stable weight for at
least 12 months

38
Riders

Increased deductible rider
Example Controlled hypertension
Increase overall deductible by 400
Premium remains the same
Hypertension is considered a covered expense

39
Riders

Option Two Temporary Rider
Placed on a condition for a specific period
Usually one to two years
Premium remains the same
Condition is not covered during rider period

40
Preliminary Evaluation
Broker Service Center 800-474-4467 Select
prompt 1 for underwriting assistance

Necessary information needed to effectively
prescreen
Age and gender
Diagnosis and date
Prescribed treatment, medications, and dosages
Quick Response Prescreen
Specialty Team
Refer to underwriting manual
Confer with underwriter
Advise of underwriting opinion

No guarantee of coverage. Final decision is up
to underwriting at time of submission

41
Service Standards

We issue 83 of all applications
61 of applicants receive preferred rating class
We handle all underwriting requirements
Amendments
HBQ questionnaires
APS (when medical histories are unclear or
complex)
MIB reports
Underwrite at time of application / telephone
Certificates are mailed to you / I.D. cards are
mailed to your client

Actual 2006 health underwriting results
41
42
What Your Clients Can Expect

Each individual listed on the application is
underwritten separately
Effective date of choice
Premium modes
Monthly bank draft (EFT)
Direct quarterly billing
Submit premium at time of application
Premium is refunded if non-issue
12-month initial rate guarantee
I.D. cards for certificates or policies are
mailed directly to client

Subject to benefit or location change
43
Golden Rule E-Store

ESTORE

43
44
E-Store Overview

Available to all appointed brokers
Offers convenient online access
Creates a professional web presence
Can reduce operating expenses
Fast and efficient
Can help grow your business

44
45
E-Store Features

Online quoting and application submission
Quote archiving and application tracking
Simple navigation to support your Golden Rule
business
Print all forms and brochures needed to write
Golden Rule plans
Check correspondence for lapses and re-rate
notification
Status of pending applications
Download quoting software
Network link for checking doctors and hospitals

45
46
E-Store Online Quoting

E-mail customized quote directly to client
View quote
Complete app and apply online
Broker Assisted Application
Assist client in completing majority of the app
E-mail completed app to client for review and
electronic signature
Client submits to Golden Rule

46
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On E-Stores My New Business and My Block of
Business sections youll find

Tracking by app number, name, paid to date, plan
name, current billed premium, and more.
Information on health class, ratings, riders,
and premium.
Details on dependents.

Visit www.goldenrulehealth.com/broker for full
details.
48
(No Transcript)
49
Update E-Store improvements
49