Cash Benefit - Mutual of Omaha

MutualCare Solutions LTCi
Product Launch
September 16, 2013
For producer use only. Not for use with the general public.
Product Overview
For producer use only. Not for use with the general public.
WHAT: New Product to replace LTC09 portfolio
 Control risk / cost sharing
 Sex – Distinct Rates
 Consistency among states (Interstate Compact-37
state approval- (39 is a possibility)
 Clarification of benefits
 Consolidated Portfolio (Mutual only)
For producer use only. Not for use with the general public.
Benefits are tailored to fit the target market….
• Ages 55-65
• Low or no inflation
• Shorter BP’s
• Flexibility to dial in premiums
For producer use only. Not for use with the general public.
Mutual Care Solutions Overview
•
Mutual Care Secure Solution
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Traditional selling approach
Benefit Multipliers
• 2,3,4,5 yrs
MMB- $1,500-$10,000 ($1 increments)
EP’s – 90,180, 365 calendar days
30% Cash – capped at max $2,400
Inflation Options
• No inflation
• Compound only
• 3%,4%,5% lifetime
• 3%,5% 20 year
Riders
• 3x MMB ROP <claims
• NF –Shortened benefit period
• Security Benefit
• Shared Care
• 0 Day HHC
• Reduce HHC 50% or 75%
• Reduce ALF 50% or 75%
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Mutual Care Custom Solution
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Provides extensive premium solve capabilities
Pool of Dollars (Policy Limit)
$50,000-$500,000 ($500 increments)
MMB- $1,500-$10,000 ($50 increments)
EP’s – 0,30,60,90,180,365 calendar days
40% Cash- capped at max $2,400
Inflation Options
• No inflation
• Compound only
• 1%-5% lifetime in .25% increments with
buy-up
• 10,15,20 year on all options with buy- up
Riders
• 3x MMB ROP <claims
• ROP under 65 < claims
• ROP < claims
• NF –Shortened benefit period
• Security Benefit
• Shared Care
• 0 Day HHC
• Reduce HHC 50% or 75%
• Reduce ALF 50% or 75%
• Professional HHC
• Joint Waiver of Premium
• Survivorship
For producer use only. Not for use with the general public.
Product Details- The Nuts and Bolts
• Issue Age – 30-79
• Tax Qualified
• Partnership Qualified
– Based on:
• State approval
• Applicants issue age
• Inflation option
For producer use only. Not for use with the general public.
Eligibility to Receive Benefits
•
Must be chronically ill
– Chronically ill means:
• (a)unable to perform at least two activities of daily living without
substantial assistance from another person who is physically present
with you, for a period that is expected to last at least 90 consecutive
days due to a loss of functional capacity; or
• (b) require substantial supervision to protect yourself from threats to
health and safety due to a severe cognitive impairment.
• Requires that a licensed health care practitioner in past 12 months
certifies requirements are met
– Activities of Daily Living include:
• Bathing, Dressing, Eating, Transferring, Toileting, Continence
For producer use only. Not for use with the general public.
Mutual Care Secure Solutions
Built-In Benefits
• Maximum Monthly Benefit (MMB)
• Options: $1,500 -$10,000 per month
• $1 increments
• Policy Limit
– Benefit multiplier determines policy limit
• Options: 24,36,48,60 months
(Benefit multiplier X Monthly benefit = Policy limit)
Ex: 36 (months) X $5,000 (MMB) = $180,000 (Policy
limit)
For producer use only. Not for use with the general public.
• Calendar day Elimination Period
– Options: 90,180, 365 days
– Begins on 1st day covered service is received
• Cash Benefit
– No elimination period to satisfy
– 30% of Home Health Care benefit
– Initial maximum of $2,400
• Can increase if inflation protection is added
• Cannot be used with International Benefit
• Cannot be used at same time as reimbursement
benefits
For producer use only. Not for use with the general public.
• Facility Care
• Nursing Home
• 100% of the MMB
• Assisted Living Facility
• Options:
50%,75%,100% of MMB
• Home Health Care
• Options:
50%,75%,100% of MMB
• Personal Care Services
• Homemaker Services
• Professional Services
– RN, Home Health
Aide, Therapist
• Adult Day Care
Services
For producer use only. Not for use with the general public.
• Respite Care
– No elim period to satisfy
• Hospice Care
– No elim period to satisfy
• Waiver of Premium
– When receiving
NH,ALF,HHC services at
least 8 days a month
• International Benefit
– Travel outside U.S.,
Canada or UK
– MMB up to 12 months
– Cannot use Cash Benefit
• Alternate Care
– May pay for benefits not
specifically listed in the
policy
– Must be recommended by
Care Coordinator
• (i.e. Christian Scientists)
For producer use only. Not for use with the general public.
Optional Benefits
• Inflation Options
– 3%,4%,5% Compound Lifetime
– 3%, 5% Compound 20 year
– No inflation
• Shared Care
– Must have identical policy/benefits
– Access to partner’s benefit
• Leave 1 year of benefits available in partner’s policy
For producer use only. Not for use with the general public.
• Security Benefit
– Provides 60% of the reimbursement benefit received
each month
– Does not reduce policy limit
• Waiver of Elimination Period for HHC
– No elimination period to satisfy when receiving Home
Health Care
– Days in which the elimination period is waived for HHC
or Adult Day Care will be used to satisfy the elimination
period for other benefits under the policy
For producer use only. Not for use with the general public.
• Return of Premium 3X Monthly Benefit
– Returns premium paid, but no more than 3 times the
max monthly benefit minus claims paid
– Excludes claims and inflation increases
– Must be in force 10 years
– If coverage decreased after issue, return is based on
decreased amount
• Non-Forfeiture/Shortened Benefit Period
– Policy must be inforce for 3 years
– Stop paying premium
– Continue coverage on reduced basis
For producer use only. Not for use with the general public.
Mutual Care Custom Solutions
Built-In Benefits
• Policy Limit
– $50,000-$500,000
– $500 increments
• Maximum Monthly Benefit (MMB)
• Options: $1,500 -$10,000 per month
• $50 increments
• Valid combination is generally based on value
between 1%-4% of policy limit
– Valid: $100,000 x 1.5% = $1,500 MMB (5.5 yrs)
– Not valid: $ 5,000 MMB with a $100,000 policy limit = 5% (1.6 yrs)
» In this example you can choose to decrease MMB or increase policy limit
For producer use only. Not for use with the general public.
• Calendar day Elimination Period
– Options: 0,30, 60, 90,180, 365 days
– Begins on 1st day covered service is received
• Cash Benefit
– No elimination period to satisfy
– 40% of Home Health Care benefit
– Initial maximum of $2,400
• Can increase if inflation protection is added
• Cannot be used with International Benefit
• Cannot be used at same time as reimbursement
benefits
For producer use only. Not for use with the general public.
• Facility Care
• Nursing Home
• 100% of the MMB
• Assisted Living Facility
• Options:
50%,75%,100% of MMB
• Home Health Care
• Includes:
– Personal Care
Services
– Homemaker Services
– Professional Services
» RN, Home Health
Aide, Therapist
• Adult Day Care
Services
• Options:
• 50%,75%,100% of
MMB
For producer use only. Not for use with the general public.
• Respite Care
– No elim period to satisfy
• Hospice Care
– No elim period to satisfy
• Waiver of Premium
– When receiving
NH,ALF,HHC services at
least 8 days a month
• International Benefit
– Travel outside U.S.,
Canada or UK
– MMB up to 12 months
– Cannot use Cash Benefit
• Alternate Care
– May pay for benefits not
specifically listed in the
policy
– Must be recommended by
Care Coordinator
• (i.e. Christian
Scientists)
For producer use only. Not for use with the general public.
Optional Benefits
•
•
Inflation Options
– 1%-5% Compound Lifetime with buy –up
– 1%- 5% Compound 10, 15, or 20 year with buy- up
– All options offered in .25% increments
– No Inflation
Buy-up:
– Increase allowed 1X per year
– Total level of inflation maximum 5%
– Available to lesser of 20 yrs or until age 75
– Not eligible if in the last 2 years, insured:
• Has had premium waived
• Has had policy paid-up
• Was chronically ill
For producer use only. Not for use with the general public.
• Shared Care
– Must have identical policy/benefits
– Access to partner’s benefit
• Leave 1 year of benefits available in partner’s policy
• Security Benefit
– Provides 60% of the reimbursement benefit received each month
– Does not reduce policy limit
• Waiver of Elimination Period for HHC
– No elimination period to satisfy when receiving Home Health Care
– Days in which the elimination period is waived for HHC or Adult
Day Care will be used to satisfy the elimination period for other
benefits under the policy
For producer use only. Not for use with the general public.
• Professional Home Health Care
– Pays up to an additional 100% of HHC MMB for
Professional Services
• Professional Services
– RN*, Home Health Aide, Therapist
Note: RN is limited to 365 days over life of the
policy
- Deducted from Policy Limit
• Non-Forfeiture/Shortened Benefit Period
– Policy must be inforce for 3 years
– Stop paying premium
– Continue coverage on reduced basis
For producer use only. Not for use with the general public.
• Return of Premium 3X Monthly Benefit
• Returns premium paid, but no more than 3 times the max monthly benefit minus
claims paid
• Excludes claims and inflation increases
• Must be in force 10 years
• If coverage decreased after issue, return is based on decreased amount
• Return of Premium < age 65 less claims
• Returns premium paid less any benefits if insured dies before age 65
• Not available for applicants 64+
• Return of Premium less claims
• Returns premium paid less any benefits upon insured’s death
• Not available for applicants 64+
For producer use only. Not for use with the general public.
Premium Savings
• Partner (both issued)
– 30%
• Partner (one issued)
– 15 %
• Preferred
– 15%
• Association/Sponsored Group/Producer
– 5% with comp offset
For producer use only. Not for use with the general public.
Association/Sponsored Group
Guidelines
For producer use only. Not for use with the general public.
• Membership requirements:
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Must be an affinity group
100 or more members
Exist for 2 or more years
By-laws/officers/membership records
Have members who pay dues or fees on a regular
basis and vote on officers or matters of policy
For producer use only. Not for use with the general public.
• Simplified membership levels
– Reduced from 3 levels of Local/State/National to 1
level of 100 members
• Eliminated 3 month waiting period
• Eliminated form that was required with app
– Required info incorporated on the app
• Changed production requirement
• Was 5 apps every 6 months
• Now 10 apps annually
For producer use only. Not for use with the general public.
Examples of groups that qualify
• Affinity relationship by:
• profession, trade, business
– Ex: Realtors, Accountants, Chambers of Commerce
• Other Sponsored Groups for consideration
include:
– Labor Unions, Alumni Associations, Credit Unions, Home
Owner Associations
For producer use only. Not for use with the general public.
Examples of Groups that won’t qualify
• Primarily consisting of members with hazardous
occupations
– Ex: Active Military, Police & Firefighters, Athletes
• Charitable/Philanthropic Organizations
– Ex: American Heart Association, American Cancer Society
• Political and Religious Groups
• Commercial ventures – (employer/employee groups)
• Customers
– Ex: Bank customers, credit card holders, gym members
• Formed for the purpose of obtaining insurance
For producer use only. Not for use with the general public.
Common Employer Marketing
Program
For producer use only. Not for use with the general public.
• 5 or more people who share a common employer are
eligible for a 5% premium allowance
• Once 5 person minimum is met- other employees of the same
company are eligible to receive the 5% allowance
• No Group Approval necessary
– Submit Common Employer Cover Sheet (M28404) with initial 5
applications
– Indicate Common Employer allowance on application
• No Employer Sponsorship
– Payroll Deduction* (PRD) not available
• *Title VII of the Civil Rights Act of 1964 is a federal law that prohibits employers
to discriminate against workers because of race, color, national origin, religion,
and sex. Therefore gender neutral premium rates must by offered with
employer voluntary or sponsored plans through which employees purchase
coverage. MutualCare Solutions does not have gender neutral premium rates.
For producer use only. Not for use with the general public.
Transition Rules
For producer use only. Not for use with the general public.
• LTC09 applications dated on or after 9/16/13 or received in
H.O. after 9/23/13will not be accepted
• Pending business will be processed as applied for
– To obtain new product – a new application, forms etc…
will be required along with a written statement advising
the intent to withdraw current application
• Inforce PH’s must reapply for new product
– Treated as Internal replacement
– Client’s current attained age will be used
For producer use only. Not for use with the general public.
Competitive Comparison
For producer use only. Not for use with the general public.
Competitive Comparison
MutualCare
Solutions
Genworth
Privileged
Choice Flex 2
John Hancock
Custom Care III
Transamerica
TransCare III
Benefit Period
Monthly
Daily Benefit
(Monthly cost rider)
Daily Benefit
(Monthly cost rider)
Daily Benefit
Elimination Period
0, 30, 60, 90, 180,
365 Calendar Days
•30, 60, 90, 180, 365
Service Days
•Calendar Days rider
30, 60, 90, 180, 365
Service Days
0, 30, 60, 90, 180,
365 Service Days
Cash Benefit
Built-in, 30% or 40%
of HHC (max $2400)
none
Cash rider with
reimbursement (15%
of monthly or 4.5%
Daily benefit)
Built-in, 10x Daily
Benefit
Return of Premium
3 options:
•ROP 3x Initial MMB
•ROP at Death
•ROP at Death before
age 65
2 options:
•Graded
•ROP after 10 years
ROP to age 65
included
ROP to age 67
included
For producer use only. Not for use with the general public.
Competitive Comparison (continued)
MutualCare
Solutions
Genworth
Privileged
Choice Flex 2
John Hancock
Custom Care III
Transamerica
TransCare III
Inflation
1% - 5% in .25%
increments Durations:
Lifetime, 10/15/20
year
FPO, 5%Simple,
3%/4%/5%
Compound
Benefit Builder, CPI,
CPI to 75, 5%
Compound
3%/5% Compound or
Step-Rated BIO,
Tailored BIO, Deferred
BIO
Rate Guarantee
None
None
None
3 Years
Discounts
•30% Partner
•15% Partner – one
applying
•15% Preferred Health
•5% Producer,
Association/Sponsore
d Group/Common
Employer
Couples discount
built into pricing
•30% Partner
•10% Preferred
Health
•5% Family
•5%/10
Group/Association
•5% Loyalty/Valued
Client
•30% Couples
•15% Spouse/Partner
applying alone
•10% Preferred Health
•5% Association Group
For producer use only. Not for use with the general public.
Illustration Software
For producer use only. Not for use with the general public.
• Winflex
– Available Day 1
– All distributions
– Download on SPA
• MutualCare Solutions Software
– Available –TBD
– All distributions
– Download on SPA
For producer use only. Not for use with the general public.
Underwriting
For producer use only. Not for use with the general public.
Consistency in Underwriting
• Risk selection will be consistent for all products
upon 2013 product release.
• 100% APS for all products
– Has become industry standard
For producer use only. Not for use with the general public.
We have decreased the following waiting
periods:
 Occupational and Speech Therapy decreased to 3 months
 Anxiety handling decreased to 6 months for age < 70
 Arthritis waiting period decreased to 3 months for mild disease
 Physical Therapy waiting period if age < 65, for acute self limiting
condition decreased to 3 months
 Spinal Stenosis waiting period to 6 months for mild disease
For producer use only. Not for use with the general public.
In addition, the following updates and changes
are included:
 Complete Metabolic Profile has replaced the term blood work
 Build Chart includes bullet “build as documented in medical records
or obtained during a face to face interview”
 Amputation, if due to cancer S (select) to IC (individual consideration)
 Anorexia and Bulimia if resolved for at least 10 years S to IC
 Provided handling for Carotid Artery Disease 50-70% stenosis,
specifically with heart valve disorder ranging from mild select,
moderate Class II, to uninsurable if severe
 Defined partial disability as < 50%
 Factor V will have a 1 year waiting period
 Fatty liver as incidental finding, not diagnosed as NASH S – IC
 Foot drop mild and nonprogressive for at least 2 years, unilateral IC
 Memory Loss when resolved for at least 1 year IC
For producer use only. Not for use with the general public.
In addition, the following updates and changes
are included, continued:
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Menigioma stable at least 3 years, no surgery planned IC
Mycosis Fungoides handling same as Lymphoma Cutaneous T cell
Sarcoidosis with remission select if 10 years, to Class I if 3 years
Scoliosis defined severity handling
Sleep Apnea dental device is acceptable treatment
Chronic Fatigue and Fibromyalgia minimum 90 day elim period
Herniated disc waiting period 6 months, mild or moderate S – IC
Lymphoma Stage IV after 5 years in complete remission Class I
Osteoporosis with tobacco use, T score -3.5 to 3.9, Class II
Peripheral Vascular/Arterial Disease whether operated or
unoperated in combination with conditions listed are uninsurable, if
progressive or with more than 2 surgical procedures
Prosthetic limb clarified if due to trauma or cancer
Residential Care Facility resident waiting period 6 months
Tobacco use within 1 year in combination with comorbid condition
Class I – D
TIA with unoperated mild heart valve disorder that is Class I
Added Transgender/Transsexual handling
Weakness added other than for acute, self limiting condition
Weight Loss Surgery after 2 years added as S – IC fully recovered, no
revisions planned
For producer use only. Not for use with the general public.
The following conditions have been added as
uninsurable conditions:
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Amyloidosis, Autism, Behcet’s
Diabetes with diabetic macular edema
Diabetes present for greater than 20 years
If aged out of disability benefits or retired due to disability
Huntington’s disease with family history and without genetic testing
to rule out disease
Cognitive screening declination by another carrier, without a
complete favorable Neuropsychological evaluation
Lyme Disease which is chronic
Meningioma that recurs after surgery
Severe neuropathy
TIA with unoperated moderate to severe heart valve disorder
Sarcoidosis currently treated and disease present outside of lungs
Herniated disc if unoperated and severe
For producer use only. Not for use with the general public.
The following conditions are now eligible for a
preferred rate:
o Asthma that is exercise induced, reactive or extrinsic
o BPH (benign prostatic hypertrophy)
o Benign essential tremor age > 65, present for 10 years, not
progressive
o Anxiety for age < 70
o Celebratory cigar use up to 1 per month
For producer use only. Not for use with the general public.
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