“Critical Care”

An Insurance Solution For Today’s Health Care Reality

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GoldenCare USA StatesAIM/GOLDENCARE MAP

AIM 1-800-672-7202 GoldenCare USA 1-800-842-7799

www.AIMforLTC.com/ACSIA

The Big Picture on “Critical Care”

• The Need Is Real and Not Widely Recognized

• “Critical Care” Is EASY to explain and the risk is relevant to most people

• Qualifying for coverage is reasonable – most get approved

– Great place to pivot when there’s an LTCi decline

• Underwriting Turn Around Time is Short – 3 days on average (No APS)

Bottom Line: Your Business Pipeline Fills Up Fast and You Get Paid Quickly

GTL State Approval List Alabama Alaska Arkansas Arizona Colorado Delaware Idaho Illinois Indiana Kansas

Kentucky Louisiana Maine Maryland Michigan Mississippi Missouri Montana Nebraska Nevada

Tennessee Texas Washington Washington DC West Virginia Wisconsin Wyoming

New Jersey New Mexico North Carolina North Dakota Ohio Oklahoma Oregon South Carolina Indiana South Dakota

Times Have Changed, the NeedIs Real and Most are Unaware!

Today, with early detection, prevention and advances in medical treatments, the odds of surviving a life altering critical condition are better than ever.

The Facts

1 in 2 will be diagnosed with cancer during their lifetime1

Every 40 seconds someone in the U.S. has a stroke.2

In 2010, 785,000 Americans had a new coronary attack 470,000 had a recurrent attack3

1United States Cancer Statistics (USCS). Centers for Disease Control and Prevention site, 2011 Cancer of All Sites - SEER Stat Fact Sheet. 2011 2Stroke Facts. Centers for Disease Control and Prevention 2011. 3Roger V, Go, A, Lloyd-Jones, D, et al. Heart disease and stroke statistics—2011 update. American Heart Association Statistics Committee and Stroke Statistics Subcommittee.

Survival odds today 86% of hospitalized heart attack

patients survive (higher for first heartattacks)1

80% of stroke patients survive the initialevent.1

– 35% recover completely or with minor impairments.2

The survival rate for kidney failure is 60% to 90%.3

50-90% for major organ transplants (including the heart, lungs, liver, and kidneys)4

1 “Why do I need critical illness insurance?”.essentialbenefits.ca. Essential Benefits. 2 Feb. 2011. Web. 2010. 2 “Cancer Facts and Figures 2011”. American Cancer Society. n.d. Sep. 2011 3 “Acute Kidney Failure”. merckmanuals.com. The Merck Manuals Online Medical Library. 16 Feb. 2011. Web. 2010. 3. “Organ Transplantation”. FAQs.org. Health. n.d. Web 16 Feb. 2011.

For many, it may be too much More than 50% of bankruptcies are caused by excess medical

expenses1

79% of these people had health insurance!1

Half of the foreclosures in America are due to debt from medical causes2

About 1.5 million homeowners are currently in danger of losing their homes due to illness related expenses.2

1 Himmelstein, David U. et. al. “Medical Bankruptcy in the United States, 2007: Results of a National Study Clinical Research Study”. Harvard U. n.d. Web.16 Mar. 2011. 2 Robertson, Egelhof & Hoke. “Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures”. August 2008. Web. Oct. 2011. 3

Health Insurance Doesn’t Cover As Much As It Used To

• Most Medical plans provide coverage for hospital and medical expenses arising from a critical illness

• Many expenses are not covered such as: – medical co-pays

– transportation to treatment centers

– Lodging

– Childcare

– What about other expenses like paying your mortgage?

Could your client’s nest egg withstand the potential financial impact of a critical illness?

“Critical Care” Something New and Different

It’s a blend of both Critical Illness and LTCi

Triggering DiagnosesCOVERED CONDITIONS:

• Cancer

• Cancer In-Situ

• Heart Attack

• Coronary Artery Bypass Surgery

• Stroke

• Alzheimer’s Disease

• Kidney Failure

• Major Organ Transplant

• Paralysis

• Coma

Straightforward Benefit AccessBased on a Medical Diagnosis, Pays CASH!

• With no restrictions! • CASH can be used for…

– Loss of income– Rehabilitation expenses– Alternative treatment options– Travel and lodging for treatment plans– Lifestyle changes– Mortgage loans & debt payments– Child care expenses

“Critical Care” Stands apart from typical Critical Illness

Policies

• Covers Alzheimer’s Disease• Increased benefits for care received in ALFs and NHs• Coverage availability up to age 84

“Critical Care” Stands apart from typical LTCi

• Trigger benefits sooner – based on diagnosis not ADLs• Underwriting – easier and MUCH faster• Higher issue rates – get paid more often!

“Critical Care”Designing A Plan

Choose One of Three Plans

Select a Monthly Base Benefit• Options: $500 to $3,000 per month in $250

increments– Dependent coverage is $500 per month

• Benefit is increased when care is received in an LTC facility:– 100% when in a Nursing Home– 50% when in an Assisted Living Facility

Example: $2,000 monthly base benefit at home:

$3,000 per month for an ALF (50% of the base benefit)

$4,000 per month for a NH (+100% of the base benefit)

NOTE: The Full Monthly Base Benefit = Nursing Home Benefit

Select a Benefit Period

• 6 months • 12 months • 18 months• 24 months

Deriving The Lifetime Maximum BenefitCalculating the Lifetime Maximum Benefit:

• “Full Monthly Base Benefit” (Nursing Home Benefit) x the benefit period x 3

Example: If the selected monthly base benefit = $2,000 the, “Full Monthly Base Benefit” is $4,000 (Nursing Home Benefit)

Lifetime Maximum Calculation: $4,000 monthly Nursing Home benefit x 24 month benefit

period x 3 = LT Max of $288,000

This is the maximum the policy will pay under any circumstance with this monthly base benefit

Coverage Limits By Diagnosis

• Cancer 100% of your chosen benefit period• Cancer In-Situ 3 months• Heart Attack 3 months• Coronary Artery Bypass Surgery2 months• Stroke 100% of your chosen benefit period• Alzheimer’s Disease 100% of your chosen benefit

period• Kidney Failure 100% of your chosen benefit period• Major Organ Transplant 100% of your chosen benefit period• Paralysis 100% of your chosen benefit

period• Coma 3 months

Example A : Lifetime Maximum – Multiple Claims at Home

24 mo BP, $2,000/Mo Base Benefit, $4,000 NH Benefit, $288,000 LT Max

Note: Full Base Benefit = Nursing Home Benefit

Initial Claim:Client diagnosed with a Stroke

Policy pays 100% of BP for Stroke = 24 months

24 months at $2,000/mo = $48,000

Lifetime Maximum:$288,000 -$48,000$240,000 remains

3 years later:Client is diagnosed with Cancer

Policy pays 100% BP for Cancer = 24 months

24 months at $2,000/mo = $48,000

Lifetime Maximum:$ 240,000 -$ 48,000$192,000 remains

6 years later:Client diagnosed with a second Stroke

Policy pays 100% BPfor Stroke = 24 months

24 months at $2,000/mo = $48,000

Lifetime Maximum:$192,000-$ 48,000 $144,000 remains

Example B: Lifetime Maximum – Claims at home and in the Nursing Home

24 mo BP, $2,000/Mo Base Benefit, $4,000 NH Benefit, $288,000 LT Max

Note: Full Base Benefit = Nursing Home Benefit

6 years later:Client is diagnosed with a second Stroke Stays in NH

Policy pays 100% BP for Stroke= 24 months

24 months in NH at $4,000/mo = $96,000

Lifetime Maximum:$144,000 -$ 96,000$48,000 LT Max Remains

Initial Claim:Client diagnosed with a Stroke. Stays home

Policy pays 100% BP for Stroke = 24 months

24 months at $2,000/mo = $48,000

Lifetime Maximum:$288,000 -$ 48,000$240,000 LT Max Remains

3 years later:Client is diagnosed with Cancer – Stays in NH

Policy pays 100% BP for Cancer = 24 months

24 months in NH at $4,000/mo = $96,000

Lifetime Maximum:$240,000-$ 96,000$144,000 LT Max Remains

“Critical Care”

Gives You an Underwriting Advantage

Over LTCi!

NOTE: TIAs or Strokes are acceptable but will be limited to the CancerCare Plus Policy

Opportunity for LTCi Declines:Circled LTCi declines (in red) are acceptable with Critical Care

APPLICATION: United Of Omaha for Nebraska

Opportunity for LTCi Declines:Circled LTCi declines (in red) are acceptable with Critical Care

Diabetes with +50 units of Insulin is acceptable but will be limited to the Cancer Care Plus Policy

Cancers are fine but are limited to the Cardiac Care Plus Policy.

Being on ANY form of Disability is acceptable

APPLICATION: United Of Omaha for Nebraska

Directly from United of Omaha’s Underwriting Guide

Field Declines for LTCi but not for “Critical Care”

Amputation due to disease Anorexia

Arrhythmia RA with more than 10mg of Prednisone

Asperser's Syndrome Atrial Fibulation with History of Stroke or TIA

Bell’s Palsy Blindness, not adapted

Buerger’s Disease Prostate Cancer, Stage IV

Any Cancer < 2 years Charcot Marie Tooth

Narcotic Use Compression Fractures

Continued:Field Declines for LTCi but not for “Critical Care”

Crest Syndrome Epstein Barr

Hemophilia Hydrocephalus

Neuropathy Pick’s Disease

Polyneuropathy Quadriplegia Sjogren’s

Spina Bifida Multiple Strokes or TIA’s

Systemic Lupus

“Critical Care”

The Application

Underwriting

• Only 5 knock-out questions– No Height or Weight questions

• Every application will have a drug prescription history check

• No APS• Average underwriting turnaround time – 3 days• In rare circumstances, phone, face-to-face at or

medical records may be needed to clarify a condition – at the underwriter's discretion

Three Plans, Three Underwriting Opportunities

Underwriting Questions

Get Cardiac Care Coverage When Critical Care and Cancer Care Aren’t Available

Get Cancer Care coverage when Critical Care and Cardiac Care Aren’t Available

Critical Care:Calculating Rates

Rate Book Page

• One page for each plan

• A block of rates for each Benefit Period

• Rates are annual

• 1.5 Factor for tobacco use

• $25 Policy Fee

Steps to Rating – 60 Year Old

• Step 1: Choose Plan A, B or C – we’ll use Plan A

• Step 2: Choose Benefit Period – we’ll use 12 Month Benefit Period

• We’ve narrowed it down to one block of rates!

Sample: Plan A, 12 Month Benefit Period

Step 3: Choose Monthly Base Benefit – we’ll choose $1,500 – Annual

Premium = $1,023.30

Step 4: Select a Monthly Modal Factor = ($1,023.30 x .09) = $92.10/mo

Sample Rates 12 month Plans (A,B and C) $1,500 per month Benefit

Base Plan - $1,500 ALF - $2,250 NH - $3,000

  Plan A  Plan B Plan CAge  Critical Care Cancer Care Cardiac Care       

       50-54 $50.63 $28.43 $22.97

     55-59 $69.44 $39.29 $33.56

     60-64 $92.00 $51.90 $48.63

     65-69 $118.44 $64.64 $68.72

     70-74 $145.37 $77.86 $91.51

       

Company History

• Located in Glenview, IL• Founded in 1936 by the

Holson family• Mutual life insurance

company• Licensed in 49 states plus

Puerto Rico• More than 1.5 million

policyholders• Manufacturer of niche

insurance products

The GTL Difference

• Agents have instant access to whoever they need to speak to… no automated phone system

• Fast and efficient underwriting…90% of business issued in 3 days or less

• Claims are paid directly to the policyholder or beneficiary…so they can use the money however they like

– If insured passes away during claim – benefit payments continue to the beneficiary– If insured recovers during claim, benefit payments continue

Electronic App Demo

Call Us!Call Us!AIM: AIM: 800-672-7202 800-672-7202GoldenCare: 800-842-7799GoldenCare: 800-842-7799

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