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Elev Elevate Y e Your Pla laceme ement Rate Mode derator or D eni nise L Liston on -- -- LifePla lans Panelis lists D emerri Bond ond – Mut utua ual of of O maha ha Tammy mmy Bucella la – John H ohn Hanc ncoc ock Amy my C hamb mbers – G enwor nworth
Younger and younger applicants • No lifetime benefits • Higher elimination periods • Decreasing carriers in traditional marketplace • Growing combo products • LTC Riders • Chronic Illness Riders • For Agent/Advisor Use Only 3
• Blurred lines across product underwriting • Tele-applications • Leveraging past experiences For Agent/Advisor Use Only 4
• Medical Records • MIB • ParaMeds • Pharmacy data bases • Tele-applications • Others…….. For Agent/Advisor Use Only 5
By not being in the home you can ask more questions which • will be important for fact gathering without seeming like you are asking “the obvious” Tele-sales requires keen listening and probing skills • It is easier for the applicant to provide more complete • medical information as you are a friendly voice versus someone with whom they have an established relationship For Agent/Advisor Use Only 6
In-Home Sales Advantage • Sales agents need to “Use Their Senses” • Hearing, Vision, Smell For Agent/Advisor Use Only 7
In-Home Sales Advantage Home environment is key to independent living • Do you live in a private home/apartment? – Do you have any stairs that you go up and down? – Do you prepare your own meals? – Do you do your own laundry and housework? – Do you have bath bars or a shower seat installed in your bathroom? – Evaluate and report on complete past and present health • status “Have you been hospitalized in the last 2 or 3 years or have you had any – medical conditions such as Memory Problems, Stroke, Cancer, Parkinson’s disease or Diabetes?” For Agent/Advisor Use Only 8
Never Assume • Ask all the questions – even if you think you know the answer – Tele-application will not allow you to bypass questions – Ask the client their height and weight • Can you tell me your approximate height and weight? – Was this done at your physician’s office? If not, when was the last time your weight was – measured there? How does this differ from what you reported? Medication use indicates an acute or chronic medical condition and can help you • probe further “Could you tell me the names of any prescription drugs you take? – Medications disclosed will set the stage for further probing – also ask them to tell you the – reason each is being used… If they don’t know it is not a good sign – For Agent/Advisor Use Only 9
For Agent/Advisor Use Only
54 year old male • Married • Working full time as a teacher • 5’10” and 190 pounds • Saw physician in May 2014 for knee pain • Medications: • – Naproxen for “arthritis” – Flexeril for “back” For Agent/Advisor Use Only 11 11
October 2013 – Annual exam, back pain still bothering him, worse after helping daughter • move, numbness left leg, refer to pain management, last MRI 2010 degenerative disc disease, mild foraminal stenosis, may need updated MRI November 2013 – referral from PCP , back pain, recent exacerbation, has numbness • radiating to left leg, schedule Epidural Steroid Injection, review old MRI ddd, spinal stenosis Epidural Steroid Injection completed, follow-up in 3 weeks – Jan 2014 – back pain improved, no numbness noted, still occasional spasm, Flexeril • prescribed, f/u prn May 2014 – right knee pain, swelling, old injury, wants injection, steroid injection • completed, Naproxen prescribed, if not better see physical therapy, consider MRI. October 2014 – Annual exam, doing okay, knee pain better after completed physical therapy • September, saw Pain Management for his ongoing back issues, had Epidural Steroid Injection For Agent/Advisor Use Only 12 12
Approving Vs. Declining Underwriter
For Agent/Advisor Use Only
65 year old female – Spouse not applying – Retired Nurse – 5’7” and 120 pounds – Saw physician in September 2014 for “checkup” – Coronary Artery Disease with stent in 2012 – Has lost 30 pounds – Quit smoking in January 2013 – Medications: – Prozac for “mild depression” • Amlodipine since “stent” • Symbicort for “allergies and colds” only used occasionally • Calcium for “osteoporosis” • For Agent/Advisor Use Only 15 15
November 2014 – “no appetite since spouse died, has lost about 30 • pounds”, Prozac prescribed, refer for counseling, “started smoking again, but trying to quit, difficulty since spouse died” History of Coronary Artery Disease • History of COPD, Symbicort daily, Albuterol as needed, FEV1 68% • History of Transient Ischemic Attack 2009 • History of Osteoporosis – “does not want to take Fosamax,” wants • Calcium and Vitamin D only, last dexa scan in 2011 lumbar spine t- score -3.0. For Agent/Advisor Use Only 16 16
Approving Vs. Declining Underwriter
For Agent/Advisor Use Only
34 year old male • Single • Full time Attorney • 5’7” and 160 pounds • Saw physician in within the past year for “checkup” • Medications: • – None For Agent/Advisor Use Only 19 19
Family History • – Mother deceased at age 48 • Huntington’s Chorea – Father alive and age 62 • Healthy Medical Records • – February 2013 – new patient, healthy male, 5’10” 160 pounds, BP 110/70, father healthy, no siblings, cardiac negative, neuro work up negative, no complaints For Agent/Advisor Use Only 20 20
Approving Vs. Declining Underwriter
For Agent/Advisor Use Only
– 63 year old female – Widowed – Retired – 5’5” and 165 pounds – Medications: • Prozac for “mood” • HCTZ for “water retention” • Fosomax for “prevention” • Metformin for “metabolic syndrome” • Flexeril for “neck pain” • Lipitor for “cholesterol” For Agent/Advisor Use Only 23 23
November 2014 – 6 month follow-up with PCP; 185 pounds; BP 140/80; no complaints, normal review of • symptoms Moderate Degenerative disc disease of cervical spine since 2010 – Osteoporosis since 2011 – T-score -2.9 • Seasonal Asthma – Glucose Intolerance since 2011 – Hypertension since 2008 – Hyperlipidemia since 2009 – Blood work • A1c 6.3 – Cholesterol 220 – Plans • Bone Density Study – Schedule appointment with dietician – Follow-up in 6 months – For Agent/Advisor Use Only 24 24
Approving Vs. Declining Underwriter
For Agent/Advisor Use Only
• 56 year old male • Spouse is applying • Full time Paramedic • 5’10” and 205 pounds • Medications: – Lisinopril for “hypertension” For Agent/Advisor Use Only 27 27
• Paramedical – Blood pressure 120/70 – Labs • Cholesterol ratio 6.4% • Triglycerides 324 • Glucose 125 • A1C 6.5% For Agent/Advisor Use Only 28 28
Medical Records – Primary Care • December 17, 2014 – blurred and double vision – saw his – ophthalmologist and was referred to a neurologist February 20, 2015 follow up visit for his high blood pressure and – arrhythmia; 5’10” 211 pounds BP normal and arrhythmia is stable Medical Records - Neurologist • March 5, 2015 blurred vision and double vision – symptoms lasted 1 – week. An MRI was normal. Further work up is recommended to include labs, a carotid ultrasound, and a CTA to determine the cause and was noted to be medically necessary. For Agent/Advisor Use Only 29 29
Approving Vs. Declining Underwriter
For Agent/Advisor Use Only
• 54 year old female • Spouse is applying • Full time Stylist • 5’8” and 128 pounds • PCP for singles one month prior to application • Medications: – Armour for “thyroid” – Atorvastatin for “cholesterol” For Agent/Advisor Use Only 32 32
• Paramedical – Blood pressure 98/63 – Labs • All Normal For Agent/Advisor Use Only 33 33
• Primary Care – November 21, 2014 – Blood pressure check and labs – BP 108/80 cholesterol 207 – February 20, 2014 follow up visit for her high blood pressure and arrhythmia; 5’10” 121 pounds BP normal and arrhythmia is stable For Agent/Advisor Use Only 34 34
Approving Vs. Declining Underwriter
For Agent/Advisor Use Only 36 36
For Agent/Advisor Use Only 37 37
For Agent/Advisor Use Only 38 38
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