Physicians Mutual Vista Care Choices Long Term Care Insurance

1. Physicians MutualVista Care Choices Long Term Care Insurance Larry E. Pike, CLU, ChFC, LTCP, CSARegional Sales Manager May 24, 2006

2. Physicians Mutual • Founded in 1902 • Been Selling LTC for 29 years • A+ rating from Weiss • A rating from AM Best • AA rating from S&P • Surplus to Asset Ratio- 54.7%

3. Vista Care Choices

4. Product Highlights • Monthly Benefit vs. Daily Benefit • Calendar Day EP vs. Service Day EP • NO Modal Factor • $1000 Cash Payment at time of Claim • Alternate Plan of Care • Restoration of Benefits • Return of Premium Options • Shared Care Benefit

5. www.brokerage.physiciansmutual.com • NO User-Id or Password Needed • Run Quotes • Download Software • Download Forms • Keep Current on Physicians Mutual

6. Long Term Care Underwriting Glenn Miller – Lead LTC Underwriter

7. Physicians Mutual Underwriting Philosophy • In the Middle • Experience • “Look for ways to issue” • Relationships • Profit Center • Board of Directors – Doctors • Underwriting Committee

8. Pre-qualification • Increase Predictability • Save Money and Time • Quick turnaround • Multiple options to communicate: • underwritinghotline@physiciansmutual.com • Phone 800-299-9409 • Fax: 402-633-5717

9. Pre-qualification The more you know about your client, the more we can help. • Age • Tobacco use • Marital status • Height/weight • Medications • All disclosed health conditions • Details, details, details

10. Co-Morbidity Chart • Easy to use • Features 10 of the most common chronic health conditions • Provides additional questions the agent can ask their client • Used in the field or over the phone • Available on our web stie

11. Long Term Care Combined Medical Conditions Quick Reference Chart DEC=Decline. Do not submit an application. IC=Individual Consideration. An application will be entertained. (File development may result in an offer of reduced benefits, a substandard rating or a decline.) *See page below for questions you should ask your client regarding above conditions. To find out if your client has uninsurable complications/symptoms, ask questions below.

13. Underwriting rules • 18-59 TI or APS’able condition • 60-64 TI required, APS’s able condition or PE w/in last 3 years • 65-69 TI and APS required • 70-84 F2F and APS required

14. Cognitive Underwriting • Under age 70 - Telephonic Interviews • Over age 70 – Face-to-Face Interviews – MCAS • Soft Signs

15. Here’s What You Can Expect Brochure • Eliminates surprises during the underwriting process • Answers many of the questions a client may ask. • Sets realistic expectations

16. The Secret to LTC Underwriting The Four C’s • Control • Compliance • Complication • Co-morbids

17. The Good LTC Risk • <70 • Married, both applying • Physically and socially active • Compliant with Treatment • Complete health disclosure

18. The Bad LTC Risk • Dependent in ADL’s/IADL’s • Impaired mobility • Inactive/Frail • Cognitive concerns • Multiple medications • Multiple health impairments

19. Top 5 Reasons for Decline • Diabetes • Cognitive Impairment • Heart Disease • Circulatory Disorders • Musculoskeletal Disorders

20. The Good Diabetic Case • Compliant with diet, medication, exercise, follow ups • No increase in medications it the past 6 months • HgbA1c < 8.0 • Below Standard Maximum Weight

21. Bad Diabetic Case • Noncompliance • Obese • Onset within 6 months, or recent medication change • Complications – retinopathy, neuropathy, nephropathy, foot ulcers • Hx of CVA or TIA

22. Anatomy of a Case Case Study #1 • How do you think the agent did with app completion and field underwriting? Application • 68 F High blood pressure and diabetes. All other health questions answered no • No Medications listed

23. Case Study #1 Phone Interview • Moved in with daughter 6 weeks ago • Hydrocodone • Insulin 40 units/day • Lasix 80 mg day • Two BP meds

24. Case Study #1 APS • CHF x 8 years • Stroke last year with residuals weakness and speech impairment • Uses a walker • Needs help with standing, bathing, dressing, medication, laundry, transportation, managing money • Has received home health care for 7 years

25. Case Study #2 Application • 70 yo M 5’7 170# • Hytrin Prostate, Niacin Cholesterol • All other health conditions answered no

26. Case Study 2# Phone Interview • Declined by another carrier “too old” • Skiing accident in ’95 • Gym, treadmill, walks dogs

27. Case Study #2 APS • 5’3 170# • BPH with TURP • Diabetes • Subdural hematoma with craniotomy in ‘03

28. Case Study #2 APS continued • 4-04 decreased concentration • 1-05 moderate memory loss • Rx Aricept

29. Case Study #3 Application • 52 M, married, 6’4 310# • Digoxin, Coumadin, Toprol – A Fib • 2 BP Meds • 3 Diabetes Meds • Both knees replaced • Quoted Standard

30. Case Study #3 Telephone Interview • Pharmacist, knees replaced ’03, ’04, Atrial Fib, Diabetes, A1c 7.6 • Treadmill 4x/week, chews tobacco

31. Case Study #3 APS • Stress test 10 Mets, no ischemia • 6-04 ER visit recurrent PAF • 12-04 338# • Sleep Apnea, CPAP

32. Case Study #3 Did we issue? • If yes at what benefits and rate class?

33. Underwriting Guide • Use Height/Weight Chart to determine weight class/eligibility • Check uninsurable medication list • Check Co-Morbidity Chart • Check Medical Impairment section for handling of disclosed health • If in doubt, speak with an underwriter

34. Questions?