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2007 Sales Training Presentation

2007 Sales Training Presentation. Confidentiality Statement.

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2007 Sales Training Presentation

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  1. 2007 Sales TrainingPresentation

  2. Confidentiality Statement The information contained herein is confidential and is the sole and exclusive property of American Progressive Life & Health Insurance Company of New York and Pyramid Life Insurance Company and may not be used, reproduced in any way, transmitted or otherwise communicated, in whole or in part, without the prior written consent of American Progressive and Pyramid Life. The information contained herein is nonpublic and requires the approval of the Centers for Medicare & Medicaid Services (“CMS”) of the United States Department of Health and Human Services and, therefore, may be inaccurate, incomplete and unreliable, but is being provided to you for your consideration as American Progressive’s and Pyramid Life’s preliminary indication of its reasonable expectation of the Medicare Advantage products, rates and commissions that will be offered in 2007 in certain counties within your territory. Your receipt of the information contained herein constitutes (i) your consent to maintain the information in strict confidence and (ii) your acknowledgement that the information is nonpublic, requires the approval of CMS and therefore may be inaccurate, incomplete and unreliable, and is the sole and exclusive property of American Progressive and Pyramid Life and may not be used, reproduced in any way, transmitted or otherwise communicated, in whole or in part, without the prior written consent of American Progressive and Pyramid Life.

  3. Today’s Options Sales Agents are Supported by: • $2 billion total assets • $1+ billion premium inforce • 20,000 + agents representing its insurance subsidiaries

  4. Operating Segments Senior Market Brokerage Career Agency Managed Care Administrative Services • Pennsylvania Life • Penncorp Life of Canada • Pyramid Life • American Pioneer Life • American Progressive Constitution Life • Union Bankers • Marquette National • WorldNet Services Corp • CHCS Services, Inc. • CHCS, Inc. • Today’s Options • Heritage Health Services

  5. Comprehensive Portfolio ofSenior Market Products Medicare Advantage Medicare Part D Senior Market Health Insurance Senior Administrative Services

  6. UAFC is Committed toYour Success! • Continual development of new products so that agents have the most advanced plans in the Senior Healthcare Market. • Providing agents with an array of Medicare products and price points to offer to seniors. • Today’s Options is a full service Medicare Healthcare Product Offering more Coverage, Benefits, Choices and Services at a Lower Premium. • Prescription Pathway is a Medicare Approved PDP, offering competitive plan premiums, formulary and a pharmacy network of over 50,000 nationwide.

  7. Today’s Goals • Introduce Today’s Options • Discuss marketing and sales strategies • Review Medicare program options • Review market conduct and compliance requirements in the sales process

  8. Today’s Options Value Propositions

  9. Savings Medicare Advantage plans result in average beneficiary savings of $100 a month Source: www.cms.gov

  10. Value Propositions Private Fee-for-Service • Offer the best of both worlds! HMO’s Medicare Supplements Today’s Options (PFFS) Freedom to Choose Your own provider $$$ Monthly Premium Savings

  11. Value Propositions • Competitive Product • Easy to sell • Part B premium refund to beneficiaries in some areas! • Convention Credit on Today’s Options production • Maximize your SALES OPPORTUNITIES!

  12. Value Propositions • Guaranteed Issue • Affordable • Monthly Premium less costly than many Medicare Supplements. • Today’s Options prohibits providers from balance billing (beneficiary usually will not receive a bill from the medical providers). • Low co-payments • Premier & Premier Plus = $5 for each PCP visit and $15 for each specialty care visit. • Value & Value Plus = $15 for each PCP visit and $30 for each specialty care visit.

  13. Freedom to Choose • Freedom to choose doctors, specialists and hospitals. • Choose any doctor, specialist or hospital.* • No referrals needed to see a specialist. • Members can get services anywhere in the U.S. • Emergency services anywhere in the world. • Predictable out-of-pocket maximum * Who is willing to accept Today’s Options terms and conditions

  14. Medicare Private Fee-For-Service (PFFS) • For Medicare beneficiaries who: • Want freedom to make their own decisions about doctors and hospitals • See a definite need for supplemental coverage beyond Traditional Medicare • Believe they pay too much for Medigap • Are turning 65 and have sticker shock from Medigap premiums • Struggle with paying Medigap premiums and living expenses at the same time

  15. Medicare Private Fee-For-Service (PFFS): Promising Future • Industry experts predict that PFFS plans will become an increasingly viable alternative to Traditional Medicare A & B with Medicare Supplements. • A strong middle-ground between HMOs and Supplement plans. • Valuable Medicare health plan alternatives for rural areas or smaller metropolitan markets, where none existed before.

  16. Comprehensive Benefits • Comprehensive benefits • Covers all services under Medicare Part A and B. • Offers additional benefits (i.e. routine exams in both plans) beyond what Medicare Parts A and B provide. • Paperless Claims • Most claims can be handled between plan and providers, so there is almost no paperwork for member to complete.

  17. PFFS / HMO / Medigap Comparison Description

  18. PFFS / HMO / Medigap Comparison Target Audience

  19. PFFS / HMO / Medigap Comparison Beneficiary Value Proposition

  20. PFFS / HMO / Medigap Comparison Providers

  21. Voluntary Care Management • Innovative Voluntary Care Management program proactively assists members with their healthcare concerns and needs. • Registered nurses work in collaboration with social workers and other healthcare professionals. • Member access to “24/7 My Nurse Line” 866-549-5048. • Today’s Options Voluntary Care Management follows inpatient admissions and provides health education and support to our members: • Members who choose to participate will be provided with “best practice” care plans, which are shared with their physician. • Members receive welcome home calls after an inpatient stay. • Some members will receive calls when certain outpatient procedures are planned in order to provide support and education. • Voluntary Care Management provides the member with coordination of their health care needs.

  22. Today’s Options Medicare Overview

  23. What is Medicare? • Federal health insurance for: • People 65 years of age and older • Qualified disabled people under 65 (about 9% of total beneficiaries) • People with End Stage Renal Disease (ESRD)

  24. Part A: Hospital Benefits • Pays for medical care furnished by Medicare-certified hospitals, skilled nursing facilities, home health agencies and hospices. • Can enroll with no premium for Part A: • Must have worked and paid Medicare taxes for 40 or more quarters (10 years). • In 2006, a patient pays an initial deductible of $952 at the beginning of each benefit period.

  25. Part B: Physicians Benefits • Generally pays 80% of the Medicare allowed amount less a $124 (in 2006) annual deductible for: • Doctors’ services • Outpatient hospital services (including ambulance transportation and emergency room visits) • Diagnostic tests, laboratory services • Some preventive care like mammography and pap smears • Outpatient therapy services (PT, OT, ST) • Durable medical equipment and supplies • Some home health care services for which Part A does not pay

  26. Part C: Medicare Advantage Plans • Medicare Advantage Plan members are still enrolled in Medicare. • The only difference is that providers’ payments come from a Private insurance company rather than Medicare and a Supplement carrier. • Includes HMOs, PPOs, PSOs, Medicare MSAs, PFFS.

  27. Part C: PFFS Plans • Freedom of choice / Availability • Members may go to any eligible doctor or hospital anywhere in the U.S. that is willing to provide care and accept Medicare PFFS terms and conditions. • PFFS includes the benefits of Parts A and B, plus additional benefits. • Replaces the need for Medicare Supplements • Members are still enrolled in Medicare • Eliminates most member out-of-pocket costs under Medicare A and B.

  28. Part D: Prescription Drug Plans • The Medicare Modernization Act (MMA) established PDPs • 38 million Medicare beneficiaries have Rx Drug coverage • 4.4 million Medicare eligibles NOT yet enrolled in part D. • From November 15, 2006 to December 31, 2006, Medicare Beneficiaries can enroll in Prescription Drug Plans.

  29. Today’s Options 2007 PRODUCT OVERVIEW

  30. What is Today’s Options? • Medicare Part C - Medicare Private Fee-For-Service Plan offered by UAFC subsidiaries: • American Progressive Life and Health Insurance Company of NY • The Pyramid Life Insurance Company • Today’s Options contracts with The Centers for Medicare and Medicaid Services (CMS).

  31. Today’s Options Overview • Offered in 35 states throughout the U.S. • Four Today’s Options plans: • Value • Value Plus – includes drug coverage • Premier • Premier Plus – includes drug coverage

  32. PYRAMIDSTATES FOR 2007 26 States 2319 Counties 29,007,065 Medicare Eligibles

  33. EligibilityWho can join Today’s Options? • Individuals can join Today’s Options if they: • Have both Medicare Part A and Part B. • Live in a state where the plan is available. (Obtain services anywhere in U.S.) • Do not have End-Stage Renal Disease (ESRD). • There is NO medical underwriting • People with Medicare who meet eligibility requirements may not be denied membership on the basis of health status. • Only one community rate premium per county. No age rating! • 2 Premium Tiers – American Progressive • 3 Premium Tiers – Pyramid Life

  34. Premiums and Other Fees • Members pay: • Monthly Medicare Part B premiums ($88.50 in 2006) • Part B premium will vary by income in 2007 • Monthly premium directly to Today's Options, if a premium is charged • Low co-insurance or co-payment amounts

  35. VA Medical Benefits • A Today's Options member who is also enrolled in the VA Medical Benefits Plan may use either plan. • The individual would elect to receive his or her health care either through the VA system or through Today's Options. • If member is enrolled in both Today’s Options and VA system: • VA will not pay Today’s Options services • Today’s Options will not pay for any VA co-pays

  36. Today’s Options Highlights What’s New for 2007

  37. Plan Options Let’s compare benefits for the two basic plans VALUE & PREMIER

  38. Today’s Options 2007Benefit Matrix

  39. Today’s Options 2007Benefit Matrix

  40. Today’s Options 2007Benefit Matrix

  41. Today’s Options 2007Benefit Matrix

  42. PLUS “Adds” Part D Benefits All the Benefits from the Premier or Value Plan, Plus: * Does not apply to out-of-pocket maximum

  43. Today’s Options:Preventative Services • Zero Co-pay for: • Bone Mass Measurement • Colorectal Screening Exams • Pneumonia and Flu Vaccines • Screening Mammograms • Pap Smears and Pelvic Exams • Prostate Screening

  44. Today’s Options Sales and Enrollment

  45. Election Periods and2007 Effective Dates

  46. Annual Enrollment Periods (AEP) Medicare Advantage Lock In = After March 31, 2007 members are locked into their selected plan

  47. Open Enrollment Periods (OEP) Medicare Advantage Lock In = After March 31, 2007 members are locked into their selected plan

  48. Today’s Options Step 1: Enrollment

  49. Today’s Options

  50. Today’s Options

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