Title: www.uageneralagency.com/foundation
1Managing Your Healthcare Costs
Limited Benefit Hospital Expense Policy
TRAINING
This is a solicitation for insurance. You may be
contacted by an Agent representing United
American Insurance Company. Policy and Rider
Forms MMGAP, SWL, RT10, R-MMGAP-HO, ABR1, DFR,
U4272.
www.uageneralagency.com/foundation
2This presentation is for TRAINING only. It should
not be shared with prospects. The SALES
powerpoint is available at www.uageneralagency.com
/foundation
3The Foundation Signature Series was designed to
help pay deductibles, copayments, and
coinsurance for individuals with current or
pending major medical health coverage or
comprehensive health insurance. No United
American or affiliate company policy can serve as
the Primary policy insurance that works in
conjunction with the Foundation Signature Series.
4The Foundation Signature Series is not a major
medical insurance plan and is not a replacement
for one.
5Calendar-Year Maximum Benefit Levels The
applicant chooses a calendar-year maximum
benefit level. All covered persons under the
same policy must have the same maximum annual
benefit.
Policy Form MMGAP
6Choose your Calendar-Year Maximum Benefit.
2,000 5,000 2,500 6,000 3,000
6,500 4,000 10,000 The calendar
year-maximum benefit you select does not have to
be the same as your major medical
deductible. The calendar-year maximum benefit
starts Jan. 1 and ends Dec. 31. Your benefit
amount starts over on Jan. 1.
Policy Form MMGAP
7Age Availability Foundation Signature Series is
available to people ages 0-63. Issue Age
Pricing. Sex Distinct. State Specific.
8Foundation Signature Series Limited Benefit
Hospital Expense Policy UA will pay up to 100
of your out-of-pocket deductible, copayment, or
coinsurance required by your major medical
policy for hospital inpatient treatment, up to
the calendar-year maximum benefit. Ages 0-63.
Policy Form MMGAP Limitations and Exclusions
apply. Preexisting Condition Limitation applies.
9- Foundation Signature Series pays deductibles,
copayments, and coinsurance - associated with inpatient charges such as
- Hospital charges for room and board
- Hospital miscellaneous charges including
operating room, equipment, - supplies, drugs,
- Hospital ICU charges
- Physician charges incurred during the hospital
stay
10Policy Benefits There is no limit to the number
of inpatient hospital confinements you can have
during one year we pay until you reach your
calendar-year maximum benefit, as long as the
expense is covered by your major medical
policy. You can choose to have benefits paid
directly to you or assigned to your health
service provider. If you die due to an
accidental bodily injury while covered under
this policy, all premiums will be refunded.
Policy Form MMGAP Limitations and Exclusions
apply. Preexisting Condition Limitation
applies. Death must occur while this policy is
in force and with 180 days of injury.
11How To File A Claim The policyholder must submit
a copy of the major medical providers
Explanation of Benefits along with a standard
hospital billing form (UB-04)
Policy Form MMGAP Limitations and exclusions
apply. Preexisting Condition Limitation applies.
12- Standard Limitations and Exclusions
- May Vary by State
- We will not pay benefits under this policy for
- Services not covered under the Primary Medical
Policy or - Expenses in excess of benefit limits or maximums
in the Primary Medical Policy or - Normal pregnancy (including childbirth, false
labor, occasional spotting, physician-prescribed
rest, morning sickness, hyperemesis gravid arum,
preeclampsia, and similar conditions associated
with a difficult pregnancy, which do not
constitute a distinct complication of pregnancy),
or voluntary termination of pregnancy or - Usual and customary routine nursery care, or
well-baby care immunizations or any other usual
and customary routine care and treatment
following full-term or premature birth, not
incident and necessary to the treatment of Injury
or Sickness or - Convalescent, skilled nursing, educational care
or for nervous or mental disorders, unless
covered by Your Primary Medical Policy or - Dental treatment, hearing aids, or eye refractive
exams, refractive surgery, or refractive
treatment or - Any Inpatient Hospital Stay or other service for
which You or a Family Member do not incur a
charge or - Any loss covered by any Workmens Compensation or
Employers Liability Law or - Any Inpatient Hospital Stay or other service that
is not medically necessary, or is cosmetic in
nature or
13- Standard Limitations and Exclusions
- May Vary by State
- We will not pay benefits under this policy for
- Any expense incurred in excess of the usual,
customary, and regular charges for any service or
materials in the geographic area where furnished
or - Charges incurred for professional, radiological,
pathological, or EKG interpretations, unless
covered by Your Primary Medical Policy or - Rehabilitative care services received at a
facility not meeting the definition of a
Hospital, unless covered by Your Primary Medical
Policy or - Treatment or services incurred outside of the
U.S. boundaries or - Infertility or sterilization treatment
procedures, unless covered by Your Primary
Medical Policy.
14Optional State-Mandated Benefits Optional
State-mandated benefit riders may require
additional premium. At this time, we have only
received the following Colorado, Home Health
Services and Hospice Care (Rider Form BR052HH)
15Optional Hospital Outpatient Benefit Rider
Policy and Rider Form MMGAP and R-MMGAP-HO
16Optional Hospital Outpatient Benefit
Rider Available at an additional cost UA will
pay 50 of your out-of-pocket deductible,
copayment, or coinsurance required by your major
medical policy for hospital outpatient treatment,
up to the calendar-year maximum benefit. Note
The total deductibles, copayments, and
coinsurance covered under the Hospital Inpatient
Benefit and the Hospital Outpatient Benefit
combined are limited to the maximum annual
benefit per calendar year.
Policy and Rider Forms MMGAP and
R-MMGAP-HO Limitations and Exclusions apply.
Preexisting Condition Limitation applies.
17Number of Outpatient Hospital Visits/Procedures
Covered There is no limit to the number of
outpatient hospital visits/procedures you can
have during one calendar year we pay until you
reach your calendar-year maximum benefit, as
long as the expense is covered by your major
medical policy. Note The total deductibles,
copayments, and coinsurance covered under the
Hospital Inpatient Benefit and the Hospital
Outpatient Benefit combined are limited to the
maximum annual benefit per calendar year.
Policy and Rider Forms MMGAP and
R-MMGAP-HO Limitations and Exclusions apply.
Preexisting Condition Limitation applies.
18- New Business Turn-In
- Application
- Privacy and disclosure information
- Consumer form
- New business transmittal form
19Underwriting Guidelines Applicants are
individually underwritten and some may not
qualify. Issuing New Business in Pend-Issue
Status Applicants with a Primary Insurance
policy in force - Verification of Primary
Insurance Coverage The Insurance carrier Name and
the Applicants policy number are required on
Question Number 1 (application form MGAPB). To
expedite the underwriting process, please also
include the policy effective date. Quality
Assurance Calls are required on all applications.
Complete the Best Time To Call section on page
4 of the application and tell the applicant to
expect a call from the Home Office.
Applications will not be issued without completed
QAC calls and verification of Primary Insurance
coverage.
20Underwriting Guidelines Applicants are
individually underwritten and some may not
qualify. Issuing New Business in Pend-Issue
Status Applicants with a pending application for
a Primary Insurance policy - Verification of
Primary Insurance Coverage The Insurance carrier
Name and the Applicants policy number are
required on Question Number 1 (application form
MGAPB). Enter the requested policy effective
date. Foundation Signature Series policies
cannot be issued until the Primary policy is
issued. The Foundation policy effective date can
be no earlier than the Primary policy effective
dates. Quality Assurance Calls are required on
all applications. Complete the Best Time To
Call section on page 4 of the application and
tell the applicant to expect a call from the
Home Office. Applications will not be issued
without completed QAC calls and verification of
Primary Insurance coverage.
21Underwriting Guidelines Applicants are
individually underwritten and some may not
qualify. Additional Premium Rider (Rated Premium
Notice) Select Benefit Riders (SBR) - Not
Allowed. Exclusion Benefit Riders (EBR) -
Allowed. Additional Premium Rider (APR) -
Allowed. Make this selection on page 1 of the
application. Use Substandard Premium Conversion
Tables F-J Rates in all statesSubmit completed
Substandard Premium Worksheet Form U-1280(04)
(all states) with the application. Use Base
Plan Premium for the MMGAP policy. Use OHE
Rider Premium for the Optional Hospital
Outpatient Benefit Rider. Underwriting will
order a prescription check on all adult
applicants for the Outpatient Rider.
22HSA Eligibility In order to be eligible to fund
an HSA, an individual must be covered under a
high deductible health plan (HDHP) and not be
covered under any non-HDHP health plan except
those providing only permitted coverage or
permitted insurance. An individuals HSA
eligibility would remain valid if supplemental
plans only provide coverage for Note This
presentation is not intended to provide tax or
legal advice. Potential applicants should be
advised to consult with a professional advisor
regarding their personal situations.
23- HSA Eligibility
- A specific disease or illness
- Hospitalization for a fixed payment per day (or
other period) - Accidents
- Disability
- Dental care
- Vision care
- LTC
- Note This presentation is not intended to
provide tax or legal advice. Potential applicants
- should be advised to consult with a professional
advisor regarding their personal situations.
24- HSA Eligibility
- Client has current HDHP
- If client has a current high-deductible health
plan and is funding an HSA then Foundation plan
cannot be sold as a supplemental plan. - If client has a current high-deductible health
plan and is not funding an HSA then the
Foundation plan could be purchased by the client
as a supplemental plan to help cover
out-of-pocket expenses. - Note This presentation is not intended to
provide tax or legal advice. Potential applicants
- should be advised to consult with a professional
advisor regarding their personal situations.
25- HSA Eligibility
- Client is purchasing HDHP
- If client is purchasing a high-deductible health
plan, client could be given a choice - if client plans to fund the HSA health plan then
the Foundation plan cannot be sold as a
supplemental plan - if the client decides to purchase the Foundation
plan to help cover out-of-pocket expenses
associated with the high deductible health plan
then the client cannot fund an HSA - Note This presentation is not intended to
provide tax or legal advice. Potential applicants
- should be advised to consult with a professional
advisor regarding their personal situations.
26United American Supplemental Plans The following
policies CAN be sold with Foundation Signature
Series SMXC, MSXC, SSXC, HIXC, HMXC, CANLS2,
CILS, UA250
27United American Supplemental Plans The following
policies CANNOT be sold with Foundation
Signature Series GSP2, GSP1, CS1, HSXC,
INDEM1, MMXC, SHXC
28January 2008 State Availability AK, AL, AR, AZ,
CO, DE, IL, TX, and WY.
29Kates Story Kate is a 45-year-old teacher. She
has major medical coverage through her employer.
She selected a 5,000 deductible policy for the
lower premiums. Kates major medical policy also
requires a copayment and 20 coinsurance.
Rates vary by state. Examples for illustrative
purposes only. A Foundation Signature Series does
not guarantee payment of all charges. There may
be expenses for which you will be responsible.
30Kates Story Unexpectedly, Kate developed
pneumonia and spent two nights in the hospital.
Fortunately, she purchased a 7,500 Foundation
Signature Series 100 inpatient coverage to help
cover her deductible, copayment, and coinsurance.
Rates vary by state. Examples for illustrative
purposes only. A Foundation Signature Series does
not guarantee payment of all charges. There may
be expenses for which you will be responsible.
31Kates Story Total Hospital Expenses Billed to
Major Medical Policy for Inpatient Hospital
Charges 15,100
Rates vary by state. Examples for illustrative
purposes only. A Foundation Signature Series does
not guarantee payment of all charges. There may
be expenses for which you will be responsible.
32Kates Story Kates Major Medical Explanation of
Benefits Foundation Paid Deductible 5,000 Found
ation Paid Hospital Admission Copayment
100 Foundation Paid 20 Coinsurance 2,000 Tota
l Kate Owed 7,100 Foundation Paid
7,100 Amount Kate Paid 0
Rates vary by state. Examples for illustrative
purposes only. A Foundation Signature Series does
not guarantee payment of all charges. There may
be expenses for which you will be responsible.
33How Kate Managed Her Healthcare Expenses Annual
Foundation Premium 605 vs. Potential
Hospital Expenses 7,100
Rates vary by state. Examples for illustrative
purposes only. A Foundation Signature Series does
not guarantee payment of all charges. There may
be expenses for which you will be responsible.
34Another Example
35Roberts Story Robert is a 33-year-old single
father. He has a major medical policy with a
1,500 deductible. Roberts policy requires a
copayment and 20 coinsurance.
Rates vary by state. Examples for illustrative
purposes only. A Foundation Signature Series does
not guarantee payment of all charges. There may
be expenses for which you will be responsible.
36Roberts Story He also purchased a 2,000
Foundation Signature Series to help cover his
deductible, copayment, and coinsurance.
Rates vary by state. Examples for illustrative
purposes only. A Foundation Signature Series does
not guarantee payment of all charges. There may
be expenses for which you will be responsible.
37Roberts Story Robert had a motorcycle accident
that resulted in a one-night hospital
stay. Total Hospital Expenses Billed to Major
Medical Policy for Inpatient Hospital
Charges 3,050
Rates vary by state. Examples for illustrative
purposes only. A Foundation Signature Series does
not guarantee payment of all charges. There may
be expenses for which you will be responsible.
38Roberts Story Roberts Major Medical
Explanation of Benefits Foundation
Paid Deductible 1,500 Foundation Paid Hospital
Admission Copayment 50 Foundation
Paid 20 Coinsurance 300 Total Robert
Owed 1,850 Foundation Paid 1,850
Amount Robert Paid 0
Rates vary by state. Examples for illustrative
purposes only. A Foundation Signature Series does
not guarantee payment of all charges. There may
be expenses for which you will be responsible.
39How Robert Managed His Healthcare
Expenses Annual Foundation Premium 88
vs. Potential Hospital Expenses 1,850 Robert
has 150 remaining in his calendar-year maximum
benefit.
Rates vary by state. Examples for illustrative
purposes only. A Foundation Signature Series does
not guarantee payment of all charges. There may
be expenses for which you will be responsible.
40Another Example
41The Lopez Familys Story Maria and Jose Lopez,
both 38 years old, are married with two
teenagers. They have a major medical policy with
a 1,000 annual deductible. Their policy also
requires a copayment and coinsurance. Their
monthly major medical premium for their family is
877.
Rates vary by state. Examples for illustrative
purposes only. A Foundation Signature Series does
not guarantee payment of all charges. There may
be expenses for which you will be responsible.
42The Lopez Familys Story
Current Healthcare Situation Current Healthcare Situation Current Healthcare Situation
Annual Deductible Monthly Premium
Major Medical 1,000 877
For illustrative purposes only.
43The Lopez Familys Story Managing Healthcare
Expenses Maria and Jose increased their major
medical deductible from 1,000 to 5,000, which
reduced their major medical monthly premium to
453. Then they selected a 7,500 United American
Foundation Signature Series for 136 in monthly
premium. Previous Monthly Major Medical Premium
877 New Monthly Major Medical Premium
453 Foundation Monthly Premium 136
For illustrative purposes only.
44The Lopez Familys Story
Current Healthcare Situation Current Healthcare Situation Current Healthcare Situation
Annual Deductible Monthly Premium
Major Medical 1,000 877
Foundation Signature Series Foundation Signature Series Foundation Signature Series
Annual Deductible Monthly Premium
Major Medical 5,000 453
Foundation Signature Series 0 136
New Total Monthly Premium New Total Monthly Premium 589
For illustrative purposes only.
45How the Lopez Family Managed Its Healthcare
Expenses The Lopez family saved 288 per month
For illustrative purposes only.
46Hospital Outpatient Benefit Rider For 187
additional monthly premium, the Lopez family
could add the Hospital Outpatient Benefit Rider
to its Foundation Signature Series. Their total
monthly premium would be 776, which would still
be a monthly savings of 101.
For illustrative purposes only.
47The Lopez Familys Story
Current Healthcare Situation Current Healthcare Situation Current Healthcare Situation
Annual Deductible Monthly Premium
Major Medical 1,000 877
Foundation Signature Series Foundation Signature Series Foundation Signature Series
Annual Deductible Monthly Premium
Major Medical 5,000 453
Foundation Signature Series 0 136
New Total Monthly Premium New Total Monthly Premium 589
Outpatient Rider 0 187
New Total Monthly Premium with Optional Outpatient Rider New Total Monthly Premium with Optional Outpatient Rider 776
For illustrative purposes only.
48- How the Lopez Family Managed
- Its Healthcare Expenses
- The Lopez family has
- a major medical policy,
- a Foundation Hospital Expense Policy,
- plus the optional Hospital Outpatient Rider,
- and still managed to save
- 101 per month!
For illustrative purposes only.
49Optional Life Policy
Policy Forms SWL or RT10
50- Optional Life Policy
- Available at an additional cost
- Whole Life Insurance Policy or
- 10-Year Renewable Term Life Insurance Policy
- Choose a face amount from 1,000 to 20,000
- Whole Life Level benefit for the life of the
insured. Premiums never increase. Builds cash and
loan value which you may use in many ways
Surrender your policy for cash, and spend however
you wish. Convert your policy to life insurance
where no premiums are ever due (such as reduced
benefit paid-up insurance, or extended term
insurance). Take a loan from your policys value. - 10-Year Renewable Term Life Level benefit term
policy with premiums that stay the same for 10
years. The policy renews and premiums increase
every 10 years. Renewable to age 121.
Policy and Rider Forms SWL or RT10 ABR1 May
vary by state.
51Optional Life Insurance Riders
Policy and Rider Forms SWL or RT10 U4272 DFR
52- Optional Riders
- Available at an additional cost
- Deposit Fund Rider
- Available only on 10-Year Renewable Term Life
insurance policy. - Earn a guaranteed minimum of 3 interest on
deposits made with - premium payments.
- Minimum deposit amount is 5.
- Maximum account balance is limited to two times
the policy face amount. - Child Term Life Rider
- Available with the purchase of an adult whole
life or term life policy. - Choose 5,000 or 10,000 of coverage for children
ages 023.
Policy and Rider Forms SWL or RT10 U4272
DFR. May vary by state.
53- Automatic Benefit
- Terminal Illness Accelerated Death Benefit
Automatically added to either life policy at no
additional charge. We will pay you 50 of your
life policy benefit if you are diagnosed with a
qualifying terminal illness while your policy is
in force. (If the policy owner is diagnosed with
a terminal illness that will result in death
within one year, we will pay 50 of the death
benefit upon our receipt of due proof of terminal
illness. This benefit is payable only once. Not
approved in all states.)
Policy and Rider Forms SWL or RT10 U4272
DFR. May vary by state.
54Foundation Rates - All are STATE SPECIAL Example
- Texas Rates
- Issue Age Rates 0 - 63
- There is only one class of rates no
smoker/nonsmoker
55- UA Partners
- Our optional non-insurance discount health
services program is also available for a 6.95
monthly fee. UA Partners with Provider Network
12.95 program is not available with Foundation
Signature Series. - Receive discounts on
- Chiropractic 20 to 40
- Dental 10 to 50
- Eye Care 20 to 60
- Hearing Aids 10 to 20
- Prescriptions Average of 20
- Mail Order Pharmacy Save More
56UA Partners 6.95 UA Partners for UA Life,
Supplemental Health, or Medicare Supplement
Policyholders Complete enrollment form F4300-I,
or the state-special versions (01) or (37). Fees
for the optional, noninsurance UA Partners
program need to be included in the MGAPB
section, Total Collected with Application.
57Thank You