EVIDENCE GATHERING: WHAT’S NEW?

1. EVIDENCE GATHERING:WHAT’S NEW? Session 24: February 27, 2006 Session Producer: Irene Juthnas Director of Underwriting MetLife

2. PANELISTS • Laurene Polignone, Assistant Vice President – Risk Management John Hancock • Amy Chambers, LTC Underwriting Manager, Genworth Financial • Cheryl Bush, Vice President – Operations, MedAmerica

3. Evidence Gathering“What’s New on the Horizon” Laurene A. Polignone John Hancock Assistant Vice President Underwriting & Claims

4. Agenda • 5 Key Selection Factors • Developing Criteria’s • Current Protocols • Distribution of Protocols • John Hancock’s latest tools • MCAS • MIB • Prescription Profiles

5. 5 Key Factors in Selecting a Tool? • Ability to assess risk exposure • Reduces or eliminates need to request multiple requirements • Quality of results • Accuracy of administration • Qualifications of individual retrieving data • Ease of applicant administration • Cycle Time • Cost

6. Developing Criteria’s? • Age • Past & Current Medical History • Benefit Structure • Date Last Consulted with PCP

7. Current Protocols

8. Distribution of Protocols2005 Percentage

9. MCAS Study • 1999 - 2005 • MCAS utilized throughout time period • Compared cognitive claims on applications received 1999 – 2005 against 300,000 applications against all claims incurred between during the time period with a cognitive • Ages 65 - 72 • Cognitive testing was not given to all applicants • Requirements guidelines and scoring criteria changed slightly during the 5 year period

10. MCAS Study • Early Results • Estimated prevalence of Alzheimer’s in the general population for ages 65 to 69 is 1.1% • Our Prevalence for 300,000 cases was 1 in 13,000 cases or .008% • Results are well below our actuarial estimates • 5 individuals passed the cognitive screen and went onto claim during the period studied. • Allowed us to moderate our cognitive scoring criteria. • Validated our approach and use of cognitive screening in these age groups.

11. MIB Service • Clearinghouse of underwriting reports for >500 life insurance carriers • Provides for the exchange of confidential, coded medical and non-medical information among its members • Uncovers misrepresentations and omissions • LTC specific codes since 6/1999 • ADL’s, IADL’s, Assistive Devices, Cognitive Test Results

12. MIB Study • 1,504 pilot size • Case Profile • 40% Preferred • 54% Select • 6% Substandard

13. MIB Study Pilot Results 184 matches 177 analyzed 143 did not reveal additional medical information • 34 provided information that lead to further investigation • 3 appeared uninsurable • 2 appeared to be risk class changes(preferred to select) • 29 appeared to be risk class changes (select – substandard)

14. Prescription Profile Service • Detailed Information • Brand & generic names, dosage, quantity • Physician name and contact info • Provides check on application / interview • Often reveals missing or forgotten conditions, physicians • Profile may indicate less severe condition(s) than physician reports • Upon signed authorization, provider queries multiple external Rx databases • Rx history ordered and delivered electronically • Turnaround time less than one minute • Displayed in easy-to read format • Shows underwriting relevance, drug indications

15. Prescription Profile Study • Sample size 4,080 • Sample ages 40 – 84 2,536 (62%) were eligibility & prescription hits 1,976 (78%) of the hits contained prescriptions • 1,769 (90%) of the prescription hits were analyzed • Focused on uninsurable applicants • Ordered medical records on 84 applicants and declined 20 • Actuaries cost benefit analysis revealed savings of $6 for every $1 spent

16. Evidence Gathering“What’s New on the Horizon” Amy Chambers Genworth Financial LTC Underwriting Manager

17. What tools is Genworth Utilizing • Application • Phone History Interview • Medical Records • Face to Face Interview • Paramed Exam • MD Exam

18. Paramedical Exams • When used • MD not seen recently • Current blood pressure readings required • Validate BMI • Younger age clients

19. Paramedical Exams • Assists in obtaining current health information • Accurate height • Current weight • Current BP • High Level of Accuracy • TAT – dependent on the client • Low Cost

20. MD Exam • When used • Indication of significant Health History • Diabetes • CAD • No recent follow up

21. MD Exam • Provides accurate, updated medical information • Lab tests • EKG • Special tests • High Level of Accuracy • TAT-client dependent • No Cost to the Company

22. Medical Summarization of Medical Records • When used • Any time we require medical records

23. Medical Summarization • Provides concise review of Medical Records • Accuracy • Sigma 4.5, consistently • Improves overall TAT • Health Professional

24. Evidence Gathering“What’s New on the Horizon” Cheryl Bush, RN VP, LTC Operations MedAmerica Insurance Company

25. Evidence Gathering • Challenges of Younger Age Applicants • Value UW Tools Used • Application: Value of Actively At Work • Phone History Interview • Medical Records • FTF: personal interview • Rate Classes

26. Evidence Gathering • Challenges of Younger Age Applicants • FTF Requirements • When is Tool Used • Value of Functional versus Cognitive • Cognitive Screening Tool • Study of EMST versus DWR: • Accept vs. Deny Ratios by Submitted Ages • Findings Of Medical Record Reviews/Audits on Denies