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EVIDENCE GATHERING: WHAT S NEW

2. PANELISTS. Laurene Polignone, Assistant Vice President

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EVIDENCE GATHERING: WHAT S NEW

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

    2. 2

    3. Evidence Gathering Whats New on the Horizon Laurene A. Polignone John Hancock Assistant Vice President Underwriting & Claims

    4. 4 Agenda 5 Key Selection Factors Developing Criterias Current Protocols Distribution of Protocols John Hancocks latest tools MCAS MIB Prescription Profiles

    5. 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. 6 Developing Criterias? Age Past & Current Medical History Benefit Structure Date Last Consulted with PCP

    7. 7 Current Protocols

    8. 8 Distribution of Protocols 2005

    9. 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. 10 MCAS Study Early Results Estimated prevalence of Alzheimers 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. 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 ADLs, IADLs, Assistive Devices, Cognitive Test Results

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

    13. 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. 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. 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 Whats New on the Horizon Amy Chambers Genworth Financial LTC Underwriting Manager

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

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

    19. 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. 20 MD Exam When used Indication of significant Health History Diabetes CAD No recent follow up

    21. 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. 22 Medical Summarization of Medical Records When used Any time we require medical records

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

    24. Evidence Gathering Whats New on the Horizon Cheryl Bush, RN VP, LTC Operations MedAmerica Insurance Company

    25. 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. 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

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