Protection for you, your finances & your future!

Transcription

1 Group Critical Illness Insurance Protection for you, your finances & your future!

2 AGENDA Who is ACE BCCA s new AD&D The Need for Critical Illness The BCCA CI Program How is the product different Policy provisions you should know Critical Illness Claims Case Studies Questions

3 Who is ACE? ACE INA Life Insurance is a member of the ACE Group of Companies One of the world s largest providers of A&H insurance, P&C insurance, reinsurance and financial services ACE Limited trades on the NYSE Operates in over 53 countries Worldwide $52.7 Billion in invested assets Web Site:

4 A NEW PARTNER

5 Basic AD&D Coverage Ancillary Benefits: 200% Paralysis Benefits Spousal Occupational Training up to $15,000 Home Alteration & Vehicle Modification: 10% of Principal Sum to a maximum of $50,000 Day Care Benefit - 5%/$5,000/4 years Special Education Benefit - 5%/$5,000/4 years Seat Belt Benefit - 10% to maximum of $25,000

6 Basic AD&D Coverage NEW - Ancillary Benefits: Bereavement Benefit In Hospital Confinement Cosmetic Disfigurement Identification Benefit CANCER RIDER: 5% of the principal sum to a maximum of $5,000.

7 Voluntary AD&D Coverage NEW - Ancillary Benefits: Common Disaster Benefit Extended Family Benefit Special Benefit for Dependent Children Employee Only Plan Family Plan Employee may elect an amount in units of $25,000 to a maximum of $300,000 As a percentage (%) of the Employee s Principal Sum Amount elected: Spouse only - 50% Spouse and child - 40%/10% Child[ren] only - 15%

8 CRITICAL ILLNESS INSURANCE

9 The Critical Illness Gap The Critical Illness Gap Prior to Critical Illness..

10 The Critical Illness Gap During Critical Illness

11 Cancer Costs: What is NOT covered by the publicly funded healthcare system? A STUDY BY: Christopher J. Longo, PhD Associate Professor, Health Services Management, DeGroote School of Business Member, Centre for Health Economics and Policy Analysis McMaster University BC

12 Publicly funded medical coverage Prescription Drugs Significant provincial variability Deductibles or co-payments are typical Not all populations are covered Not all drugs are included

13 Items not publicly funded Complementary and Alternative medicines Most provinces provide no coverage for these items Include items like massage therapy, chiropractic services, Chinese medicine, homeopathy Vitamins and Supplements Most provinces provide little or no coverage for these items Include items like nutritional supplements, special vitamins to correct for chemotherapy induced imbalances

14 Items not publicly funded Devices Limited coverage for these items through provincial programs Costs in this category may include: wigs, prostheses, wheelchair, and other assistive devices Family care Whether for children or elder care these costs must be borne by the patient as no provincial financing programs exist Particularly problematic for those with frequent visits related to radiation treatment

15 Items not publicly funded Travel and accommodation costs This category includes car expenses, taxis and parking For accommodations some special rates through individual hospices, but no designated provincial program available. These costs can be very significant

16 The need for Group Critical Illness How bad could it be? Cost categories include: Prescription drugs In-home healthcare Devices & equipment Vitamins & supplements Total Monthly Cost: $1,653 to $3,078 Typical Duration: 11 months Accommodation & meals Family care Travel Homemaking services Patient and Caregiver lost income Source: Longo-CJ, Patient Burden in Cancer

17 What is Critical Illness Insurance? A lump sum benefit payable if you are diagnosed with a covered condition as defined in your policy, and you satisfy the survival period YOU decide how you use your benefit!!

18 Spectrum Covered Conditions Heart Attack Cancer Stroke Blindness Paralysis Severe Burns Coronary Artery Bypass Surgery Multiple Sclerosis Alzheimer s Disease Loss of Limbs Loss of Speech Motor Neuron Disease Coma Deafness Parkinson s Disease Major Organ Failure Aorta Surgery Benign Brain Tumor Occupational HIV Heart Valve Replacement Major Organ Transplant

19 Why BCCA Critical Illness? Guaranteed Issue Coverage Ductal Carcinoma in Situ Loss of Independence Early Stage Prostrate Cancer (T1a or T1b) treatment 2 nd Event Coverage Enhanced!

20 Coverage for DCIS (Ductal Carcinoma In Situ) Benefit Payment: 20% of the principal sum to a maximum of $20,000. Incidence of Ductal Carcinoma In Situ: 23,140 new breast cancer cases diagnosed in Canada in % of these will be DCIS DCIS incidence has been increasing significantly over the last 20 years due to widespread mammography screening, along with improvements in imaging technology and increased biopsy rates.

21 Early Stage Prostate Cancer Treatment Benefit Benefit Payment: 20% of the principal sum to max. $20,000. Incidence of Prostate Cancer in Canada Prostate cancer is most common cancer among Canadian men (excluding non-melanoma skin cancer).* In 2010, an estimated 24,600 men will be diagnosed with prostate cancer.* Statistics indicate that 1 in 7 men will develop prostate cancer at some point during his lifetime.* *Prostate cancer statistics, 2010 Canadian Cancer Society.

22 2 nd Event Coverage Simple Definition! If 1st claim Cancer or Heart Attack, Stroke or By-Pass Surgery, 2 nd claim can be one of: Heart Attack Cancer Stroke Blindness Paralysis Severe Burns Coronary Artery Bypass Surgery Multiple Sclerosis Alzheimer s Disease Loss of Limbs Loss of Speech Motor Neuron Disease Coma Deafness Parkinson s Disease Major Organ Failure Aorta Surgery Benign Brain Tumor Occupational HIV Heart Valve Replacement Major Organ Transplant **FULL payment on second claim

23 Loss of Independence Unable to perform, by oneself, at least 2 of the following 6 activities of daily living: - Bathing - Dressing - Toileting - Bladder and Bowel Continence - Transferring - Feeding OR a Cognitive Impairment. Benefit Payment: 25% of principal sum

24 Additional BCCA Unique Features: Hospital Cash Daily Benefit of $50 for 3 consecutive days or more due to an Accident Maximum 120 days 200% payout on Occupational Injury Blindness, Coma, Deafness, Dismemberment, Loss of Speech, Paralysis, Severe Burns

25 BCCA Guaranteed Issue Coverage For Mandatory Coverage: Groups 2 lives (with medical evidence) - $10,000 Groups 3-9 lives (Guaranteed Issue) - Groups 10+ lives (Guaranteed Issue) - $25,000 Maximum $50,000 Maximum Groups 50+ lives (Guaranteed Issue) - $100,000 Maximum Minimum Amount: $10,000 Increments: $5,000

26 Plan Features 1. Pre-existing Condition Sickness, disease, injury or condition for which you sought, received advice, consultation, investigation, diagnosis or treatment during the 2 year period immediately prior to the effective date of coverage Pre-Existing Medical Conditions are not covered day survival period Employee/spouse survives 30 days from date of diagnosis Day Cancer Exclusion

27 Pre-existing Condition Example: 24 Months before Effective Date Group CI Effective Date 24 Months after Effective Date Medical advice, consultation, investigation, diagnosis, or for which treatment was required or recommended by a licensed medical practitioner Insured is diagnosed with a Covered Condition) that was directly related to the medical advice, consultation, investigation, diagnosis, or for which treatment was required or recommended by a licensed medical practitioner: PRE-EX EX APPLIES PRE-EX EX EXHAUSTED NEWLY diagnosed conditions would be eligible Insured is diagnosed with a Covered condition not related to any pre-existing existing condition: PRE-EX EX DOESN'T APPLY

28 CRITICAL ILLNESS CLAIMS

29 Our A&H Claims Team Process AD&D and CI claims per month Team consists of 7 members combining over 70 years of experience Biggest Challenge in CI Claims: Pre-Existing Condition

30 Our A&H Claims Team Medical Consultants: Dr. Eric Fonberg, MD, MPH, MBA, CCFP (EM): Emergency & Family Physician, Toronto East General Hospital, Rouge Valley Health System Insurance industry Medical Consultant for 5 major insurance companies Dr. Justin Busse, MD, CCFP (EM): Emergency & Family Medicine William Osler Health Centre Medical Consulting since 2002 for insurance industries Teaching emergency medicine for CCFP (EM) residents, Queen s University

31 Critical Illness Insurance Claims Process 1. Employee has a claim contacts Benefits Administrator 2. Contact BCCA 3. Disease specific forms are completed 4. Completed forms faxed or couriered to ACE for review by ACE team and additional medical info requested from physician or hospital

32 Employer Feedback Law Firm: employees Mandatory CI - $25,000 benefit not Associates or Partners Effective Date November Claims Feedback from VP HR: High number of LTD claims for Cancer - other Illnesses Employee complaints: LTD only covering 60% of earnings - 20% coinsurance on drugs Group CI introduced to address complaints Only few law firms offer this benefit attract/retain employees

33 Employer Feedback Grocery Chain: 1200 Lives Mandatory CI - $10,000 benefit - Effective Date March Claims Feedback from Broker: Company president s wife diagnosed with Breast Cancer Had the funds pay for treatment at Cleveland Clinic Broker asked president about what would happened if employee developed Cancer no funds no contacts Implemented individual CI for Executive Compensation Group CI for all other employees, spouses and children FAMILY PLAN

34 Employer Feedback Production Enhancement Service Provider: Oil and Gas Industry Over 300 lives Mandatory CI - $50,000 Executives; $10,000 all other employees Effective Date July Claims Employer feedback: An inexpensive but valuable addition to benefits package Financial assistance to help employees and family important to employer Choice to provide different benefit levels market driven Company funds benefit

35 Things you should be aware of 1 in every 2.5 women and 1 in every 2.2 men will have some form of cancer in their lifetime. Every 4 minutes a Canadian is diagnosed with cancer. 67% of costs associated with cancer treatment in Canada are not covered by any public health plan. any public health plan. Survival rate of at least 5 years for cancer is currently 62%. Survival rate in Canada is currently 80% for heart attacks. 1 in every 20 Canadians will suffer a stroke. Survival rate is 85% for strokes. 52% of employed Canadians would use their retirement money and work longer than planned to deal with major illness costs

36 ACE Life Group CI Claims Experience Cancer 66% Heart Attack 16% Coronary Artery Bypass Surgery 6% Multiple Sclerosis 5% Paralysis 1% Stroke 4%

37 SPECTRUM Group Critical Illness Insurance Questions?