Professional Documents
Culture Documents
Golden Rule Insurance Company, a UnitedHealthcare company, is the underwriter and administrator of these plans. Not For Consumer Use All the information in this guide is confidential.
Feb 25 2011 09:25:55
(800) 474-4467
HourS of operation: 8:00 a.m. to 6:00 p.m. Eastern (M-TH) 8:00 a.m. to 5:00 p.m. Eastern (F) new BuSineSS fax: (317) 713-7875 For submission of: Applications & Applicant medical documentation LicenSing fax: (618) 943-5239 For submission of: Licenses & Appointment Renewal Fees e-Store: www.UHOne.com/Broker Quote and submit applications Preliminary Evaluation Broker Education events Business reports including pending and existing business emaiL: In E-Store click on Contact Us
HourS of operation: 8:00 a.m. to 6:00 p.m. Eastern (M-F) new BuSineSS appLicationS: Mail To: Golden Rule Insurance Company HEALTH APPLICATION PO Box 68994 Indianapolis, IN 46268-0994 underwriting maiLing addreSS: 7440 Woodland Drive Indianapolis, Indiana 46278-1719 rSa medicaL: (866) 665-6025 High Blood Pressure (HBP) Questionnaires cLient underwriting interviewS for verification: (800) 307-4217 premium payment maiLing addreSS: P. O. Box 740209 Cincinnati, OH 45274-0209
1 2
Discounts vary by provider, geographic area, and type of service. For automated convenience, the IVR System of the above Customer Service Center number is available: 5:00 a.m. to 9:00 p.m. Eastern (M-F); Saturday 5:00 a.m. 4:55 p.m. Eastern time.
TA B L E O F C O N T E N T S
2 3 4 5 6 Important Contact Information Contents Product Offerings Rules for Eligibility How to Prepare for Accurate Quoting and Application Submission 7-10 11-14 15 16-17 18 19 20 21 22 Review Unacceptable Conditions Rate Class Charts What to Expect From Our Underwriting Process Underwriting Actions Preliminary Evaluation (Underwriting Guidance) E-Store Online Quoting & Application E-Store Features Premium Modes and Payment Information Single-Payor Options for Multiple Individual Plans 23 24 25 26-27 Underwriting Appeals Frequently Asked Questions State Product Availability Chart Notes
Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.
Product Offerings*
Plan Type copay pLanS More Traditional Plans Higher Premiums, Lower Deductibles May Be Ideal For Anyone who prefers the convenience of copay benefits for routine healthcare expenses. Families with children who have regularly scheduled doctor office visits. Adults who want copay benefits for preventive care and prescription drugs. Plan Name Copay SelectSM
More comprehensive
Out-of-Pocket** Lower
HeaLtH SavingS account pLanS Market-Leading Plans High Deductible Plan plus Savings Account
Those interested in trading low deductible health insurance for a higher deductible plan to save money on monthly premiums. Persons interested in more control over how their health-care dollars are spent. Families interested in one calendar-year deductible per family.
HSA 100
More comprehensive
Lower
Higher
HSA 70SM
More affordable
Higher
Lower
Anyone willing to take responsibility for routine health-care expenses in exchange for lower premiums. Anyone seeking lower-cost protection from unexpected accidents and illnesses. Early retirees needing a bridge to Medicare.
Plan 100
More comprehensive
Lower
Higher
Plan 80SM
More affordable
Higher
Lower
Saver 80SM
Even more affordable
Higher
Lower
dentaL pLanS
Higher
Lower
* Varies by state. ** Out-of-pocket exposure is deductible, coinsurance, and copays. Under all plans, additional expenses may be incurred that are not eligible for reimbursement by the insurance.
Age
Eligible from birth up to age 64 for individual health. Please note: There are no pre-existing condition exclusions for children under the age of 19. No age restrictions on dental.
Other Coverage
Golden Rule maintains specific guidelines regarding other medical coverage. Generally, well issue our plans in addition to only the following types of coverage: Student accident insurance. Accident-only plans. Dread disease policies (e.g., cancer). Coverage through Medicaid.
Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.
Determine Eligibility
Create Quote
Track Application
DIGESTIVE SYSTEM
Alcoholic Pancreatitis (Chronic or recurrent) Crohns Disease (Present will not consider) 1 attack and unoperated but recovered 2-year clearance
CANCER/TUMORS
Bladder Cancer (5-year clearance) Brain Cysts (Present or within 2 years or with after-effects) Brain Tumor (Benign within 2 years or with aftereffects. Will not consider malignant brain tumor) Breast Cancer (2-year clearance if cancer-free and not in lymph nodes. 5-year clearance if local or regional metastasis. Declined if distant metastasis) Cancer Present Cervical Cancer (Present. If cured will consider) Colon Cancer (5-year clearance) Giant Cell Carcinoma Hodgkins Disease Kidney Cancer (5-year clearance) Leukemia Leukoplakia Lymphoblastoma Lymphocytic Interstitial Pneumocystitis Lymphoma Lymphosarcoma Lung Cancer (10-year clearance) Malignant Melanoma Multiple Myeloma Ovarian Cancer (7-year clearance) Polyposis Prostate Cancer (2-year clearance) Reticulum Cell Sarcoma Skin Cancer Squamous Cell (Present) Stomach Cancer (5-year clearance) Testicular Cancer (5-year clearance) Tongue Cancer (5-year clearance) Uterine Cancer (10 years without hysterectomy*)
*Total hysterectomy and no metastasis, can consider
4
2 or more attacks/unoperated but recovered 4-year clearance 2 or more attacks/operated/recovered 2-year clearance Cirrhosis or Fatty Liver Colon Polyps (Present) Colostomy or Ileostomy Cystic Fibrosis Diverticulitis (Present) Enlarged Liver Esophageal Varices Hepatitis (Chronic or recurrent) Hepatitis C Always declined Hepatitis A Can consider with a 6-month clearance, no meds, and normal Liver Functions Test Hepatitis B Can consider with a 12-month clearance, no meds, and normal Liver Functions Test Gastric Bypass (Declined unless 5-year clearance and stable weight for at least 12 months) Gluten Intolerance Ulcerative Colitis (If surgically corrected, we can consider)
EAR/EYE
Menieres Disease (Declined if condition is progressing or having problems with equilibrium) Optic Neuritis (Declined if present or diagnosed within 1 year with no etiology) Retinal Hemorrhage Sjogrens Syndrome
Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.
GENITOURINARY SYSTEM
Hydronephrosis (Present) Kidney Dialysis Kidney Infections can be considered unless chronic* Kidney Stones Bilateral (Present in both kidneys) Kidney Transplant Nephrosclerosis Nephrosis Nephrotic Syndrome Neurogenic Bladder
FEMALE DISORDERS
Unless pending surgery, can consider most female disorders with riders. Check Cancer Listing.
GENERAL IMPAIRMENTS
Abnormal Lab Values with no etiology Assistive Devices (Canes/walkers/etc.) Chronic Fatigue (If present) Disabled DWI/DUI First Offense 2-year clearance 2 or more decline Epstein Barr Syndrome (Present decline 1-year clearance from recovery can consider) Lyme Disease (1-year clearance If given antiobiotics before testing, will still require clearance) Nursing Home Confined Organ Transplant Recipient Parotid Gland Removal within 3 years Pregnancy (Current) Polyarteritis Protein C Deficiency Sarcoidosis (Present or within 5 years) Sleep Apnea (Decline unless surgically corrected and 1-year clearance) Spinal Meningitis (6-month clearance from recovery) Workers Comp Benefits (If released from care can consider cannot consider if legal case is still pending)
HEART CIRCULATORY
Aneurysms (Anywhere in the body) Angina Angioplasty Aortic Stenosis Aplastic Anemia Arterial Blockage (Anywhere in the body) Arteriosclerosis Atrial Fibrillation (2-year clearance) AV Malformations Bicuspid Aortic Valve Bradycardia (Heart rate under 45) Bruits Present (Sounds of turbulent blood flow) Buergers Disease1 Cardiac Defibrillator Implanted Cardiac Hypertrophy Cardiomyopathy Cerebral Hemorrhage Congenital Defects2 Congestive Heart Failure (CHF) Corarctation of Aorta Coronary Artery Disease (CAD) Coronary Bypass Coronary Insufficiency Coronary Occlusion Coronary Spasms
Coronary Thrombosis Cytomegalovirus (CMV) (If present) Deep Vein Thrombosis (Still on blood thinners) Diastolic Murmurs or Systolic Murmurs Grade 3-6 Ejection Fraction of less than 50% Endarterectomy Endocarditis (Within 5 years) Heart Attack (Myocardial Infarction) Heart Bypass Surgery Hemochromatosis Hemorrhagic Diathesis (Hemophilia) High Blood Pressure (If present and Standard II build) Intermittent Claudication (Narrowing of leg arteries Ischemia) ITP (Idiopathic Thrombocytopenia) Kawasaki Disease (Present or within 6 months of recovery) Left Bundle Branch Blockage (LBBB) Lown-Ganong-Levine Syndrome (If symptomatic) Mitral Insufficiency Mitral Regurgitation (Trace or Trivial Regurgitation is considered with MVP) Mitral Stenosis Myocarditis (Within 6 months) Obstructive or Stenotic Murmurs Pacemaker Pericarditis (If Viral, 2-year clearance. If due to Heart/ Lung problems or multiple attacks, would be declined) Peripheral Vascular Disease Pulmonary Hypertension Pulmonary Stenosis Raynauds Disease Rheumatic Heart Disease Sick Sinus Syndrome Sickle Cell Anemia Stroke Tachybrady Syndrome Tetralogy of Fallot
3
Valve Replacements Ventricular Contractions Ventricular Fibrillation Ventricular Paroxysmal Tachycardia Von Willebrands Disease (If present) Wolfe-Parkinson-White Syndrome (If symptomatic)
MUSCULAR/SKELETAL
Ankyslosing Rheumatoid Spondylitis (Inflammation of spine and large joints) Cerebral Palsy Muscular Dystrophy Myasthenia Gravis Osteomyelitis (Present) Pagets Disease Paraplegic Parkinsons Disease Pathological Fractures Polymyalgia Rheumatica Psoriatic Arthritis Quadriplegic Rheumatoid Arthritis (5-year clearance with no treatment) Spina Bifida Tourettes Syndrome (We can consider if under the age of 20 well adjusted, and no Obsessive Compulsive Disorder must attend regular school)
NERVOUS SYSTEM
Alcohol/Substance Abuse Treatment (5-year clearance from date of last treatment {not including AA} if only one offense) Alzheimers Disease Autism Bipolar (Manic Depression) Downs Syndrome Epilepsy (1-year clearance since last seizure) Eating Disorders (Anorexia/Bulimia with present or ongoing treatment; after treatment, weight must be stable for 2 years) Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.
Thalessemia Major Transient Ischemia Attacks (TIA) Transposition of the Great Arteries
THYROID/GOUT DISORDERS
Graves Disease (Present and under treatment less than 6 months can consider on a case-by-case basis. Treatment over 6 months can consider/rider) Hyperthyroid (Case by case less than 6 months decline more than 6 months, we can consider with rider) Thyroid with goiter or pending surgery
RESPIRATORY SYSTEM
Asbestosis Bronchitis Chronic C.O.L.D. (Chronic Obstructive Lung Disease) C.O.P.D. (Chronic Obstructive Pulmonary Disease) Emphysema Lung Cyst or Abscess (Present) Pulmonary Embolisms Pneumonia (Present) Tuberculosis (Present)
Obstruction of small and medium arteries and veins by inflammation triggered by smoking. Patent ductus arteriosus (present), dextrocardia, atrial septal defect, atrioventricular canal defect, Ebsteins Anomaly, Eisenmengers complex, hypoplastic left heart syndrome, pulmonary atresia and stenosis, and truncus arteriosus. 3 Combination of heart defects consisting of large ventricle septal defect/displacement of aorta/narrowing of outlaw from right side of heart/thickening of right ventricle wall. 4 If cured by hysterectomy more than 2 years ago, may consider w/o rider.
1 2
10
WA MT ID WY NV NE UT CO KS OK IA IL MO IN KY TN AR MS
AK
ND MN SD WI MI PA OH WV VA NC SC AL GA NY
VT NH
ME
MA RI
CT NJ DE MD DC
Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut*, D.C., Delaware*, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky*, Louisiana*, Maryland, Michigan, Mississippi, Missouri, Nebraska, Nevada, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota*, Tennessee, Texas, Virginia, West Virginia, Wisconsin, Wyoming*
AZ
NM
TX
LA FL
HI
P
Height 4 6 4 7 4 8 4 9 4 10 4 11 5 0 5 1 5 2 5 3 5 4 5 5 5 6 5 7 5 8 5 9 5 10 5 11 6 0 6 1 6 2 6 3 6 4 6 5 6 6 6 7 6 8 6 9 6 10 6 11 7 0
S1
STanDaRD I Height/Weight
Male
S2
Height 4 6 4 7 4 8 4 9 4 10 4 11 5 0 5 1 5 2 5 3 5 4 5 5 5 6 5 7 5 8 5 9 5 10 5 11 6 0 6 1 6 2 6 3 6 4 6 5 6 6 6 7 6 8 6 9 6 10 6 11 7 0
STanDaRD II Height/Weight
Female 132 - 152 137 - 158 142 - 164 148 - 170 153 - 176 158 - 182 164 - 188 169 - 194 175 - 201 180 - 207 186 - 214 192 - 221 198 - 228 204 - 235 210 - 242 216 - 249 223 - 256 229 - 264 235 - 271 242 - 279 249 - 287 255 - 294 262 - 302 269 - 310 276 - 319 283 - 327 291 - 335 298 - 344 305 - 352 313 - 361 320 - 370 Male
Female 64 - 73 67 - 76 69 - 79 71 - 82 74 - 85 77 - 88 79 - 91 82 - 94 85 - 97 87 - 100 90 - 104 93 - 107 96 - 110 99 - 114 102 - 117 105 - 121 108 - 124 111 - 128 114 - 131 117 - 135 120 - 139 124 - 143 127 - 147 130 - 150 134 - 154 137 - 158 141 - 163 144 - 167 148 - 171 152 - 175 155 - 179 or or or or or or or or or or or or or or or or or or or or or or or or or or or or or or or 112 - 131 116 - 136 120 - 141 125 - 147 129 - 152 133 - 157 138 - 163 143 - 168 147 - 174 152 - 179 157 - 185 162 - 191 167 - 197 172 - 203 177 - 209 182 - 215 188 - 222 193 - 228 199 - 234 204 - 241 210 - 248 216 - 254 221 - 261 227 - 268 233 - 275 239 - 282 245 - 290 251 - 297 258 - 304 264 - 312 270 - 319
91 - 133 94 - 137 97 - 142 100 - 147 104 - 152 107 - 157 110 - 162 114 - 167 117 - 172 121 - 177 125 - 183 128 - 188 132 - 194 136 - 199 140 - 205 144 - 211 148 - 217 152 - 223 156 - 229 160 - 235 164 - 241 168 - 247 173 - 253 177 - 260 181 - 266 186 - 273 190 - 279
81 - 90 84 - 93 87 - 96 90 - 99 93 - 103 96 - 106 99 - 109 102 - 113 105 - 116 108 - 120 112 - 124 115 - 127 118 - 131 122 - 135 125 - 139 129 - 143 132 - 147 136 - 151 139 - 155 143 - 159 147 - 163 151 - 167 154 - 172 158 - 176 162 - 180 166 - 185 170 - 189
or 134 - 157 or 138 - 162 or 143 - 168 or 148 -173 or 153 - 179 or 158 - 185 or 163 - 191 or 168 - 197 or 173 - 203 or 178 - 209 or 184 - 216 or 189 - 222 or 195 - 229 or 200 - 235 or 206 - 242 or 212 - 249 or 218 - 255 or 224 - 262 or 230 - 270 or 236 - 277 or 242 - 284 or 248 - 291 or 254 - 299 or 261 - 306 or 267 - 314 or 274 - 322 or 280 - 329
158 - 180 163 - 187 169 - 193 174 - 200 180 - 206 186 - 213 192 - 220 198 - 227 204 - 234 210 - 241 217 - 248 223 - 256 230 - 263 236 - 271 243 - 279 250 - 286 256 - 294 263 - 302 271 - 311 278 - 319 285 - 327 292 - 336 300 - 344 307 - 353 315 - 362 323 - 371 330 - 380
Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.
11
Please note: Some states do not use Preferred I rating class. A rating class may be adjusted depending upon discovery during our underwriting process.
Tobacco Rate-Up
Tobacco use adds a surcharge to the premium rate. The tobacco surcharge varies by age and rating class.
12
WA MT ID WY NV NE UT CO KS OK IA IL MO IN KY TN AR MS
AK
ND MN SD WI MI PA OH WV VA NC SC AL GA NY
VT NH
ME
MA RI
CT NJ DE MD DC
AZ
NM
TX
LA FL
HI
Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.
13
Please note: A rating class may be adjusted depending upon discovery during our underwriting process.
14
Depending upon the complexity of the medical conditions of the individuals submitted on the application, underwriting will usually reach a decision in 2-30 days. Our underwriting process may involve one or more phone calls to your clients to discuss their medical conditions. Please notify your client that they may receive a phone call to obtain and verify medical information. We may order information from the Medical Information Bureau and an attending physician statement from a physician. Periodically some physicians require an individualized release for medical records rather than accepting the release contained on the application. When this occurs, the receipt of the records is delayed, and therefore, the final decision cannot be made until the information is received. Once we receive the information requested we will make an underwriting decision. Each individual is underwritten separately and therefore one or more of the applicants may be issued coverage while others may not.
You may check the progress of pending applications by visiting E-Store, and checking under My Business, located under My Business on the home page. All issued applications will be sent to you unless you notify us that you want the coverage documents sent directly to your clients. Once issued, plans and ID cards are mailed separately; plans are mailed from us and ID cards are sent by a vendor. Depending upon the state or product selected, an association fee may be required in addition to monthly premium. These fees range from $4 to $40 per month depending on your clients choice of FACT membership level (Basic, Choice, and Elite). The membership provides an array of purchase discounts for travel, entertainment, and medical needs. (See What is FACT on page 24.)
Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.
15
Underwriting Actions
Each individual on an application is underwritten separately. Underwriting actions are based on the information on the application as well as information we obtain during underwriting. If coverage cannot be issued as applied for, we will consider a rate-up. If a rate-up can not be utilized, an exclusion rider may be applied. If a rider cannot be applied, only then is the application declined. This decision process can vary state by state, but generally follows this process.
No rate-ups No riders Used when the condition is well controlled Ongoing costs are relatively low Applicant can qualify for a preferred health class even with a rate-up Rate-ups in 10% increments Additional information page 17 Well controlled condition Ongoing medical costs are too high for a rate-up May apply increased medical deductible** May apply increased drug deductible on Copay plan** May remove drug copay card** Preferred health class rating will not be applied
Underwriting Actions
Issue as Applied
Medical Rate-Up*
Limited Duration/Indefinite
Decline
Can exclude a specific ailment, body part, or system Limited duration or indefinite exclusionary period Avocation rider excludes activity or hobby Additional information page 17 Unacceptable conditions Potential serious condition or undiagnosed ailment 4 or more medical riders on one person
16
Rate-Up If a condition is well-controlled with prescription medication(s), diet, and/or routine office visits, a premium
rate-up may be used. The amount of the premium rate-up will vary by the ongoing costs of the treatment. Any premium increase applies only to the applicant with the condition; other covered family members will not be affected by the rate-up. Increased Prescription Drug Card Deductible If a condition is well-controlled, a prescription drug deductible increase may be used. The increased deductible amount will vary by the expected ongoing prescription costs. This increased deductible can only be used with plans containing the prescription drug card benefit. Increased Medical Deductible If a condition is well-controlled, a medical deductible increase may be used. The increased deductible amount will vary by the expected ongoing costs. This increased deductible is typically used with plans that do not contain the prescription drug card benefit. Exclusion of the Prescription Card Medical history and/or prescription drug use may prohibit the issuing of the prescription drug card.
Medical Riders Exclude coverage for specified conditions or body parts. Medical riders may be temporary (up to 10
years in length) or indefinite. Common riders include: asthma/allergies Excludes Outpatient treatment only. This rider may exclude any outpatient diagnosis or treatment of allergies and asthma. This includes, but is not limited to, evaluation, testing, treatment, therapy, and medication therefore, and any complications. Back Disorders Two separate riders may apply: 1. The first option excludes coverage for any injury to, disease of, or disorder of the spinal column, including the vertebrae, intervertebral discs, spinal cord, nerves, surrounding ligaments and muscles, treatment or operation therefore and complications therefrom. 2. The other option excludes loss as a result of outpatient diagnosis or treatment of any injury to, disease of, or disorder of the spinal column, including the vertebrae, intervertebral discs, surrounding ligaments and muscles. This includes, but is not limited to, office visits or outpatient consultations with a doctor, chiropractor, or other medical practitioner or medical professional, spinal adjustments, physical therapy, X-rays, and other diagnostic tests. Cholesterol/Lipids Excludes Outpatient treatment only. This rider may exclude outpatient treatment for elevated cholesterol, hyperlipidemia, or hypertriglyceridemia, including testing, dietary counseling, office visits, and medication. Psychological/Psychiatric Disorders. Two separate riders may apply, depending on the condition and severity. 1. The first option excludes any outpatient diagnosis or treatment of psychiatric and/or psychological disorders. This includes, but is not limited to, evaluation and/or testing, treatment, counseling, therapy, and/or medication therefore and complications therefrom. 2. The other rider option excludes any treatment for any type of psychological or psychiatric disorder. This includes any treatment for substance abuse as well as complications that may occur.
Note: Medical riders may be reviewed for removal after the policy/certificate has been in force for 12 consecutive months. Note: State variations may prevent some of the underwriting actions noted above.
Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.
17
18
Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.
19
E-Store Features
The home page is your link to all the tools available on E-Store. The tabs listed across the top of the page provide easy navigation throughout the site.
My Business
Prospect List My New Business My Existing Business Lapse Notifications Re-Rate Notifications
My Account
Broker Information Security & Admin Settings
20
Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.
21
List Bill
A single payor may elect to facilitate payment for two or more employees who have personal health insurance plans. The individuals covered by the List Bill must all have the same effective date of the month. Payments by business check is the only option available on list bill. The individuals are paying for their own individual insurance and the employer is simply facilitating payment. See availability by state on page 25.
Employer Payor
Business Checks Accepted Monthly Bill Option EFT Option Effective Dates Yes Yes Yes Applicants may have different effective dates Employer Payor agreement must be signed (located on E-Store under broker/ forms or in booklet # 39203-G-0410)
List Bill
Yes Required No All applicants must have same effective date List Bill Employer Payor document must be signed (located on E-Store under broker/forms or in booklet # 36749-G-0410) Yes, only after all policies are issued
Documents Required
E-Store Capable Fees EFT Monthly Individual Bill List Bill Optimal Use
- N/A - N/A - $25 per list bill per month Groups up to 25+, must have at least 2 policies
22
Underwriting Appeals
Our underwriting process is thorough and complete and our underwriting decisions are final. Applicants may appeal an underwriting outcome if they believe the decision was based on outdated or incorrect medical information. The applicant may submit a request to review an underwriting decision by writing or calling our Client Services department and providing the updated or corrected information.
Tobacco
A tobacco surcharge is automatically added when an applicant indicates they use tobacco. The surcharge assessed ranges from 1.12 to 1.90 depending upon the individuals age and rate class. Removal of this surcharge only occurs if the insured has been smoke free for a minimum of 12 consecutive months. The insured must submit a new application along with the fee for a urinalysis to verify no presence of tobacco. Fees range from $60 to $83 depending on the state. Medical history and claims will be reviewed upon receipt of the new application, in addition to the urinalysis to make the determination.
months this surcharge may be removed. A signed request must be submitted by the insured stating they no longer hold a valid license for a motorcycle and no longer ride motorcycles, and have not done so in the last 24 months.
to themorThe client was not offered group continuation of coverage (including COBRA). Creditable coverage includes group or individual health insurance coverage, Medicare, Medicaid, Armed Forces coverage, Indian or tribal coverage, state risk pool coverage, public health coverage, and Peace Corps Act coverage. A plan is NOT creditable coverage if it: a) provides coverage only for accidents, disability, or liability; b) is credit-only insurance; or c) is a secondary to other insurance. Generally, a group health plan is any coverage existing in connection with employment. Included are: employersponsored plans (so long as at least one employee participates); coverage of an employee under an individual policy of insurance that is part of a plan, fund, or program established or maintained by an employer that provides medical care to employees or their dependents; coverage of a business owner so long as at least one employee other than the business owner and the business owners spouse also participates in the plan; and coverage of partners in a plan maintained by the partnership.
Motorcycle
A motorcycle surcharge (20%) will be added to the base premium of an applicant if that applicant holds a valid motorcycle license. This surcharge will be added at the time of issue. Several states do not have a surcharge and instead simply exclude the applicant while on a motorcycle: CO, KS, KY, LA, NV. If the insured has not held a valid motorcycle license in the last 24
Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.
23
24
PRODUCTS
PaYMEnT OPTIOnS
Dental
S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S
Vision
M, D M, D M, D D M, D M, D M, D M, D M, D M, D M, D M, D M, D M M, D M, D M, D M, D M, D D D M, D M, D M, D M, D M, D M, D M, D M, D M, D M, D D
Continuity
X X
Employer Payor
X X X
List Bill
X X X
X X X X X X X X X
X X X X X X X X X
X X X
X X X X X
X X
X X
X X X X X X X X X X X X X X
X X X X X X X X
X X X X X X X X
X X X X X X X X X X X X
X X X X X X X X X X X
X X X
X X X
S S
M, D M, D
Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.
25
Notes
26
Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.
27
Visit E-Store at www.UHOne.com/broker or Call Broker Services at (800) 474-4467. Make sure you are using current brochures, applications, and rates for your state!
Copyright 2011 Golden Rule Insurance Company, the underwriter of these plans marketed under the UnitedHealthOne brand. 39831-G-0311