mmgap_ga-ppt-training uai0569 r0108 this is a solicitation for insurance. you may be contacted by...

MMGAP_GA-PPT-TRAINING UAI0569 R0108

www.uageneralagency.com/foundation

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.

Managing Your Healthcare CostsLimited Benefit Hospital Expense Policy

TRAINING

MMGAP_GA-PPT-TRAINING UAI0569 R0108www.uageneralagency.com/foundation

This presentation is for TRAINING only.It should not be shared with prospects.

The SALES powerpoint is available at www.uageneralagency.com/foundation


The 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.


The Foundation Signature Series is not a major medical insurance plan

and is not a replacement for one.


Calendar-Year MaximumBenefit 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


Choose 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


Age Availability

Foundation Signature Series is available to people ages 0-63.

Issue Age Pricing.Sex Distinct.

State Specific.


Foundation Signature SeriesLimited 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.


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


Policy BenefitsThere 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.


How To File A ClaimThe policyholder must submit a copy of the

major medical provider’s Explanation of Benefits along with a standard hospital billing form (UB-04)

Policy Form: MMGAP*Limitations and exclusions apply. Preexisting Condition Limitation applies.


Standard Limitations and ExclusionsMay Vary by State

We will not pay benefits under this policy for:1. Services not covered under the Primary Medical Policy; or2. Expenses in excess of benefit limits or maximums in the Primary Medical Policy; or3. 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

4. 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

5. Convalescent, skilled nursing, educational care or for nervous or mental disorders, unless covered by Your Primary Medical Policy; or

6. Dental treatment, hearing aids, or eye refractive exams, refractive surgery, or refractive treatment; or

7. Any Inpatient Hospital Stay or other service for which You or a Family Member do not incur a charge; or

8. Any loss covered by any Workmen’s Compensation or Employers’ Liability Law; or9. Any Inpatient Hospital Stay or other service that is not medically necessary, or is cosmetic in

nature; or


Standard Limitations and ExclusionsMay Vary by State

We will not pay benefits under this policy for:10. Any expense incurred in excess of the usual, customary, and regular charges for any

service or materials in the geographic area where furnished; or11. Charges incurred for professional, radiological, pathological, or EKG interpretations, unless

covered by Your Primary Medical Policy; or12. Rehabilitative care services received at a facility not meeting the definition of a Hospital,

unless covered by Your Primary Medical Policy; or13. Treatment or services incurred outside of the U.S. boundaries; or14. Infertility or sterilization treatment procedures, unless covered by Your Primary Medical

Policy.


Optional State-Mandated BenefitsOptional 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)


Optional Hospital Outpatient Benefit Rider

Policy and Rider Form: MMGAP and R-MMGAP-HO


Optional 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.


Number 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.


New Business Turn-In

Application Privacy and disclosure information Consumer form New business transmittal form


Underwriting GuidelinesApplicants 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 CoverageThe Insurance carrier Name and the Applicant’s 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.



Issuing New Business in Pend-Issue Status

Applicants with a pending application for a Primary Insurance policy -

Verification of Primary Insurance CoverageThe Insurance carrier Name and the Applicant’s 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.



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.


HSA EligibilityIn 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 individual’s 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.


HSA Eligibility1. A specific disease or illness

2. Hospitalization for a fixed payment per day (or other period)

3. Accidents

4. Disability

5. Dental care

6. Vision care

7. LTC



HSA Eligibility

Client has current HDHP

1. If client has a current high-deductible health plan and is funding an HSA then Foundation plan cannot be sold as a supplemental plan.

2. 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.



HSA Eligibility

Client is purchasing HDHP

1. If client is purchasing a high-deductible health plan, client could be given a choice:a) if client plans to fund the HSA health plan then the Foundation plan

cannot be sold as a supplemental planb) 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



United American Supplemental Plans

The following policies CAN be sold with Foundation Signature Series:

SMXC, MSXC, SSXC, HIXC, HMXC, CANLS2, CILS, UA250


United American Supplemental Plans

The following policies CANNOT be sold with Foundation Signature Series:

GSP2, GSP1, CS1, HSXC, INDEM1, MMXC, SHXC


January 2008 State Availability

AK, AL, AR, AZ, CO, DE, IL, TX, and WY.


Kate’s StoryKate 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. Kate’s 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.


Kate’s StoryUnexpectedly, Kate developed pneumonia and spent two nights in the hospital. Fortunately, she purchased

a $7,500 Foundation Signature Series 100% inpatient coverageto help cover her deductible, copayment, and coinsurance.



Kate’s StoryTotal Hospital Expenses Billed to Major Medical Policy for Inpatient Hospital Charges: $15,100



Kate’s StoryKate’s Major Medical Explanation of Benefits Foundation Paid Deductible $5,000Foundation Paid Hospital Admission

Copayment $ 100Foundation Paid 20% Coinsurance $2,000

Total Kate Owed $7,100

Foundation Paid $7,100Amount Kate Paid $0



How Kate Managed Her Healthcare Expenses

Annual Foundation Premium $605– vs.–

Potential Hospital Expenses $7,100



Another Example


Robert’s StoryRobert is a 33-year-old single father. He has a

major medical policy with a $1,500 deductible. Robert’s policy requires a copayment and 20% coinsurance.



Robert’s StoryHe also purchased a $2,000 Foundation Signature Series to help cover his deductible, copayment, and coinsurance.



Robert’s StoryRobert 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




Robert’s StoryRobert’s Major Medical Explanation of BenefitsFoundation Paid Deductible $1,500Foundation Paid Hospital Admission

Copayment $ 50Foundation Paid 20% Coinsurance $ 300

Total Robert Owed $1,850

Foundation Paid $1,850 Amount Robert Paid $0


How Robert Managed His Healthcare Expenses

Annual Foundation Premium $88

– vs.–Potential Hospital Expenses

$1,850Robert has $150 remaining in his calendar-year maximum benefit.



Another Example


The Lopez Family’s 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.



For illustrative purposes only.

The Lopez Family’s StoryCurrent Healthcare Situation

Annual Deductible Monthly Premium

Major Medical $1,000 $877


The Lopez Family’s StoryManaging 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





Current Healthcare SituationAnnual Deductible Monthly Premium


Foundation Signature SeriesAnnual Deductible Monthly Premium


Foundation Signature Series

$0 $136

New Total Monthly Premium $589


How the Lopez Family Managed Its Healthcare Expenses

The Lopez family saved

$288 per month



Hospital 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.




Current Healthcare SituationAnnual Deductible Monthly Premium



Foundation Signature SeriesAnnual Deductible Monthly Premium


Foundation Signature Series

$0 $136

New Total Monthly Premium $589

Outpatient Rider $0 $187

New Total Monthly Premium with Optional Outpatient Rider

$776


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.


Optional Life Policy

Policy Forms: SWL or RT10


Optional Life PolicyAvailable 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 policy’s 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.


Optional Life Insurance Riders

Policy and Rider Forms: SWL or RT10; U4272; DFR


Optional RidersAvailable 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 0–23.

Policy and Rider Forms: SWL or RT10; U4272; DFR.May vary by state.


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.


Issue Age Rates: 0 - 63 There is only one class of

rates; no smoker/nonsmoker

Foundation Rates - All are STATE SPECIALExample - Texas Rates


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 $$


UA 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.”


Thank You

mmgap_ga-ppt-training uai0569 r0108 this is a solicitation for insurance. you may be contacted by...

Documents

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calendar yearmaximum

policy form

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maximum annual benefit

major medical policy

policy benefits