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Program
Tuesday, May
13, 2008
5:30–7:30 P.M.
Hospitality Suite, Sponsored by Heritage Labs
Wednesday, May 14, 2008
7:30–8:30 A.M.
Registration and Continental Breakfast with Exhibitors
8:30 A.M.
Opening Remarks
Hank George, FALU, CLU, FLMI; Chair, LOMA Health Underwriting Study Group
Jim Huffman, FLMA, ACS, Assistant Vice President, Insurance Operations, LOMA
8:45–9:45 A.M.
Overview of Major Reform Proposals Related to Health Care
Robert Imes, Senior Policy Consultant, Blue Cross and Blue Shield Association
With growing voter concern about health care, Congress and this year's presidential candidates have responded with a wide range of health care reform proposals. Employer and individual mandates, new government-sponsored plans, market rule changes, and many more reform ideas are being discussed. It is not just tax credit and deduction proposals this year, and sometimes it is surprising to see who is supporting what. This session will provide an overview of the major reform proposals and the outlook for the future.
Robert Imes is a Senior Manager for Public Policy with the Blue Cross Blue Shield Association (BCBSA). He focuses on issues relating to federal and state insurance market regulation, antitrust, uninsured, medical research, and prevention and wellness. Previously, Imes was an associate at Groom Law Group where he counseled insurers and employers concerning ERISA, COBRA, insurance laws, tax law, and legislative issues. Prior to that, Imes researched private health insurance market issues at Georgetown University's Health Policy Institute. Imes holds a J.D. cum laude from Georgetown and a B.A. from the Ohio State University.
9:45–10:15 A.M.
Refreshment Break with Exhibitors
10:15–11:15 A.M.
Everything You Must Know About Lab Testing
Betsy R. Sears, MSM, MT (ASCP), Executive Vice President, ExamOne
There have been many advances in insurance laboratory testing. Health underwriters see routine lab reports on most cases where they get medical records. This lecture will make key tests and their risk implications crystal clear and provide attendees with new perspectives on the role of testing in 21st century health underwriting.
Sears is EVP – Sales Support/Client Solutions at ExamOne and has over 21 years of experience in the insurance laboratory environment. She works closely with ExamOne's laboratory operations and medical staff on customer issues and supports insurance customers through a variety of presentations on laboratory, medical and risk assessment topics. Her duties also include managing some of the International sales initiatives and overseeing Insurance Client Solutions in the U.S. and Canada.
11:15–11:30 A.M.
Morning wrap up/Questions
11:30–11:45 A.M.
Morning wrap up/Questions and a few minutes from our sponsor
11:45 A.M.–1:00 P.M.
Lunch with Exhibitors
Sponsored by RSA Medical
1:00–4:30 P.M.
Interactive Sessions |
2:45–3:00 P.M.
Refreshment Break with Exhibitors
Sponsored by MRS, Inc. |
Individual Medical Underwriting
Individual Medical Underwriting sessions will address
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First
premium handling
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Distribution
channel issues
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HIPAA
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Application
for insurance options
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Electronic
application challenges
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Expert
underwriting systems
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Imaging
in underwriting systems
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Underwriting
technology support
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Telephone
interviews
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Underwriting
contact with the applicant/agent
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Telecommuting
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Quality
assurance/auditing
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Underwriting
metrics
Small Group Underwriting
Topics to be addressed in the Small Group Underwriting interactive session include:
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Quotes
vs. placements
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Eligibility
issues
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Applications/health
statements
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Waiver
of Health statements
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"New"
groups (no previous carrier)
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Electronic
enrollment
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Distribution
channel issues
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Underwriting
systems
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Underwriting
manual/rating engine
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Expert
underwriting systems
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Technology
support
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Quality
assurance/auditing
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Telephone
interviews
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Role
of the underwriting in decision-making
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New
business metrics
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Process variation for risk assessment
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Predictive modeling
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Impact of negative publicity
5:00–6:30 P.M.
Reception
Sponsored by Milliman IntelliScript
Thursday, May 15, 2008
7:30–8:30 A.M.
Breakfast with Exhibitors
Sponsored by Ingenix
8:15–9:15 A.M.
Health Insurance Regulatory Landscape: The View From The NAIC
John Englehardt, FSA, MAAA, CLU, ChFC, Life & Health Actuary, Research
Division, NAIC
The role of the National Association of Insurance Commissioners is to assist state insurance
regulators in serving public interest and achieve fundamental insurance regulatory goals in a responsive, efficient and cost effective manner. Englehardt will provide insight into current initiatives effecting the development and delivery of health insurance in the United States.
As a Life and Health Actuary for the NAIC, Englehardt supports the Accident and Health Working Group of the Life and Health Actuarial Task Force. Prior to joining the NAIC, he was the Life and Health Actuary with the Alabama Department of Insurance, served as vice president and actuary of several life insurance companies, and was a consulting actuary specializing in product development and reserve valuations.
9:15–9:45 A.M.
Refreshment Break with Exhibitors
9:45–10:45 A.M.
Underwriting and Pricing Mental Health Benefits - Facts vs. Fiction
Stephen P. Melek, Principal & Consulting Actuary, Milliman
The real costs of providing insured mental healthcare benefits is often misunderstood. Some believe that mental health parity will cost a fortune and have fought against it for years. Others believe that mental healthcare benefit costs start and stop with the behavioral carve-out. This session will explore the various sources of costs of providing mental health benefits, including those in specialty and primary care settings. We will also discuss the impact of co-morbid psychological disorders on members with chronic medical conditions. Lastly, it will include a pro-and-con discussion of mental health parity benefits.
Melek is a principal and consulting actuary with the Denver office of
Milliman. His areas of expertise include healthcare product development, management, and financial analyses.
He has advised HMOs, PPOs, managed care organizations, behavioral healthcare firms and associations, insurance companies, employers, hospitals, physician groups, PHOs, and state insurance
companies, and has written and published extensively on behavioral healthcare.
10:45–11:30 A.M.
The Insurability Implications of Rx Compliance
Hank George, FALU, CLU, FLMI; Chair, LOMA Health Underwriting Study Group
How does insurance applicant compliance with prescription drugs affect their insurability? Hank just did an educational program on this subject and he will be presenting a cross-section of evidence showing that Rx compliance is one of the cornerstones of assessing morbidity risk based on studies published in the worldwide medical literature.
Hank George, FALU, CLU, FLMI is founder and chair of the Health Underwriting Study as well as President of HGI Inc., a firm that specializes in underwriting education and other resources for risk appraisal. Hank is a 35 year veteran of underwriting, having been with Northwestern Mutual, Manulife, Lincoln Re and ExamOne before starting his own business in 2003. He writes for The National Underwriter and Best’s Review as well as publishing two e-newsletters.
11:30–11:45 A.M.
Morning wrap up/Questions and a few minutes from the lunch sponsor
11:45–1:00 P.M.
Lunch
Sponsored by MIB Solutions, Inc.
1:00–4:30 P.M.
Interactive Discussions |
2:45–3:00 P.M.
Refreshment Break with Exhibitors
Sponsored by Fiserv |
Individual Medical Underwriting
Roundtable discussion of the following Individual Medical Underwriting philosophy issues:
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Eligibility
for coverage
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Use
of preferred pricing/preferred underwriting
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The
current buzz in changes in treatment of medical conditions
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Underwriting
requirements
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Distribution
channel risk quality
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Dietary
supplement underwriting
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Occupational
underwriting for individuals
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Laboratory
trends/genetics
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Prescription
drug underwriting
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Rating/ridering/underwriting-by-deductible
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Pre-ex/misrep
investigations
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Renewal
underwriting
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Claims
feedback/partnering
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"Post
issue" underwriting
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Ancillary
product underwriting
Small Group Underwriting
Small Group Underwriting discussion will address:
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Participation/eligibility
on in-force groups
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Renewal
process
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Renewal
systems
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Renewal
pricing
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Predictive
modeling
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"Post
issue" underwriting
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Special
issues relating to mid-size groups
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Renewal
metrics
Friday, May 16, 2008
7:30–8:30 A.M.
Continental Breakfast
8:30–11:30 A.M.
Interactive Sessions
This morning is devoted to interactive discussion of issues, situations and case studies submitted by the attendees:
9:45–10:00 A.M.
Networking Refreshment Break
11:30 A.M.
Meeting Adjourned
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Thank You to Our 2008
Exhibitors and Sponsors!
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Clinical Reference Laboratory is a leading provider of laboratory testing for the life and health industry and recognized as the industry leader for providing new testing technology. We are committed to providing our clients with innovation in IT services, unparalleled personalize service, better risk selection tools and overnight processing of samples – all focused on providing a competitive advantage to our clients.
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Colibrium Partners is a new breed of consulting partner offering strategic, business and IT solutions and consulting to the insurance industry. Colibrium Partners
leverages Benchmark Requirements, a Benchmark Application and a BPM Insurance Framework to provide sales and service automation solutions. This approach
maximizes the value provided by utilizing ROI based Benchmark Requirements as the starting point, a Benchmark Application to ensure user effectiveness and
adoption and BPM to implement complex business rules rapidly while enabling the business to own and maintain the solution.
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ExamOne, a Quest Diagnostics Subsidiary, is the nation’s leading provider of risk assessment information for the life insurance industry. Our integrated supply chain includes paramedical examinations, laboratory testing, attending physician statements, teleunderwriting and inspections. This integration simplifies the order, status and retrieval of these products, provides one source for all underwriting requirements and accelerates the policy application-to-issue cycle.
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Fiserv is teaming up with hundreds of insurance carriers to align technology with business needs for every insurance process. Our life and health underwriting solution delivers powerful rules-based decisioning and case management. You can make smart decisions in a fraction of the time it takes today.
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Hank George Inc.
(HGI) offers the only independent underwriting education programs in North America for life, health, disability, critical illness and long term care underwriters. We also provide an online pharmaceutical guide with essential information underwriters need to assess the significance of medications used by insurance applicants. As a driving force in teleunderwriting, Hank George, Inc. offers a broad range of services to insurers embracing this revolutionary approach to risk appraisal, worldwide.
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Heritage Labs
provides laboratory testing services for the insurance and financial services industries. As the value provider, we were the first to offer BMI, eGFR and Cotinine Confirmations at no additional cost. As the innovation leader, we’ve long been one of the most automated labs in the country. Heritage Labs is also an FDA-registered manufacturer of medical devices and customized specimen collection kits.
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Ingenix offers a full range of solutions designed to facilitate and streamline the day-to-day workflow. Combined with its Reden & Anders subsidiary - a leading actuarial and underwriting consulting firm - Ingenix provides integrated products, strategic consulting and change management services designed to automate standard processes that reduce costs while driving profitable growth. The company's advanced technologies provide compelling new ways for health plans to generate new business with faster, more accurate quotes, and protect renewal business. More information about Ingenix can be obtained at
http://www.ingenix.com.
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MIB Solutions, Inc.
Undisclosed health conditions on an application can cost your company millions in early, unforeseen claims.
MIB's Checking Service increases underwriting
effectiveness by giving you more complete information to ascertain the risk. Stay competitive, maximize profit, and minimize risk by putting North America’s
largest database of medical conditions on insurance applicants to work. Visit with us at the expo to learn more about the MIB
advantage.
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Milliman
IntelliScript® delivers detailed prescription histories to underwriters' desktops. IntelliScript prescription histories are:
- authorized in advance by the applicant
- delivered online via the Internet within seconds
- designed to uncover critical medical information
IntelliScript is quickly becoming a standard tool to enhance medical underwriting. If you're considering prescription histories, please contact us.
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MRS has over 20 years of experience in providing quality risk assessment and claims investigation information to the life and health insurance industry. Tools include TeleInterviews, TeleUnderwriting, APS retrieval and more. Recently, MRS began offering SAS platforms to manage and automate new business and application flow.
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Realtime Solutions Group provides Realtime STP™ software solutions that can help individual health insurers streamline their new business process. From a robust eApplication with eSignatures to a more efficient rules-based underwriting process, Realtime can help you reduce time to issue and create immediate and sustainable competitive advantage in your sales channels.
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Risk Concepts LLC provides the most comprehensive underwriting manual available for individual health lines. The Risk Concepts Individual Medical manual was
developed by underwriters, for underwriters. The manual includes suggested rating and surcharge actions for thousands of medical conditions. Underwriting
actions are protective, yet designed for maximum rates of issue.
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At RSA
Medical, to strive for exceptional service and to exceed your expectations daily is both a corporate mission and a shared personal belief. We feel a brand is the sum of your experiences with a product or service—the intangible impression you’re left with, created over time. Brands are serious business, and RSA Medical takes its brands as seriously as money in the bank. We protect the value of our brands by delivering superior quality to our customers—every time. We hope this meeting will serve as a window through which you can see into, and better understand, the brand that is RSA Medical. |
For information about Exhibitor
and Sponsorship Opportunities, click here.
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