NOTE.-The above listing of policies issued by form does not contain the policyholders on several forms where no tabulation is made as to age. Records are not maintained by distribution of age within policy form on this type of coverage. 33-420-64-pt. 4A——5 Hon. PAT MCNAMARA, U.S. Senator, U.S. Senate Building, MUTUAL OF OMAHA INSURANCE CO., DEAR SENATOR MCNAMARA: Attached you will find the information which we indicated was not yet available in the answers to the questionnaire which you furnished us. In answer to question No. 5, we have attached representative copies of our advertising. Cordially yours, A. M. HANSEN, Vice President. OMAHA, NEBR., March 19, 1964. Mr. V. J. SKUTT, President, Mutual of Omaha, Benefit Health & Accident Association. DEAR MR.SKUTT: Senator McNamara has asked me to write to you in connection with his letter of March 11. Would you be kind enough to modify the questionnaire to reflect the following changes: Question I, "total policyholders (classified by group and individual)" should read, "total number of different persons insured against items of medical expenseexclusive of holders of disability insurance policies (classified by group and individual)." In question No. VI, where reference is made to policyholders, it should be understood that the intent of the question is to determine persons. That is, if the individual has two or more policies he should not be counted as two policyholders but rather as one person. As a general rule it would be appreciated if you would subtract from all totals those persons who are under age 65 and who are enrolled in one of your "senior security" contracts by virtue of having a spouse age 65 or over. Thank you for your cooperation. Sincerely, JAY B. CONSTANTINE, Staff Director, Subcommittee on Health of the Elderly. MARCH 11, 1964. Mr. V. J. SKUTT, President, Mutual of Omaha, Benefit Health & Accident Association, DEAR MR. SKUTT: As you know, the Subcommittee on Health of the Elderly has announced that it will hold public hearings on the subject of Blue Cross and other private health insurance coverage for older Americans. In connection with the preparations for those hearings Mr. Constantine, of the subcommittee staff, at my direction, has been in touch with your Mr. Chamberlain to discuss certain questions on an informal basis. It would be very much appreciated if you would forward your responses to the attached questions and requests for material as soon as possible. I have asked Mr. Constantine to cooperate fully with you in the event that you desire further clarification of the information requested. At such time as specific dates for the hearings are decided upon, it is our intention to ask you to testify on the efforts of your organization to meet the health insurance needs of our older population. Thank you for your cooperation. Sincerely yours, PAT MCNAMARA, Chairman, Subcommittee on Health of the Elderly. PLEASE PROVIDE INFORMATION AS OF END OF EACH OF LAST 3 CALENDAR YEARS FOR PERSONS AGE 65 AND OVER (EXCEPT WHERE OTHERWISE INDICATED) I. Total policyholders (classified by group and individual). A. Available data (of any type) concerning other health insurance coverage held by your policyholders-commercial and/or Blue Cross. II. Benefits and premiums: A. Policy forms issued, by principal benefits (hospital daily room and board indemnity; allowances for hospital extras; allowances for physicians' services; surgical schedule) noting changes made during each year. B. Monthly premium charged for each type of policy form described in A (please note all changes made during each year). C. Number of policyholders for each policy form described in A. III. Experience: A. Premiums earned by policy form. B. Claims incurred by policy form. IV. Exclusions and limitations (including waiting periods) on conditions covered for each of the policies currently available. V. Copies of all advertising and promotional literature directed toward older people. VI. Underwriting: A. Initial issuance of individual policies—percent rated as impaired risks and comparison with persons under age 65 rated risks. B. Copies of all administrative directives to agents and/or brokers relating to field underwriting of individual policies for 65 and over applicants. C. Underwriting subsequent to policy issuance or filing or payment of claims. 1. Copies of all restrictive riders or waivers employed. 2. Number of riders issued and number of those to whom riders or waivers were issued who received or filed for a benefit. 3. Cancellation and/or number terminated (nonrenewal) by type of policy and indicating how many of these had received a benefit. 4. Copies of administrative directives to claims personnel relative to company policy on cancellation, ridering of policies, non-renewal and rating-up of policies. VI. Attrition: A. Number of policyholders signed up during calendar years 1960, 1961, and 1962. B. Of those who (during the above years) are no longer policyholders, number who are no longer insured for reasons other than death (specify reasons: lapses; terminations; cancellations; etc.) C. Of all those no longer insured (including deaths) how many received a benefit? D. How many were reinstated? A. What are the unique risks involved in underwriting health insurance for the aged and to what extent do you believe these can be met by private health insurance? B. Do you anticipate that premium increases will be necessary on some or all of your policies for the 65 and over population during the next 2 years? Please elaborate, indicating, where appropriate, the percentage increase anticipated and the reasons therefor. APPENDIX B RESPONSES TO SUBCOMMITTEE QUESTIONNAIRES RECEIVED FROM "STATE 65" INSURERS: DEAR SIR: In accordance with the request in your letter of March 10 addressed to the Associated Connecticut Health Insurance Cos. which I acknowledged under date of March 20, I am pleased to enclose herewith a memorandum covering the seven questions forwarded with your letter of March 10, together with the material requested. To the extent that it has been possible and practical to do so, the answers given are full and complete. Sincerely yours, WILLIAM N. SEERY, Chairman, Executive Committee. ANSWERS TO QUESTIONS RECEIVED WITH LETTER OF MARCH 10, 1964, FROM HON. PAT MCNAMARA, U.S. SENATOR, CHAIRMAN, SUBCOMMITTEE ON HEALTH OF THE ELDERLY Question 1. All literature describing benefits and premiums, including scripts and "tearsheets" used in promotion. Answer 1. Herewith are the following items: A. Question and answer leaflet used in connection with open enrollment period. B. Sales folder used in connection with second open enrollment period. C. Sales folder used in connection with third open enrollment period. D. Sales folder currently in use. E. Enrollment booklet provided for each person insured. F. Enrollment booklet amendment effective November 1, 1962. G. Enrollment booklet amendment effective January 1, 1964 (form 651-2). H. Current enrollment booklet for each person becoming insured. I. Copies of newspaper advertisements. J. Copies of scripts for radio and television. Question 2. Total number of different persons enrolled in program from inception to March 1, 1964; total number of persons accepted for coverage during initial "open" period, total number insured immediately prior to and following each of the two subsequent "open" periods; and total number of persons insured as of March 1, 1964 (please break down these data to show subtotals indicating numbers of persons in each of your various coverage options). NOTE. For this and subsequent questions, provide data, to the extent possible, distinguishing between persons age 65 and over and those under age 65. Answer 2. A. The total number of individuals enrolled at any time, up to March 1, 1964, is 35,166. B. The total number of individuals accepted for insurance during the initial open enrollment period was 21,849, broken down as follows: Option 1: (648 under 65). Option 2: (208 under 65). 13, 770 | Option 3: (42 under 65)-- -- 2,225 964 C. The total number insured as of April 1, 1962, preceding the second open enrollment period was 19,848, broken down by option as follows: D. The total number insured as of May 1, 1962, after the second open enrollment period was 25,577, broken down by option as follows: Option 1. Option 2. 17, 153 Option 3. 4, 488 Option 4.. 2, 893 1, 043 E. The total number insured as of October 1, 1962, before the third open enrollment period was 24,581, broken down by option as follows: Option 1.. Option 2.... 16, 552 | Option 3.. 4, 216 Option 4. 2, 801 1, 012 F. The total number insured as of November 1, 1962, after the third open enrollment period was 27,017, broken down by option as follows: G. The total number insured on March 1, 1964, was 25,479, broken down by option as follows: Option 1 (642) Option 2 (141). 18, 076 Option 3 (38) 3, 787 Option 4 (22) 2,720 896 NOTE.-The number of those under 65 as indicated in B and G above is not significant. A count on those under 65 is not available with respect to C, D, E, and F without undue time and expense being involved. Question 3. How many of those persons accepted for coverage during your initial open period were still insured under the program as of March 1, 1964? Answer 3. Of the 21,849 original insured members, there are 15,619 who remain insured, broken down by option as follows: Option 1. 10, 191 Option 3. 1, 510 580 Question 4. What was the average age of the "Connecticut 65" policyholders as of end of your initial enrollment period? What was the average age as of March 1, 1964? Answer 4. The average age of those insured as of October 1, 1961, was 74.6 years. The average age of those insured as of March 1, 1964, was 74.1 years. Question 5. Please provide all data available relating to premiums earned, claims incurred, utilization, etc., for each of the various options and types of coverage. Answer 5. A. The following is the earned premium by option and the incurred claims from October 1, 1961, to March 1, 1964: B. In the period from October 1, 1961, to March 1, 1964, claim payments have been made to 8,670 different individuals. C. The following is a count of 1963 claims broken down by option: Question 6. Please provide the details of any and all premium and/or benefit changes made to date in your program. Answer 6. Amendment effective January 1, 1964 (form 651-2 included as item G with answer 1) covers all premium and/or benefit changes made to date. These include a limitation of $1,000 per calendar year for the "covered" expense of registered graduate nurses under the $10,000 maximum major medical expense benefits and a similar limitation to $750 per calendar year with respect to the $5,000 maximum major medical expense benefits. Premium rates were increased from $10 to $11 for option 1, from $17 to $19 for option 3, and from $14.50 to $15.50 for option 4. For future enrollees a modification was made with respect to benefits in certain instances where medical or surgical care, treatment, diagnosis, or consultation was provided in connection with an injury or sickness during the 90 consecutive days immediately preceding the effective date of coverage. Question 7. Advise whether any premium and/or benefit changes are anticipated or will be required during the next 2 years. Explain fully. |