Other Services
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Doctor to Doctor interview with Attending PhysiciansAn attending physician statement (APS) is one of the most frequently used sources of medical background information when evaluating an insurance application. It can be the more expensive and time consuming underwriting requirement, as it may take weeks or even months to be obtained by traditional methods, causing the underwriting process time to be severely delayed. When the Chief Underwriter or the Medical Director deem adequate to have a Doctor to Doctor phone interview ON THE RIGHT THING is the solution because domestic and foreign Attending Physicians are easily available to take our Physicians’ phone calls. As many medical conditions require supporting evidence from the doctor, before ending the interview, we always request a written statement of our conversation. We can also summarize extensive and laborious APS’s and medical records, transforming a pile of documents into powerful structured information.
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Obtaining Foreign
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Medical Records TRANSCRIPTION AND TRANSLATION
ON THE RIGHT THING certified translators take care of all your medical records translation needs for or into English, Spanish and Portuguese, including but not limited to, medical records, policies, applications, forms and all kinds of life and health insurance related legal documents. Additionally our team offers their unique transcription service, as we realized that handwritten medical or legal documents sometimes are useless even for the translator if they are not previously typed into a readable text. Call ON THE RIGHT THING, the experts in Life and Health documents transcriptions and translations.
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UW Consulting for product design and implementationWe offer a comparative study of the main domestic or international life, health or disability insurers’ policies. Identifying the pros and cons of each policy to create a life, health or disability policy able to successfully compete in this tough market. Develop applications, medical and non-medical forms and questionnaires required to accurately collect the required information to handle the underwriting and claims functions. We’ll also coach your Marketing and Sales personnel in implementation of your new policy, and will be available for ongoing training for your producers.
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Claim InvestigationON THE RIGHT THING has standardized three types of death claims investigations in a progressive manner:
1. Death confirmation is the type of investigation most frequently performed, and here the areas of investigation include determining the claimant’s age and gender, proper identification and cause of death. 2. Identification of the Claimant is confirmed through interviews with relatives, friends, co-workers and neighbors, and is supported with public documents. Other elements can be used to verify the identity, including matching social security numbers, checking criss-cross directories and comparing physical descriptions from public documents. Additional investigative techniques may include fingerprints and skeletal examination, visual inspection of scars, moles and tattoos, inspection of the deceased’s personal effects and clothing, dental records, family’s photographs and videos. 3. Determine cause of death is important because some policies will decline benefits in case of suicide or when death resulted from the deceased’s participation in a crime or hazardous sports or avocations, such as aviation. As well as accidental death coverage will provide benefits only in the event of accidental death. Despite this standardization, the process starts with the application being investigated for misstatements if the claim is contestable. Some of the resources we commonly use in our investigations are interviewing the beneficiary and simultaneously obtaining his authorization to release medical and police records, neighborhood sources as they may help to verify identity, age and gender of the deceased, and might provide useful information about the death; Medical records, credit reports, court and vital statistics office’s records, signed statements from witnesses, newspaper articles and other insurer investigations. |
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Actuarial ServicesWe provide a comprehensive analysis of the proposed insurance premiums based on current rates of disability, morbidity, mortality, fertility and other contingencies among our target market, either the United States or any other country or region of the world, focused in our target population, as in the case of the Latin American elite population, which is different from the general Latin American population.
The effects of consumer choice and the geographical distribution of the utilization of medical services and procedures inside and outside their country of residence, and the utilization of drugs and therapies, lifestyles and avocations in our target market. This will ensure you collect an insurance premium that is attractive to the market and will adequately cover the cost of the benefits provided by the company. |
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TrainingON THE RIGHT THING provides training and guidance for insurance professionals to master the skills required to successfuly accomplish their ultimate goal of having an application turned into a policy.
Training may be required when you are considering to enter in a new market, or in a new line of insurance products, as it happens when health insurance experts are exploring opportunities in the life or health insurance field. The training program will be designed according to specific goals and needs of individuals or companies. Our experts will also assist you in designing your own internal training program and provide on-going coaching |
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MIB AuditsWe provide a comprehensive analysis of the proposed insurance premiums based on current rates of disability, morbidity, mortality, fertility and other contingencies among our target market, either the United States or any other country or region of the world, focused in our target population, as in the case of the Latin American elite population, which is different from the general Latin American population.
The effects of consumer choice and the geographical distribution of the utilization of medical services and procedures inside and outside their country of residence, and the utilization of drugs and therapies, lifestyles and avocations in our target market. This will ensure you collect an insurance premium that is attractive to the market and will adequately cover the cost of the benefits provided by the company. |
Compliance
We provide a comprehensive analysis of the proposed insurance premiums based on current rates of disability, morbidity, mortality, fertility and other contingencies among our target market, either the United States or any other country or region of the world, focused in our target population, as in the case of the Latin American elite population, which is different from the general Latin American population.
The effects of consumer choice and the geographical distribution of the utilization of medical services and procedures inside and outside their country of residence, and the utilization of drugs and therapies, lifestyles and avocations in our target market. This will ensure you collect an insurance premium that is attractive to the market and will adequately cover the cost of the benefits provided by the company.
The effects of consumer choice and the geographical distribution of the utilization of medical services and procedures inside and outside their country of residence, and the utilization of drugs and therapies, lifestyles and avocations in our target market. This will ensure you collect an insurance premium that is attractive to the market and will adequately cover the cost of the benefits provided by the company.
Genetic Information Non-Discriminatory Act (GINA)
Its Potential Impact on Individual Health Insurance Underwriting
GINA was enacted in May 2008 and it became effective on May 21, 2009 for health insurers that underwrite individual medical insurance (excluding life, LTC, DI and critical illness/specified disease). For group health plans and group health insurers, and entities that are already compliant with ERISA and HIPAA, GINA may have little impact on their procedures and operations. For health insurers that have never used genetic testing in underwriting, this may also be true. However, the most pronounced change to be experienced by health plans and insurers may be in GINA’s prohibition on the use of family history in underwriting individual health insurance.
Its Potential Impact on Individual Health Insurance Underwriting
GINA was enacted in May 2008 and it became effective on May 21, 2009 for health insurers that underwrite individual medical insurance (excluding life, LTC, DI and critical illness/specified disease). For group health plans and group health insurers, and entities that are already compliant with ERISA and HIPAA, GINA may have little impact on their procedures and operations. For health insurers that have never used genetic testing in underwriting, this may also be true. However, the most pronounced change to be experienced by health plans and insurers may be in GINA’s prohibition on the use of family history in underwriting individual health insurance.
The Genetic Information Nondiscrimination Act of 2008 (GINA) was enacted on May 21, 2008 to prohibit discrimination in health coverage based on genetic information.
In the individual market, health insurance issuers are prohibited from using genetic information to determine individual eligibility or premium rates, although they are allowed to use information about the manifestation of a disease or disorder to determine eligibility or premium rates for an individual. Individual market health insurance issuers are also prohibited from using genetic information in imposing a pre-existing condition exclusion, although a manifestation of a disease or disorder in an individual can be the basis for an exclusion. In the Medicare Supplement market, GINA prohibits issuers from denying or conditioning the issuance or effectiveness of a policy (including the imposition of any exclusion of benefits based on a preexisting condition) or discriminating in the pricing of the policy based on an individual's genetic condition. However, if otherwise permitted under section 1882 of the Social Security Act, the issuer can still impose such limitations based on a manifested disease of an individual who is covered or would be covered under the policy. GINA also prohibits group health plans and health insurance issuers in the group, individual, and Med Supp markets from requesting or requiring an individual or family member of an individual to undergo a genetic test. Plans and issuers are not precluded from obtaining and using the results of a genetic test to make a determination regarding payment, but they may only use the minimum amount of information necessary. Health plans and health insurance issuers in the group, individual, and Medicare Supplement markets are prohibited from requesting, requiring, or purchasing genetic information for underwriting purposes or prior to an individual's enrollment under a plan or policy. Plans and issuers are still allowed to collect (that is, to request, require, or purchase) health information that relates to the manifestation of a disease or disorder of an individual enrolled in a plan or who is covered by or would be covered by a policy issued in the individual or Med Supp market, and use it for permitted underwriting purposes with respect to that individual. Furthermore, an exception to the prohibition on requesting, requiring, or purchasing genetic information is included for collection of genetic information which is incidental to the request, requirement, or purchase of other information concerning an individual, provided it is not used for underwriting purposes. GINA defines genetic information as information about that individual's genetic tests, the genetic tests of family members of the individual, and the manifestation of a disease or disorder in family members of the individual. The term genetic information also includes an individual's request for, or receipt of, genetic services, but does not include information about the sex or age of any individual. Genetic services are further defined as a genetic test, genetic counseling (which includes obtaining, interpreting, or assessing genetic information), or genetic education. A genetic test is defined for purposes of Title I of GINA as an analysis of human DNA, RNA, chromosomes, proteins, or metabolites that detects genotypes, mutations, or chromosomal changes. The term is not meant to include an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes, or an analysis of proteins or metabolites that is directly related to a manifested disease, disorder, or pathological condition that a health care professional with appropriate training and expertise could reasonably detect. Definitions of family member and underwriting purposes are also included, as well as provisions clarifying that references to genetic information concerning an individual include the genetic information of a fetus carried by a pregnant woman and of an embryo legally held by an individual utilizing an assisted reproductive technology.
For health insurance issuers in the individual market, the provisions of GINA are effective with respect to health insurance coverage sold, issued, renewed, in effect, or operated in the individual market after May 21, 2009.
Key Points on GINA:
Application - GINA applies to all group health plans and health insurers, except that it does not apply to life insurance, long-term care, disability or specified disease/illness insurance1. The effective date is by May 21, 2009 (Med Supp is July 1, 2009).
Applicability to the individual health insurance market - A health insurer offering individual health insurance coverage is prohibited from establishing rules for eligibility (including continued eligibility) of any individual on the basis of genetic information (unless eligibility is based on the manifestation of a disease or disorder in that individual). Further, health insurance issuers in the individual market are prohibited from setting premium rates or creating preexisting condition exclusions on the basis of genetic information unless the rates or preexisting condition exclusions are made on the basis of a manifestation of a disease or disorder.
GINA covers “genetic information” of an individual and the “genetic information” of family members.
GINA does not cover an individual's manifested disease or condition-a condition from which an individual is experiencing symptoms, being treated for, or that has been diagnosed. No discrimination in premiums based on genetic information - GINA prohibits health plans and insurers issuing group, individual and Medicare supplemental policies from adjusting premiums or contribution amounts, or discriminating in premiums based on predictive genetic information.
Limitations on genetic testing - Health insurers are barred from requesting or requiring an individual or family member to undergo a genetic test (except when obtaining or using the results of a genetic test in making a payment determination – see below).
Prohibition on collection of genetic information - Genetic information may not be collected (requested, required or purchased) for underwriting purposes. Health plans may obtain the results of genetic tests without violating GINA for payment purposes or research (subject to restrictions) or if the genetic information is collected incidentally.
GINA Definitions:
Genetic test – an analysis of human DNA, RNA, chromosomes, proteins, or metabolites that detects genotypes, mutations, or chromosomal changes – Exception: An analysis that does not detect genotypes, mutations, or chromosomal changes or is directly related to a manifested disease, disorder, or pathological condition is not a genetic test. Examples of protected tests are:
Tests for BRCA1/BRCA2 (breast cancer) or HNPCC (colon cancer) mutations
Classifications of genetic properties of an existing tumor to help determine therapy
Tests for Huntington’s disease mutations
Carrier screening for disorders such as cystic fibrosis, sickle cell anemia, spinal muscular atrophy, and the fragile X syndrome
Genetic information - information about an individual’s genetic tests, the genetic tests of family members, and the manifestation of a disease or disorder in family members of such individual; genetic information includes any information respecting the request for, or receipt of, genetic services or participation in clinical genetic research by an individual or any family member. “Genetic information” does not include information about sex or age.
Underwriting purposes - rules for, or determination of, eligibility (including enrollment and continued eligibility) for benefits under the plan or coverage - the computation of premium or contribution amounts under the plan of coverage - the application of any pre-existing condition exclusion under the plan or coverage - and other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits.
Family member – broadly defined to mean a dependent and any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of such individual as follows: • First-degree relatives: parents and siblings • Second-degree relatives: grandparents, grandchildren, aunts, uncles • Third-degree relatives: great-grandparents, first cousins, great-aunts and great-uncles. • Fourth-degree relatives: great-great grandparents, first cousins once removed.
What GINA Does NOT Do:
- Does not prevent health care providers from requesting genetic tests of their patients
- Does not mandate health insurance coverage for any particular test or treatment
- Does not prohibit medical underwriting based on current health status, when based on the manifestation of a disease or disorder in that individual, for establishing rules for eligibility (including continued eligibility), and setting premium rates or creating preexisting condition exclusions
- Does not cover life, disability, long-term-care or specified disease/critical illness insurance markets
Post Diagnosis, GINA Does Not Apply. GINA and similar state laws only apply to asymptomatic individuals. Once the individual is diagnosed with colon cancer, he or she is now in the same boat as anyone else who has a serious health condition and applies for renewal of the policy. Whether the insurer is legally allowed to raise premiums or decline to renew the policy depends on state insurance law. In virtually every state, the insurer is given wide leeway to either cancel the policy or to increase the rates. A few states have guaranteed reissue provisions, but that's very unusual.
See the entire document at: http://mib.com/html/compliance.html using the following:
Username: membercontent
Password: MIB4compliance
HIPAA
ERISA
In the individual market, health insurance issuers are prohibited from using genetic information to determine individual eligibility or premium rates, although they are allowed to use information about the manifestation of a disease or disorder to determine eligibility or premium rates for an individual. Individual market health insurance issuers are also prohibited from using genetic information in imposing a pre-existing condition exclusion, although a manifestation of a disease or disorder in an individual can be the basis for an exclusion. In the Medicare Supplement market, GINA prohibits issuers from denying or conditioning the issuance or effectiveness of a policy (including the imposition of any exclusion of benefits based on a preexisting condition) or discriminating in the pricing of the policy based on an individual's genetic condition. However, if otherwise permitted under section 1882 of the Social Security Act, the issuer can still impose such limitations based on a manifested disease of an individual who is covered or would be covered under the policy. GINA also prohibits group health plans and health insurance issuers in the group, individual, and Med Supp markets from requesting or requiring an individual or family member of an individual to undergo a genetic test. Plans and issuers are not precluded from obtaining and using the results of a genetic test to make a determination regarding payment, but they may only use the minimum amount of information necessary. Health plans and health insurance issuers in the group, individual, and Medicare Supplement markets are prohibited from requesting, requiring, or purchasing genetic information for underwriting purposes or prior to an individual's enrollment under a plan or policy. Plans and issuers are still allowed to collect (that is, to request, require, or purchase) health information that relates to the manifestation of a disease or disorder of an individual enrolled in a plan or who is covered by or would be covered by a policy issued in the individual or Med Supp market, and use it for permitted underwriting purposes with respect to that individual. Furthermore, an exception to the prohibition on requesting, requiring, or purchasing genetic information is included for collection of genetic information which is incidental to the request, requirement, or purchase of other information concerning an individual, provided it is not used for underwriting purposes. GINA defines genetic information as information about that individual's genetic tests, the genetic tests of family members of the individual, and the manifestation of a disease or disorder in family members of the individual. The term genetic information also includes an individual's request for, or receipt of, genetic services, but does not include information about the sex or age of any individual. Genetic services are further defined as a genetic test, genetic counseling (which includes obtaining, interpreting, or assessing genetic information), or genetic education. A genetic test is defined for purposes of Title I of GINA as an analysis of human DNA, RNA, chromosomes, proteins, or metabolites that detects genotypes, mutations, or chromosomal changes. The term is not meant to include an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes, or an analysis of proteins or metabolites that is directly related to a manifested disease, disorder, or pathological condition that a health care professional with appropriate training and expertise could reasonably detect. Definitions of family member and underwriting purposes are also included, as well as provisions clarifying that references to genetic information concerning an individual include the genetic information of a fetus carried by a pregnant woman and of an embryo legally held by an individual utilizing an assisted reproductive technology.
For health insurance issuers in the individual market, the provisions of GINA are effective with respect to health insurance coverage sold, issued, renewed, in effect, or operated in the individual market after May 21, 2009.
Key Points on GINA:
Application - GINA applies to all group health plans and health insurers, except that it does not apply to life insurance, long-term care, disability or specified disease/illness insurance1. The effective date is by May 21, 2009 (Med Supp is July 1, 2009).
Applicability to the individual health insurance market - A health insurer offering individual health insurance coverage is prohibited from establishing rules for eligibility (including continued eligibility) of any individual on the basis of genetic information (unless eligibility is based on the manifestation of a disease or disorder in that individual). Further, health insurance issuers in the individual market are prohibited from setting premium rates or creating preexisting condition exclusions on the basis of genetic information unless the rates or preexisting condition exclusions are made on the basis of a manifestation of a disease or disorder.
GINA covers “genetic information” of an individual and the “genetic information” of family members.
GINA does not cover an individual's manifested disease or condition-a condition from which an individual is experiencing symptoms, being treated for, or that has been diagnosed. No discrimination in premiums based on genetic information - GINA prohibits health plans and insurers issuing group, individual and Medicare supplemental policies from adjusting premiums or contribution amounts, or discriminating in premiums based on predictive genetic information.
Limitations on genetic testing - Health insurers are barred from requesting or requiring an individual or family member to undergo a genetic test (except when obtaining or using the results of a genetic test in making a payment determination – see below).
Prohibition on collection of genetic information - Genetic information may not be collected (requested, required or purchased) for underwriting purposes. Health plans may obtain the results of genetic tests without violating GINA for payment purposes or research (subject to restrictions) or if the genetic information is collected incidentally.
GINA Definitions:
Genetic test – an analysis of human DNA, RNA, chromosomes, proteins, or metabolites that detects genotypes, mutations, or chromosomal changes – Exception: An analysis that does not detect genotypes, mutations, or chromosomal changes or is directly related to a manifested disease, disorder, or pathological condition is not a genetic test. Examples of protected tests are:
Tests for BRCA1/BRCA2 (breast cancer) or HNPCC (colon cancer) mutations
Classifications of genetic properties of an existing tumor to help determine therapy
Tests for Huntington’s disease mutations
Carrier screening for disorders such as cystic fibrosis, sickle cell anemia, spinal muscular atrophy, and the fragile X syndrome
Genetic information - information about an individual’s genetic tests, the genetic tests of family members, and the manifestation of a disease or disorder in family members of such individual; genetic information includes any information respecting the request for, or receipt of, genetic services or participation in clinical genetic research by an individual or any family member. “Genetic information” does not include information about sex or age.
Underwriting purposes - rules for, or determination of, eligibility (including enrollment and continued eligibility) for benefits under the plan or coverage - the computation of premium or contribution amounts under the plan of coverage - the application of any pre-existing condition exclusion under the plan or coverage - and other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits.
Family member – broadly defined to mean a dependent and any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of such individual as follows: • First-degree relatives: parents and siblings • Second-degree relatives: grandparents, grandchildren, aunts, uncles • Third-degree relatives: great-grandparents, first cousins, great-aunts and great-uncles. • Fourth-degree relatives: great-great grandparents, first cousins once removed.
What GINA Does NOT Do:
- Does not prevent health care providers from requesting genetic tests of their patients
- Does not mandate health insurance coverage for any particular test or treatment
- Does not prohibit medical underwriting based on current health status, when based on the manifestation of a disease or disorder in that individual, for establishing rules for eligibility (including continued eligibility), and setting premium rates or creating preexisting condition exclusions
- Does not cover life, disability, long-term-care or specified disease/critical illness insurance markets
Post Diagnosis, GINA Does Not Apply. GINA and similar state laws only apply to asymptomatic individuals. Once the individual is diagnosed with colon cancer, he or she is now in the same boat as anyone else who has a serious health condition and applies for renewal of the policy. Whether the insurer is legally allowed to raise premiums or decline to renew the policy depends on state insurance law. In virtually every state, the insurer is given wide leeway to either cancel the policy or to increase the rates. A few states have guaranteed reissue provisions, but that's very unusual.
See the entire document at: http://mib.com/html/compliance.html using the following:
Username: membercontent
Password: MIB4compliance
HIPAA
ERISA
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