Broker Guide

Updated March 2011

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

Important Contact Information

By Golden Rule Insurance Company, a UnitedHealthcare Company
UnitedHealthOne is the brand name of the UnitedHealthcare family of companies that offer individual and family health insurance products. Golden Rule Insurance Company is the underwriter and administrator of these plans. UnitedHealthcare is an operating division within UnitedHealth Group, the largest single health carrier in the United States. UnitedHealthcare provides a full spectrum of consumer-oriented health benefits plans and services to individuals, public sector employers, and businesses of all sizes, including more than half of the Fortune 100 companies.

UnitedHealthcare Choice Plus network Big Network & Big Savings

Available across the country. Over 5,200 hospitals. Over 700,000 physicians. Network discounts of up to 50%!1

Broker Contact Information

Broker Service center:

Client Contact Information (800) 657-8205

cuStomer Service2:

(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.

Note: All the information in this guide is confidential.

Feb 25 2011 09:25:55

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

Premium Cost Higher

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

HigH deductiBLe pLanS Simple-to-Understand Plans Lower Premiums, Higher Deductible

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

SHort term HeaLtH pLanS 1-11 Month Plans

College students Benefit waiting period Medicare gap

Short TermSM Value Short TermSM Plus Short TermSM Copay

Higher Lower Lower

Lower Higher Highest

dentaL pLanS

Best for network dentist

UnitedHealthcare Dental PremierSM UnitedHealthcare Dental ValueSM

Higher

Best for non-network dentist

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.

Note: All the information in this guide is confidential.

Feb 25 2011 09:25:55

Rules for Eligibility

Foreign Residence and Travel
U.S. citizens that have been overseas for less than 12 months are eligible for coverage. Within the first six months of coverage if an applicant or policyholder intends to travel to a destination where war exists or war is imminent we will not issue coverage. Coverage will not be issued to foreign-born applicants that intend to return to their native country. Individuals that have not been in the United States for 12 consecutive months will not be considered for coverage. (This does not include adopted children.) If your clients travel internationally, International Medical Group (IMG) provides specific coverage and may be reached at (800) 628-4664.

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.

Short term eligibility up to 64 .

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.

How to Prepare for Accurate Quoting and Application Submission

1. Determine clients eligibility by reviewing Rules for Eligibility (page 5). 2. Review the listing of Unacceptable Conditions (pages 7-10). Some conditions present an increased risk we are unwilling to accept. An automatic decline will likely result for any individual with one or more of theses conditions. If surgery is pending or serious ailments exist without a diagnosis, a decline will also likely occur. Everyone has the right to apply for coverage, and clients who appear unacceptable may apply if they choose. 3. Determine accurate height and weight of each applicant. 4. Establish the proper rating class for your client by reviewing our Rate Class Charts and Definitions (pages 11-14). Accurate height and weight for each applicant is important and will drive the rating class of the applicant. Medical conditions, previous insurance, and tobacco use may also be factors in determining your clients rating class and will vary by state. Please utilize the proper state chart.
Quoting and Application Submission Flow Chart

Determine Eligibility

Review Unacceptable Conditions

Determine Height and Weight

Establish Rating Class

5. Complete a Preliminary Evaluation if there are conditions present that could affect underwriting (page 18). 6. Quotes. When quoting through E-Store, several options are available for you. Quoting is easy and fast; simply click on Quoting and Applications. Generate a quote and email it to your client, or you may create and add your client as a new prospect, and then create a quote. You may also email the quote, brochure, and application (page 19). Quotes can be obtained by utilizing E-Store, our software, calling our Broker Service Center, or your broker account executive. 7. Submitting application. Your client may submit their application online. The most efficient application submission is the utilization of our online process. You may submit your clients application by mailing a paper application to us, or faxing a paper application to our New Business department (contact info listed on page 2). 8. Tracking applications. After submission of an application and for 30 days following the final outcome, you may check under New Business. Thirtyone (31) days after issue you may track your business under My Business.

Submit Preliminary Evaluation (if necessary)

Create Quote

Complete and Submit Application

Track Application

Note: All the information in this guide is confidential.

Feb 25 2011 09:25:55

Review Unacceptable Conditions

BACK DISORDERS
Disabled Pending Surgery

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.

Review Unacceptable Conditions Continued

ENDOCRINE
Addisons Disease Adrenal Hyperplasma Diabetes Mellitus (May be able to consider Gestational Diabetes) Discoid Lupus (chronic) (Within 2 years) Hyperinsulinemia Systemic Lupus

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.

Polycystic Kidney Disease Renal Artery Stenosis

*Other kidney problems we can consider: duplication of kidney, born w/o kidney

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

Note: All the information in this guide is confidential.

Feb 25 2011 09:25:55

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

Review Unacceptable Conditions Continued

Huntingtons Chorea Hydrocephalus Multiple Sclerosis Neuropathy Retardation (Severe) Schizophrenia Seizure or Convulsive Disorder (Unknown etiology unless last seizure was a long time ago and current EEGs are normal Usually 2 years) Suicide Attempt (Within 5 years, 2 or more attempts need 10-year clearance Thoughts of suicide 1to 2-year clearance/ideations of suicide 2- to 5-year clearance) Turners Syndrome

SEXUALLY TRANSMITTED DISEASES

AIDS HIV Positive

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

Note: All the information in this guide is confidential.

Feb 25 2011 09:25:55

Rate Class Chart for the Following States

OR CA

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

PREfERRED I & II Height/Weight

Female 74 - 111 77 - 115 80 - 119 83 - 124 86 - 128 89 - 132 92 - 137 95 - 142 98 - 146 101 - 151 105 - 156 108 - 161 111 - 166 115 - 171 118 - 176 122 - 181 125 - 187 129 - 192 132 - 198 136 - 203 140 - 209 144 - 215 148 - 220 151 - 226 155 - 232 159 - 238 164 - 244 168 - 250 172 - 257 176 - 263 180 - 269 Male 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

*States without Preferred I rating classes.

Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.

11

Rate Class Chart for the Following States Continued

Definition of Rating Classes
Preferred I Designed for applicants who fall within the Preferred I and II height and weight guidelines. Additionally, these applicants have been covered by health insurance within the past 63 days. Preferred II Designed for applicants who fall within the Preferred I and II height and weight guidelines and are in good health. These applicants do not have current or prior insurance coverage within the past 63 days. Standard I Designed for applicants whose height and weight place them in the Standard I chart, or applicants with ongoing medical conditions. Standard II Designed for applicants whose height and weight place them in the Standard II chart.

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

Note: All the information in this guide is confidential.

Feb 25 2011 09:25:55

Rate Class Chart for the Following States

OR CA

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

Kansas New Mexico

AZ

NM

TX

LA FL

HI

Preferred Health Class Height/Weight Chart

Height 4 10 4 11 5 0 5 1 5 2 5 3 5 4 5 5 5 6 Male Weight (lbs.) 106-146 109-148 112-151 115-154 117-157 121-160 124-163 128-167 131-171 Female Weight (lbs.) 99-138 100-140 103-143 106-146 108-150 111-153 113-157 116-161 119-165 Height 5 7 5 8 5 9 5 10 5 11 6 0 6 1 6 2 6 3 Male Weight (lbs.) 134-175 138-178 141-184 145-189 149-195 153-202 157-209 161-216 165-224 Female Weight (lbs.) 122-168 125-172 129-176 132-179 136-184 140-189 144-194 148-200 151-205 Height 6 4 6 5 6 6 6 7 6 8 6 9 6 10 6 11 7 0 Male Weight (lbs.) 170-232 174-240 179-248 183-256 187-264 194-272 200-280 206-288 212-296 Female Weight (lbs.) 155-209 160-214 165-219 171-225 177-231 182-236 188-242 194-248 200-255

Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.

13

Rate Class Chart for the Following States Continued

(Kansas and New Mexico)
Definition of Rating Classes
Preferred Designed for applicants who fall in the Preferred height and weight guidelines and are in good health. Standard Designed for applicants whose height and weight place them in the Standard chart or applicants with ongoing medical conditions. Tobacco Those applicants who are currently or have used tobacco products within the last 12 months.

Please note: A rating class may be adjusted depending upon discovery during our underwriting process.

Standard Health Class Height/Weight Chart

Female Height 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 Ages 18 to 45 Standard Acceptable 80-149 82-153 84-155 86-159 88-163 90-168 92-173 94-178 97-182 99-186 102-191 105-196 108-202 111-206 115-212 118-217 121-222 124-230 127-236 130-244 134-250 137-258 141-265 144-273 148-280 152-286 155-295 150-167 154-171 156-176 160-180 164-184 169-189 174-194 179-200 183-205 187-209 192-215 197-220 203-227 207-232 213-239 218-244 223-251 231-258 237-266 245-274 251-282 259-290 266-298 274-306 281-313 287-321 296-328 Age 46 and over Standard Acceptable 80-155 82-159 84-162 86-166 88-170 90-175 92-180 94-185 97-190 99-194 102-199 105-204 108-210 111-215 115-221 118-226 121-232 124-239 127-246 130-254 134-261 137-269 141-276 144-284 148-291 152-298 155-306 156-174 160-178 163-182 167-186 171-190 176-196 181-202 186-207 191-213 195-217 200-223 205-228 211-235 216-241 222-248 227-253 233-260 240-267 247-276 255-284 262-293 270-301 277-309 285-317 292-324 299-333 307-341

Standard Health Class Height/Weight Chart

Male Height 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 Ages 18 to 45 Standard 88-161 90-165 92-169 94-173 96-177 99-182 102-187 104-192 107-198 110-202 113-207 116-212 119-218 122-224 125-230 128-235 132-242 135-248 139-256 143-264 147-272 151-280 155-287 158-295 162-302 166-310 170-317 Acceptable 162-180 166-184 170-188 174-193 178-197 183-203 188-209 193-215 199-220 203-225 208-231 213-236 219-244 225-249 231-257 236-262 243-270 249-277 257-286 265-294 273-303 281-312 288-320 296-328 303-336 311-345 318-253 Age 46 and over Standard 88-174 90-178 92-182 94-186 96-190 99-196 102-202 104-207 107-213 110-217 113-223 116-228 119-235 122-241 125-248 128-253 132-260 135-267 139-276 143-284 147-293 151-301 155-309 158-317 162-324 166-333 170-341 Acceptable 175-186 179-190 183-195 187-200 191-204 197-210 203-216 208-222 214-228 218-232 224-238 229-244 236-252 242-258 249-266 254-272 261-279 268-286 277-296 285-304 294-314 302-322 310-332 318-340 325-349 334-357 342-366

14

Note: All the information in this guide is confidential.

Feb 25 2011 09:25:55

What to Expect From Our Underwriting Process

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*

Rider Non Medical

Increased Deductible, Rx Card

Rider Medical/Avocation

Limited Duration/Indefinite
Decline

Unacceptable Risk or too many riders.

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

*Not available in KS, KY, NM, and NV **On an individual basis

16

Note: All the information in this guide is confidential.

Feb 25 2011 09:25:55

Underwriting Actions Continued

If a client has a condition that increases risk, Golden Rule may issue coverage with a modification rather than decline coverage. Common modifications include:

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

Preliminary Evaluation (Underwriting Guidance)

To assist the application process, we have two options for obtaining underwriting guidance. You may call the broker service center or use our preliminary evaluation form on E-Store. By utilizing our preliminary evaluation, information is transmitted directly to our underwriting team who will review and provide a response to you regarding your applicants eligibility. Go to www.UHOne.com/broker and login. Select Services > Preliminary Evaluation. Click on the Create New Evaluation Form > New Form button. Fill out the form and click submit. Track your evaluation responses from the main evaluation screen. Receive an answer in as little as 2-4 hours.

18

Note: All the information in this guide is confidential.

Feb 25 2011 09:25:55

E-Store Online Quoting and Application System

Please visit our online E-Store at www.UHOne.com/broker.
This site provides a quick and simple approach to quotes, quoting submission, and tracking. In order to use this site, registration is required. 1) Click on Register Now on home page. 2) Your National Producer Number (NPN) is your broker identification number with us. Input that number where required. 3) You will be required to choose a security question and provide an answer for added security. 4) Choose a password and enter where prompted.

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.

Quoting & Application

Instant Quote Applications in Progress Prospect List

My Business
Prospect List My New Business My Existing Business Lapse Notifications Re-Rate Notifications

Licensing & Compensation

Compensation Statements More tools coming...

My Account
Broker Information Security & Admin Settings

Sales Tools & Broker Training

Supplies & Forms Preliminary Evaluation Tool Add Quoting Link to Your Website On Demand Webinars Scheduled Health Webinars

20

Note: All the information in this guide is confidential.

Feb 25 2011 09:25:55

Premium Modes and Payment Information

A minimum of one months premium must accompany an application and will be processed at time of application approval. First year premiums are guaranteed for the first 12 months.* We may adjust the premium rates after the first 12 months. The type of plan, age, and gender of covered persons, type, and levels of benefits, time the coverage has been in force, and their place of residence are factors that may be used in establishing rate classes.

Modes for Initial Payment:

For the premium payment submitted on an electronic application we are able to accept Visa, MasterCard, or Electronic Funds Transfer (EFT) from a checking account as long as authorization is included with the application. For paper applications we can also accept a personal check. Please note that payment will be processed upon issue if paying by EFT, credit or debit card. If paying by personal check, payment will be processed immediately upon receipt of application.

Modes for Ongoing Premium Payment:

eLectronic fundS tranSfer (eft) montHLy Your clients may set up direct automatic payments from their checking or savings accounts. To setup Electronic Funds Transfer (EFT), please include appropriate banking information with the application. Applicants may select the date of the month the payment is transferred to us, however it must be within 10 days after the due date.** If no date is selected, the transfer will automatically occur on the premium due date. Please note that plans set up with Electronic Funds Transfer (EFT) generally stay in force longer due to the automatic payment method. no billing fee is associated with this choice. eLectronic fundS tranSfer (eft) QuarterLy Your clients also have the option to set up EFT on a quarterly basis after their coverage has been issued. Contact Client Services at (800) 657-8205 to change the payment option to quarterly EFT once coverage has been issued. Or go to www.UHOne.com, click on the Customers tab, click on Download Health Insurance Forms, and obtain an EFT authorization form and submit it to us for processing. direct BiLL montHLy or QuarterLy Your clients may elect to have bills mailed to them monthly or quarterly. A bill will be sent two weeks in advance of the premium due date. There is a $10 per paper-mailed-invoice billing fee ($120 annually for monthly direct bill and $40 annually for quarterly bill).

*Subject to address change or benefit change. **TN and TX exception.

Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.

21

Single Payor Options for Multiple Individual Plans

Employer Payor
A single payor may elect to facilitate payment for one or more employees who have personal health insurance policies or certificates. All individuals covered by the Employer Payor agreement may have differing effective dates. Payment options are monthly EFT, quarterly EFT, monthly direct bill and quarterly direct bill. Direct bill payments may be made by business check. Each Individual is paying for their own insurance. The employer is simply facilitating payment. See availability by state on page 25.

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

Yes, only after all policies are issued

- 0 - $10 per policy/certificate per month - N/A Small groups <10

- N/A - N/A - $25 per list bill per month Groups up to 25+, must have at least 2 policies

22

Note: All the information in this guide is confidential.

Feb 25 2011 09:25:55

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.

HIPAA Health Insurance Portability and Accountability Act

In some states we offer HIPAA coverage for your clients. The following criteria must be met in order to qualify*: 1. The client does not have any other health insurance coverage (or it will be involuntarily terminated soon). 2. The client has been insured by creditable coverage (as defined below) for the last 18 months or more with no lapse in coverage of more than 63 days. 3. The clients most recent coverage was under a group health plan (as defined below) , a governmental plan, or a church plan. 4. The clients most recent coverage was not terminated due to nonpayment of premiums, fraud or intentional misrepresentations. 5. The client is not eligible for any coverage under a group health plan (as defined below), Medicare, or Medicaid. 6. The client accepted and exhausted any group continuation of coverage (including COBRA) that was offered

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

* Check specific application packets for state variations.

Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.

23

Frequently Asked Questions

How do I obtain nonresident appointments? You will need to submit an application, a copy of your current resident license, and an appointment fee. Call (800) 474-4467 for assistance or obtain the required forms at www.UHOne.com and click on Brokers. Where do I fax licensing information? Licensing information should be faxed to our Lawrenceville, IL, office at (618) 943-5239. Must I carry Errors and Omissions insurance to be appointed with Golden Rule? No, it is not required, but we reserve the right to require it in the future, and we recommend it for your own protection. How do I obtain current information about Golden Rule plans? Go to www.UHOne.com/broker for the most current information. How do I know if my supplies are current? Get the latest supplies from our E-Store website. If you are still unsure if you have the correct supplies, call us at (800) 474-4467. How do I obtain a preliminary evaluation of a clients insurability? We have an online tool that assists you in determining coverage eligibility. Please refer to page 18. Where do I fax applications? (317) 713-7875 Is premium required with the application? At least one months premium is required with the application. Premium paid by EFT (checking account or credit card) will not be processed until policy is issued. Paper checks will be deposited immediately upon receipt. What are the options for payment? For the first premium payment, Visa, MasterCard, Electronic Funds Transfer (EFT) via E-Store, check, or money order is accepted. For ongoing payments, your clients can setup automatic payments from a checking or savings account each month, or we can bill the client directly on a monthly or quarterly basis. Fees may apply. Why do you offer List Bill and Employer Payor options if an employer cannot pay for premiums? These are simply a convenience for the employer or other third party to aid in collection and submission of employees individual premiums to Golden Rule. See page 22 for more details. How do I keep track of my clients plans once theyre issued? You will find reports on your issued business on E-Store under My Business. What is faCT? FACT is the Federation of American Consumer and Travelers, an independent association. In some states, in order to be eligible, applicants for health plans are required to become members of FACT because they are association group plans. The membership cost varies per month and can be paid with the applicants monthly premium. For this monthly fee the applicant receives consumer and travel discounts from FACT. Visit the FACT website at http://usafact.org to obtain more information.

24

Note: All the information in this guide is confidential.

Feb 25 2011 09:25:55

State Product Availability Chart

PRODUCTS anD PaYMEnT OPTIOnS OffERED In THE fOLLOWInG STaTES
Updated 8/23/10

PRODUCTS

PaYMEnT OPTIOnS

Long Term Health Products Available State

AK AL AR AZ CA CO CT DC DE FL GA IA IL IN KS KY LA MD MI MO MS MT NC ND NE NH NM NV OH OK PA SC SD TN TX UT VA WI WV WY X X X X X X X X X X X X X X X X X X X X X X

Short Term Products Available

X X X X X X X X X X X X X X X X X X X X X X

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

Visit E-Store for current product brochures, applications, and rates

M Benefit can be added to Long Term Health Product S Benefit is a Stand-Alone Product D Benefit can be added to a Dental Stand-Alone Product

Note: All the information 09:25:55 Feb 25 2011 in this guide is confidential.

25

Notes

26

Note: All the information in this guide is confidential.

Feb 25 2011 09:25:55

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

Feb 25 2011 09:25:55