LIMRA’s MarketFacts Publication Features Univita’s Long Term Care Experience

Univita Health, a long term care insurance administrator in the United States, as well as a provider of home-based care management, announced important findings in key claim practices for successfully managing closed blocks of long term care insurance.

In a release, the Company noted:

Their findings are published in the recent issue of LIMRA's MarketFacts Quarterly. In addition to converting more long term care (LTC) insurance closed blocks than any other company in the industry, Univita's LTC division has over 1.4 million LTC policies under management, handling over 1 million claim transactions that pay over $1.4 billion in claims annually. The findings in this study are based on Univita's more than 20 years of research, analysis, and practice in claims and care management, including claims audits of many of the leading insurance companies in the industry.

For a variety of reasons, many insurance companies have exited the LTC market, leaving carriers with closed claims blocks that will be paid out over 30 to 40 years and have huge liabilities associated with them. At the end of 2012, 45 percent of covered lives and approximately 37 percent of premium dollars in the industry were held in closed blocks. Because company resources may be redirected to more viable and growing product lines within a company, closed blocks often have more limited resources to devote to claims adjudication, customer service, system enhancements and compliance. A closed block is also more likely to be comprised of a complex mixture of policy generations with wide variations in contract language - making it more difficult to administer adequately and reliably, especially with respect to benefit eligibility, provider eligibility and claims and care management.

Maintaining profitability, mitigating avoidable losses, and complying with regulatory requirements are major concerns for all carriers, but especially for those with closed blocks. This is even more apparent as it has become difficult to obtain rate increases even if a carrier can show a need for the increase based on claims experience.

This is where best practices in claims management can make a significant difference to the performance of a closed block. Critical practices include accurate benefit eligibility decisions, managing the plan of care, accurately assessing for cognition, staying engaged with claimants and families to monitor and encourage recovery, providing meaningful and appropriate care management, and conducting periodic claim audits to compare actual protocols to best practices.

The article demonstrates the importance of carriers continuing to invest in claim practices, personnel, systems and compliance efforts to ensure that their closed LTC insurance blocks are performing as effectively and efficiently as possible.

Authors of this report include Univita's Angela Forsell, Dr. Stephen Holland and Eileen Tell. Angela Forsell is Vice President, Clinical Services, for Univita Health. She has more than 35 years of experience in claims and care management with an emphasis on LTC. Stephen K. Holland, M.D., serves as Chief Medical Officer for Univita Health. He contributes more than 25 years of LTC and managed care leadership experience. Eileen J. Tell is Senior Vice President, Product Development and Analytic Services for Univita Health. She has nearly 30 years of experience as an industry leader in LTC policy, research and consumer education.

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