13/04/2021
There is a post from someone who is very critical of IMG and Kaiser Ultimate Health Builder. The post consisted of 24 questions.
Nakakapagod sagutin, kasi ang ibang questions paulit-ulit and obviously shows he does not understand the solution he so passionately criticizes. He even thought that the K100 plan for a 22 year old is different from a K100 plan for a 50 year old.
This person is an intelligent guy, very knowledgeable in his field. I consider him a valuable resource person in insurance matters. But he was hasty and jumped to conclusions without adequate understanding of the subject matter.
He did raise some good questions.
Here are his 24 questions, plus I added a few more, and I added links to the answers posted in this group. Actually, many of his questions have parts (a), (b), (c), so the actual question count is more like 46.
I'll edit this post as we post more answers to his questions.
Most of the questions are answered in separate posts. but some of the simpler questions I answered inline.
Please LIKE this post, but please do not yet share until we have answers to all the questions.
QUESTIONS About Ultimate Kaiser Health Builder (K-100)
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CQ1. What tests are included in the “Annual Physical Examination Benefits?”
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1509529042436638/
CQ2. What are included in the “Dental Benefits?”
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1512019705520905/
CQ3. What are included in the “Basic Medical Benefits?”
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1514252838630925/
CQ4. Does the plan include both in-patient and out-patient service benefits throughout the 20-year period?
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1569780676411474/
CQ5a. Are the yearly health bonus amounts guaranteed?
CQ5b. If these are not guaranteed, what are the factors that determine the actual amounts to be given?
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1570570402999168/
CQ6a. Among the product features listed is “Longer Health Insurance coverage which is up to 7 years.” Does “health insurance coverage” refer to the APE, dental and basic medical benefits, as well as room & board?
CQ6b. If no, what does it refer to?
CQ6c. If yes, does that mean that after the 7th year the policyholder no longer has these benefits?
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1571960889526786/
CQ7a. How much is the term insurance coverage during accumulation period?
CQ8b. How much is the coverage during the extended period?
CQ7c. How much is the coverage during the long-term care period?
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1572348772821331/
CQ8. Until what age is the long-term care period?
Answer. The long term care period ends when planholder takes out all his money from Kaiser. On maturity, he can take out all the cash value of his plan, and the long term care period ends immediately.
Or if (as recommended), he just takes 10% of annual earnings every year as some sort of "pension" or provision for long term care, his long term care period can last forever ( or realistically, until he passes away). When he passes away, any residual value is transferred to the beneficiary.
CQ9a. Is the ABL during the extended period still P60K per year or does it depend on the total yearly health benefits (health benefit + bonus)?
Answer.
Depends on "health savings account" or sum of yearly health benefit + yearly health bonus + last years total health benefit + interest on last years total health benefit less current year utilization.
CQ9b. In the illustration, the total yearly health benefits at year 8 is P42,981. Will this be the ABL for that year or is it P60K?
Answer.
Value of "health savings account"
CQ9c. And for Year 12 is the ABL P166,117, assuming there were no claims made in the preceding years?
Answer
Yes, assuming projections are correct.
CQ10a. If the policyholder makes a claim of P130,314 at Year 11, is it correct to say that the policyholder’s ABL for Year 12 will only be P22,772?
Answer
Yes, assuming projections are correct.
CQ10b. Continuing from the scenario above, what will the ABL be in Year 13 assuming no further claims were made?
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CQ11a. Is the cost of room and board the only amount charged to the total yearly benefit balance during the extended period?
Answer. Cost of all inpatient and outpatient benefits availed of will be charged against his "health savings account." This includes all doctor fees, procedures, medicines, room and board, etc.
CQ11b. Or will the cost of APE, dental and basic medical benefits also be charged to the total yearly benefit balance during the extended period?
Answer. APE, dental benefits are free only during the first 7 years. If member avails of these benefits during the extended period, the cost is charged against the "health savings account."
CQ12a. How was the P269,750 total accumulated unused health benefit at the end of 20 years derived? The last entry in the row labeled “10% Accumulated Unused Yearly Health Benefits” is only P254,227.
Answer. P254,227 is a typo. The correct number is P245,227. (Nagkabaligtad ang 4 at 5)
For any year, the accumulated yearly health benefit is the previous year, plus 10% (or effiectively, times 1.1) plus the current year's yearly health benefit ( P10,000)
For the previous year, the figure is P213,834.
For the 19th year, the figure is P213,834 * 1.1 + P10,000 = P245,227
For the 20th year, the figure is P245,227 * 1.1 + P10,000 = P269,750
CQ12b. How was the P446,419 additional health benefits at the end of 20 years derived? The last entry in the row labeled “Accumulated yearly bonus” is only P390,398.
Answer. This is a bit more complicated.
For any year, the accumulated yearly health benefit is the previous year, plus 10% (or effiectively, times 1.1) plus the current year's yearly health BONUS.
The yearly health bonus will be computed based on earning of the Kaiser funds reserved for future claims. For projection purposes this is an actuarial computation, which is based on statistics and actuarial data, which "roughly" is 0.8 to 0.9% higher than the previous year.
Accumulated Health Bonus
For the 18th year, the figure is P339,999
For the 19th year, the figure is P339,999 * 1.1 + P16,397 = P390,396
For the 20th year, the figure is P390,396 * 1.1 + P16,983 = P446,419
CQ13a. Since the illustration mentions a 10% accumulation rate, part of the premium must be invested somewhere. Where is the money invested?
Answer. At least 51% of all premiums are treated as provisions for future claims, and invested in various funds.
CQ13b. Is it in an investment fund managed internally by Kaiser, or is it placed in a fund managed by another company?
CQ13c. If it’s another company, which company is this and what is the specific name of the fund?
In 2013, Soldivo Funds was launched, where Kaiser invested at least P100M in the Soldivo Bond Fund, and another P100M in the Soldivo Strategic Growth Fund. As of end 2013, Kaiser owned 80% of each fund, with the remaining 20% owned by Rampver Financials.
Soldivo funds are strengthened by the infusion of additional investments by IMG members.
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CQ14a. Is there a way for the policyholder to independently validate the actual rate of return or will the policyholder just rely on what Kaiser will say as the rate of return? (By way of comparison, an investor in a mutual fund, UITF or VUL can validate the one-year return of the fund by checking the beginning and ending NAVPS or NAVPU which are readily available by the general public.)
CQ14b. If yes, how?
CQ14c. Where can the policyholder check the actual health benefit credited for the year to his plan and the running balance of the health benefits and health bonus?
Answer.
Get a statement of account.
CQ15a. Part of the fine print says: “If floor is 6% there will be no Additional Health Benefits.” What does it mean?
CQ15b. Does it mean that if the actual rate of return is 5% or lower each year during the extended period there will be zero yearly health bonus and the policyholder will only have the yearly health benefits?
CQ15c. And if this is the case, is it correct to say that the policyholder’s total health benefits at the end of 20 years, assuming there are no claims during the extended period, will only be P269,750 instead of P716,169?
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CQ16. Will the P450K long-term care benefit & bonus be given to the policyholder in cash and in full at the end of the 20-year period?
Answer.
It is added to the "health savings account"
CQ17a. If the policyholder makes a single claim during the extended period, say P60K in year 10, will he still get the P450K long-term care benefit & bonus?
Answer.
Yes!
CQ17b. If yes, will he get it in full or will the amount be P450K less all claims made during the extended period?
Answer.
Yes, he gets it in full, credited to the "health savings account."
CQ18a. Can you use the Ultimate Kaiser Health Builder plan to accumulate funds for retirement or college education?
CQ18b. If yes, can the policyholder invest additional amounts on top of the installment amounts? For example, can I add P50,000 every other year from Year 3 to 15?
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1567126386676903/
CQ19a. Can you withdraw an amount from the plan during the accumulation or extended period?
CQ19b. If yes, how much can the policyholder withdraw and will the plan still remain active?
Answer:
19a. Yes, planholder can "withdraw" from the plan during the extended period (years 8-20) through use of health benefits (consultation, outpatient procedures, hospitalization).
Planholder can "withdraw" all or part of the fund during the long term care period (years 21 onwards)
19b. Planholder can "withdraw" the entire balance of his health fund during the extended period, and the plan will still be active. The following year he can still hget yearly health benefits and yearly health bonus. On maturity he can still get the long term care benefit and the long term bonus (if still eligible).
If planholder "withdraws" the entire balance during the long-term care period, the plan is terminated and will have no more residual value.
CQ20. The coverage of the plan is only up to 20 years (age 42 in the illustration). Why is there still an extended benefit balance at age 65?
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1590740560982152/
CQ21a. The video about the Ultimate Kaiser Health Builder plan mentioned that the long-term bonus (equal to 85% of the total premiums) is given on the 20th year ONLY IF no claims were made during the 7-year paying period. Can you confirm if this is correct?
Answer.
Yes, if no HOSPITALIZATION claims were made in the first 7 years.
CQ21b. Does this mean that even if I just avail of one APE or dental prophylaxis during the paying period I will already forfeit the P350K long-term bonus?
No. Free benefits such as APE and dental checkups and simple tooth extractions and minor adjustments are free.
CQ21c. If no, which specific claims during the paying period will result in the forfeiture of the long-term bonus?
Answer
The long term care bonus is forfeited if planholder uses the Kaiser Ultimate hospitalization benefits at least one during the first 7 years. Note that planholder can avail of the maximum hospitalization benefit every year for seven years and still have guaranteed renewal/continuation of the plan.
In some HMOs, it is possible for the plan to be discontinued if with high claims for consecuritve years.
CQ22. To have more clarity on the expected benefits after the 20-year period, here’s a simulated scenario. Assume that the policyholder availed of the service benefits and made the claims below:
Year 1 to 7 – APE, Dental benefits
Year 8 – P50,000 claim
Year 12 – P75,000 claim
Year 17 – P90,000 claim
Can you provide the values at the end of 20 years for the following amounts?
a. total accumulated unused health benefit
b. total additional health benefits
c. long-term care benefit
d. long-term care bonus
Answer. The answer to items a to d are interrelated, so let us have only one answer.
Availment of the free benefits (APE and dental benefits in year 1 to 7) will not affect the cash value/maturity value of the plan. Those benefits are free.
The long term care benefits will be given on maturity regardless of any benefit availment during the 20 years of the plan.
If no hospitalization benefits are claimed in the first seven years, the long term care bonus will be given.
Effectively, the sum of the long term care benefit and the long term are bonus, it the amount of the term insurance. During the 20 years of the plan, if planowner dies, beneficiary wlll get this amount. If planholder lives long enough to plan maturity, planholder (not beneficiary) gets this same amount (long term care benefit and long term care bonus)
The total of the accumulated health benefits and accumulated yearly bonus are indistinguishable (let us call this total the "health savings account (HSA) total". At any given time from year 8 to 20, planholder can avail of benefits up to the HSA total. It is this HSA total which earns interest every year, and every year the yearly health benefit and additional health bonus is added.Whatever the total of this compounding computation (net of availments) will be the unused accumulated health benefits component of the maturity value.
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Note. I wonder how many FAs or licensed insurance agents or certified investment solicitor or registered financial planner will be able to correctly answer a similar question:
If in my VUL/invesment fund I withdrew
Year 8 – P50,000
Year 12 – P75,000
Year 17 – P90,000
What will be the value of my investments at the end of 20 years?
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CQ23. Does the contract have a provision which allows the policyholder to cancel and terminate the plan within a certain period (e.g. 10 days from effective date) and get a refund?
Answer
Kaiser allows applicants to cancel within 30 days from filing of application. If application is approved with no insurance benefit, member has the option to withdraw application with full refund.
CQ24a. Are there are other plans besides K-100, like a K-200 or K-300?
CQ24b. It there is a K-200 or K-300 are the benefits 2x or 3x, respectively, of the K-100 plan?
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1567131010009774/
More questions.
1. Is there an FAQ?
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/897378010318414/
2. The illustration of benefits is a mystery. Can you explain?
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1563535043702704/
3. It is a bit confusing. Do the benefits change over time?
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1528144800575062/
4. Is there a need for something like the Kaiser Ultimate Health Builder ?
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1553367654719443/
5. What is the logic behind long term healthcare?
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1036155259774021/
6. What hospitals are accredited by Kaiser?
Answer: https://www.facebook.com/groups/KaiserIMGTalk/permalink/1512020698854139/
7. What should I learn about Kaiser Ultimate?
Answer: You can read between the lines and read:
https://www.facebook.com/groups/KaiserIMGTalk/permalink/1525169950872547/
Please LIKE this post, but please do not yet share until we have answers to all the questions.
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