1 Trends in the Disability Market Chris Jerome Vice President, Group Underwriting Operations March 21, 2006

2 Trends in Disability Market Disability Costs Cyclical and Non-Cyclical Cost Drivers Workforce Implications of Non-Cyclical Factors Implications for Our Market Key Questions to Consider

3 Overview of the Current Disability Industry Many external factors have been working against the health of the disability industry… Disability Aging Interest Rates Economic Factors Other Risk Factors All providers impacted by above trends…..

4 Between 1990 and 2000, the median age of the US “working age” population increased from 40 to 42 and it will continue to rise Changes in Risk Dynamic - Aging Source: US Census Bureau. Statistical Abstract of the US: 2006, Section I, Table 12 The largest proportional increase came from the age bracket, as the “baby boomers” continue aging

5 Changes in Risk Dynamic Source: UnumProvident Rate Basis The population and workforce are aging Impact of aging along the disability curve can be steep – cost increases of 4 – 8% per age year are common. Source: UnumProvident LTD Block UnumProvident block and new sales have been aging by 4-6 months each year

6 Interest Rates Declining rates impact new money invested, and therefore Net Investment Income as well as reserves Source: Federal Reserve Board: H15 Interest has a direct and significant impact on cost (100bp shift requires approximately 4% shift in rates) Interest rates affect all players and all sizes and segments of cases

7 Disability Incidence and Economic Recessions Submitted incidence increased more steeply, initially, in the most recent recession. Now 4 years later, it continues to exhibit a similar pattern as observed in recession. Submitted incidence continued to climb long after the recessions officially ended. In 1990–1991 recession, ending in March 1991, incidence reached its peak 19 quarters later. Source: UnumProvident LTD Block Qtr End of Recession The horizontal axis above is quarters since the recession with 0 being the end of the recession.

8 Other Risk Factor Trends OBESITY - Nationwide % overweight, measured by BMI Prevalence of obesity has increased over the last several years Over past decade there has been a tenfold increase in the incidence of STD claims attributed to obesity Growing body of scientific evidence demonstrating significant associations between obesity and other chronic diseases (e.g. diabetes, stroke, hypertension, etc.)

9 Change in Disability Deaths While aging is currently a secular trend impacting disability costs for US private insurers, due to the demographic profile of US employees, other secular costs such as disability death rates also affect disability cost. The actual rates of disability death in recent years have been relatively stable; however, in the early 1990’s the disability death rates were declining. Source: UnumProvident LTD Block

10 Disability Costs Summary Costs Are rising –Interest rates –Economy –Obesity –Aging –Even mortality Which are cyclical? What are workforce implications of non-cyclical? All contributing to higher disability costs

11 Work Force Dynamics

Source: Employment Policy Foundation analysis and projections of Census/BLS and BEA data. Millions of People Expected Labor Force and Labor Force Demand Palpable by the End of This Decade A Growing Shortage of Workers in the US: 12

13 Age of Workers Percent Growth in U.S. Population by Age: Dramatically Different Patterns of Growth by Age 1.Declining number of mid-career workers 2.Few younger workers entering the work force 3.Rapid growth in the over-55 workforce Source: US Census Bureau International Data Base

14... Continuing for Our Working Lives! Age of Workers Percent Growth in U.S. Workforce by Age: Source: US Census Bureau International Data Base

15 Why? Dramatic Increase in Life Expectancy Source: U.S. Social Security Administration Average Life Expectancy at Birth in the U.S.

16 Aging, Disability and Healthcare Costs Patterns & Trends

17 Median age of employed population by selected industry Source: 2003 Current Population Survey, U.S. Department of Labor

18 Distribution of short (STD) and long (LTD) term disability by age Source: UnumProvident Disability Database,

19 Risk dynamics-STD duration of lost time by age group Source: UnumProvident Disability Database,

20 Risk dynamics-STD by major impairment category Source: UnumProvident Disability Database,

21 Risk Dynamics-STD lost days by selected impairments Source: UnumProvident Disability Database,

22 Ambiguous Impairments Ambiguous Impairments High Scores Prevalence = % of ee’s reporting condition Prevalence = % of ee’s reporting condition Medical Conditions & Productivity Connections

23 Healthcare costs by age x risk Source: Musich, McDonald, Hirschland, Edington, Disease Managements & Health Outcomes 2002; 10(4): ; University of Michigan Health Management Research Center. Used with permission. Dee Edington, Ph.D. University of Michigan, Ann Arbor, Michigan

24 Implications for Benefits Design Productivity Increasing need for Disease/”Condition” Management Aging Increasing incidence, duration cost pressures Cost pressures Increasing Medical costs Ancillary Benefits?? Decision Pressure Shift from Employer to Employee funding +?

25 What base level of ancillary benefits will employers fund? What design will “stabilize” employer costs? What gaps will remain for employees? How will employees choose what to add? What will employees consider understandable? What will employees consider affordable? Things to Consider

26 Critical Illness LTC Medical Dental STD IIP LTD Generally Er Funded Choices made by Er Old ChoicesNew Approach? Consumer Choice Disease Mgmt. Medical Vision Dental LTD IIP Greater Employee Responsibility Reduced Employer Funding Longer EPs for disability Higher co-pays if “unmanaged Greater Need for support service Greater Need for asset consideration HSA HRA Co-pay STD