Transcript Personal Cancer Indemnity (PCI)

Personal Cancer Indemnity
Field Sales Guide
• M-1071
• Standard information only.
• Refer to state-specific introduction package for variations.
• Page numbers on slide match those in book.
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Personal Cancer Indemnity
Introduction
Cancer Facts
In the United States:
• Men: 1-in-2 lifetime risk of developing cancer.
• Women: 1-in-3 risk.
• Regular screening exams could increase survival rate.
Page 15–16
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Personal Cancer Indemnity
Why AFLAC’s PCI?
• Out-of-pocket costs (copayments and deductibles).
• Additional expenses not necessarily covered by major medical.
• Wellness Benefit promotes early detection!
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Personal Cancer Indemnity
Policy Provisions
Important Provisions
• 30-day waiting period.
• Effective date.
• Diagnosis date.
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Personal Cancer Indemnity
Policy Benefits
PCI Highlights
• All benefits are indemnity.
• Three distinct plan levels.
• Simplified application process.
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Personal Cancer Indemnity
Cancer Screening Wellness Benefit
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Mammogram
Breast Ultrasound
Pap Smear
ThinPrep
Biopsy
Flexible Sigmoidoscopy
Hemocult Stool Specimen
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CEA
CA 125
PSA
Thermography
Colonoscopy
Virtual Colonoscopy
Chest X-ray
Payable once per person per calendar year
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Personal Cancer Indemnity
First-Occurrence Benefit
• One-time payment made upon the diagnosis of internal cancer:
Level 1
Level 2
Level 3
Insured/Spouse
$1,500
$2,000
$5,000
Child
$2,250
$3,000
$7,500
• Internal cancer includes melanomas classified as Clark’s Level III and
higher or a Breslow measurement (thickness) greater than 1.5 mm.
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Personal Cancer Indemnity
Hospital Confinement
Benefit
• Level 1:
$200 days 1–30
$400 days 31+
• Levels 2 & 3: $300 days 1–30
$600 days 31+
Medical Imaging
Benefit
• Pays for initial diagnosis or
follow-up evaluation of internal
cancer.
• Level 1
$100
• Level 2
$150
• Level 3
$200
• Once per person per year
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Personal Cancer Indemnity
Radiation and
Chemotherapy Benefit
Anti-Nausea Benefit
$200/day
• Level 1
$100
• Levels 2 & 3 $300/day
• Level 2
$125
• Radiation Therapy
• Level 3
$150
• Level 1
• Must Be FDA or NCI Approved
• Not Payable Same Day as
Experimental Treatment
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Personal Cancer Indemnity
Experimental Treatment
Benefit
• Level 1
$200/day
Immunotherapy Benefit
• Level 1
$300
– Lifetime maximum $1,500
• Levels 2 & 3 $300/day
• Must be NCI approved
• Level 2
$400
– Lifetime maximum $2,000
• Not payable same day as
Radiation and Chemotherapy
• Level 3
$500
– Lifetime maximum $2,500
• Not payable for medications paid
by R&C or Experimental Benefits
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Personal Cancer Indemnity
Nursing Services Benefit
• Level 1
$100
• Level 2
$125
• Level 3
$150
• Payable only for days when
Hospital Confinement paid
Surgical/Anesthesia
Benefit
• Benefits listed in Schedule of
Operations
• Procedures through same
incision considered one
• Additional 25% paid for
anesthesia
• Excludes skin cancer and
reconstructive surgery
Pages 29–30
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Personal Cancer Indemnity
Outpatient Hospital
Surgical Benefit
• Level 1
$200
• Levels 2 & 3
$300
Skin Cancer Surgery
Benefit
• All Levels:
– Biopsy
$100
– Excision of skin lesion
$100
– Flap or graft
$375
– Excision with flap or graft $600
Pages 30–31
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Personal Cancer Indemnity
Prosthesis Benefit
• Surgically implanted
– Level 1
$2,500
– Level 2
$3,000
– Level 3
$3,000
• Non-surgically implanted
– Level 1
$200
– Level 2
$225
– Level 3
$250
• Lifetime maximum of 2 each
• Not payable for TRAM Flap procedure
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Personal Cancer Indemnity
Reconstructive Surgery Benefit
• TRAM Flap
– Level 1
– Levels 2 & 3
$2,500
$3,000
• Breast Reconstruction
– Level 1
$625
– Levels 2 & 3
$700
• Breast Symmetry
– Level 1
– Levels 2 & 3
• Facial Reconstruction
– Level 1
$625
– Levels 2 & 3
$700
• Additional 25% paid for
anesthesia
$325
$350
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Personal Cancer Indemnity
Blood and Plasma Benefits
Inpatient
During a covered confinement;
benefit is multiplied by the number
of days confined
• Level 1
• Level 2
• Level 3
$50
$100
$150
Outpatient
During outpatient treatment in
physician’s office, clinic, hospital, or
ambulatory surgical center
• Level 1
• Levels 2 & 3
$200
$250
Pages 32–33
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Personal Cancer Indemnity
Second Surgical Opinion
Benefit
• Level 1
• Level 2
• Level 3
$200
$250
$300
• Not payable same day as NCI
Evaluation/ Consultation Benefit
NCI Evaluation/Consult
Benefit
• $500 benefit
• Additional $250
transportation/lodging costs
– If more than 50 miles from
home
• Payable at Aflac Cancer Center
• Not payable same day as Second
Opinion Benefit
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Personal Cancer Indemnity
Ambulance Benefit
Transportation Benefit
• $200 ground
• More than 50 miles from home
• $1,000 air
• Level 1
– Limit
$.40 per mile
$1,200
• Limit 2 trips per confinement
• Levels 2 & 3 $.50 per mile
– Limit
$1,500
• Treatment for dependent child
– 2 adults to accompany child
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Personal Cancer Indemnity
Lodging Benefit
• More than 50 miles from home
– Level 1
$50
– Levels 2 & 3
$60
• Limit of 90 days per year
Transplantation Benefit
• Payable once per person
• Bone Marrow
– $10,000 inpatient/outpatient
– $1,000 for donor
• Stem Cell
– Peripheral stem cell
– Level 1
$2,500
– Levels 2 & 3
$5,000
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Personal Cancer Indemnity
Extended-Care Facility Benefit
• Within 30 days of hospital confinement
• $100 per day for confinement
• Limited to same number of days Hospital Confinement paid
• Not payable on same day as Hospital Confinement
• If extended-care stays separated by 30 days, second stay not
covered unless again confined to hospital
• Limit of 365 days per person
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Personal Cancer Indemnity
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Hospice Benefit
• First day
– Level 1
– Levels 2 & 3
Home Health Care
Benefit
• $50 per visit
$500
$1,000
• Each day thereafter
– All Levels $50
• Not payable same day as Home
Health Care
• Limit of $12,000 per person
• Within 7 days of hospital release
• Authorized by physician
• Licensed/certified person
• Limit
– 10 visits per hospitalization
– 30 visits per year per person
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Personal Cancer Indemnity
Waiver of Premium
Benefit
• Disability for at least 90 days
• Inability to perform usual job
– 2 or more ADLs if unemployed
• Waived if receiving Hospice
Benefits
Continuation of
Coverage Benefit
• Up to two months
– Payroll deduction
– 6 consecutive months
– 30 days notification
– Insured re-establishes
premium payment
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Personal Cancer Indemnity
Optional Riders
Building Benefit Rider
• Increases the FOB by $100
– per unit purchased
• Builds until age 65 or internal
cancer diagnosed
• Issue ages:
– 18–70 payroll
– 18–64 nonpayroll
Return of Premium
Benefit Rider
• Cash value based on AP
• Benefit is less any claims paid,
including Wellness
• Begins after 5 years; maximum
refund at 20 years
• Not eligible as pre-tax or
employer-paid
• Issue ages: 18–59
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Personal Cancer Indemnity
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Specified-Disease Benefit Rider
• Benefits for hospital confinement due to listed diseases
• 10 new diseases added
• Issue ages:
– 18–70 on payroll
– 18–64 on non-payroll
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Personal Cancer Indemnity
Administrative Guidelines
Administrative Guidelines
• Payroll: 18–70
• Eligible for pre-tax
– ROP Rider
• Nonpayroll: 18–64
• Advanced Effective Date
• Available to:
– field force
– government allotment
• Payment Modes
• Domestic Partners
• Dependent children to age 25
• 1099 Workers
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Personal Cancer Indemnity
Completing the Application
Applications and Forms
• Payroll Application
A-75001
• Nonpayroll Application
A-75002
• Payroll Cancer History Form
A-75030P
• Nonpayroll Cancer History Form
A-75030D
• Conversion Application
• Application to Remove Skin Cancer Exclusion Rider A-90030R
Pages 94–111
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Personal Cancer Indemnity
Direct on SmartApp®
Direct on SmartApp®
Bank Draft Authorization
• Bank draft and credit card only
• Transit/ABA and account numbers
• Drafted immediately
• Separate BDA for each application
• Effective date
• Draft date
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Personal Cancer Indemnity
Sales Support Material
Sales Support Materials
• Brochures
– A-75175 Level 1
– A-75275 Level 2
– A-75375 Level 3
• Insert Pages
– A-75075 Building Benefit Rider
– A-75076 Return of Premium Rider
– A-75077 Specified-Disease Rider
– A-59276 NCI-Designated Cancer Centers
• Mailer
– A-75080
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Personal Cancer Indemnity
Leave With the Applicant
Leave with the Applicant
• Brochure/Insert Page(s)
• Guide to Health Insurance for People with Medicare - if applicable
• Replacement Notice, if required by state
• A-8691, if applicable
• Outline of Coverage, if required by state
– Applicant must acknowledge receipt of outline on the application or
business will be returned
– A-75125 Level 1
A-75225 Level 2
A-75325 Level 3 Page 125
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Personal Cancer Indemnity
Premium Rates
Types of Coverage
Premiums
• Individual
• M-RS068
• One-Parent Family
– Under age 25, and qualified
by IRS)
• Payroll, Direct, and Association
rates
• Premium Quote and SmartApp®
• Two-Parent Family
– named insured, spouse,
dependent children
• Premium Worksheet M-1061
Pages 129–133
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Personal Cancer Indemnity
Commissions
Commissions
• ROP rider has a separate commission package
• PCI production eligible for:
– stock bonus
– nationally sponsored contests
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Personal Cancer Indemnity
Claims
Claims
• Cancer
– S-2029 (see S-3087)
– Pathology report required for
first claim
• Wellness
– Automated letters sent
annually after first claim
• Return of Premium
– Submit written request to
Claims
• Waiver of Premium
– Use form H-C0019
• Specified-Disease
Use form S-2029
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Personal Cancer Indemnity
Consultative Sales Process
Marketing PCI
Commitment Objective
• What do you want to accomplish?
• Set a clear commitment objective before the meeting.
• Something that will move the sales process forward.
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Personal Cancer Indemnity
List of Forms for Selling PCI
PCI Forms
• Leave with applicant:
– Brochure and NCI insert page
– Rider Insert Pages
– Outline of Coverage
• Obtain from applicant:
– Application
– Cancer History Form
– Replacement Notice
– Statement of Understanding
– if effective date advanced
more than 60 days
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Personal Cancer Indemnity
• Mailed with policy packet:
– Welcome Letter
– Policy
– Selected Riders
– Privacy Forms
– Copy of Application
– Replacement Notice, if
applicable
Page 170
PCI Forms
• Additional forms
– Mailer
A-75080
– Field Sales Guide
M-1071
– Guide to Health Insurance for People with Medicare A105712004
– Rate Booklet
M-RS068
– Premium Worksheet
M-1061
– Reinstatement Application
A-75003
– Transmittal
M-0018R
– Payroll Account Acknowledgement Form M-0138
– Request for Change Form
H-L0046
– Claims Instruction Sheet
S-3087
– Claim Form
S-2029
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Personal Cancer Indemnity
Thank You & Good Luck!!