Transcript Application Guide NGL AssetGuard

Application Guide
NGL AssetGuard
The
Standard
NGL AssetGuard
Application Form
2735FE 12/08
(Applications will vary by state;
before writing new business,
please verify the current version
approved for your use on
MyNGLIC)
Application Example:
Insured/Annuitant Information
Be sure to indicate Male or Female
Where should the policy be mailed?
Complete all information on this line
Complete all information on this line, if applicable
Complete all information on this line
Any missing information could result in issuance delay
Payment Methods & Modes
The Health Question*:
Determines Underwriting Class
Health question must be answered “NO” for Standard Issue.
If answered “YES” or not answered, Guaranteed Issue will be used.
* May vary by state.
Payment Plan + Mode
5,000.00
X
Bank Of America
12345678
70-1238901
15th
Remember to check box C to indicate growth rate!
* “Increased Face Amount” (based on funeral price) or “Inflation Protected” amount.
Use Premium Calculators on MyNGLIC to best calculate Face Amount.
Beneficiary Information
NGL Funeral Expense Trust
Write the name and address of where proceeds should be directed.
If it is Insured’s Estate, please write “Estate of Insured”.
If assigning to one of NGL’s Trusts, please be sure to specify which:
NGL Funeral Expense Trust or NGL Estate Planning Trust.
The Signature Section(s)
If your state application includes any replacement questions,
all of the questions must be completed.
Remember to complete both Applicant’s AND Agent’s Sections
State of Sale
City/Town where sale is MADE
Insured Signature
Agent Signature
Date
Agent PRINTS Name
Owner Signature
NGL Agent # Here
Date
Agent License #
Only use 2nd line in Agent Statement if splitting commissions
%
Acknowledgment of Payment
John Smith
Agent Signature
5,000
Date
Trust Assignments
NGL Funeral Expense Trust
NGL Estate Planning Trust
NGL Funeral Expense Trust
Assignment Form (#2591-FET*)
John E. Smith
Mary K. Smith
(Optional)
Owner Signature
Date
• Use this trust if the client is
concerned with Medicaid
Qualification
• Excess proceeds paid to
the Estate of the Insured
(or the state, if your state
requires it)
• Policyholder must sign. If
Power of Attorney (POA),
include POA paperwork.
* May be state-specific. Please check MyNGLIC.
NGL Funeral Expense Trust
Assignment Form
For NGL Use Only.
Use ONLY if your client
needs to immediately
apply for Medicaid and
transfer the ownership
rights immediately.
NGL Estate Planning Trust
Assignment Form (#2591-EPT)
John E. Smith
Mary K. Smith
John E. Smith, Jr.
Owner Signature
Date
• Excess proceeds paid to the
beneficiary named on the form
• Policyholder must sign. If Power
of Attorney (POA), include POA
paperwork.
• May be used in combination with
the Funeral Expense Trust. Total
value of the combined policies
may not exceed the Estate
Planning Trust maximum (may
vary by state).
Reminders and FAQs
Helpful Reminders
To ensure that your application can be processed
quickly, please remember:
• Indicate where/to whom the policy should be
sent on the top of the application .
• If EFT is being drawn from a:
– Checking Account: Please include a voided check.
– Savings Account: Please have the applicant
contact the bank to get the correct bank information
and verify that EFT withdrawals are allowed.
Common Application Errors
• Incomplete/Missing Information:
– Agent statement and replacement questions are incomplete
– Signature Date is missing
– Missing or incomplete state requirements such as disclosures or
trust assignment forms
• May be caused by using old forms, which may not have all the
current state requirements included
• Premium Discrepancies:
– Using standard rates on guarantee issue cases
• Payment Type Issues:
– Agent’s personal checks are not accepted
– Money Orders must be purchased by the applicant (not the
agent) and MUST be signed.
• For any contract or policy changes, please contact the
Agent Support Team
Submitting
Applications and Claims
Submitting Applications via Fax
• Complete Application Cover
Page (#2802)
• Fax with Application to:
866.228.9927
• Please ensure this form is
the FIRST PAGE of your fax.
• Do not fax and mail your application materials;
send via fax or via mail, not both. Please fax the
application just ONCE.
• We are only able to accept faxed payment for
initial premium from one account. Initial premium
payments from multiple accounts must be mailed
to NGL with checks from each account.
• Business should not be sent to NGL until it is
ready to be issued.
Claims Process
• Claims may be submitted via fax and are generally
processed in two business days or less.
• A copy of the death certificate is required:
• If death occurs within the first two years of issue on a
standard issue policy, a death certificate is required
• In Kentucky, Louisiana, Ohio and Wisconsin.
Covered Funeral and Burial Items
Copies of bills for the funeral (or other related
services) should be submitted with the claim form.
These may include:
• Professional services
• Embalming and other
treatment of remains
• Cremation
• Caskets
• Vaults
• Funeral home
facilities and services
• Stationery
• Flowers
• Transportation of the
body
• Opening and closing
of the grave
• Cemetery charges
Submitting Claims via Fax
• Complete the appropriate
Claim Form:
– NGL Funeral Expense Trust
Claim Form (#FE-CF)*
– NGL Estate Planning Trust
Claim Form (#EP-CF)*
– Beneficiary Claim Form
(#2803PNCF)*
– Multiple Payees Claim Form
(#FE-MP-CF)*
• Fax to:
866.228.9450
* Some states use state-specific forms.
Check MyNGLIC to ensure correct form usage.
Questions?
Call 800.356.5306 for assistance!
© 2010 National Guardian Life Insurance Company, Madison, WI.
NGL, National Guardian and the tree of life logo are registered trademarks of National Guardian Life Insurance
Company. National Guardian Life Insurance Company is not affiliated with the Guardian Life Insurance Company
of America, a/k/a The Guardian or Guardian Life.
For Agent Use Only.
ABLAG-BSP