Transcript Assurant Health Supplemental Coverage (ASC)

Assurant Health Supplemental
Coverage (ASC)
Clay Peek, Peek Performance Inc
www.peekperformanceinsurance.com
864 228 2635 office
Lynette Helgeson; DSC and Field Sales Trainer
Assurant Supplemental
Coverage (ASC)
Variety of Supplemental plan Options
• Dental Insurance
• Accident Medical Expense
– Accident Fixed
– Accident Medical Expense
• Critical Illness/Cancer Heart Stroke (CI and
CHS)
Easy integration to IM
Dental Insurance
Dental Insurance
• Clients can choose their own dentist — no network
restrictions
• Benefits available the next day for cleanings
• Three affordable and convenient plan designs to meet
client needs and budgets
• Coverage is portable
• Sold ages 0-64, guaranteed renewable to age 70
• Can sell a stand-alone dental policy to a child
– No underwriting, only dental professionals are
prohibited
– No orthodontic benefit or TMJ benefits
Dental Insurance
•Preventive visits
two times a year
•Limited benefits
the first year for
Basic and Major
•6 month wait on
Major services
Basic Plan
(Level I)
Intermediate
Plan
(Level II)
Plus Plan
(Level III)
$75 per visit
$100 per visit
$100 per visit
Basic
Services
$25 - $200
based on
procedure
$50 - $400
based on
procedure
$50 - $400
based on
procedure
Major
Services
None
None
$20 - $1,000
based on
procedure
Calendar
Year Max
$500
$1,000
$1,500
Preventiv
e
(2 visits/year,
separated by
6 months)
Dental Exclusions
This plan provides limited benefits for specified dental services and treatment. It’s not a major medical insurance
plan and does not provide benefits for:
• Any procedure or treatment not shown on the list of covered services
• Procedures before the effective date, after the termination date of coverage, or in excess of the maximum calendar
year benefit
• Any procedure performed by an immediate family member or a person other than a dentist or dental hygienist or, in
Idaho, a denturist
• Any service that is not required for the preservation or restoration of oral health
• Experimental or investigative services
• Preventive services performed within 150 days of previously submitted preventive services
• Repairs to dental work within 180 days of the initial procedure
• Replacement prosthetics, crowns, inlays or onlays within 5 years of the previous placement
• Dental implants or the removal of implants
• Cosmetic services, unless performed to correct a functional disorder
• Orthodontic treatment and services
• Services performed outside the United States, its territories and Canada, except for emergency dental treatment
• Replacement of any tooth missing prior to the effective date
• Placement of full or partial dentures, including a Maryland Bridge, unless replacing a functioning natural tooth
extracted while you were covered
• Inlays, onlays, bridgework or crowns for those under age 16, except for stainless steel or plastic crowns
• Any procedure or treatment required due to war or any act of war; participation in the military service of any
country or international organization; attempted suicide or self-inflicted sickness or injury; taking part in a riot
or insurrection; participating in an illegal occupation or activity; voluntary use of any controlled substance,
except when taken as instructed by a physician; riding in any aircraft not licensed to carry passengers or not
operated by a duly licensed pilot; operating a motor vehicle while your blood alcohol level was over the legal
limit
Product form: 8079
J-106070 (2/2013) For agent use only.
Not for distribution to consumers.
Assurant Health is brand name for products underwritten and issued by Time Insurance Company, , Milwaukee, WI.
Accident Medical
Accident Medical
Two Assurant Supplemental plans to chose from:
Accident Fixed Benefit pays a set cash benefit for
covered services resulting from accidents
Accident Medical Expense pays for out-of-pocket medical
expenses not covered by other plans
• Both provide extra security and help when it’s needed
most
• Both offer a variety of benefit levels to meet any
budget
• Both are easy to integrate with an Assurant Health
Access or Individual Medical plan – just check a box on
the online application
Accident Fixed
• Pays a set cash benefit for each covered injury service
that can be used for any expenses
• No deductible
• Rates vary based on occupation
• Two coverage level options
(when sold stand alone)
• Simplified underwriting process
– GI when integrated
(when sold stand alone)
Accident Fixed - benefits
Benefit Summary
Level 1
Level 2
Accident Emergency Treatment
(ER or doctor’s office)
$100 Adult/ $50 Child
$100 Adult / $50 Child
Initial Accident Hospitalization
(ICU)
$1,000
$1,000
ICU Confinement
$500/day
$500/day
Accident Hospital Confinement
$250/day
$300/day
Up to $2000 (2nd degree)/$20,000 (3rd
degree)
Up to $2500 (2nd degree) /$25,000 (3rd
degree)
$15,000
$20,000
- Dislocation
Up to $4000
Up to $5000
- Fractures
Up to $4000
Up to $5000
$100-$800
$130-1000
Scheduled amounts up to $2000
Scheduled amounts up to $2500
Up to $150,000 Adult / $75,000 Child
Up to $250,000 Adult / $100,000 Child
$150/$1000
$200/$1500
$100/night
$125/night
$200
$200
$100/day
$150/day
$25
$35
Accident Specific–Sum Injury
- Burns
- Coma, 7 days unconscious
- Lacerations
- Surgical Repair
Accidental-Death/Dismemberment
Ambulance (ground/air)
Lodging
Major Diagnostic Exams
Rehabilitation Unit
Accident Follow-up Treatment
Accident Fixed-Benefit exclusions
This is an accident-only insurance plan. It provides limited benefits for specified treatment of accidental injuries.
It is not a major medical insurance plan and does not provide benefits for:
• Sickness
• Services provided by a member of your immediate family or your employer
• Services rendered outside the territorial limits of the United States and Canada
• An illness treatment or medical condition arising out of intentionally self-inflicted injury
• Dental care except for treatment for injury to healthy, natural teeth due to a covered accident
• Injury caused by or resulting from:
— Attempted suicide or self inflicted injury by an insured person
— Injury caused by the insured person’s service in the armed forces or related auxiliaries such as the National Guard
or Army Reserve or exposure to acts of war other than terrorism
— Cosmetic surgery or elective surgery unless medically necessary. For purposes of this exclusion, cosmetic surgery
does not include reconstructive surgery when the service is incidental to or follows surgery resulting from trauma,
infection or other diseases of the involved part resulting from a covered accident or sickness, and reconstructive
surgery because of a congenital disease or anomaly of a covered dependent child
— Sporting activity for pay or financial reward, including coaching and officiating
— The insured person’s operating a taxi or any other livery service for any kind of compensation or profit
— Injury or sickness caused to an insured person as a result of his/her participating in a felony
— Racing a vehicle, including cars, motorcycles and boats
— The insured person’s being under the influence of alcohol or drugs, unless the drugs were taken as instructed
by a physician
— Participating in aviation activities other than as a fare-paying passenger on a common carrier
Product form: 8032
J-106073 (Rev. 2/2013) For agent use only. Not for distribution to consumers.
Assurant Health is brand name for products underwritten and issued by Time Insurance Company, , Milwaukee, WI.
Accident Medical
Expense (AME)
• Pays up to the chosen benefit level ($2,500, $5,000,
$7,500, $10,000) for out-of-pocket medical expenses
resulting from an accident and not covered by other
insurance plans
• Low $250 deductible per accident/per person
• Help customer choose individual or family coverage
and cash reimbursement amount
• 24-hour coverage included
• Guaranteed Issue – no separate medical underwriting
Accident Medical Expense
At a Glance
*Benefits may vary by state, see state specific benefit schedule for details
Plan Features & Coverage Details
Accident Reimbursement Levels
(per person, per accident)
$2,500 / $5,000 / $7,500 / $10,000
Deductible
$250 per accident/per person
Waiting Period
None
Calendar Year Maximum
None—benefits paid per accident
24-hour Coverage (on-the-job & off-the-job)
Yes
Accidental Death & Dismemberment
100% of AME benefit upon death; 25% to 100%
of AME benefit for dismemberment
(dependent on affected body part)
Plan Limitations
Ambulance Service Limitation
$300 per accident/person
Physical Medicine Limitation
$25 per visit up to $250 per accident/per person
Durable Medical Equipment Limitation
$100 per accident/per person
Accident Medical Expense Exclusions
Claims resulting from or related to sickness, except when such sickness is the direct result of an
accidental injury or accidental dismemberment, are not covered under this policy. In addition,
charges directly or indirectly resulting from any of the following are not covered:
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•
•
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•
•
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Medical event, treatment, services or supplies for which equal or greater benefits are received
from another policy
Dental treatment except as otherwise covered for a dental injury
Hernia or heat exhaustion
Treatment of mental or emotional disorders, alcoholism, substance abuse and drug addiction
and drugs and medicines for inpatient or outpatient treatment of such disorders or abuse
Cosmetic service, treatment that is not medically necessary and experimental or
investigational services
Treatment, services and supplies provided for or by a masseur, masseuse or massage
therapist, a rolfer; massage therapy; meditation or relaxation therapy; aromatherapy; holistic
therapies; acupuncture, biofeedback, neurotherapy and electrical stimulation
Services or supplies ordered, directed or performed by a covered person, an immediate family
member, an employer of a covered person or a person who ordinarily resides with a covered
person
Treatment incurred outside of the United States, its possessions or Canada
All prescription and over-the-counter products, drugs or medicines
Exclusions continued…
We will not pay benefits for accidental injury, accidental dismemberment or accidental death directly
or indirectly resulting from or related to any of the following:
•
•
•
•
•
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War or any act of war, whether declared or undeclared; foreign or domestic acts of terrorism;
or participation in military service
Voluntarily taking, absorbing or inhaling any gas, poison or drugs and voluntary use of alcohol
or any controlled substance
An attempt to commit or participation in an assault or commission of a felony, whether or not
charged
Any hazardous activity, including but not limited to parachute jumping, hang-gliding, bungee
jumping, air travel in any vehicle other than a regularly scheduled flight by an airline, racing
any motorized or non-motorized vehicle, rock or mountain climbing, spelunking,
intercollegiate sports and extreme sports. Also excluded are treatment and services required
due to accidental injury received while practicing or preparing for any such activity
Any hazardous occupation or other activity for which compensation is received in any form,
including sponsorship, such as but not limited to operating a taxi or delivery service;
participating, instructing or accompanying others in skiing, horse riding, rodeo activities,
professional or semi-professional sports; adult sporting competitions at a national or
international level and extreme sports. Also excluded are treatment and services required due
to accidental injury received while practicing or preparing for any such compensated activity
Intentionally self-inflicted injury, suicide or attempted suicide
Product form: 8227
J-106072 (Rev. 2/2013) For agent use only. Not for distribution to consumers.
Assurant Health is brand name for products underwritten and issued by Time Insurance Company, , Milwaukee, WI.
Critical Illness /
Cancer Heart Stroke
Critical Illness
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Policy Term
– 10 or 20 years
Policy Terminates at the earliest of:
– Policy term
– Age 65, the CI benefits expire
– The full life face amount is paid
Add-ons:
– Spouse coverage – same amount as
policyholder
– No dependent coverage
– Waiver of Premium option
– Accidental Death Benefit option
Rate Factors
– Issue age is 18 through, and including
age 59
– Based on tobacco use
– Height and weight
Waiting Periods (varies by state)
– 90 Days for Cancer /30 Days for all
other sickness related conditions
• Covered Conditions 100%
benefit:
– Cancer (~invasive)
Blindness
– Heart Attack
Paralysis
– Stroke
Coma
– Kidney Failure
Deafness
– Major Organ Transplant
Loss of Limbs
– Burns
• Covered Conditions 25% benefit
– Coronary Artery Bypass
Cancer (~in situ)
– Advanced Alzheimer’s
Heart Valve Surgery
Critical Illness exclusions
This plan provides limited benefits for specified critical illnesses and events. It’s not a major medical
insurance plan and does not provide benefits for:
• Conditions for which you were previously diagnosed or underwent a procedure anytime prior to your plan
effective date
• Cancer first diagnosed within 90 days (30 days in IL and MD) of your plan effective date, or any other condition
due to sickness first occurring within 30 days of your plan effective date. In such event, your coverage will be
terminated and your premium returned
• Conditions related to or caused by a pre-existing condition until you have been continuously covered for 12
months. A condition that has been specifically excluded from coverage will continue to be excluded after 12
months of continuous coverage
• Conditions or procedures related to or caused by:
— War or any act of war; participation in the military, foreign or domestic acts of terrorism that result in a
nationwide epidemic
— Mental illness, anxiety or nervous disorders, and substance abuse
— Injury sustained when operating a motor vehicle while your blood alcohol level was over the legal limit
— Voluntary attempt to commit, participation in or commission of a felony, misdemeanor or illegal act
— Suicide, attempted suicide or self-inflicted sickness or injury
— Engaging in any hazardous occupation or other activity including exercising or practicing for any such activity
— Aviation activities other than as a fare-paying passenger of an airline
• A disease, other than bacterial infection, occurring through an accidental injury or medical or surgical treatment
• Complications of cosmetic services
• Complication of a sickness, injury or medical treatment or services that are not covered
• Procedures performed outside of the United States or its territories
Product Form: 8059
J-106075(Rev. 2/2013) For agent use only. Not for distribution to consumers.
Assurant Health is brand name for products underwritten and issued by Time Insurance Company, , Milwaukee, WI.
Cancer Heart Stroke
• Options available :
– Cancer only
– Heart/Stroke only
– Cancer & Heart/Stroke
• Face amounts
– Standalone - $10k – $75k in
$5,000 increments
– Integrated EASE $5k – 70k in
$5k increments
$5k benefit option for integrated
plans only
In all states except OH, MN and WA
• No term limits, can keep until
age 75
• Apply ages 18 – 64 (filed up to
70)
• Single/ +spouse / +kids options
• Rating
– Individual and Family Rated
– Tobacco Rated
– Gender Rated
– Age Rated
– Standalone rates will be the
same as integrated
• Waiting periods
– 90 days for Cancer
– 30 days for Heart/Stroke
• On a Health Chassis
– No Life Benefits
• Guarantee Issue when:
–
$5k bundled with IM
Cancer and Heart/Stroke Exclusions
This plan provides benefits for specified diseases (listed earlier) and identified in the benefit
schedule. We will not pay benefits for claims resulting, whether directly or indirectly, from
specified diseases related to or resulting from any of the following:
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Any disease the covered person was diagnosed with prior to the effective date of this policy.
Any disease first diagnosed in the applicable benefit waiting period (as shown in the benefit
schedule) immediately following the policy effective date. In such event, we will terminate
the covered person’s coverage under this policy and refund the premium paid for that
coverage.
Arrhythmia resulting in heart attack in association with use of an illegal drug or controlled
substance, except when administered with advice of the covered person’s health care
practitioner.
Any amount in excess of any maximum benefit.
Diseases or conditions that do not meet the definition of a specified disease in this plan.
Product form: 8230
J-106076 ( Rev. 4/2013) For agent use only. Not for distribution to consumers.
Assurant Health is brand name for products underwritten and issued by Time Insurance Company, , Milwaukee, WI.
In Summary
• Wide portfolio of plans and supplemental
coverage to choose from
• Simplified integration of products where
available
• Easy application process
• Convenient 1st and 15th effective date options
No matter the need, there’s a solution
Short Term Medical
Individual Major Medical
Assurant Supplemental
Coverage
Agents must be licensed and appointed by the state
in which our products are sold.
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Questions?
Thank you!
Assurant Health Access plans have limitations and exclusions. A list is available at assuranthealth.com. Coverage is
renewable provided there is compliance with the plan provisions, including dependent eligibility requirements; there
has been no discontinuation of the plan or Assurant Health’s business operations in this state; and/or you have not
moved to a state where this plan is not offered. Assurant Health has the right to change premium rates upon
providing appropriate notice.
Assurant Health is the brand name for products underwritten and issued by Time Insurance Company,
Milwaukee, WI.
J-106067 (rev. 1/2014)
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