Date post: | 30-Dec-2015 |
Category: |
Documents |
Upload: | lucas-shaw |
View: | 212 times |
Download: | 0 times |
Personal Accident Indemnity (PAI)
2
Preface
• Field Sales Guide – generic.
• State introduction packet via e-mail for state specifics.
• Slide numbers correspond to page numbers.
• Refer to Guide when calling Customer Call Center.
Policy Benefits
4
Personal Accident Indemnity Base Plan
• 24-hour coverage for death, dismemberment, or injury
• Set indemnity amount
• Guaranteed-issue on payroll
• Two levels
• No sickness benefits
Page 15
5
Wellness Benefit Emergency Treatment Benefit
• Both levels – $60 per policy per year
• Not payable first policy year
• Automated letters
Page 16
Physical Dental
Eye Exams Mammograms
Pap Smears Immunizations
PSAs Ultrasounds
Blood Screenings
Flexible Sigmoidoscopies
• Both Levels– $120 insured and spouse– $70 child
• Within 72 hours of accident
• Payable once per 24 hours
• Payable once per accident, per person
6
Follow-Up Treatment Initial Hospitalization Benefit Benefit
• Level 1 $25 per treatment
• Level 2 $35 per treatment
• Within 30 days of accident
• Outpatient basis
• Limit 6 treatments per accident, per person
• Not payable for same visit as Physical Therapy Page 17
Hospital Confinement
Intensive Care Unit Confinement
Level 1 $1,000 $1,500
Level 2 $1,000 $2,000
• Confined for 24 hours
• Within 30 days of accident
• Once per year, per person
• Paid in addition to other hospital benefits
7
Hospital Confinement Intensive Care Unit Benefit Confinement Benefit
• Level 1 $200 per day
• Level 2 $250 per day
• Confined at least 18 hours
• Within 30 days of accident
• 365 days per accident, per person
Page 18
• Both Levels $400 per day
• Within 30 days of accident
• Up to 15 days
• In addition to Hospital Confinement Benefit
8
Accident Specific Sum Major Diagnostic Benefit Exams Benefit
• See pages 25 & 26
• $25–$150,000
Page 19
• Level 1 $150
• Level 2 $200
• 3 exams: CT scan, MRI, or EEG
• Once per person, per year
• No lifetime maximum
9
Physical Therapy Benefit Rehabilitation Unit Benefit
• Level 1 $25 per treatment
• Level 2 $35 per treatment
• Within 30 days of accident
• Completed within 6 months
• Limit 10 treatments
• Not payable for same visit as Follow-up Benefit
Pages 19–20
• Level 1 $100 per day
• Level 2 $150 per day
• Confined in hospital and then transferred to Rehabilitation Unit
• Up to 30 days
• 60 days per year
10
Appliance Benefit Prosthesis Benefit
• Level 1 $100
• Level 2 $125
• Once per accident, per person
• Level 1 $500
• Level 2 $750
• Not payable for:– Hearing Aids– Wigs– Dental Aids
• Once per accident, per person
Crutches Wheelchairs
Leg Braces Back Braces
Walkers
Pages 20–21
11
Blood / Plasma Ambulance Benefit Platelets Benefit
• Level 1 $100
• Level 2 $200
• Not payable for immunoglobins
• Once per accident, per person
Ground Ambulance
AirAmbulance
Level 1 $150 $1,000
Level 2 $200 $1,500
• Within 72 hours of accident
Pages 21–22
12
Transportation Benefit Family Lodging Not for ambulance Benefit
• Level 1 $400
• Level 2 $600
• Over 100 miles
• Up to 3 round trips
• Parent accompanying child
• Level 1 $100 per night
• Level 2 $125 per night
• During time insured is confined
• Over 100 miles from home
• Up to 30 days per accident
Pages 22–23
13
Accidental Death Accidental Benefit Dismemberment
Insured/ Spouse
Child
Level 1 Common Carrier
$100,000 $15,000
Level 1 Other Accidents
$25,000 $7,500
Level 2 Common Carrier
$150,000 $25,000
Level 1 Other Accidents
$40,000 $12,500
• Occurs as a result of accident
• Within 90 days of accident
• Highest single benefit paid
• Death due to injuries
• Within 90 days of accident
Pages 23–24
14
• Waive up to 2 months’ premium
• Payroll deduction
• 6 consecutive months
• Notification within 30 days
• Insured re-establishes premium
Continuation of Coverage PAE compared to PAI
• Bold benefits increased
• May not be used as an advertising piece
Pages 24–26
15
Limitations and Exclusions
• Services by immediate family
• Under the influence
• Driving a taxi
• Extreme activities
• Illegal activity
• Self-inflicted
• Cosmetic or elective surgery
• Dental treatment
• War
• Serving in armed forces,
• Aviation
• Sporting activity for wage
Pages 33–34
16
Important Definitions
• Totally Disabled (80% loss of income)
• Base Pay Earnings
• Successive Periods of Disability
• Pregnancy and Childbirth
• Maternity Exclusion
• Pre-Existing Conditions
• Benefit/Elimination PeriodPages 47–50
17
Disability Riders
Page 51
• Off-the-Job Accident Disability Rider
• Spouse Off-the-Job Accident Disability Rider
• On-the-Job Accident Disability Rider
• Sickness Disability Rider
18
Disability Riders
• Guaranteed Renewable for Life
• Benefit triggers
• Age 70, hospitalization required
• With the exception of spouse rider:– Benefit periods must match– Accident elimination periods
must match
Page 51
• Payroll only
• Occ classes A, B, C and E
• Ages 18–64
• Not allowed with government allotment accounts
• Minimum income–$10,000
• Work 30 hours per week
19
Off-the-Job Accident Spouse Off-the-Job Disability Rider Disability Rider
• Primary insured only
• Minimum 1 unit $100
• Max 20 units $2000
• 0 or 7 day elimination
• 6 or 12 month benefit
• Available to associates– E classification
Page 51
• Minimum 1 unit $100
• Max 7 units $700
• One premium rate
• 0 day elimination/6 month benefit period
• Not available to associates
20
On-the-Job Accident Sickness Disability Disability Rider Rider
• Primary insured only
• Minimum 1 unit $100
• Max 10 units $1000
• 0 or 7 day elimination
• 6 or 12 month benefit
• Available to associates – E classification
Page 52
• Age banded 18-49 and 50-64
• Primary insured only
• Minimum 1 unit ($100)
• Max 20 units ($2000)
• 14 day elimination period
• 6 or 12 month benefit period
• Not available to associates
21
Aflac Associates and Taxation of Disability Disability Benefits
• May buy disability– 2+ years– Income verification
• Spouse/Sickness Riders
• Off-the-job disability rider
• On-the-job disability rider
• Application A-34004
• Paid by employer or pre-tax
• Interchangeable
• SmartApp®
• FICA
• Quarterly/annual reports
Pages 55–56
Administrative Guidelines
23
Eligibility Base Accident Plan
Page 77
• Issue ages 18–64 (no age bands)
• Occupational classes A, B, C, D, and E
• Payroll, direct, non-payroll/association
• Dependent children to age 19, 23 if full-time students (varies by state)
• Eligible for pre-tax
• Available for field force through account 00316
24
Advanced Effective Date Portability
Page 77
• Up to 90 days
• Over 60 days – Need form A-13072
• Direct at payroll rate – One month premium
through payroll deduction
• No conversions on direct
Setting Up the Account
26
Setting Up The Account
SmartApp®
SIC Approvals
Industry Classifications
Pages 85–88
Completing the Application
28
Applications
Complete in black ink
• A-34001 Payroll with Disability riders
• A-34001A Payroll BASE Accident only
• A-34002A Nonpayroll (base only)
• A-34004 Nonpayroll with Disability riders (associates only)
Page 91
29
How To Complete Conversions
• Job titles/duties are different!
• Incorrect premium is one of top reasons apps pend!
• 70% replacement questions
• Review question requirements
• Applications vary by state
Pages 92–115
• Use new business application
• Provide current policy number
• Additional units of disability added– Total units and premium
based on attained age
• Standard conversion commissions
Leave With Applicant
31
Page 119
• Replacement Notice – Varies by state– Form A-8691– Replacing existing competitor accident insurance– Available on SmartApp®
– Paper application duplicate
• Outline of Coverage
Leave With Applicant
Premium Rates
33
Types of Coverage Premium RatesRate Booklet M-RS065
Pages 127–131
• Individual
• Named Insured/Spouse Only
• Two-Parent Family
• One-Parent Family
• Payroll, Direct, Association
• Sickness Rider age banded
• Available on Premium Quote
• Premium Worksheet M-1018
• No registration fee
• Rates may vary by state
Commissions
35
Commissions
• Count toward contests and stock bonus
• Broker commissions prorated
Pages 135–136
1st Year Renewals
New Associate 26.00% 4.30%
Veteran Associate 22.70% 6.30%
Sales Support MaterialsClaims
37
Sales Support Materials Claims
Pages 139–146
• Brochures
• Rider Insert Pages
• Specific-Sum Insert Pages
• Mailer
• S-00198
• S-13270.1
• Continuing Disability
Off-the-Job Personal Accident Indemnity
39
Off-the-Job PAI
• Benefits same as the PAI– but only for accidents that occur off the job
• Administrative Guidelines identical to PAI Guidelines except:– On-the-Job Disability Rider not available– Not available for field force– Payroll Only– Premiums approximately 14% less
– Varies by industry classification
Pages 149–167
Review of the Consultative Sales Process
Marketing PAI and Off-the-Job PAI
42
New Accounts Business Survey Form
• Contact employer/owner
• Benefits specialists/HR personel
• The five buying decisions
• Business Survey– Form MMC-98-394-R
• Available on Associate Services, under Internet Accessible Forms
Pages 183–187
Underwriting ProcessIndustry Classification Guide
List of Forms for Selling PAI & Off-the-Job PAI
Thank You and Good Luck!!
Self StudySelf Study