Supplemental Insurance Protection SB Accident Disability Dir Gen Approval Date: 06/03/2014 Code : 53509401 Revised Date: 09/25/2015 Supplemental Insurance Protection Accident Disability Direct Form CH-26114-IP (01/10), or its state variation See Separate Presentation for State Specific Variations ©2015 SureBridge® Product Training Materials | Proprietary and Confidential. For more plan details, refer to the product materials. The benefits described in this presentation are subject to all provisions, terms, definitions, and limitations and exclusions of the applicable policy. Supplemental plans serve a specific purpose in the insurance market. These plans are not intended as substitutes for accident and sickness health insurance and should not be construed as such.
Supplemental Products Availability Chesapeake’s SureBridge product suite is one of the largest supplemental insurance portfolios in the industry and includes critical illness, cancer, accident, disability income, hospital and fixed indemnity, dental and vision policies1. Chesapeake also has one of the broadest marketing footprints in the industry through its producer distribution systems. AK WA ID MT ME OR ND MN NH WI NY VT MI WY SD CA MA RI NV CT UT PA NE IA IL OH IN NJ CO WV DE MO VA KS MD HI KY DC AZ NC NM OK TN TX AR SC GA MS AL All products available Subset of products available No products available LA FL 1 Product Availability varies by state.
Supplemental Products Superior Client/Broker Experience Quoting Compare packages with different combinations of supplemental products Present total price for solution Commissions Initial Premium and any application fee are taken upon policy issue Most policies issued within 24 hours Book of Business report available on your Broker Portal Application Single e-app for any combination of supplemental products Flexibility to select different products and/or benefit options for each family member on app Smart app – only the questions for the products selected are asked Simplicity – all questions are yes/no Product Brochure provided Claims Claim form provided with complete instructions for submission Claim forms are typically analyzed and adjudicated within 7 days after receipt
Supplemental Products Sales Pitch Changes in the market present opportunities to sell supplemental plans During 2015, Essential Health Benefit (EHB) plans can have out-of-pocket limits as high as $6,600 for individuals and $13,200 for families (increased in 2016 to as high as $6,850 for individuals and $13,700 for families). This can leave large gaps in coverage which may be filled with supplemental plans. Advanced premium tax credits for EHB plans are available for individuals or families making up to 400% of the federal poverty level. Premium dollars saved due to premium tax credits may allow your customer to purchase supplemental insurance that can help fill gaps left by high deductibles and coinsurance on EHB plans. Number of family members Poverty Guideline for family income (as of 2015) Can still qualify for a subsidy under the ACA with an income up to 1 $11,770 X 400% $47,080 2 $15,930 $63,720 3 $20,090 $80,360 4 $24,250 $97,000 5 $28,410 $113,640 Premium dollars saved due to tax credits can be used to pay for supplemental plans and help reduce coverage gaps. Need a subsidy calculator? Try http://kff.org/interactive/subsidy-calculator/
Accident Disability Direct Sales Pitch The Accident Disability Direct plan is a piece of the puzzle to help fill in caused by high out-of-pocket expenses or to supplement lost wages. On the right, health insurance is supplemented by the following: Accident Disability Direct for a monthly total disability benefit, Accident Companion* for lump sum accident coverage, Hospital Confinement Direct* for hospital coverage. Health Coverage Coverage Gap Accident Disability Direct Accident Companion Hospital Confinement Direct *See the appropriate training documents for more details on these other products.
Accident Disability Direct Product Comparison The Accident Disability Direct plan is designed to provide a Monthly Total Disability benefit if the insured becomes Totally Disabled within 30 days of an Injury while covered under the policy and is Actively at Work: Must be Actively at Work Total Disability must begin within 30 days after the Accidental Injury Total Disability for a full month provides for the lesser of The Monthly Indemnity Benefit; or 60% of the insured’s gross prior monthly income Total Disability for a partial month is 1/30 per day of the Monthly Indemnity Benefit For Accidents Only A comparison of benefits to the Income Protection Direct is shown to the right. Income Protection Direct Accident Illness Accident Disability Direct Accident Only
Accident Disability Direct Navigation? Accident Disability Direct is located under the Disability tab of the SureBridge Point of Sale Tool.
Accident Disability Direct Understanding Guaranteed Issue (GI) Products Underwriting Changes Guaranteed issue (GI) products are lower benefit levels which can be selected at the point of sale for some products, including: Hospital Confinement Direct Critical Illness Direct Accident Disability Direct Income Protection Direct A customer can also check a box on the app to get a GI version of these products, should they not qualify for their original selection. These plans do not have height, weight or any medical Underwriting questions. Eligibility questions still apply, such as citizenship, income or blue or white collar. Claim Adjudication There is no impact to claims processing if a plan is guaranteed issue (GI). If a plan was subject to pre-ex or waiting periods as a non-GI plan, it is still subject to pre-ex and waiting periods as GI plan. All exclusions and limitations and other plan provisions from the non-GI plan also apply to the GI plan. State Applicability GI products are available in the following states: AL, AR, CO, GA, IA, ID, IL, IN, KS, LA, ME, MI, MO, MS, NC, NE, NH, NV, OH, OK, PA, SC, TN, TX, UT, WI, WY
Accident Disability Direct Benefit Options vs Accident Disability Direct Benefit Options vs. Average Gross Income (AGI) Annual Gross Income Maximum Monthly Indemnity Benefit that can be selected Under $10,000 Decline Coverage1 $10,000 - $19,999 $500 $20,000 - $29,999 $500, $1000 $30,000 - $39,999 $500, $1000, $1500 $40,000 - $49,999 $500, $1000, $1500, $2000 $50,000 and over $500, $1000, $1500, $2000, $2500 1Important Note: If you do not meet the minimum income requirements, you still cannot get guaranteed issue coverage.
Accident Disability Direct Benefit Schedule GI Option Option 1 Option 2 Option 3 Option 4 Availability Ages 19-60 Benefit Options* Due to Injury that occurs after the effective date of coverage Must be Actively at Work Total Disability must begin within 30 days after the Accidental Injury Total Disability for a full month provides for the lesser of The Monthly Indemnity Benefit; or 60% of the insured’s gross prior monthly income Total Disability for a partial month is 1/30 per day of the Monthly Indemnity Benefit $500 $1,000 $1,500 $2,000 $2,500 *Benefit cannot exceed 60% of gross monthly earnings.
Accident Disability Direct Benefit Schedule GI Option Option 1 Option 2 Option 3 Option 4 Availability Ages 19-60 Maximum Period Payable Options Selected independent of Benefit Amount Benefit continues through end of Maximum Period Payable selected as long as Total Disability continue 12 Month 12 or 24 Months Elimination Period Options 90 Day 14 or 30 Days
Accident Disability Direct Benefit Schedule Ages 19-60 Waiver of Premium When an insured has been continuously disabled as defined for 90 days and receiving benefits, future premiums will be waived for the remainder of the disability period. Insured must resume premium payments within 31 days when no longer eligible for waiver of premium to keep coverage in force. Recurrent Disability When the insured is disabled after a Period of Total Disability and has not been actively at work for at least 6 months following the end of the preceding disability, New elimination period not required Subject to the Maximum Period Payable that started with the preceding Period of Total Disability If the Maximum Period Payable has ended, no benefits will be payable for a recurrence Concurrent Disability If a Total Disability is caused by more than one injury, benefits are paid as only one injury.
Accident Disability Direct Claims Example Jenny Heart, age 43, had a car accident. Jenny is knocked unconscious, fractures her skull, breaks multiple ribs and both legs. Jenny is flown by Care Flight to the ER where an MRI and X-rays are taken. She spends an additional 7 days in an ICU room and another 15 days in the hospital recuperating from surgery. After she was released from the hospital, Jenny was unable to work for 6 months while she received physical therapy. Luckily, in addition to her bronze level EHB health insurance, Jenny has a Level 4 Accident Disability Direct plan. BILL After PPO Discounts Hospital Stay (22 Days) $3,000 $2,000 $60,000 Paid By Health Plan $0 $60,000 Out of Pocket $3,000 $2,000 $0 The Bronze EHB plan paid $68,650, leaving Jenny OOP $6,350. Jenny’s monthly benefit did not exceed 60% of her gross monthly so SureBridge paid Jenny $15,000 over the 6 month period and waivered her premiums for 3 of the 6 months. This amount covered the gap left by the EHB plan and gave Jenny money to help with her lost wages and other incidental expenses such as her mortgage and car payment. Paid By SureBridge Plan Care Flight Emergency Room Surgeon and Anesthesiologist $10,000 $8,650 $1,350 $6,350 $15,000
Accident Disability Direct Renewability The policy is guaranteed renewable to age 65, subject to the Company’s right to discontinue or terminate the coverage as provided in the TERMINATION OF COVERAGE section of the policy.
Accident Disability Direct Accident Disability Direct FAQs New Business and Underwriting Cannot be sold with another Accident Disability offered by CLICO. Minimal application questions apply to this product. Claim Payment Cash benefit paid to the member on a monthly basis – includes coordination of benefits with Worker’s Comp, Employer Disability and Social Security Disability. Maternity is not covered. Average claim processing time is 7 business days unless an additional review is conducted for provisions of the coverage (i.e. pre-existing, etc.) Initial benefit requires completed disability form* signed by the Member, Physician, and Employer. Ongoing benefits require follow-up treatment plan by the Physician. *Form with complete instructions can be found in the Member’s policy packet and online through the Member Portal.
Accident Disability Direct Underwriting Quick Reference Question Summary Applies to Accident Disability Direct Applies to Accident Disability Direct GI Applicants Info, Height/Weight Per Height Weight Chart - Occupation/duties of Primary Applicant Yes Occupation/duties of Spouse Applicant Felony activity Primary unemployment Yes – Primary Spouse/domestic partner unemployment Primary income See Income Rules Spouse/domestic partner income Spine joint surgery Disability claim history Disability prone Important Information Summarized questions are based on the generic 2015 application. See the Accident Disability Direct section of the Chesapeake Underwriting and Product Guide for detailed application question information.
Accident Disability Direct Pricing Examples Rates can change. These rates come from the generic brochure dated August 2015: CH ACC DIS DIR 815. The chart below is only an illustration of benefit and premium options per covered person for plans. Premiums may vary by state. Monthly Premiums¹ GI Option $500 Option 1 $1,000 Option 2 $1,500 Option 3 $2,000 Option 4 $2,500 30 Year old Male (White Collar) $3.56 $6.02 $9.18 $12.50 $15.83 30 Year old Female $3.05 $5.16 $7.87 $10.72 $13.57 (Blue Collar) $8.90 $15.04 $22.95 $31.26 $39.57 $7.63 $12.89 $19.67 $26.80 $33.92 Sample ¹ The chart above is only an illustration of benefit and premium options per non-tobacco covered person. Premiums may vary by state.
Accident Disability Direct This presentation is not inclusive of all policy provisions. See product materials and/or state-specific training presentation for complete details and any additional state variations regarding Termination of Coverage, Renewability, Premium Changes, Eligible Dependents, Exclusions and Policy Definitions. SureBridge® is a registered trademark used for both insurance and non-insurance products offered by subsidiaries of HealthMarkets, Inc. Supplemental insurance products are underwritten by The Chesapeake Life Insurance Company®. Administrative offices are located in North Richland Hills, TX. SureBridge products are individual supplemental products and are not available as group coverage. This material cannot be copied or used in any way for advertising or presentation purposes. THIS POLICY PROVIDES LIMITED BENEFITS. This type of plan is not considered “minimum essential coverage” under the Affordable Care Act and therefore an Accident-Only Disability Income Insurance Policy does not satisfy the individual mandate that you have health insurance coverage. This is not Medicare Supplement Insurance. Benefits may vary by state. See state variations and product materials for more detail.
Accident Disability Direct Thank You For Everything You Do! Accident-Only Disability Income Insurance Policy