List Bill Procedures

Acceptance of List Bill Program Page 1 of 2 DOC-9773

Acceptance of List Bill Program We hereby certify that the premium for the insurance coverage is paid by the company or that the company is making a contribution towards each employee’s premium We hereby certify that the premium for the insurance coverage is being payroll deducted from each applicant’s earning only as a convenience to the employee an that our only function will be to remit the premium payment to PALIC within the required 31 day grace period provided by the policy(ies) Page 2 of 2 DOC-9773

Acceptance of List Bill Program All applicants to be enrolled are listed in the attached PALIC’s List Bill Transmittal form. Attached is employee census data of all applicants to be considered for enrollment Please indicate below whether a list of applicants will be provided by completing the attached List Bill New Business Transmittal form or by attaching an equivalent employee census. Page 2 of 2 DOC-9773

Employers Bankdraft Acceptance Program If a company bankdraft is selected the employer agrees to be responsible for removing employees from the bankdraft account once the employee is no longer eligible to participate in the Companies bankdraft program and that PALIC will not be responsible for refunding any employees premium if the employer failed to notify PALIC prior to processing the deduction from the employers account. We also agree to honor all changes resulting from premium increases due to age changes, rate increase and dependent eligibility when presented. DOC-7810

Employers Bankdraft Authorization DOC-7812

List Bill New Business Transmittal Form Standard Issue 150.00 $30 Per HSP/HCS App with a $150 max per employer. DOC-7813

List Bill New Business Transmittal Form Contingent Issue New employee are eligible for benefits in:  30 days  60 days  90 days days DOC-8213

List Bill New Business Transmittal Form Contingent Issue Employment Date For New Employee Additions DOC-8213

List Bill New Business Transmittal Form Contingent Issue We attest that during the past three (3) months, except for minor illness of one (1) week or less or pregnancy, that the employees listed above have not had any illness, injury or health related problem that has prohibited any proposed insured from working full time at his/her regular occupation or performing the normal activities of a person of the same age. DOC-8213

Pay Periods Semi-Monthly 1st & 15th – Billing Frequency (Monthly) .X 24 pay periods a year Effective Date of Coverage…………………….. E Monthly Billing ……………………………..………. B Copy of List Bill Transmittal Provide listing of employees and deductions to employer. Send applications and List Bill Transmittal to PALIC Sunday Monday Tuesday Wednesday Thursday Friday Saturday 1 X 2 Applications 3 4 5 LBT 6 7 8 9 10 11 12 13 1st Deduction 14 15 X 16 17 18 19 20 21 22 23 24 25 B 26 27 List Bill sent 15 days prior to due date 28 29 30 31 Sunday Monday Tuesday Wednesday Thursday Friday Saturday 2nd Deduction X 1 2 3 Effective Date and billing Due Date. Additions will be on the same day of the following month(s) 4 5 6 7 8 9 E 10 1st Deduction for second months premium etc. 11 12 13 14 X 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Workflow Employer Sponsored Plans Secures Acceptance of List Bill Form and Submits to New Business DOC-9773 Agent Enrolls Group and Completes Transmittal Form with Employer and Submits Form to Underwriting with Policy Fee Underwriting reviews Applications and makes decision based on pre-determined requirements Underwriter Submits Transmittal to Billing Team for Billing Coordination with Employer List Bill – DOC -9773 Employer Bank Draft DOC -7810 List Bill – 7813 List Bill Contingent - 8213 Employer BD - 7812 New Business Issues Policies and Mails policies to designated person for delivery Billing Team Mails Initial Bill and Letter to Employer or Coordinates Initial Draft Notice Employer remits Insurance Premium to PALIC

Employer Welcome Letter

Rules for Contingent Issue Underwriting Employer Eligibility: The industry must not be on this list of Ineligible Industries. Adult Entertainers/Dancers, Armed Services (Active Duty), Asbestos/Toxic Chemical Workers, Athletes-Professional or Semi-Professional (who participate in a contact sport such as (Football, Soccer, Basketball, Baseball, Wrestling), Crop Dusters, Explosive Workers, Gambling and Racing related workers, High Rise Steel workers, Legal Professionals-We will consider attorney’s handling criminal cases not civil cases, Physicians, Race Car Drivers, Rodeo and Circus worker, skydivers, Stuntmen, Underground Workers, Unemployed due to disability, Window washers above 3 stories

Rules for Contingent Issue Underwriting Employee Eligibility: The health and Critical Illness plans are available as long as the employee has not reached age 65. Employee’s must work at least 28 hours weekly to be included in the list bill. INITIAL ENROLLMENT PERIOD is the time that an employee is eligible and applying for coverage and last for 31 days. For employee’s to be added after the initial enrollment period, they will be considered a late enrollee and must wait until the waiting period is met. This period is determined by the employer and the employee must apply within 31 days after that time period. Otherwise they will be subject to full underwriting.

Rules for Contingent Issue Underwriting Dependent Eligibility: Spouses-Ages 17-65, Dependent Children Ages 0-25 (This may vary by state) Coverage may be applied for when the employee is eligible and applying for coverage in order to qualify for contingent issue. All applicants purchasing Critical Illness will have to answer the questions on the Critical Illness application. If an employee marries, adopts a child or is court ordered to cover eligible dependents, those dependents must apply for coverage within 31 days of the time they are eligible. Anyone applying meeting this and wants to purchase Critical Illness must answer all of the questions on the Critical Illness application. - Any late enrollee must show evidence of insurability at the expense of the employee  

Contingent Issue Underwriting Eligibility Guidelines ** Unless Pre-Approved by underwriting for special consideration

Contingent Issue Underwriting Eligibility Guidelines

eApplication enrollment 1. The first requirement for an agent to use the eApp for an employer sponsored list bill is that prior to starting the enrollment they must send in the Employers Acceptance of List Bill Form 9773. In presenting an Employer Bankdraft Program both the Employer Bankdraft Acceptance Form 7810 and the Employer Bank Draft Authorization Form 7812. must be sent in prior to starting the enrollment. Once we receive the completed forms (that adheres to list bill rules) the HO will email or fax the agent a List Bill Number and Affiliation Code to use on the eApplication. This will keep the group together for billing as well as commissions.

eApplication enrollment 2. Under Payment Mode, a drop down box will allow you to select a “Monthly List Bill”. Once you select either Monthly List Bill or Monthly Employer Bankdraft two boxes will pop up asking for Billing Number and Affiliation Code. These numbers need to be entered into the eApp before you can proceed with the application process. This is what keeps the group together for billing purposes. The number will start with three alpha letters GBN and followed by 6 numbers. Example GBN 012345. – Zero not an alpha “O”

Rules for Contingent Issue Underwriting When multiple agents use the same computer, make sure the Agent ID is correct before you start the application process. The system retains the last number used until changed.

Post Sales and Service Check all applications. Do you have all the required information and signatures? Complete the New Business Transmittal. Provide a copy of the New Business Transmittal to payroll administrator. Review the payroll administrator and confirm when the first deductions will start and when the first billing will arrive.

Post Sales and Service Make sure the payroll department knows how to contact you or someone at Philadelphia’s American Life’s home office if they have concerns. PALIC will send out a welcome letter to the payroll administrator with contact information, an “800 Number”, and a Q & A brochure on our billing and collection process. Take the opportunity to setup a time for the annual review. This can be profitable in four ways. Increase or add coverage to employees who are already participating Solicit new employees Solicit employees who are currently not participating Reinforces your position within the account.

Thank You