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Personal Accident Indemnity (PAI)
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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.
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Policy Benefits
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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
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5 Wellness Benefit Emergency Treatment Benefit Both levels –$60 per policy per year Not payable first policy year Automated letters Page 16 PhysicalDental Eye ExamsMammograms Pap SmearsImmunizations PSAsUltrasounds 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
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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
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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
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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
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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
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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 BracesBack Braces Walkers Pages 20–21
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11 Blood / Plasma Ambulance Benefit Platelets Benefit Level 1 $100 Level 2 $200 Not payable for immunoglobins Once per accident, per person Ground Ambulance Air Ambulance Level 1$150$1,000 Level 2$200$1,500 Within 72 hours of accident Pages 21–22
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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
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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
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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
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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
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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 Period Pages 47–50
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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
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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
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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
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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
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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
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Administrative Guidelines
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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
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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
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Setting Up the Account
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26 Setting Up The Account SmartApp ® SIC Approvals Industry Classifications Pages 85–88
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Completing the Application
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28 Applications Complete in black ink A-34001Payroll with Disability riders A-34001A Payroll BASE Accident only A-34002ANonpayroll (base only) A-34004Nonpayroll with Disability riders (associates only) Page 91
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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
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Leave With Applicant
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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
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Premium Rates
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33 Types of Coverage Premium Rates Rate 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
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Commissions
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35 Commissions Count toward contests and stock bonus Broker commissions prorated Pages 135–136 1st YearRenewals New Associate26.00%4.30% Veteran Associate22.70%6.30%
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Sales Support Materials Claims
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37 Sales Support MaterialsClaims Pages 139–146 Brochures Rider Insert Pages Specific-Sum Insert Pages Mailer S-00198 S-13270.1 Continuing Disability
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Off-the-Job Personal Accident Indemnity
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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
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Review of the Consultative Sales Process
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Marketing PAI and Off-the-Job PAI
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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
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Underwriting Process Industry Classification Guide List of Forms for Selling PAI & Off-the-Job PAI Thank You and Good Luck!! Self Study
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