ASC Training Assurant Supplemental Coverage. Assurant Supplemental Coverage (ASC) for Dental, Accident and Critical Illness. These products have been.

ASC Training

Assurant Supplemental Coverage

Assurant Supplemental Coverage (ASC) for Dental, Accident and Critical Illness.

• These products have been introduced in several states (refer to the Agent site for details).

• Why are we selling ASC? It is an existing product we already sell. We want to increase sales. We want to make it easier for agents to sell. We want to provide win/win opportunities for

ourselves, agents and our customers.

How are ASC products sold?

Supplemental products can be sold as: • Standalone

Each product is sold individually.• Bundled

Any or all of the 3 products are sold together in a combination at one time.

• Integrated An integrated application is an ASC dental plan

sold with an IM product. ASC Accident intergrated with Access

Fundamentals Accident and critical illness cannot be integrated

with an IM application.

Quoting/Submission of ASC Products in EASE• Each of the 3 ASC products requires demographic

information, authorizations, and limited health history details that vary slightly between products.

• When 2 or 3 products are quoted and sold together, all information from the applicant will be gathered in one seamless process without duplicating questions.

• Although there is a single submission process, each product application submitted will receive a distinct eight digit application number (same as our existing IM and Health Access business).

Quoting/Submission of ASC Products in EASE (cont.)

• The applicant will be provided with the application number for each product they submitted.

• Each application will be reviewed and issued independently.

• ASC applications are subject to Instant Issue logic subject to rules specific to each product. For bundled submissions, each application that

passes Instant Issue logic will be approved, even if others do not pass.

Call in Path

Applicants may NOT call in to provide their initial health history interview on standalone or bundled ASC applications!

Business Rules

• Many of the current IM mandates will NOT apply to the ASC products because they are Not Major Medical Plans.

• Refer to State Mandates for specific details.• The following provisions apply:

ESB (on accident and dental) Civil Union (in applicable states)

• The following provisions do NOT apply: HIPAA GINA COGO Continuity/Pre-x

• The following provisions MAY apply: Health Replacement Form (on accident only in select

states) Life Replacement Form (on critical illness only in select

states)

Business Rules (cont.)• Effective dates:

The first available effective date will be one day after the application signature date.

There is no conditional receipt on the ASC apps but, we will honor the requested effective date (regardless of billing type/money collected) unless: - The application is not received within 10 days

of date signed- OVS info not submitted within 10 days of date

signed- The issue date is > 30 days from date signed

If any of the above conditions are not met, the approval date will be date of issue.

Business Rules (cont.)

Files will be closed after 31 days from the signature date of the application if open requirements cannot be obtained (same as IM guidelines).

Once a file is closed, it may NOT be re-opened (same as Health Access guidelines).

A new application would be required if the applicants would like to continue.

Counter Offers and Final Actions for ASC Products

• Counter offers on ASC plans include the following: Risk class changes are available for Critical Illness

only:- Risk class options are Standard (smoker) or

Preferred (non-smoker) Partial declines available only on Critical Illness (if

a primary applicant is declined on an accident or dental plan, all applicants should be declined)

• There are no HIPAA counter offers.• There are no amendments, ratings, SERs, CSDs or

AOAs.• Applications will not be Conditionally Issued.• When a counter offer is accepted, all applications

will be Standard Issue, even if an applicant was removed.

Dental Insurance Eligibility

• Primary and spouse are eligible up Age 0-64 at purchase and guaranteed renewable to age 70, see state specific mandates. (This means the effective date can be the day before the applicants 64th Birthday) for standalone, integrated and bundled submissions.

On a standalone submission, the primary can be a minor child as long as they are 1 month or older.

On an integrated IM/Dental application, the primary must be 19 years of age or older.

• Dependent age guidelines may vary, therefore, please refer to State Mandates.

• If the primary is ineligible, the Entire Application will be Declined.

• IM rules for Employer Sponsored Business (ESB) apply for Dental.

Dental Insurance Underwriting

• The contract is with the primary only. Therefore, an application signed by the primary (or parent/legal guardian of minor primary) is required in order to issue the policy.

• Underwriting is on an accept/reject basis. This means we will not apply riders, ratings, or CSDs.

• The only risk class available is Standard.

• There will be no MIB, RX, or ICR checks.

Dental Insurance Underwriting

• Underwriters will assess risk based on responses by all applicants to the Citizenship and the Occupation questions.– Citizenship/Residency –IM rules apply

– There are no special UW guidelines for the Dental

Accident Insurance

Can Be Standalone or Bundled• Pays a flat benefit for each covered benefit under the

plan.

• It is designed to help cover the expenses associated with an accident.

• It pays regardless of other coverage in place; there is no coordination of benefits.

• There are no co-pays or deductibles.

• There are no network requirements; an insured may visit any hospital or doctor.

Accident Eligibility

• The product is available to a primary, spouse, and/or dependents based on age requirements.

• The contract is with the primary only (age 18 through 64- This means the effective date can be the day before the applicants 65th birthday ). Therefore, an application signed by the primary is required.

• Dependent age guidelines may vary, therefore, please refer to State Mandates.

• If the primary is Ineligible, the entire application will be Declined.

• IM rules for Employer Sponsored Business (ESB) apply for Accident.

Accident Underwriting

• Underwriting is on an accept/reject basis. Underwriters will not apply riders, ratings, or

CSDs. MIB and Rx check will not be used. Decision is made based on limited medical and

non-medical information including:• Height and weight• Adverse driving history• Back, neck, and joint disorders • Age

• Standard is the only available risk class.

Accident Paper Application

We will use the information from the application to determine eligibility based on other coverage and will review build and limited medical questions.

Reviewing Adverse Responses for Accident• Height/weight out of range

–Decline –No action on build for dependents

• DUI question answered adversely–Decline

Critical Illness Eligibility• Primary and spouse are eligible starting at age 18 through 59

(This means the effective date can be the day before the applicants 60th birthday).

• Dependent children are NOT eligible and cannot be quoted. If dependent children are included on a paper application,

they will be removed from the application.

• There are ineligible industries, occupations and recreational activities that can be viewed by the applicant or agent in EASE. These details may be viewed in the Agent Guide or in the

processing manual.

• Employer Sponsored Business (ESB) rules do NOT apply for Critical Illness.

• Underwriting is on an Accept/Reject basis. Underwriters will not apply riders, ratings, or CSDs.

Critical Illness Underwriting

• Available risk classes are standard or preferred. Applicants are eligible for preferred rates if

they do not use tobacco. (Question is asking within the last 12 months)

Height and weight and medical history are not considered for preferred rates.

• Review process will utilize new guidelines for Critical Illness added to the UW Manual. Underwriters will only review conditions

that are required to be disclosed on the application.

MIB and Rx check will be used

Critical Illness Underwriting Cont.

• Applicants may have more than on CI policy however, they CANNOT exceed $100K in benefits.

Example: A UW receives a new application for CI The Other Coverage tab indicates the applicants have a

current CI policy with Colorado Bankers. Current benefit amount is $25K. Not replacing. The UW needs check to verify the current benefit amount

and the requested benefit amount do not exceed the max benefit of $100K.

• The Life Replacement Form will be required from all Applicants Replacing Critical Illness Policies.

ASC-Underwriting Overview

Critical Illness Application

• We will use information from the application to determine eligibility due to benefit amounts of other coverage.

• We will also review the declined/postponed/rescinded/reformed question.

Critical Illness/Life Policy • Individual guaranteed renewable CI policy on a term

life chassis (has term life coverage as part of the policy) providing a lump-sum benefit for 15 first-ever diagnosed critical illnesses and procedures:

– Advanced Alzheimer’s Disease– Blindness, Deafness, Loss of Limbs– Cancer Type A & B, Coma– CABG, MI, Heart Valve Surgery– ESRD (kidney failure)– Major Burns, Major Organ Transplant– Paralysis, Stroke

Critical Illness/Life Policy

• Issue Ages 18 through 59.

• Eligible for critical illness until age 65.

• Eligible for term life benefit until age 85.

• A death benefit is included.

• Eligible: Primary only/Primary & Spouse

• MIB and Rx checks will be done on every applicant.

Ineligible Occupations = Decline:These occupations prevent the issuance of Critical

Illness coverage. Other occupations not listed may also result in the applicant being ineligible for coverage.

– Armed Forces personnel– Asbestos workers– Boxers, prize fighters and mixed martial artists– Crop dusters– Off-shore oil and natural gas workers– Professional motor vehicle racers– Stunt person/stunt flyers– Underground miners

Ineligible Occupations (cont.):• Ineligible occupations:• Adult entertainers/dancers

– Air traffic controllers– Circus/carnival/amusement park

performers/workers– Commercial fisherman/crew– Explosive workers– Professional athletes– Divers– Horse trainers– Loggers– Long haul truckers– Rodeo– Ski instructors, etc.

Ineligible Avocations = Decline:

More than one time participation in the past 5 years or planned future participation in:

•Boxing•Parkour or Free-running•Extreme sports

Other Ineligible Conditions = Decline:• DUI/DWI in the past 5 years

• Three or more moving violations in the past 5 years

• Pending felony charges or conviction in the past 10 years.

Q13 List of declinable conditions (Always see GLs). We pay benefits for these conditions:

• Stroke, TIA• Peripheral vascular/arterial disease• Crohn’s disease/Ulcerative colitis• COPD/Emphysema • Pulmonary fibrosis/Cystic fibrosis• Alzheimer’s disease, Dementia• Systemic Lupus Erythematosus• Diabetes• Leukemia, Melanoma, Non-Hodgkin’s Lymphoma,

AIDS/HIV, Multiple Sclerosis, ALS, Paralysis, Organ or Stem Cell Transplant

Q13 Additional conditions that may/may not be a declinable condition; see guidelines:

• Heart disorders• Liver disorders, excluding fully recovered

Hepatitis A• Kidney disorders, excluding kidney stones• Blood disorders• Tuberculosis (TB)• Cancer or Tumor, Skin Cancer (2 or more

occurrences), Hodgkin lymphoma• Alcoholism, Alcohol or Chemical Dependency,

or Drug or Alcohol Abuse• Bipolar, Schizophrenia, or Chronic Depression

Build Table (Accept/Decline; no preferred option):

See Build Table

Build Table:

ASC Cancer and Heart/Stroke

ASC Cancer and Heart/Stroke

• The Assurant Supplemental Coverage (ASC) Cancer and Heart/Stroke plan is a fixed indemnity plan which provides coverage for life threatening conditions such as cancer, heart attack, and stroke.

• Applicants can choose coverage for Cancer only, Heart/Stroke only, or Cancer and Heart/Stroke — paying for only those conditions they’re most concerned about.

• Add Cancer and Heart/Stroke to a Portfolio or AHA plan in a single process, with no more than two additional questions for Cancer and four questions for Heart/Stroke.

Product Information• Coverage is available for primary, spouse, and dependent

children. • Primary and Spouse/Domestic Partner – Age 18

through 64• Dependents – Unmarried children through age 25

(may vary by state). 

• Pre-existing applies to this plan. Additionally, there is a benefit waiting period:

• Cancer (90 days – may vary by state)• Heart/Stroke (30 days – may vary by state)

• ESB, HIPAA and Health Care Reform do not apply.

• Applicants right to examine is 30 days (rather than the usual 10 days).

• Applicants may have a CHS plan and remain eligible for an HSA plan.

Product Information• The billing methods currently available for other

ASC products will be available for CHS.– Note: Direct bill will not be available for

ASC products submitted electronically as of the May implementation. Paper submissions still will include the direct bill option.

• When applicants provide their email address, they will be automatically enrolled in eDelivery.

Electronic Submissions

• Integrated interviews may be completed online or as a call-in.

• Stand Alone or Bundled interviews must be completed online.

• The call-in path is not available for stand alone or bundled submissions.

Paper Submissions

• Paper applications are accepted for stand alone Cancer and Heart/Stroke submissions.

• Integrated paper submissions are not available. – AHA – paper applications are not

accepted.– Portfolio – both the Portfolio and CHS

applications must be completed.

• Stand alone CHS quotes can be created in EASE or a CHS rate sheet can be submitted with the paper CHS application.

Paper Application Packets

• CHS application packets include:– Tip Sheet with applicant instructions on

how to complete the application, who should sign the application, etc

– Rate Sheet for manual calculation of premium rates

– Application– Billing Page– Any state required forms, such as Health

Replacement forms

• Paper application packets will be available on the Supplemental tab of Find-a-Form as of the implementation.

CHS Integrated with AHA

• Health questions and authorizations for both AHA and CHS must be completed.

• Risk is assessed for each product separately based on the health information provided for each product.– Both applications may be accepted.– If one is accepted, the other may be

declined.

CHS Integrated with a Portfolio Plan• Health questions for the Portfolio plan only

must be completed.

• Risk is assessed for both products based on the information provided on the Portfolio plan.– If the Portfolio plan is issued, the CHS

plan will be issued.– If the Portfolio plan is not issued, the

CHS plan will be marked incomplete.– Any applicants eligible for the CHS plan

may re-apply.

Risk Philosophy

• Risk assessment will be based on health history, MIB, pharmacy check information, and ICR information.

• There is no AOA required for CHS.

• GINA does not apply

Underwriting

• When CHS is submitted stand alone or bundled or is integrated with AHA, all applicants must be eligible for the application to be issued.– Each application is decided separately.– An application will be issued when all

applicants are acceptable based on eligibility and health criteria.

– When an application is incompleted, any applicants who are eligible may reapply.

– For electronic submissions, the underwriting decision will be presented in EASE or IM Consumer, as happens today for AHA submissions.

Underwriting Outcomes

• Instant issue logic will run for electronic and manual registry applications.

• CHS submissions may result in standard issue, decline, or incomplete status when submitted stand alone, bundled, or integrated with AHA.

• CHS may result in standard issue, incomplete, or automated counter offer (risk class) when integrated with a Portfolio product.

Key Points to Remember!

• CHS may be integrated with a Portfolio plan, with AHA plans, purchased as stand alone, or bundled with other ASC products.

• The philosophy for underwriting CHS is Accept/Reject.

• Systems have been enhanced to allow point of submission underwriting for this product.

Questions ?