TLC PG 0110 For agent/broker use only. Not for public ... · Marketing 866-475-5986 817-285-3452 [email protected] National Sales Desk 866-475-5986 817-285-3452 [email protected]

TLC PG 0110 For agent/broker use only. Not for public distribution.

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TABLE OF CONTENTS

WELCOME 3 INTRODUCTION 3 CONTACT INFORMATION 4 PRODUCT INFORMATION 5 WHAT SETS TRANSCARE® APART 5 STANDARD PRODUCT BENEFITS 6 FACILITY CARE BENEFITS 7 HOME HEALTH CARE BENEFITS 7 ADDITIONAL BENEFITS 9 ELECTED POLICY BENEFITS 9 PREMIUMS AND PAYMENT MODE 11 PREMIUM DISCOUNTS 11 SUITABILITY GUIDELINES 12 UNDERWRITING GUIDELINES 12 MULTILIFE – WORKSITE AND ASSOCIATION 13 WORKSITE – ELIGIBILITY 14 WORKSITE – UNDERWRITING TYPES 15 WORKSITE – PLAN DEFINITIONS AND CRITERIA 17 WORKSITE – RE-ENROLLMENTS AND NEW HIRES 20 ASSOCIATION AND UNION – ELIGIBILITY 22 UNDERWRITING QUICK REFERENCE GUIDE 24 STEPS TO ESTABLISHING A WORKSITE/ASSOCIATION CASE 26 ENROLLMENT SUPPORT – NATIONAL SALES DESK 28 NEW BUSINESS PROCEDURES 29 SUBMITTING BUSINESS 30 TOOLS AND MATERIALS 33 CONTRACTING AND LICENSING 34 ADMINISTRATION 34 PROFESSIONAL CONDUCT AND MARKETPLACE STANDARDS 35

Page 3For agent/broker use only. Not for public distribution.

WELCOMEWelcome to Transamerica Long Term Care’s Producer Guide for the TransCare® product. The product is designed to meet your clients’ financial and personal goals.

This Producer Guide has been developed with a specific goal in mind: to provide you with the tools and information you need to effectively present TransCare® to your clients. This guide will provide guidance on how to do business with Transamerica Life Insurance Company including information on policy benefits/limitations and the sales, application and/or enrollment processes.

This guide also provides an overview of the underwriting guidelines and Transamerica’s new business requirements. For additional information on the underwriting process, please refer to the Individual Underwriting Field Guide (TLC A UG 0608).

PLEASE REMEMBER: Policy benefits, exclusions, limitations, and issue parameters will vary by state. For complete information regarding the product in a given state, please consult the policy form approved for use in that state. In the event of a variance between this producer’s guide and the policy form, the language found in the policy form will prevail.

Should you have any questions or need any additional information, contact your MGA, Transamerica Field Representative or the National Sales Desk.

INTRODUCTIONTransamerica Long Term Care is uniquely positioned to assist you in the Individual and MultiLife long term care insurance market. Transamerica has one of the strongest, most comprehensive products in the LTCi industry. It is built upon many years of experience and having written over 300,000 policies in both the Individual and MultiLife markets.

We are uniquely positioned to provide you with:

• Strong, flexible product• Competitive compensation• MultiLife discounts• Discounts available to extended family members• Multiple rate structures• Six rate classes• Underwriting flexibility• Innovative High Potential Employee (HPE) concept

reduces participation requirements• Electronic enrollment

• Insurer financial strength• Policy portability• “Tailor-Made” programs• Premium payment options (Lifetime, Limited Pay,

Single Pay, Direct or List Bill / Payroll Deduction)• Dedicated Worksite Administration Department• Personalized service• National Sales Desk support• Website support and services• Field enrollment support

When using this Producer Guide, please remember to also consult the Agent Resource Center (www.taltc.com) for specific state product requirements and benefits.

Page 4 For agent/broker use only. Not for public distribution.

CONTACT INFORMATIONATTENTION: You must verify the following information before submitting any business:

• that you are properly licensed and appointed by Transamerica Long Term Care and the state in which you intend to solicit business;

• that the product you wish to offer is approved in the state in which you intend to solicit business;• that you signed and returned the Professional Conduct Principles and Policies Acknowledgment that

accompanied your licensing and appointment paperwork; and• that an Implementation Memo has been issued for your case (MultiLife cases).

Mailing Addresses

Worksite Administration Contracting and Licensing Overnight or Express DeliveryTransamerica Life Insurance Company

P. O. Box 95302Hurst, TX 76053-5302

Email: [email protected]

Transamerica Life Insurance CompanyP. O. Box 95302

Hurst, TX 76053-5302

Email: [email protected]

Transamerica Life Insurance Company1900 L. Don Dodson Drive, Suite 300

Bedford, TX 76021

Office Phone Numbers and Email AddressesPhone Fax Email

Agent Administration: Contracting & Licensing 800-468-5843 866-636-7496 [email protected]

Commissions 800-468-5843 866-636-7496 [email protected] 866-745-3542 817-285-3477

Customer Service 800-227-3740 817-285-3450Marketing 866-475-5986 817-285-3452 [email protected]

National Sales Desk 866-475-5986 817-285-3452 [email protected] Business 800-227-3740 817-285-3450 [email protected]

Premium Accounting 800-227-3740 817-285-3460Worksite Administration 800-687-1490 877-532-4908 [email protected]

Agent Resource CenterBe sure to visit the Agent Resource Center (ARC) at www.taltc.com. The ARC provides information on how to do business with Transamerica Life Insurance Company:

• Quoting – download the TransQuote Illustration System to your computer or run quotes directly from the ARC. Instructions are available using the Help button at the upper right of each page of the TransQuote software

• Applications – access the status of applications submitted for underwriting along with needed requirements for policy issue

• Product Material – all approved supplies such as application/disclosure packages and marketing material are available to order, download or print

• Licensing – view licensing requirements by state• Other information – view information on a variety of long term care topics such as state partnership programs

and cost of care by state

Ordering SuppliesSupplies (forms and marketing material) are available for order on the Agent Resource Center located at www.taltc.com. You must be licensed and appointed with Transamerica Long Term Care to order supplies.

Electronic Enrollment Support Electronic enrollment is available for Worksite enrollments. Laptops, preloaded with the rates, plans and software are available to support a smooth enrollment. For further information, please contact your MGA, Transamerica Field Representative or National Sales Desk.


PRODUCT INFORMATIONUnderstanding TransCare®

TransCare® is designed to help your clients maintain financial security in the event they find themselves in need of long term care. TransCare® also provides clients with the opportunity to get care when and where it is needed. A sickness, accident or cognitive impairment requiring long term care (LTC) can be costly. Owning LTC insurance may help ease the burden of the high cost of LTC.

For employers, TransCare® may help complete the employee benefit package. TransCare® gives employers an opportunity to demonstrate their commitment to help employees manage their home and work lives – all at a very competitive cost. This protection, in turn, may provide employers with the added advantage of attracting and retaining employees in a competitive marketplace.

For associations and unions, TransCare® may be an attractive benefit for members and simultaneously assist members in meeting their LTC needs. Enhancing membership benefits with TransCare® provides the association or union with an outstanding incentive to attract new members.

Note: The following summaries are general explanations of the coverage available. Definitions, terms, conditions and availability of benefits vary by state; please refer to the specific contract forms for details. This material is for agent use only. You should always refer to the Outline of Coverage and the contract forms for details.

WHAT SETS TRANSCARE® APARTTransCare® provides some of the best long term care benefits and services available today while providing the flexibility required to meet your clients’ needs.

Information about each of the following TransCare® features can be found in the Product Features section of this guide.

Industry-Leading Discounts

A variety of discounts are available to clients (may differ by state).

• Spousal Discount: 40% for couples applying together for identical benefits.• Worksite Discount: 10% to 15% for worksite cases insuring 5 or more employees.• Association Discounts: 10% for Professional Associations and Unions and 5% for Social Affinity associations.

Additional information regarding discounts can be found in the “Premiums” section of this guide.

Care at Home

TransCare® provides several features that may allow an Insured to remain at home as long as possible. A standard 0-day (benefits are available from day 1 of benefit eligibility) Elimination Period for Home Health Care benefits is included in most states.

Alternative Payment Benefit

TransCare® provides a monthly lump sum benefit (10 times the Maximum Daily Benefit) in lieu of all other benefits. The Alternative Payment Benefit is paid directly to the Insured and may be used in any way he or she sees fit.

Six Rate Classes

In addition to Preferred and Standard rating classes, Transamerica can offer coverage on a Class 1 through Class 4 basis with increases in premium.

Long Term Care Expertise

With many years of experience, Transamerica Long Term Care is devoted exclusively to the marketing and servicing of Long Term Care insurance.


STANDARD PRODUCT BENEFITSBenefits vary by state. Please see the state specific Outline of Coverage (Disclosure Form in some states) for complete details.

Coverage AvailableTransCare® is an individual tax-qualified Long Term Care insurance product offering integrated coverage for Nursing Home, Assisted Living Facility, Adult Day Care and Home Health Care. This plan has been designed to qualify as a tax qualifying policy under Federal Law (The Health Insurance Portability and Accountability Act of 1996).

Issue AgesIssue ages for TransCare® are 18 through 79.

Maximum Daily Benefit (MDB)Maximum Daily Benefit selections range from $50 to $400 per day. TransCare® will cover the actual, out-of-pocket charges incurred by the Insured, up to the Maximum Daily Benefit for each day the Insured is eligible for benefits and is receiving Nursing Home, Assisted Living Facility, Adult Day Care or Home Health Care services.

Benefit PeriodThe Benefit Period is the number of years that daily benefits are payable to the Insured. The following benefit periods are available:

• Two years• Three years• Four years

• Five years• Six years• Unlimited

Maximum Benefit (Pool of Money)The Maximum Benefit (or Pool of Money) is the maximum dollar amount that the policy will pay. The Maximum Benefit is calculated by multiplying the Maximum Daily Benefit by 365 and then by the Benefit Period. For example, the Maximum Benefit for a policy with a $100 Maximum Daily Benefit and a five year Benefit Period would be $182,500 ($100/day X 365 days X 5 years = $182,500). This Maximum Benefit increases if a Benefit Increase Option is selected.

Using the Maximum Benefit as a Pool of Money may extend the life of the policy. For example, on days when an Insured incurs long term care expenses that are less than the Maximum Daily Benefit, the remaining daily benefit up to the Maximum Daily Benefit would remain in the Pool of Money. Referring to the above example, long term care expenses of $50 per day could extend the Benefit Period from 5 years to 10 years.

Elimination Period

TransCare® provides several features that may allow an Insured to remain at home as long as possible. A standard 0-day Elimination Period for Home Health Care benefits is included in most states which means that Home Health Care benefits are available from day 1 of benefit eligibility.TransCare® has a separate Elimination Period that applies to benefits payable under the Nursing Home and Assisted Living Facility benefits. Like many health insurance deductibles, the Elimination Period is the number of days the Insured is responsible for paying the cost of LTC services before the policy begins to pay benefits. The Elimination Period is cumulative, meaning that once enough service days have been accumulated to satisfy the Elimination Period, it need never be satisfied again.TransCare® has five Elimination Period options to choose from:

• 0-day • 30-day • 60-day

• 90-day• 180-day

PortabilityEach TransCare® policy is issued on an individual basis, meaning that the Insured owns his or her policy. In the event employment or association membership is terminated for any reason, coverage will continue as long as timely premium payments are made. Premium amounts, discounts and coverage amounts remain the same for the Insured and any extended family members who purchased via the program. Upon termination with the sponsoring employer or association, premium payment modes will be changed to monthly Electronic Funds Transfer (EFT) or direct bill (quarterly, semi-annual or annual).


FACILITY CARE BENEFITSNursing HomeFor those Insureds who require higher levels of care, TransCare® provides benefits for actual, out-of-pocket charges incurred for each day confined in a Nursing Home. Nursing Home benefits will be paid after the Elimination Period has been satisfied, up to the selected Maximum Daily Benefit.

Assisted Living FacilityWe will pay the actual, out-of-pocket charges incurred for room and board, not to exceed the charge for a one-bedroom unit, and for the necessary Maintenance and Personal Care Services for each day confined in an Assisted Living Facility up to the chosen Maximum Daily Benefit.Note: The definition and title of an Assisted Living Facility varies by state. Please consult your state-specific Outline of Coverage for more information.

Bed ReservationWhile receiving Nursing Home or Assisted Living Facility benefits, TransCare® will cover actual, out-of-pocket charges incurred if the Insured is charged for his or her room while temporarily absent for any reason, except for discharge. This benefit is provided for up to 60 days in any one calendar year or as credit toward your Elimination Period if not yet satisfied. This benefit will reduce the Maximum Benefit Amount.

Restoration of Nursing Home BenefitsFollowing a Nursing Home confinement where benefits have been paid and then the Insured recovers, we will restore the Nursing Home benefit amount to the applicable Maximum Benefit. To qualify, the Insured must no longer be a claimant and, therefore, no longer meet the requirements found in the Benefit Eligibility provision for a period of 180 consecutive days.

HOME HEALTH CARE BENEFITSHome Health CareWe will pay the actual, out-of-pocket charges incurred for each day of Home Health Care (Professional and Basic), up to the chosen Maximum Daily Benefit. Basic Services must be provided by or through a Home Health Care Agency, unless the Insured Person is receiving the Care Coordination Benefit. If the Insured is utilizing the Care Coordination Benefit, Basic Services may be provided by a provider who is licensed or certified as required by the state to provide such services and is approved by the Care Coordinator.

Adult Day CareThis benefit pays the actual, out-of-pocket charges incurred for each day an Insured Person receives Adult Day Care for at least 4 hours provided by and at an Adult Day Care Center, not to exceed the chosen Maximum Daily Benefit.

Hospice CareIf an Insured Person has no reasonable prospect of recovery and, as estimated by his or her Doctor, has a life expectancy of 6 months or less, we will pay the actual, out-of-pocket charges incurred for each day Hospice Care is provided by a Hospice Care Provider, up to the chosen Maximum Daily Benefit. We will not pay more than 180 days of Hospice Care.

The Home Health Care benefits described above cannot be used to satisfy the Elimination Period selected for Nursing Home and Assisted Living Facility Benefits.

Care Coordination BenefitsSee the state specific Outline of Coverage for details.Under TransCare®, a Care Coordination benefit is provided whereby a Care Coordinator can assist an Insured in:

• Assessing the Insured’s needs• Developing a Plan of Care• Monitoring the Insured’s progress and helping to modify the Plan of Care• Providing a referral list of care providers from which the Insured may choose to receive services, if needed.

Use of the Care Coordination benefit is not required in order to access the policy unless otherwise noted. There will be no charge to the Insured for the services of the Care Coordinator if the chosen Care Coordinator is contracted by us for as long as the Insured meets, or is expected to meet, the Benefit Eligibility provisions of the policy.


The benefits for the Care Coordination services provided by the Care Coordinator are not subject to, nor will they satisfy, the Elimination Period. The use of the benefit does not reduce the total Maximum Benefits provided under the policy.

The following benefits are available only if the Insured Person is receiving the Care Coordination Benefit. The Care Coordinator must approve the provider of the care, services or training for these benefits. We must also agree to any modification to or installation in the Home in advance of the work being done.

Respite Care

Respite Care is provided when a family member or other caregiver who normally provides Long Term care services on a regular basis takes short-term leave, up to a total of 30 days per calendar year. This provides the caregiver with temporary relief from the responsibilities of caregiving. Care provided under this benefit can be provided at home, in a Nursing Home, or in an Assisted Living Facility.

This benefit will not be payable when other benefits (i.e., Nursing Home, Assisted Living Facility or Home Health Care) other than Care Coordination, are payable under this policy.

Therapeutic Device

We will cover the actual, out-of-pocket charges incurred by the Insured up to a Lifetime Maximum equal to 50 times the Maximum Daily Benefit for the rental or purchase of a Therapeutic Device (the decision to rent or buy is ours) to be used in the Insured’s home. The following are examples of equipment that are considered Therapeutic Devices: special hospital-style beds, crutches, wheelchairs, infusion pumps or respirators.

For purposes of this benefit, the Insured’s “Home” does not include an Assisted Living Facility.

Home Modification

We will cover the actual, out-of-pocket charges incurred by the Insured up to a Lifetime Maximum equal to 50 times the Maximum Daily Benefit for modifications to the Insured’s home that will enhance their ability to perform ADL’s and allow the Insured to live safely and independently in the home. Examples of Home Modification include: ramps, grab bars, or similar accessibility modifications. We must approve the provider, labor, equipment and supplies. Approval from us is required prior to any modification or installation.


Medical Alert System

We will cover the actual, out-of-pocket charges incurred by the Insured up to a maximum amount equal to 50% of the Maximum Daily Benefit to monitor, rent or purchase a Medical Alert System (the decision to purchase or rent is ours). The Lifetime Maximum is 50 times the Maximum Daily Benefit. Approval from us is required prior to any modification or installation.


Caregiver Training

We will cover the actual, out-of-pocket charges incurred by the Insured for the Insured’s informal caregiver to receive Caregiver Training. We will cover this benefit up to a Lifetime Maximum equal to 10 times the Maximum Daily Benefit. Caregiver Training is defined as appropriate training and instruction provided by a person approved by the Care Coordinator to provide the knowledge and skills necessary to the Insured’s informal caregiver for the proper use and care of a therapeutic device or the performance of the appropriate caregiving procedures.

Contingent Nonforfeiture BenefitAfter the expiration of the rate guarantee (if any) and if we increase an Insured’s premium rates to a level which results in a cumulative increase of the annual premium equal to or exceeding the percentage of the initial premium and the Insured is unable to afford the increased premium, he or she may choose one of two coverage options offered in this provision.

The initial premium is based on the Insured’s age when the policy was issued, plus the premium for any benefits that have been added since then, and/or minus the premium for any benefits that have been reduced since the policy was issued.


ADDITIONAL BENEFITSAlternative Payment BenefitWe will pay 10 times the Maximum Daily Benefit amount in advance for each calendar month the Insured Person continues to be benefit eligible. We will pay this benefit on a monthly basis in lieu of all other benefits for care or services provided under this Policy. The Insured may use the money in any way he or she sees fit. There is no elimination period for this benefit in most states.

Waiver of PremiumWhen the Insured meets the Benefit Eligibility requirements, has satisfied the Elimination Period and is receiving Benefits under the policy, we will waive all premiums while the Insured remains on claim.

International CoverageCoverage may be obtained worldwide through the Alternative Payment Benefit.

Lifestyle Benefit ChangesPolicyholders may adjust their Daily or Monthly Benefits as they see fit. Increases in coverage must be approved by our Underwriting Department and will be subject to an additional premium for the increase in coverage. The new premium, if an increase was submitted, will be based on attained age. This feature allows policyholders the ability to adjust coverage as their needs change in the future without having to purchase another policy.

Rate GuaranteePremium rates for this Policy are guaranteed, where permitted, from the Policy’s Effective Date for a period of 3 or 5 years. A few states (CT, FL, IL, MD, TN and WI) do not allow a rate guarantee.TransCare® provides the option of purchasing additional rate guarantees beyond the included Rate Guarantee Period. The Insured can purchase up to a 10 year Rate Guarantee Period in one-year increments. We cannot increase premiums during any applicable rate guarantee period. When the rate guarantee period ends, the premium will be adjusted by any premium increases that have occurred during the rate guarantee period. However, if the Insured purchases a limited pay plan with a matching rate guarantee period, the premiums will not be affected by any premium increases. We cannot single the Insured out for a premium rate increase, but we can change premium based on our experience with all Insureds in the same premium class. Once coverage is issued, we cannot cancel the Policy as long as premiums are paid on a timely basis.

ELECTED POLICY BENEFITSThe following benefits are not part of the standard product package but can be added to customize a plan that meets your client’s needs and budget. An additional premium may be required for each of the elected policy benefits chosen.

Benefit Increase OptionsDeferred Benefit Increase Option The Insured may add a Benefit Increase Option without evidence of insurability at a future date as long as there has been no claim or the Insured is not currently eligible to claim. This offer will be extended to the Insured within ninety days prior to the first, the third and the fifth anniversary date of the policy.

Simple Benefit Increase OptionIf elected by the Insured, the Simple Benefit Increase Option provides for an annual 5% increase of the original benefit amount of the policy. This option is not available in all states.

Compound Benefit Increase OptionIf elected by the Insured, the Compound Benefit Increase Option provides an automatic benefit increase designed to help protect Insureds from rising Long Term Care costs. The benefit will be based on the prior year’s benefit amount. The Insured may elect a compound benefit increase of 3% or 5%. In states where the 3% Compound Benefit Increase is not available the 5% Simple Benefit Increase may be offered.


Step-Rated Compound Benefit Increase OptionIf elected by the Insured, this option allows the protection of a benefit increase option at a lower initial rate. The benefit increases by 5% each year along with an associated increase in premiums each year. The Insured can elect to stop the increases on any anniversary date of the policy.NOTE: If the Insured does not elect to add the Compound Benefit Increase Options, the Simple Benefit Increase Option, or the Step-Rated Compound Benefit Increase Option, the policy will be issued with the Deferred Benefit Increase Option. The Deferred Benefit Increase Option may be exercised at the end of the first, third and fifth years. The premium will be based on age at time of exercising the option.

Nonforfeiture Shortened Benefit PeriodIf the contract lapses due to non-payment of premium after the third policy anniversary, we will continue the contract at the same rate of coverage for a shortened benefit period.

Monthly Home CareBecause the charges for Home Health Care and Adult Day Care services may vary from day-to-day, this option makes the Home Health Care and Adult Day Care benefits available on a monthly basis (30 continuous day total) rather than a daily basis. This means that the Maximum Daily Benefit (MDB) no longer applies and the entire benefit may be used in one day, ten days, or whatever best suits the Insured’s needs. The Insured must be using the Care Coordination Benefit in order to receive this benefit.

Professional ServicesThe number of days Professional Services are received during a 30-day period multiplied by 2 times the Maximum Daily Benefit will be paid. Professional Services include a variety of care services performed by licensed professionals such as registered nurses, physical therapists and nutritional specialists.

Full Restoration of Benefits For a period of 180 consecutive days, the Insured Person must not meet the requirements found in the Benefit Eligibility provision for Cognitive Impairment and the inability to perform at least the required number of daily activities shown on the Schedule Page. The 180 consecutive days begins on the day a Licensed Health Care Practitioner certifies that the Insured Person does not meet the requirements for Benefit Eligibility and such certification is filed with Transamerica Life. The policy must remain in force throughout the 180 consecutive day time period. If these conditions are met, we will restore such benefit amounts that We paid to the remaining Maximum Benefit. This includes any increases to the Maximum Benefit that may have occurred under a Benefit Increase Option, if elected. The amounts applied to the restoration will only be available for subsequent stays or care subject to the restored Maximum Benefit. The restored amount will not exceed the Maximum Benefit payable.

Joint Waiver of PremiumIf we are waiving premiums for one Spouse or Domestic Partner under the Waiver of Premium Benefit, we will waive all premiums for the 2nd Spouse or Domestic Partner. We will stop waiving the premiums for both Spouses or Domestic Partners when neither qualifies for benefits under the policy.

Return of PremiumSubject to any provision to the contrary, if this benefit has been continuously in force from its Effective Date, a benefit will be paid after all Insured Persons have died. We will also pay this benefit if the Policy should lapse and the last death occurs within 90 days of the date the last premium payment was due.

Paid-up ProvisionIf the Insured elected a premium paying period that is equal to or greater than 10 years and he/she has chosen to discontinue premium payment prior to the end of the Premium Paying Period, a percentage of the dollar benefit amounts under the policy will become paid-up. If coverage is subsequently reinstated, as provided under the Reinstatement or Extended Reinstatement provision of the policy, all benefit amounts in force at the time premium payments were discontinued will restored as of the date of Reinstatement.

Cancellation ProvisionIf the Insured elected a premium payment schedule that is less than 10 years, the policy will become fully paid-up and no further premiums will be due. If the Insured should die or otherwise cancel coverage, Transamerica Life will return a portion of the premium (excluding any waived premiums and benefits paid) to the Insured or the Insured’s estate.


Limited Payment OptionsThe Insured can choose to pay premiums on a limited pay basis. There are three options: Single Pay, 10-Year Limited Payment and Pay-to-65. All Limited Payment Options are guaranteed renewable during the premium payment period and become non-cancelable thereafter. The Pay-to-65 option is available for purchase up to 60 years of age (age 55 in NY). After the first Policy Anniversary, premiums will not be refunded if the Limited Pay Option chosen is cancelled or changed. Limited Payment Options cannot be paid in advance. Policyholders will have access to a Limited Payment Option Contingent Nonforfeiture should a rate increase occur and trigger that benefit option.

PREMIUMS AND PAYMENT MODEPremiums may be paid Annually, Semi-Annually, Quarterly, Monthly PAC (bank draft), or via Payroll Deduction (for MultiLife cases). We will accept a credit card to pay only the required premium submitted with the application and any additional premium that may be required at delivery of the policy. Credit card payment is not available on an ongoing basis. Use a separate Credit Card Authorization (CCA-501) form for each transaction.Unless the policy is List Billed (MultiLife cases), two months premium MUST be submitted with EACH application (may vary by state).List Bill is only available when five or more applications are received during the initial enrollment period.We encourage the use of the TransQuote Illustration System available on the Agent Resource Center when calculating premiums for your customers. However, the premium shown on the Schedule Page is the final premium.

PREMIUM DISCOUNTSThe following premium discounts may be available with TransCare®.

• 40% Spousal Discount with both spouses applying in “good faith” for identical benefits • 10% Preferred Rate Discount with Full Underwriting or Abbreviated Application Underwriting

Spousal Discount A 40% Spousal Discount may apply for married couples or domestic partners. Domestic partners are defined as two unrelated individuals living with one another in a permanent stable relationship for at least 2 years. Both spouses must apply in “good faith” for identical benefits (i.e., a field decline is not considered a “good faith” application).If both requirements are not met, single rates will apply. The Spousal Discount will not be removed in case of death, divorce or policy lapse of one spouse.

Preferred Health DiscountApplicants must be quoted using Standard Rate. If during the underwriting process it is determined that the applicant qualifies for the Preferred Health Discount, the policy will be issued with that discount. This discount is not available with Modified Guaranteed Issue or Simplified Issue (MultiLife cases) underwriting. The 10% Preferred Health Discount may apply to individuals who:

• Have not used tobacco in last three years• Meet the Transamerica Long Term Care’s medical risk guidelines


SUITABILITY GUIDELINESLong Term Care Personal WorksheetPeople buy long term care insurance for many reasons. Some clients don’t want to use their own assets to pay for long term care. Some clients buy insurance to make sure they can choose the type of care they get. Others don’t want their family to have to pay for care or don’t want to go on Medicaid. But long term care insurance may be expensive, and may not be right for everyone.

By state law the insurance company must ask each applicant for his income and asset levels. This information should be used by the producer and the applicant to help determine if the contemplated policy will be suitable for the client. You should review with the client the total premium that will be charged for the coverage selected.

As a general rule, premiums for an LTC policy should not exceed 7% of the clients income. This recommendation is found in the National Association of Insurance Commissioner’s (NAIC) Long Term Care Model regulation. Additionally, the Personal Worksheet follows the NAIC guidelines on assets, suggesting that an applicant have a minimum of $30,000 in assets (excluding a house) before considering the purchase of a Long Term Care policy.

When we receive the completed application we will verify that the suitability form is completed and signed by the applicant or that the applicant has checked the opt-out box and signed the form. We may also ask the Insured to verify his responses during the underwriting telephone interview if one is completed.

UNDERWRITING GUIDELINESIf you need assistance with underwriting and are not sure if your client will qualify, please contact us via email at [email protected]. When the Underwriting Department responds to you, print a copy of the response and attach it to your application. While their response will not bind their underwriting response, it may expedite the decision. Every effort will be made to place the applicant in the best rating classification, regardless of what has been applied for. When the underwriting evidence indicates that a policy cannot be issued as applied for, rather than simply decline, we will give consideration to providing an alternate offer. In addition to Preferred and Standard premium rates, we can offer coverage on a Class 1 through Class 4 basis with increases in premium. Please refer to the Individual Underwriting Field Guide (TLC A UG 0608) for complete details.


MULTILIFE – WORKSITE AND ASSOCIATION


WORKSITE – ELIGIBILITYEligibility

Eligible Employees (EE’s) – the group of employees, as defined by the employer and agreed to by Transamerica, that is eligible for benefit enrollment during the Open Enrollment Period (OEP) who have been actively at work on a full time basis (30 hours or more) for at least 6 months and are age 18 - 65.

Eligible Spouses – spouses of eligible employees that are actively at work on a full time basis (30 hours or more) for at least 6 months and are age 18 - 65 may be eligible for Abbreviated Application with Underwriting.

Extended Family Members – children, siblings, parents of the employee or parents of their spouse, and other family members such as cousins.

Certain worksite characteristics are more likely to lead to expressed interest in Long Term Care insurance by employees. In addition to size; other measures of favorable and unfavorable LTC groups should be considered when planning to approach a worksite group.

Most Favorable Unfavorable• Average age greater than 45• Employee incomes greater than $35,000 • Low annual staff turnover• High Tech, skilled labor or “white collar”• High enrollment in multiple benefit programs• Active marketing support of employer• LTC not previously offered

• Average age less than 40• Employee incomes less than $35,000• High staff turnover• Low skilled laborer• Poor enrollment with existing benefits or limited

benefits available• Low employer support

Experience has also shown that a certain population within the worksite is more likely to purchase. High Potential Employees (HPE) are employees that are most likely to buy Long Term Care insurance. This group is usually between ages 45 and 65 with annual incomes greater than $35,000.

All LTC Worksite cases MUST be approved by Transamerica Life Insurance Company PRIOR to making a formal commitment to the employer or soliciting any applications. A signed Service Group Request (SGR) is required and the resulting Implementation Memo is our commitment to you and your client detailing the specifics of the offer. It is your indication that the enrollment has been approved.

Transamerica reserves the right to alter its underwriting criteria at any time and/or decline to underwrite any group based on overall risk factors. If you have questions regarding current guidelines, do not hesitate to call the National Sales Desk.


WORKSITE – UNDERWRITING TYPES The Long Term Care product includes the availability of Modified Guaranteed Issue (MGI) underwriting for certain groups that qualify based on their size and achieving the required participation levels. Transamerica also offers Simplified Issue (SI) and Abbreviated Application (AA) underwriting for smaller groups. Please refer to the chart for the appropriate level of underwriting.

Underwriting Type MinimumGroup Size

ParticipationRequirements

Modified Guaranteed Issue (MGI) 15 EE’s Greater of 15 EE applications or 10% of HPE

Simplified Issue (SI) 10 EE’s Greater of 10 EE applications or 5% of HPE

Abbreviated Application (AA) 10 EE’s 5 EE applications

Full None None

Transamerica reserves the right to decline to underwrite any group based on overall risk factors.

Modified Guaranteed Issue (MGI)

Worksites with 15 or More Eligible Employees (EE’s):

MGI is available to all EE’s when:

• Minimum participation is equal to the larger of a) 15 EE’s or b) 10% of HPE

• Minimum participation is based on the number of EE applications completed during the open enrollment period.

EE’s will have the opportunity to select coverage from predetermined benefit plan(s) selected by the employer with the assistance of the agent and approved by Transamerica. The total Maximum Benefit of the largest benefit plan cannot exceed four (4) times the total Maximum Benefit of the smallest benefit plan selected. EE’s who select plans outside the benefit levels allowed for MGI and SI must complete the entire application and undergo full underwriting. Note: In the event that participation requirements are not met, the MGI underwriting offer will be withdrawn and full underwriting will be required of all applicants. MGI is only available during the Open Enrollment Period (OEP).

Simplified Issue (SI)

Worksites with 10 or More EE’s:

SI is available to all EE’s when:

• Minimum participation is equal to the greater of a) 10 EE’s or b) 5% of HPE

• Minimum participation is based on the number of EE applications completed during the enrollment period.

EE’s will have the opportunity to select coverage from predetermined benefit plan(s) selected by the employer with the assistance of the agent and approved by Transamerica. The total Maximum Benefit of the largest benefit plan cannot exceed four (4) times the total Maximum Benefit of the smallest benefit plan selected. EE’s who select plans outside the benefit levels allowed for MGI and SI must complete the entire application and undergo full underwriting.

Note: In the event that participation requirements are not met, the SI underwriting offer will be withdrawn and full underwriting will be required of all applicants. SI is only available during the Open Enrollment Period (OEP).


Abbreviated Application with Underwriting (AA)Worksites with 10 or More EE’s:AA is available to all EE’s and their Spouses who are employed full time and not yet 66 years old. Five EE applications must be completed during the enrollment period to meet the minimum participation requirement. EE’s will have the opportunity to select coverage from any benefit level available in the applicable state.Note: In the event that participation requirements are not met, the AA underwriting offer will be withdrawn and full underwriting will be required of all applicants. The Worksite discount is withdrawn.

Full UnderwritingTransamerica offers full underwriting for groups that do not otherwise qualify for one of our limited underwriting or Worksite discount programs. In this situation, any employee, spouse or family member will undergo full underwriting.


WORKSITE – PLAN DEFINITIONS AND CRITERIAEmployer Pay All/Executive Carve Out (EPA/ECO) Worksite PlansThe employer pays 100% of premium for a single pre-approved benefit plan for all employees or for all employees in a Defined class.

• Married rates apply to all eligible married employees in the class even if the spouse does not apply.• Single rates apply to all single employees in the class.

If an EPA/ECO worksite has more than one defined class, each class must have at least five employees.• An employer may define up to a maximum of five classes.• Defined classes must follow generally accepted, well defined groupings such as: Job Titles, Income Groupings,

Management/Non-management, Partners/Associates, etc.A Worksite discount of 10% applies to employees in the class and their spouses.A Spouse may apply for an individual policy. Spouses applying for identical benefits will be eligible for married rates and the worksite discount, if

• The spouse applies for the same pre-approved benefit plan during the OEP• The spouse applies “in good faith” (i.e., field decline is not considered a “good faith” application) • When both of the above requirements are not met, single rates apply

A 40% spousal discount may apply. The Marital Discount will NOT be removed from the policy in event of death, divorce or policy lapse of one spouse. If one spouse is declined the other will retain the discount as long as the applicants submitted applications in good faith.Defined classes must follow generally accepted, well defined groupings such as: Job Titles, Income Groupings, Management/Non-management, Partners/Associates, etc.“Buy ups” are not allowed. A “Buy up” occurs when: the Daily Benefit, the Elimination Period, or the Benefit Period is different from the pre-approved EPA/ECO plan selected.

Employer Pay Some (EPS) Worksite PlansThe employer pays at least 25% of the premium for a single pre-approved benefit plan for all employees or for all employees in a defined class. The daily benefit for the pre-approved benefit plan must be greater that 50% of the average Nursing Home care cost for the state as found on the Agent Resource Center www.taltc.com. Voluntary rate structure applies to all eligible employees in the class.A Worksite discount of 15% applies to employees in the class and their spouses.Married employees and married family members may qualify for Married rates if:

• Both apply for the same pre-approved benefit plan during the OEP• Both spouses must apply “in good faith” for the same level of coverage (i.e., field decline is not considered a

“good faith” application). Different premium paying periods or different payment methods are NOT considered different benefits

• When both of the above requirements are not met, single rates apply Up to a 40% discounted married rate may apply. The Marital Discount will NOT be removed from the policy in case of death, divorce or policy lapse of one spouse. If one spouse is declined the other will retain the discount as long as the applicants submitted applications in good faith.Preferred health discounts may be available to qualified applicants who undergo Abbreviated Application or Full Underwriting and when the following conditions are met.

• The applicant has not used tobacco products in the last three years, and• The applicant meets the medical risk criteria. • The applicant must be approved as better than standard risk.

Applicants will be quoted the Standard Rate. If Underwriting determines that the applicant qualifies for the Preferred health discount, the policy will be issued with that discount.The Preferred health discount is not available to applicants given a Class Rating or underwritten utilizing MGI or SI. If using MGI or SI, standard rates apply.Defined classes must follow generally accepted, well defined groupings such as: Job Titles, Income Groupings, Management/Non-management, Partners/Associates, etc.


Voluntary Worksite PlansThe Worksite is offered pre-approved LTCi plans on a voluntary basis for EE and their family members.

• Employees may elect, but are not required, to apply for coverage• Spouses and extended family members may be eligible to participate• An employer may offer different long term care insurance plans by defined classes within the group of EE.

Defined classes must follow generally accepted well defined groupings such as: Job Titles, Income Groupings, Management/Non-management, Partners/Associates, etc.

A Worksite discount of 10% is available.Married employees and married family members may qualify for Married rates if:

• Both apply for the same pre-approved benefit plan during the OEP.• Both spouses must apply “in good faith” for the same level of coverage (i.e., field decline is not considered a

“good faith” application). Different premium paying periods or different payment methods are NOT considered different benefits.

• When both of the above requirements are not met, single rates apply Up to a 40% discounted married rate may apply. The Marital Discount will NOT be removed from the policy in case of death, divorce or policy lapse of one spouse. If one spouse is declined the other will retain the discount as long as the applicants submitted applications in good faith. Single rates apply for; single employees, single family members, and married applicants who do not qualify for the marital discount.Preferred health discounts may be available to qualified applicants who undergo Abbreviated Application or Full underwriting and when the following conditions are met.

• The applicant has not used tobacco products in the last three years, and• The applicant meets the medical risk criteria. • The applicant must be approved as better than standard risk.

Applicants will be quoted the Standard Rate. If Underwriting determines that the applicant qualifies for the Preferred health discount, the policy will be issued with that discount.The Preferred health discount is not available to applicants given a Class Rating or underwritten utilizing MGI or SI. If using MGI or SI, standard rates apply.


Worksite – Plan Definitions and Criteria

Employer EmployeeProgram Contribution Marital Status U/W Rating Group Discount

EPA/ECOPays 100% of Plan on every employee in a defined class

No Buy Ups allowed

All married employees receive the marital

discount regardless of spouse application

Standard 10%

EPS

Pays at least 25% of the premium for a Base Plan

with a minimum daily benefit equal to 50% of the state’s average NH cost as shown

on the TA website

Married employees only receive the marital discount if

the spouse applies for same benefits

Single employees pay the single rate

Standard 15%

Voluntary Pays no contribution or less than EPS minimum

Married employees only receive the marital discount if

the spouse applies for same benefits

Single employees pay the single rate

Standard 10%

• No discounts available for less than five (5) employee applications.• No list bill for less than five (5) policies• Underwriting: MGI at greater of 15 employees or 10% of HPE

SI at greater of 10 employees or 5% of HPE AA at minimum of 5 employees

Program Spouse Applies in Good Faith Spouse Rules

EPA/ECOEmployee and Spouse get Married Rates(All married employees receive the marital discount regardless of spouse application)

Standard with 10% group discountPreferred health discount available

subject to underwriting

EPS Employee and Spouse get Married RatesStandard with 15% group discountPreferred health discount available


Voluntary Employee and Spouse get Married RatesStandard with 10% group discountPreferred health discount available



WORKSITE – RE-ENROLLMENTS AND NEW HIRES Enrollment after a successful initial Open Enrollment Period (OEP) is available when one of the following options is requested at the time of the original worksite approval.

Option IAnnual Re-enrollment (Available for new hires or for all employees) Annual Open Enrollment Periods may be available, subject to Home Office approval, for Worksites that successfully met their previous enrollment period’s participation requirement. The method of underwriting will be determined according to the following criteria:

Annual Re-enrollment period with Modified Guarantee Issue (MGI), Simplified Issue (SI), and Abbreviated Application (AA) may be available if:

• The original/previous participation level was met, and• The Home Office has approved the re-enrollment

Applicants must have been employed full-time for at least 6 months with the sponsoring employer at the time of application and appropriately answer all application questions.

Re-enrollment Participation Requirements

Re-enrollment Participation Requirements apply when Option I is selected and the re-enrollment is applicable to all employees.

Underwriting Type Minimum Size ParticipationRequirements*

Previous EnrollmentParticipation

Modified Guaranteed Issue (MGI) 15 EE’s Greater of 15 EE

applications or 10% of HPE

Worksite must have met all participation requirements

during the previous enrollment

Simplified Issue (SI) 10 EE’s Greater of 10 EE applications or 5% of HPE

Worksite must have met all participation requirements

during the previous enrollment

Abbreviated Application (AA) 10 EE’s 5 EE applications None

Full None None None

* Re-enrollment participation requirements are based on the number of employees that have not purchased Long Term Care coverage and the current number of HPE’s.

A current census and Re-enrollment Form must be submitted to the Home Office for review 90 days prior to the proposed OEP. The Home Office will determine the current HPE and the total employee counts which will be used to establish the number of HPE’s which will be required. HPE’s are considered to be ages 45-65 with annual incomes greater than $35,000.

Depending on the Worksite’s enrollment policies and Home Office agreement, new employees may be eligible to apply for coverage at any time using Full Underwriting. Full Underwriting may also be available at anytime to applicants, who do not meet the MGI, SI, and AA criteria or who wish to apply outside of the approved Annual Re-enrollment period.

Option II

New Hire Rule (Available for new hires only)

• New employees that become eligible can apply for Coverage, using the same underwriting (MGI, SI or AA) if the employee applies within 30 days after they have reached the employer’s required Worksite eligibility date. The standard Worksite eligibility for benefits is normally six months and full time (30 hours/wk, active at work). Note: All approval parameters will be listed in the Implementation Memo.

• Transamerica reserves the right to request a census annually for Worksites that choose Option II.

• MGI, SI, and AA will not be available to the employee after the 30 day period. Once the 30 day period has passed, the employee must undergo Full Underwriting.


Submit the appropriate re-enrollment form and current Census data to the Home Office

Home Office ApprovalRe-enrollment Memo released

Confirm employer commitment and schedule events leading to enrollment

Enrollment

Option III

Full underwriting

Full underwriting is available to new and current employees subject to the Employer’s enrollment policies and Home Office agreement.

Re-Enrollment Work Flow

The following should occur prior to any re-enrollment regardless of the Option chosen:


ASSOCIATION AND UNION – ELIGIBILITYAll Association cases MUST be approved by Transamerica Long Term Care PRIOR to making a formal commitment or soliciting any applications. The Implementation Memo is our commitment to you and your client. The Memo details the specifics of the offer. It is your indication that the enrollment has been approved.

Transamerica reserves the right to alter its underwriting criteria at any time and/or decline to underwrite any group based on overall risk factors. If you have questions regarding current guidelines, do not hesitate to call the National Sales Desk.

The Association Discount is available to members of associations that have agreed to endorse our product offering and have been approved by the home office. A professional association or union must exist as a career/trade/skill/profession based organization. Affinity associations include churches, service groups, etc. whose members do not have a professional worksite relationship. In either case, by-laws or articles incorporation of the association must be submitted to the home office.

• AA is available to all Eligible Members and their Spouses ages 18-65 who are employed full time.• Minimum participation of 5 applications completed during the initial enrollment period.• Maintenance of the minimum annual participation requirements.• Eligible members have the opportunity to select from a full range of benefits available to the Association market.

Eligibility

Eligible Members – Any member of the association is eligible to apply.Association members and spouses that are actively at a workplace on a full time basis (30 hours or more) for at least 6 months and are age 18-65 may be eligible for Abbreviated Application with Underwriting.All others (i.e., Association members working part-time, spouses working part-time, extended family members, etc.) are subject to Full Underwriting.Extended Family Members – children, siblings, parents of the employee or parents of their spouse, and other family members such as cousins.

Association and Union Underwriting

Abbreviated Application (AA) underwriting is available to Associations that meet prescribed size and participation requirements. The minimum acceptable Association membership size is 250. Please refer to the following chart for Association size and participation requirements.

Association Size(Minimum Size - 250 members)

Annual Participation RequirementsMinimum Applications per Quarter Minimum Applications per Year

250 to 2,500 members 5 252,501-5,000 members 10 50

5,001-10,000 members 15 7510,001+ members 0.2% of total members 1.0% of total members

For very large associations, Transamerica is willing to consider individualized marketing plans. Options may include adjustments to underwriting rules per association segments or regions.

Participation will be monitored quarterly. If the participation falls below the prescribed levels, appropriate action will be taken which could include closing the association to new Long Term Care sales.

Members of the Association, their spouses, and extended family members, who do not otherwise qualify for the Abbreviated Application underwriting program, may apply for coverage with full underwriting.


Voluntary Association and Union Plans:

Definition – The Association offers sponsored LTCi on a voluntary basis to eligible Members and their extended family members.

An Association discount may be available with Standard rates.• 10% Professional Association and Union, or• 5% Affinity Association Discount

Preferred health discounts may be available to qualified applicants.

Married members and married family members qualify for Married rates if both spouses apply “in good faith” for the same level of coverage (i.e., field decline is not considered a “good faith” application).

Single rates apply to single members, single family members, and married applicants who do not qualify for the marital discount.


UNDERWRITING QUICK REFERENCE GUIDEIMPORTANT NOTES:

• If the worksite does not meet the Open Enrollment Period participation levels, the entire worksite will be required to undergo Full Underwriting.

• Any applicant, who is offered coverage on a MGI/SI basis, who chooses to apply for benefits outside the offered program and who is subsequently declined or rated for health reasons after being Fully Underwritten, cannot default back to the MGI/SI underwriting.

• If there is any indication that MGI, SI or AA criteria will not be met for an individual, the applicant should complete all questions in sections “A”, “B” & “C” of the application.

• The Medical Information Bureau (MIB) and the Prescription Drug Database (Rx) will be ordered on any SI, AA, or Full Underwriting application. An Attending Physician Statement (APS) may also be ordered. See chart below for details.

• A minimum of 5 applications is required to establish a list bill and to qualify for any worksite discount.

Application Types and Use

Application Type Underwriting Type Ages Market/ProductFull Application(“C” Application) Full All Individual

“ABC” Application

Modified Guarantee Issue (MGI)Simplified Issues (SI)

Abbreviated Application (AA)Full

< 65< 65< 65All

WorksiteAssociation

Underwriting Types

Type Availability Premium Classes Evidence

Modified Guaranteed Issue (MGI)

Up to age 65Worksite

Home Office Pre-approvalStandard “A” Application Section

Simplified Issue (SI)

Up to age 65Worksite

Home Office Pre-approvalStandard

“A & B” Application SectionsRX Database

MIB

Abbreviated Application (AA)

Up to age 65Association

WorksiteHome Office Pre-approval

Preferred (Health)StandardRated 1-4

“A & B” Application SectionsTelephone Interview

APS “for cause”RX Database, MIB

Full UnderwritingAll ages

All productsAll distribution channels

Preferred (Health)StandardRated 1-4

Full application or “ABC” sectionsTelephone Interview (<age 65)

Face to Face Assessment (>age 66 w/for cause at all ages)

RX Database & MIB on allAPS (all ages >66 & for cause <65)


WORKSITE

Employer Pay All/Executive Carve Out (EPA/ECO) Worksite Underwriting

Underwriting Type Max Age Participation Requirements Maximum Benefits

MGI 65 15 EE applications5 Year Benefit

90 Day Elimination Period$200 Daily Benefit

SI 65 10 - 14 EE applications5 Year Benefit

90 Day Elimination Period$200 Daily Benefit

AA 65 5 EE applications All AvailableFull 79 5 EE applications All Available

*EPA/ECO rates are available only when the employer pays 100% of the premium for 100% of the employees in the Defined class(es).

• In an Employer Pay All /Executive Carve Out (EPA/ECO), an Employer offers a single Benefit Plan and pays 100% of the premiums for 100% of the Employees in an existing Defined class of Employees. Multiple Defined classes will be available based on generally accepted criteria such as: Board Members, Job Titles, Income Groupings, Management/Non-management, Partners/Associates etc. Each defined class must have a minimum of 5 employees. The Defined class(es) should have existed for 2 years.

• EPA/ECO Worksite requires pre-approval after submission of a completed Service Group Request Form and Census. Approval details (such as Underwriting Type, Benefits, Discounts, Open Enrollment Period, Effective Date, Billing Information etc) will be documented in an Implementation Memo.

• “Buy-ups” are not allowed for EPA/ECO programs. • The EPA/ECO discounts require at least 5 Employee Applications.• MGI, SI and AA require applicant to be employed Full Time for at least six months at enrolling worksite. Full Time

is defined on a specific worksite basis, but will not be less than 20/hrs per week. Regularly it is 30/hr per week.• Applications for benefits that are outside the approved Benefit plans (i.e. “Buy-Ups”) are not allowed.

Voluntary and Employer Pay Some (EPS) Worksite UnderwritingUnderwriting Type Max Age Participation Requirements Maximum Benefits

MGI 65Greater of 15 EE applications or 10%

of HPE

5 Year Benefit90 Day Elimination Period

$200 Daily Benefit

SI 65Greater of 10 EE applications or 5% of

HPE

5 Year Benefit90 Day Elimination Period

$200 Daily BenefitAA 65 5 EE applications All AvailableFull 79 5 EE applications All Available

• HPE = High Potential Employees / Age 45-65 and income ≥ $35,000/yr.• Each Worksite requires pre-approval after submission of a completed and signed Service Group Request Form

and Census. Approval details (such as Underwriting Type, Benefits, Discounts, Open Enrollment Period, Effective Date, Billing Information etc.) will be documented in an Implementation Memo.

• The Group Discount (Voluntary/EPA/ECO 10% or EPS 15%) requires a minimum of 5 Employee Applications.• An EPS case is a situation where the Employer pays a portion (minimum 25%) of the premium for 100% of the

Employees in a defined class(es). Voluntary rates apply. We will consider different Benefit Plans for each existing defined class. A defined class must have a minimum of 5 employees. The defined classes should have existed for 2 years and should be generally accepted criteria such as Board Members, Job Titles, Income Groupings, Management/Non-management, Partners/Associates, etc.

• MGI, SI and AA require applicant to be employed Full Time for at least six months at enrolling worksite. Full Time is defined on a specific worksite basis, but will not be less than 20/hrs per week. Regularly it is 30/hr per week.

• Applications with total benefits outside the approved MGI and SI Maximum Benefits or where Participation Requirements are not met are subject to Full Underwriting.


STEPS TO ESTABLISHING A WORKSITE/ASSOCIATION CASEStep 1Prepare the Proposal using the Agent Resource Center tools or by requesting assistance from the NSD. If requesting assistance from the NSD, a current Census will be required.

Step 2Download the appropriate forms: All Worksite and Association cases require the submission of the Service Group Request (SGR) form and a completed Census before an Implementation Memo can be issued. These, and other, forms are available on the Agent Resource Center or by contacting the NSD at 866-475-5986 for assistance.In addition, Association cases require that the group’s Bylaws and/or Articles of Incorporation be submitted.

Step 3

Meet with the Client to develop the Plan design that fits the situation. Complete the Service Group Request (SGR) form and have it signed by the Worksite/Association representative.

• Acquire a complete Census. Census data should be provided in electronic format whenever possible and include an Employee ID, Last Name, First Name, Date of Birth, Date of Hire, Salary, Full-Time/Part- Time, Job Title, Marital Status, State of Residence, Gender, Group Number, Group Name. MS Excel is required when uploading to illustration software. Note: Census data that is to be uploaded to the TransQuote Illustration System must be in the format prescribed in the TransQuote Help documentation.

• When a Third Party Administrator is involved details of the arrangement must be submitted and the Home Office MUST approve the Third Party Administrator. A TPA Agreement must be completed prior to submission of applications. Contact the National Sales Desk for assistance.

Step 4

Request Home Office approval: The submitted SGR and Census data will be evaluated in the Home Office. High Potential Employee (HPE) analysis and other factors will be used to establish the rate structure, discount and underwriting allowances for Employer groups. The Company reserves the right to approve or not approve any Worksite or Association. Census data may be submitted in advance of the SGR to complete the HPE analysis in advance.

Step 5

Home Office approval: Once approved, the Implementation Memo will be released documenting the benefits, rates, discounts, underwriting type, Open Enrollment Period (OEP) dates, coverage effective dates, billing information, etc.

The Implementation Memo includes the Service Group Number (SGN) which is to be recorded on EACH application in the “Employer/Assoc. No.” box in the Business Information section located at the beginning of the application. The SGN drives the discounts and underwriting and if omitted causes processing delays.

Step 6

Confirm Client Commitment and Schedule Events: Review and confirm the details of the Implementation Memo with the Client. Schedule presenters, agents and enrollers per marketing plan.

Enrollment support is available from the Home Office.

Step 7

Enrollment: Enrollment may only begin once the Implementation Memo is issued. Applications must be:

• Submitted using the Worksite Transmittal formAttn: Transamerica Worksite AdministrationP.O. Box 95302, Hurst, TX 76053-5302 or fax to 1-888-816-7481.

• Dated within the OEP with SGN indicated on each application. (See Implementation Memo for scheduled OEP.)

• Received in the Home Office not later than 15 days following the last day of the OEP.


Prepare Proposal:Use the TransQuote Illustration System available on the Agent Resource

Center.

Use appropriate forms available on the Agent Resource Center:Service Group Request (SGR) form and sample Census data layout.

Meet with Client:Select Plan design. Complete the SGR (including the employer signature), and obtain current Census data (Plus bylaws and/or articles of incorporation

for Associations.)

Submit the SGR, Census data and any other documentation

Home Office Approval

Implementation Memo released

Review Implementation Memo.Confirm client commitment and schedule events leading to enrollment

Enrollment

*Agent knowledge of the Client may allow these steps to be compressed inwhich case all documentation may be submitted together.

PRE-ENROLLMENTTransamerica is committed to working closely with you to coordinate the pre-enrollment process. We have made every effort to keep the paperwork to a minimum and to maintain a simple and smooth workflow that will allow you to focus on what you do best. If at any time you have questions, please contact the National Sales Desk (NSD) at 866-475-5986 for assistance.

Pre-Enrollment Work Flow


ENROLLMENT SUPPORT – NATIONAL SALES DESKYour success is our success. Transamerica provides enrollment support for spouses and family members of the EE through the National Sales Desk (NSD). The NSD is staffed with experienced licensed agents who are trained and certified in Long Term Care insurance. They continually update their knowledge through professional programs and continuing education.

The NSD is also available to support the full enrollment with on-site enrollers, trainers and supervisors.

Because the NSD is acting as an agent; taking applications and closing sales, there is a moderate adjustment to commissions. Call your MGA or Transamerica Field Representative for details and schedules.

Once the consumer has decided on a plan, the NSD agent will walk the applicant through the application process. If need be, the NSD agent will contact the applicant to assure a smooth process through to contract issuance.

NSD agents:

• understand the applications and forms and how they must be completed• have experience in supporting on-site enrollers• have experience enrolling spouses and family members• are licensed to sell long term care insurance in all states • are familiar with state-specific regulations• are knowledgeable about state-specific long term care provisions, requirements, and limitations

Improve Your Enrollment Participation – NSD agents are here to:

• explain long term care benefits, answer questions and quote plan rates• offer information on state LTC Costs of Care• provide assistance in completing the application • enroll employees and extended family members after work and by appointment

NSD can provide several levels of support:

• on-site employee enrollment• telephonic electronic employee enrollment• telephone support for spousal and extended family members only (non-employee support)• support for enrollment in states where Broker/Agent is not LTC licensed• enroll employees and extended family members after normal work hours

For further information, please contact your MGA or Transamerica Field Representative.


NEW BUSINESS PROCEDURES


SUBMITTING BUSINESSAt Time of Application

NOTE: State variations may require the use of additional or different forms.

The following items MUST be delivered to the applicant at the time of application:

• The Disclosure Package that includes the following:• Outline of Coverage (Disclosure Form in some states)• “Things You Should Know Before You Buy Long Term Care Insurance” • Potential Rate Increase Disclosure Form, if applicable• Authorization for the Release of Health Information• MIB Authorization for Release of Health Information• Privacy Notice• Disclosure Notice – Medical Information Bureau and Fair Credit Reporting• If replacing existing coverage, Replacement Notice form should be used• State specific forms or guides if applicable

• The NAIC Shopper’s Guide to Long Term Care Insurance• Conditional Receipt• If eligible for Medicare; The Guide to Health Insurance for People with Medicare

Note: The coverage comparison section of the NAIC Shopper’s Guide must be completed anytime a comparison of Long Term Care coverage is done.

The following items MUST be submitted with the application:

• Signed Authorization for the Release of Health Information• Signed MIB Authorization for the Release of Health Information• Signed Replacement Notice, if applicant is replacing existing coverage• A completed Personal Worksheet• Service Group Number (SGN) must be indicated on EACH application in the “Employer/Assoc. No.” box located

in the Business Information Section (for MultiLife cases).

For MultiLife cases, applications to be underwritten as MGI, SI or AA must both be fully completed during the Open Enrollment Period (OEP) and received in Home Office within 15 days of the last day of the OEP. Applications completed after the end of the OEP or received later than 15 days after the OEP will be subject to Full Underwriting.

Resident States

In most cases, you will use the application that is approved in the state where the application is being taken. However, if your applicant is a resident of the following states, you MUST submit the application that is approved for that applicant’s resident state:

Alabama Alaska Connecticut IdahoKansas Maryland Massachusetts Minnesota

New Jersey New York South Carolina Wisconsin

For Resident States, the agent must be licensed in the Resident State and in the state sold. For example, if the applicant resides in AL and is sold a policy while in MS, the agent must be licensed in both AL and MS.

Submitting Premium

When Payroll Deduction is selected, no initial premium is necessary with the application (MultiLife cases).

For both MultiLife and Individual cases, payment for the entire initial premium amount must be submitted with the application when the payment mode selected is Annual, Semi-annual, or Quarterly.

When the Monthly premium mode is selected, a check for two months premium must be submitted with the application (CA and NH require only 1 month). Additionally, a completed Automatic Payment Authorization (PAC) form and canceled check must be submitted with the application.

Monthly direct billing is not available.


Automatic Payment Authorization Form (PAC)

If the PAC form is not submitted with the application it will be requested at the delivery of the policy. If this form is not received in the Home Office and all other requirements have been met, the billing mode will be changed to direct quarterly billing.

Balance of Premium

The balance of any premium due must be received in the Home Office before the coverage will become effective.

Payroll Deduction – List Bill (MultiLife Cases)

A Payroll Deduction – List Bill program allows LTCi premiums to be withheld from the employee’s paychecks and paid directly to Transamerica Life Insurance Company by the employer.

• At least 5 applicants must select this option to establish a Payroll Deduction – List Bill.

• Do not collect initial premium when the Payroll Deduction – List Bill payment option is selected.

• The effective date will be established by the Home Office. Do not communicate an Effective Date to the employer until you have received the Implementation Memo.

• Premium rates will be based on each Insured’s age as of the policy’s effective date. Backdating to save age will not be permitted.

• A payroll deduction form will be required with each application.The Payroll Deduction – List Bill may include the employee’s dependents and any other eligible extended family members purchasing a LTCi policy through the employee’s relationship with the employer. This is contingent upon the approval of both the employer and the employee.For applicants paying premiums through Payroll Deduction – List Bill, the policy effective date will normally be the first of the month following two full months from the date the application is signed.

Example: The application is signed on April 9. Count forward to the first of the following month, May 1. Then, go forward two months, July 1. The effective date would be July 1. Use this date to correctly determine the Insured’s age on the application. Correct initial premium covering the full premium cost must be submitted by the employer within sixty (60) days of the billing effective date or the policy will be considered “not paid” and to never have been in-force. Future premiums must be remitted to the Home Office by the 10th of the month following the month in which premiums were payroll-deducted. All Payroll Deduction – List Bill worksite cases will receive a payroll start deductions list one month prior to the billing effective date.

If an employee terminates employment, the date of termination should be noted by the employer on the list bill and all collected premium should be submitted (including partial premiums) to the Home Office. The employee will be contacted by the Home Office with instructions for continuing their coverage under a new payment plan.

If the employee wishes to cancel coverage, they must send the request in writing to the Home Office. The employer and/or employee should call the Customer Service Department at (800) 227-3740 for guidance. The employee will be contacted by the Home Office with instructions for discontinuing their coverage.

Effective Date

The effective date on individual policies is the date on the accurately completed application unless a later effective date is requested by the applicant in which case the coverage will be effective on the date requested.

Backdating to save age may be indicated on an application with a date no more than 30 days prior to the application date on individual business. Backdating is not allowed for worksite or association business. The application should be dated with the current date and the backdated effective date should be indicated in the Effective Date field (if other than the application date). Rates should be calculated as of the age of the Effective Date selected. Premiums must be paid from the Effective Date indicated. The schedule page on the issued policy will reflect the Effective Date indicated.

For MultiLife cases, the effective date is determined by the Worksite Administration department and is defined in the Implementation Memo.


Delivery Requirements

Completed delivery requirements must be returned to the Home Office within 25 days from the date sent.

Delivery Receipt

When a policy is delivered by the agent, a delivery receipt must be completed. The delivery receipt must be signed, and received in the Home Office within 25 days. If the delivery receipt has not been received by the 25th day, a new policy will be sent directly to the policyholder. This will ensure compliance with requirements under the IRS code which mandate that tax-qualified long term care policies be delivered to the policyholder within 30 days of approval.

A delivery receipt is also required when the policy is delivered (mailed):

• in the states of Louisiana, Nebraska, Pennsylvania, South Dakota, West Virginia and New York

• when the policyholder’s resident state is different than the state where the application was signed; or

• when the policyholder has elected Single Pay in which case a receipt specific to Single Pay is required.

Note that the agent may instruct the Home Office to send the policy directly to the policyholder.

Signed Endorsement

When required, a signed endorsement must be received in the Home Office before coverage will become effective. Endorsements are required for changes to benefits, changes in premium, and corrections to an incomplete or incorrect application.

Statement of Good Health

This form is used when the Underwriter requires verification that an applicant’s health status has not changed since the date the application was signed. It might be used if the underwriting process took longer than expected. If this form is requested, it must be signed and returned to the Home Office before coverage will be effective.


TOOLS AND MATERIALSAgents and Producers must only use Marketing Materials approved for use by Transamerica Long Term Care. Before using any new advertising, you must submit the material for review and approval by the Transamerica Long Term Care Compliance Department. Please refer to the Professional Conduct Principles and Policies (TLC A PC 0608) for complete details.

Forms and Marketing Materials

Forms (application, disclosure packages, etc.) and marketing materials (brochures, flyers, etc.) are available for download and order on the Agent Resource Center or through your MGA or the National Sales Desk. Separate materials have been developed for use with MultiLife and Individual cases.

Illustrations/ Proposals

The TransQuote Illustration System is available to agents who are licensed and appointed with Transamerica Long Term Care. Illustrations can be run directly from the Agent Resource Center. The TransQuote Illustration System may also be downloaded to your computer for convenient off-line quoting.

Census Data (MultiLife Cases)

Census data is required on all Worksite cases. It should be provided in electronic format whenever possible and include an Employee ID, Last Name, First Name, Date of Birth, Date of Hire, Salary, Full-Time/Part- Time, Job Title, Marital Status, State of Residence, Gender, Group Number, Group Name. MS Excel is required when uploading to illustration software. Note: Census data that is to be uploaded to the TransQuote Illustration System must be in the format prescribed in the TransQuote Help documentation.

Service Group Request Form (MultiLife Cases)

The SGR form contains information about the worksite and the benefit packages upon which the employer and the agent have decided. The SGR is used to communicate information to the Home Office and to help establish rates and underwriting procedures to be used. The form always requires the authorized signature of a representative of the Worksite/Association.

Implementation Memo (MultiLife Cases)

The Implementation Memo will be issued as the last step prior to enrollment and solicitation of applications. Once the Home Office has released the Implementation Memo with an established Open Enrollment Period (OEP), the agent may begin taking applications. Applications dated before the OEP will not be accepted.

Electronic Enrollment Support (MultiLife Cases)

Electronic enrollment is available for Worksite enrollments. Laptops, preloaded with the rates, plans and software are available from Transamerica. This gives you the capability of one-on-one agent enrollment with each applicant without the need for paper forms.

Worksite Transmittal Form (MultiLife Cases)Transmittal forms are required when submitting business. These forms are available from the Agent Resource Center (www.taltc.com) and must be completed each time applications are sent into the Home Office.


CONTRACTING AND LICENSINGAgentsAll Long Term Care agents must be properly licensed and be current on all Long Term Care training requirements for all State(s) in which they expect to do business. Agents will be contracted and appointed with Transamerica Long Term Care before being permitted to sell and take any applications under Transamerica Life Insurance Company (TLIC). Agents wishing to write Long Term Care insurance may contact the Transamerica Life Insurance Company Licensing Department by phone or email requesting the Application for Appointment and the Agent Agreement. The agent may return the completed Application for Appointment and signed Agent Agreement by mail, fax or email. Background Investigations will be required for all applicants.Transamerica Life Insurance Company Licensing Department contact information:

Transamerica Life Insurance Company Telephone: 1-800-468-5843Licensing Department Fax: 1-866-630-7496P.O. Box 95302 Email: [email protected], TX 76053-5302

Once an agent has been appointed, a welcome letter will be sent to the agent, along with the executed contract, via email or mail.

EnrollersEnrollers must be licensed and appointed through the Transamerica Long Term Care. The LTC Marketing Department will notify all internal departments when enrollers are involved with a service group. All of the previous information applies when enrollers are involved except for the following:

• Correspondence – all correspondence normally going to the writing agent will instead be sent to the submitting producer.

• Commission – Since commission is not paid by the LTC Division to enrollers, they will not receive commission statements.

• Reports – enrollers will not receive any production reports. These will be sent to the submitting producer.

ADMINISTRATIONReplacements

We strongly recommend that you compare the proposed policy with the current policy, and document the reasons for recommending a replacement. We suggest that you retain your own copy of this written comparison and recommendation. You and the applicant will then need to sign the replacement form and return it along with the application.

If the Long Term Care Insurance policy is replacing a policy underwritten by another AEGON Insurance Group Company:

• We will ask for the producer’s brief, written explanation as to why this replacement is in the policyholder’s best interest.

• Any LTC policy or rider replacing an existing LTC policy or rider pays the 2nd year commission rate in the 1st year. Exceptions may apply (subject to state imposed limitations) if the policy or rider being replaced is not a Transamerica Company or other AEGON company policy or rider, AND the replacement policy is clearly and substantially better than the policy being replaced.

Reinstatements

Full Underwriting – regardless of the type of policy, benefits or underwriting standards used when the original application was made

Any policy, regardless of benefits or original underwriting, that has lapsed for non-payment of premium may be reinstated within 90 days of the date of lapse, subject to Full Underwriting. A full application must be submitted, without a premium deposit, and will be subject to Full Underwriting. In some states, reinstatement is available for up to 6 months when the lapse was due to cognitive impairment.

Long Term Care Policies may not be reinstated after 90 days. After 90 days applicants must reapply following the Full Underwriting procedures, with a full application and a premium deposit.

Please contact the Customer Service Department for additional information regarding the reinstatement rules and procedures.


PROFESSIONAL CONDUCT AND MARKETPLACE STANDARDSCode of Professional Conduct

As a Company, we are committed to treating our customers fairly and ethically. Our distributors are the individuals and firms authorized to sell our insurance products. You have a responsibility to treat our customers fairly and ethically. Our employees, who support our agents, brokers and representatives and serve our mutual customers, share that responsibility and trust. As distributors and employees, we will apply the principles and policies included in Professional Conduct Principles and Policies. Agents and Producers receive a copy and sign an acknowledgement at the time of contracting. The complete text can be found on the Agent Resource Center.

Insurance Marketplace Standards Association (IMSA)

Transamerica is committed to following the ethical principles set forth by the Insurance Marketplace Standards Association (IMSA) in the sale of life and Long Term Care Insurance to individuals. In so doing the Company subscribes to the six principles of IMSA (see the Agent Resource Center for additional information):

• To conduct business according to high standards of honesty and fairness and to treat our customers as we would expect to be treated

• To provide competent and customer-focused sales service

• To compete fairly

• To provide advertising and sales material that is clear, honest and fair in content

• To handle customer complaints and disputes fairly and promptly

• To maintain a system of supervision and monitoring reasonably designed to demonstrate the Company’s commitment to and compliance with these principals.

If you have questions about any market conduct matter, please contact your management or the LTC Marketing Department:

Transamerica Long Term CareP. O. Box 95302

Hurst, TX 76053-5302(866) 475-5986


TLC PG 0110 For agent/broker use only. Not for public ... · Marketing 866-475-5986 817-285-3452 [email protected] National Sales Desk 866-475-5986 817-285-3452 [email protected]

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