critical illness dental accident. crisis recovery critical illness policy

Download Critical Illness Dental Accident. CRISIS RECOVERY Critical Illness Policy

Post on 29-Dec-2015

217 views

Category:

Documents

2 download

Embed Size (px)

TRANSCRIPT

  • Critical IllnessDentalAccident

  • CRISIS RECOVERYCritical Illness Policy

  • Critical Illness PolicyProvides immediate cash for your customers when they are diagnosed with a covered medical crisis.They can use the money for:

    Treatment not covered by or limited by their existing .medical insurance.

    Non-medical expenses resulting from their condition: . travel, childcare, and spouses time off from work.

    Extended convalescence services or for rehabilitation.

    Mortgage, auto loans and credit card payments

    Or, any way you choose. There are NO restriction on how ..they spend their money.

  • Crisis RecoveryFive benefit level to choose from: .

    $10,000 $20,000 $30,000 $40,000 $50,000

    Dependent Chldren's Benefit: $10,000 per child

    Provides up to $50,000 to help cover out-of-pocket medical expenses and the other costs associated with a covered critical illness.

    Crisis Recovery is designed to ease the financial pressure by providing a lump sum cash benefit paid directly to you upon diagnosis of a covered illness to help you cope with the high cost of recovering from a Medical Crisis.

  • Two Category of BenefitsIf you collect a benefit for the first diagnosed illness or procedure under this policy in one category of benefits and then have a second diagnosis of a condition or procedure in another category under this policy we will pay the maximum benefit to you again. If a partial benefit is paid (25%) the remainder of the benefit will be payable upon the diagnosis of another covered condition.

  • Two Category of Benefits

    CATEGORY ONE BENEFITS

    ConditionsPercent PaidCancer (Internal Cancer)100%Non-Invasive Carcinoma In-Situ25%

    CATEGORY TWO BENEFITS

    Heart Attack100%Stroke100%Coronary Artery Bypass25%Angioplasty10%Pacemaker Implant- Single chambered30%Pacemaker Implant- Double chambered40%End Stage Renal Failure100%Organ Transplant (kidney)50%Organ Transplant (heart, lung, liver and pancreas)100%

  • Policy ProvisionsWaiting PeriodThe benefits of this Policy are payable for loss that begins more than 90 days after the Effective Date of coverage for each Insured person. If the Diagnosis is made within the first 90 days, we will pay 25% of the benefit payable as listed in Category One and Two of the policy. During the first 90 days after the Effective Date of coverage, Reinstatement date or for a second date of occurrence resulting in a Diagnosis or procedure in a Multiple Condition instance, We will pay 25% of the Percentage Benefit Payable listed in the Policy Schedule.

    Reduced BenefitsReduction of Benefits Due To AgeAny benefits remaining at age 65 or older will reduce 50%.Guaranteed RenewableThis Policy is guaranteed renewable to age 75 by the timely payment of premiums. It must be paid on or before its due date, or within the 31 days that follow. When an Insureds coverage terminates at age 75, coverage for other Insured persons, if any, shall continue under this Policy.

  • Policy ProvisionsAttained Age PricingIn order to make this plan as affordable as possible, we used a pricing method that is called Attained Age Pricing. By using this method the cost of the plan is lower at the beginning and takes small incremental increases each year there after.

    This is in contrasts to a method called Issue Age Pricing where the premium starts out much higher but remains at the same level for several years or the life of the policy.

    Which method is better?We believe that Attained Age Pricing is better for the consumer since its more affordable up front and allows you to purchase the amount you need by paying less when your income is lower and as your income continues to grow you will be able to pay a little higher premium.

    In comparing this method to other insurance carriers that prices their product using Issue Age Pricing, we find that our method can save you as much as 20% to 30% (see graph) in the first 10 Years depending on your age.

  • Policy Provisions

    Chart1

    2.84.4

    3.64.4

    Attained Age Pricing

    Issue Age Pricing

    Attained Age Pricing vs Issue Age Pricing

    Sheet1

    Attained Age PricingIssue Age Pricing

    5 Years2.84.4

    10 Years3.64.4

  • Policy ProvisionsPre-Existing Sickness or Injury ProvisionThe benefits of the policy will not be payable during the first 12 months that coverage is in force with respect to an insured person for a loss caused by a Pre-Existing Sickness or Injury disclosed or not disclosed in the application. This 12 month period is measured from the effective date of coverage for each insured person. A Pre-Existing Sickness or Injury means a Sickness or Injury which is Diagnosed by a legally qualified physician or for which medical advice or treatment was recommended or received from a legally qualified physician within 12 months prior to the effective date of coverage for each insured person.

  • CRISIS RECOVERYIf you knew that you would be diagnosed with cancer in six months, would you buy this insurance?How do you know that you wont be?

  • Critical Illness Availability AKORNVAZTXLAARMOKSNEIAMSALGAFLILINOHKYWVVAPAHIWICAIDMTWYWAUTCONMOKSDNDMNTNSCNCMIMENY4.13All states listed except North Carolina has the Standalone 24HR Enhanced Accident Plan approved

    Approval Pending Release

    Crisis Recovery Approved States

  • Dental ChoicePlus

  • Introducing a new type of hybrid dental insurance policy that combines traditional fully insured benefits with PPO discount pricing.

  • Freedom of ChoiceUnlike many PPO plans that will not pay anything if you go outside their network, Dental Choice Plus will pay the non-network provider at the same rate as if they were in network.

    Your client will only be responsible for the non-network charges that are in excess of the pre-negotiated network fee schedule.

  • Individual Dental PlanNo waiting periods on Diagnostic and Preventive care benefits.Diagnostic & Preventive paid at 100% when using a network provider.Two plan options to choose from with Calendar Year Maximums benefits of either $1,500 or $2,000. Over 169,000 access points across the United States.

    eApplication enrollment

    Employer Sponsored Plan

    In addition to the key benefits list for individual plans, employer sponsored plans are available.

    Available for groups of 3 or more

    $25 application fee is waived

    List Bill eApplication enrollment

    Rates for ages 65+

  • Dental Choice Plus Benefits * Insured pays only the discounted pre-negotiated network provider rate. $25 Application Fee For Individual Applications. Application Fees are waived for employer sponsored plans **Annual coinsurance amounts are based on policy years.

    Reimbursement Method In/OutStandard Plan Pays**Yr. 1 / Yr. 2 / Yr. 3+Enhanced Plan Pays**Yr. 1 / Yr. 2 / Yr. 3+Diagnostic & PreventativeNo Wait100% / 100% / 100%100% / 100% / 100%Basic (Filings & Simple Extraction)Basic6 months 50% / 65% / 80% 50% / 65% / 80%EndodonticMajorNo Wait 0%* / 25% / 50% 0%* / 25% / 50%PeriodonticsMajorNo Wait 0%* / 25% / 50% 0%* / 25% / 50%Oral SurgeryMajorNo Wait 0%* / 25% / 50% 0%* / 25% / 50%RestorationsMajorNo Wait 0%* / 25% / 50% 0%* / 25% / 50%OrthodonticsMajorNo Wait 0%* / 25% / 50% 0%* / 25% / 50%Prosthodontics MajorNo Wait 0%* / 25% / 50% 0%* / 25% / 50%Co-Pay (Per Person, Per Visit) No more than 3 per person per calendar year $25 Thru age 64 $40 over age 65$25 Thru age 64 $40 over age 65Insurance Calendar Year Maximum per person per calendar year$1,500$2,000Orthodontic and Prosthodontics Lifetime Maximum ($1,000 Lifetime Max, Limited to $350 per Calendar Yr.)$1,000$1,000

  • Good oral hygiene and regular dental care is important throughout your life Given the suspected link between periodontitis and systemic health problems, prevention is the first step to maintain good long-term health.

    Dental Choice Plus is economical because it focuses on benefits you neednot benefits you may never use.

    Diagnostic & Preventive Services are paid at 100% with only a $25 co-pay when using a network provider. No waiting periods or deductibles.

  • Diagnostic & Preventative Services paid at 100% No Waiting Periods Dental Choice Plus focuses on providing the benefits you need to maintain good oral health at affordable prices

    Examples of Diagnostic & Preventive Services when receiving benefits through PPO Waiting Periods Amount Paid Routine oral exams - 1 exam per 6 month period No Waiting Period 100%Bitewing X-rays (up to a set of 4) - 1 set per Calendar YearNo Waiting Period 100%Full Mouth X-rays (Panoramic Film or Full Series) - no less than 36 months apartNo Waiting Period 100%Prophylaxis (cleaning and scaling of teeth) - 1 per Calendar YearNo Waiting Period 100%Topical application of Fluoride for dependent children under 19 - 1 per Calendar Year No Waiting Period 100%Consultation - other than treating doctorNo Waiting Period 100%Comprehensive Oral ExamNo Waiting Period 100%Sealant - dependents under 14, one treatment per tooth no less than 36 months apartNo Waiting Period 100%Space Maintainers - the initial appliance for dependent children under 13, including adjustments within the 6 month period immediately following installationNo Waiting Period 100%

  • The schedule applies to services provide by a participating General Dentist and i

Recommended

View more >