PRODUCT DESCRIPTION INFORMATION
What is this coverage? Can you tell me more about this coverage? What does this cover?
Accidental Death and Dismemberment covers the insured in the event of loss of life, limb, sight, speech or hearing due to a covered accident.
DEPENDENT and AGE QUESTIONS
- Insured and spouse: 18 and older
- Dependent children: 19 and under, or under 26 if enrolled in accredited institution of higher learning
- No termination age; however, coverage reduces by 50% at age 70
BENEFITS
- Offers up to $300,000 of supplemental coverage elected and paid by the primary insured
- Individual or Family coverage available
FAMILY COVERAGE PERCENTAGES
- Spouse without children – 60% of additional coverage amount
- Spouse with children – 60% of additional coverage amount
- Child(ren): 20% of additional coverage amount
ADD ON BENEFITS:
- You only need to read the description for the benefit being asked about
Escalator Clause Option Benefit: For every year an insured’s additional coverage remains continuously in force, it will be increased by 5% each year for a maximum of five years. (NOTE: The Escalator Clause Option Benefit also applies to insureds with complimentary only coverage.).
Higher Education Benefit: If you suffer an accidental death, a benefit of 5% of your accidental death benefit is payable for higher education expenses in equal monthly installments for each year for four consecutive years for each dependent child who is enrolled as a full-time student in an institution of higher learning. Or, the child is in the 12th grade and enrolls as a full-time student in an accredited college, university or trade school within one year from the date of death. Maximum benefit is $10,000 per year for up to four years. If at the time of the insured’s death there are no dependent children, we will pay a benefit in the amount of $2,000.
In-Hospital Indemnity Benefit: If you are confined to a hospital as an inpatient as a result of a covered loss for more than 7 consecutive days (starting within 30 days of the accident), then a monthly benefit will be paid. The monthly benefit will equal 1% of the additional coverage amount up to a maximum of $2,500 for up to 12 months. A benefit equal to 1/30th of the monthly benefit will be paid for each day of a benefit period of less than one month. Successive periods of Hospital Confinement arising out of the same injury will be considered one Hospital Confinement only if they are separated by a period of less than one month.
Therapeutic Counseling Benefit: If an insured suffers an injury resulting in a loss of life or a covered loss, which is payable under the Accidental Death Benefit and the insured or covered dependents requires Therapeutic Counseling, reimbursement for the charges for such counseling, to the individual who incurs the expense, as long as the provided Therapeutic Counseling begins within ninety days of the Accident; and is completed within one year from the date of the Covered Loss. The maximum amount payable will be the lesser of: the actual cost of the therapeutic counseling or $5,000. [Therapeutic counseling means treatment or counseling provided by a licensed therapist or counselor who is registered or certified to provide psychological treatment or counseling.
Common Carrier: This benefit pays twice the elected additional coverage loss of life that occurs while riding as a passenger in or on, or boarding or alighting from, any common carrier while on a trip.
What is a common carrier?
“Common Carrier means any land or water conveyance licensed to carry persons for hire or air travel carrier.”
HYPOTHETICAL or “IS THIS COVERED” SCRIPTING
- IF CUSTOMER WANTS TO KNOW IF SOMETHING SPECIFIC IS EXCLUDED OR WANTS EXAMPLES OF WHAT COULD BE COVERED
“I will be happy to help you better understand the benefits and exclusions of this insurance plan.”
What is covered?
This accidental death and dismemberment insurance provides benefits in the event of an accidental death and for loss of limb, sight, speech, or hearing as the result of a covered accident. Some common types of accidents that may be covered are slip and fall injuries and motor vehicle accidents. The facts and circumstances of each claim are thoroughly reviewed to determine whether the injury is a covered loss under this limited benefit policy and whether any policy exclusions apply.
This insurance does not pay benefits for death due to natural causes or suicide. Other common exclusions are when you die in a motor vehicle accident where you are the driver and your blood alcohol level exceeds the legal limit; commission of a crime, or felony; use of drugs and alcohol: and acts of war. Each claim is thoroughly evaluated to determine if a benefit is payable according to the terms of the policy. Exclusions vary by state.
Is this (Hypothetical) death covered? (Follow up – Part 2, if needed)
- IF CUSTOMER WANTS A DEFINITIVE ANSWER AS TO WHETHER OR NOT A SPECIFIC CONDITION IS COVERED
You have really good questions. I do realize you are asking about (HYPOTHETICAL) and it is the carrier who reviews claims and determines whether a benefit is payable. If you have a claim, we encourage you to file it for a formal claim decision. Keep in mind that if the situation you describe is not covered, there are countless, unknown situations that are covered.
ENROLLMENT
Both my husband and I have our names on this letter. Can we both sign up for the complimentary insurance?
“Complimentary coverage will be enrolled as the account holder who signs the form. Additional family coverage can be purchased for both the husband and wife to be covered.”
What does dependent child mean? Are my grandchildren covered?
“Dependent children are living with you and dependent on you for financial support as evidenced by your federal tax return.”
Can my handicapped child be covered?
“The definition of a covered child is determined by the state the coverage is written under, but the child must be financially dependent on the insured. The final determination is made by the insurance company once a claim is filed.”
How do I assign more than one beneficiary?
“You can name as many beneficiaries as you would like by either writing your additional beneficiaries on the back of your enrollment form or adding an additional piece of paper to the envelope when you mail in your enrollment form.”
Do I automatically receive the no-cost basic insurance?
“No. you must complete and return the enrollment form.”
Do I have to purchase additional coverage to receive my complimentary coverage?
“No. The Complimentary coverage is given to you as a valued customer.”
How much additional coverage may I choose?
“You alone can decide how much coverage you need. AD&D insurance has coverage levels to fit your budget, from $10,000 to $300,000.”
Who can I name as my beneficiary?
“Name anyone or as many beneficiaries as you would like.”
Can I get insurance for my spouse and family, too?
“Yes. Family insurance covers you, your spouse/domestic partner and/or dependent children at a percentage of your coverage amount.”
Who is covered under the family plan?
“The Family Plan would provide coverage for yourself, your spouse/domestic partner and any eligible dependent children that you may have. Please refer to your Insurance Coverage Document for more detailed information.”
How do I enroll?
“Simply complete and sign the enrollment form and send it to the Plan Administrator in the reply envelope provided in your package or you can enroll online using the Invitation Code or QR Code on your Activation form.”
I lost or threw away my envelope. What is the address to send the paperwork to?
“You can mail it to:
Benefit Plan Administrator
P.O. Box 689070
Franklin, TN 37068-9070″
Do I have to take a medical exam or answer a lot of health questions? Can I be turned down?
“No. Medical exams, blood tests or answering health questions are not required to enroll and or keep this coverage. Your acceptance is guaranteed.”
CANCELLATION
Can I cancel / Can I get my money back?
“If you are not happy with this insurance for any reason, you may cancel at any time and all billing will stop.”
RATES AND BILLING
Do the rates go up?
“Your rates will not go up on an individual basis or because you have filed a claim. As a group, rates may be changed on a class basis.”
How will I be billed for this coverage?
“You will be conveniently billed to the account provided at the time of enrollment.”
Can I get billed directly?
“You will be conveniently billed to the account provided at the time of enrollment.”
FULFILLMENT AND EFFECTIVE DATES
When will I receive the certificate of insurance?
“You can expect to receive the certificate of insurance within 15 days of your enrollment.”
When does coverage begin?
“Your effective date will be shown on your certificate of insurance that you will receive within 15 days of your activation. Please note that your effective date may be delayed depending on the billing cycle of your financial institution.”
CLAIMS
How are benefits paid?
- Benefits for loss of life will be payable in accordance with the beneficiary provisions and the survivors as shown in the Payment of Claims section of the Certificate / Policy of Insurance.
- All other proceeds payable under this Policy, unless otherwise stated, will be payable to the Covered Person or to the Covered Person’s survivors as shown in the Payment of Claims section of the Certificate / Policy of Insurance.
How do I file a claim?
“Once you enroll, you can receive and complete our Insurance Claim Forms by calling our Claims Department where a representative would be glad to assist you in filing a claim.”
How long does it take to process my claim?
“After you file a claim, the carrier will make a decision to approve or deny your claim. If the carrier approves the claim, the insured person or beneficiary will be paid within 60 days of receiving complete proof of loss.”
ADDITIONAL QUESTIONS
What coverage is provided by this insurance? Is this Life insurance?
“This is Accidental Death and Dismemberment insurance which provides benefits in the event of loss of life, limb, sight, speech, or hearing as the result of a covered accident. While not life insurance, this is great supplemental coverage due to its low cost. Also, many life insurance policies require a medical exam prior to obtaining coverage. Accidental Death & Dismemberment insurance does not require an exam and acceptance is guaranteed.”
Can you remove me from your mailing list?
“Yes, we can. I’ll take care of that now and it will take 30 to 60 days to process. Please disregard any solicitations you receive during that time. You can also be removed from all mailing lists by calling the Direct Marketing Association at 212-768-7277 and you can register your phone number with donotcall.gov.”
Is this offer still available after 14 days?
“Yes, the offer is still available.
Is there an age cutoff?
“There is no age cutoff, however, benefits will be reduced by 50% at age 70.”
Why is there an age reduction?
“The possibility of death due to an accident increases with age so the age reduction helps ensure rates don’t change over the life of the coverage.”
Does this policy have a cash value?
“No. There is no cash value for this insurance.”
What if I have other insurance?
“This insurance will pay all benefits due to a covered accident regardless of any other insurance you may have.”
Are on-the-job accidents covered?
“Yes. Your coverage is effective 24 hours a day, anywhere in the world.”
Who provides this insurance?
“Zurich American Insurance Company is the underwriter.”
Who is the plan administrator?
“Franklin Madison is the plan administrator.”
Who do you work for?
“I am employed by [TLC & Associates] / [InteLogix].”