PRODUCT DESCRIPTION INFORMATION

What is this coverage? Can you tell me more about this coverage? What does this cover?

The Hospital Accident Plan (HAP) provides cash benefits to the insured in the event of hospitalization due to a covered accident.

DEPENDENT and AGE QUESTIONS

• Insured and spouse: U.S. resident age 18 or older
• Dependent children; under 19, or between the ages of 19 and 25 if enrolled in accredited institution of higher learning.
• No medical exam required.
• Coverage is guaranteed.
• There is no termination age; however, benefits reduce by 50% at age 65 and reduce 25% at 75 (except in MN). Emergency Treatment benefits remain the same no matter the insureds age.

BENEFITS

• $900 Daily Hospital Benefit
  • • Pays 100% of daily benefit for each day of hospitalization for a covered accident —up to 365 days for any one injury
• $1,800 Intensive Care Unit
  • • For Intensive Care Unit (ICU)—daily hospital benefit is doubled for each day in the ICU
• $450 Emergency Room
  • • For hospital emergency room as outpatient visit within 72 hours of the accident-plan pays expenses incurred of $450 per covered visit
• Benefits can vary by state

FAMILY COVERAGE PERCENTAGES

Spouse:

• Emergency Treatment Benefit – up to $450 depending on coverage purchased.
• Spouse with children – 50% of the Daily Hospital Benefit
• Spouse without children – 60% of the Daily Hospital Benefit

Dependent Child:

• Emergency Treatment Benefit – up to $450 depending on coverage purchased.
• Each dependent child – 20% of the Daily Hospital Benefit
• Each dependent child of a single parent – 40% of the Daily Hospital Benefit

Are there any additional benefits?

“You automatically receive the following benefit (Except in MN): Inflation Protection – for each year from the plan effective date, the In-Hospital, Intensive Care, and Emergency Room Benefits will increase by 10% for as long as your coverage is in force until it reaches 150% of the original amount.”

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 hospital accident insurance provides a benefit if you are hospitalized due to a covered injury sustained in an accident. Some common types of accidents that may be covered are slip and fall injuries, motor vehicle accidents, and sporting accidents. The facts and circumstances of each claim are thoroughly reviewed to determine whether the injury is a covered loss and whether any policy exclusions apply.

This insurance does not pay benefits for hospitalization due to sickness. Other common exclusions are the use of drugs and alcohol, repetitive stress syndromes, and activities like riding in or flying a private aircraft and drag racing. 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) situation 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 determine 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

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.”

Both my husband and I have our names on this letter. Can we both sign up?

“Family coverage can be purchased for both husband and wife to be covered.”

What does dependent child mean?  Are my grandchildren covered?

“The primary insured person’s unmarried child from the moment of birth, including natural child, grandchild, stepchild or adopted child from the date of placement with a primary insured person.”

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.”

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″

Can I get insurance for my spouse and family, too?

“Yes, the family plan will automatically cover you, your spouse or domestic partner and all your dependent children. Your daily In-Hospital, emergency room, and Intensive Care Unit benefits will be the full amount you have selected on your enrollment form. Your spouse or domestic partner will receive 50% of this amount and each of your dependent children will receive 20%. If there are no eligible children, your spouse or domestic partner will receive 60% of your amount; if there is no spouse or domestic partner, each dependent child will receive 40%.”

Can I be turned down for this insurance?  Do I have to take a medical exam or answer a lot of health questions?

“No. Medical exams, blood tests or answering health questions are not required to enroll and or keep this coverage. Your acceptance is guaranteed.”

MONEY BACK GUARANTEE

Can I cancel / Can I get my money back?

“You have a no-risk, 60-Day, 100% Money Back Guarantee. If you are not happy with the insurance for any reason, and you have not submitted a claim that has been paid, or will be paid, simply contact us within the first 60 days of enrollment for a complete refund of your premium and the coverage will be canceled back to its effective date.”

RATES AND BILLING

How much does this coverage cost?

“The cost is $17.65 per month for you or $29.95 per month for you and your family.”

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.”

When will I be billed?

“Your billing schedule will be shown on your certificate of insurance that you will receive within 15 days of your activation. Please note that your effective and billing dates may be delayed depending on the billing cycle of your financial institution.”

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?

“Once you enroll today, you can expect to receive the certificate of insurance within 15 days.”

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?

“Your benefits will be paid in one lump sum after the Covered Person’s discharge from the hospital.”

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.”

When do I get my cash benefit?

“After you file a claim, the carrier will make a decision to approve or deny your claim. If the carrier approves your claim, your benefits will be paid in one lump sum after the covered hospital stay and you are discharged from the hospital.”

Why would you need my hospital records to process a claim?

“Those records are required by the insurance company to verify you were hospital confined and that the primary cause of the hospital confinement was due to a covered accident.”

Do I have to use the cash benefits to pay medical bills?

“No. You can use your payment for medical, family or personal expenses of any kind – or spend it in any way you want, for anything you need.”

ADDITIONAL QUESTIONS

Is there an age cutoff? Whose age is the reduction based on?

“There is no termination age; however, confinement benefits reduce by 50% at age 65 and reduce to 25% at age 75 (except in MN). If an insured person is age 65 or older on the date of an accident then the benefit amount for the accident only in-hospital benefit and the accident only intensive care benefit will be reduced to 50%. If an insured person is age 75 or older on the date of an accident, then the benefit amount for the accident only in-hospital benefit and the accident only intensive care benefit will be reduced to 25%.”

Why is there an age reduction?

“The possibility of injury due to an accident increases with age so the age reduction helps ensure rates don’t change over the life of the coverage.”

Is this offer still available after 14 days?

“Yes, the offer is still available.”

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.”

What if I have other insurance?

“This insurance will pay all cash benefits due to a covered accident regardless of any other insurance you may have.”

Who provides this insurance?

“Federal Insurance Company, a Chubb company, is the underwriter.”

Are on-the-job accidents covered?

“Yes. Your coverage is effective 24 hours a day, anywhere in the world.”

Who is the plan administrator / Who are you / Who do you work for?

“Franklin Madison is the plan administrator.”

“I’m a customer service agent here to answer questions for you about the Hospital Accident Protection plan offered to you through your financial institution.”

“I am employed by [TLC & Associates] / [InteLogix].”