PRODUCT DESCRIPTION INFORMATION
What is this coverage? Can you tell me more about this coverage? What does this cover?
Injury Care Accident Insurance provides cash benefits directly to the insured due to a covered injury.
DEPENDENT and AGE QUESTIONS
- Insured and spouse: U.S. resident age 18 or older.
- Dependent children: Less than 26 years of age; 26 years or older provided the child remains chiefly dependent due to a physical or intellectual disability.
- No medical exam or health questions required.
- Coverage is guaranteed.
- There is no benefit reduction or termination age.
- No lifetime benefit maximum.
BENEFITS
The coverage has one plan that can pay you cash benefits in four ways:
- Injury Lump Sum – payable per injury up to $10,000 for fractures, burns, broken teeth, eye injuries, and more
- Immediate Care – payable up to $1,200 for ER and doctor visits, X-rays, hospitalization, and more.
- Ongoing Care – payable up to $5,000 for surgery, skin grafts, prescriptions, and more.
- Recovery Care – payable up to $1,000 for inpatient and outpatient therapy.
FAMILY COVERAGE AMOUNTS
Spouse and dependent children receive 100% of the benefit 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 Injury Care Accident Insurance provides a benefit 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, burns, and sporting accidents resulting in ER and doctor visits, X-rays, hospitalization, fractures, broken teeth, skin grafts, prescriptions, and inpatient and outpatient therapy. 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, drag racing, and participation in semi-professional or professional competitive athletics. 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 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
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?
“The primary insured person’s unmarried child from the moment of birth, including natural child or adopted child from the date of placement with a primary insured person.”
Can my handicapped child be covered?
“Yes, insurance would be extended beyond this limitation for qualified handicapped children.”
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 at 100% of the benefit amount.”
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 30-day free look with no obligation. 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 30 days of enrollment for a complete refund of your premium and the coverage will be canceled back to its effective date.”
“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
How much does this coverage cost?
“The cost is $20.00 per month for you or $49.50 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 directly to the insured.”
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 directly to you.”
Why would you need my hospital records to process a claim?
“Those records are required by the insurance company to verify you were confined in the hospital 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 or reduction of benefits due to age.”
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?
“Securian Life Insurance 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 Injury Care Accident Injury plan offered to you through your financial institution.”
“I am employed by [TLC & Associates] / [InteLogix].”