PRODUCT DESCRIPTION INFORMATION
What is this coverage? Can you tell me more about this coverage? What does this cover?
The Recuperative Care Plan provides cash benefits for hospitalization and recuperation to the insured upon release from the hospital, in the event the insured is hospitalized by a covered accident or sickness.
DEPENDENT and AGE QUESTIONS
- Insured and Spouse: 18 and Older
- Dependent children: birth to 19 years or under 25 if a full-time student
- No termination age; however, Recuperative Accident and Recuperative Sickness benefits reduce 50% at age 65 and by an additional 25% at age 75, regardless of age at enrollment
- NORTH CAROLINA AND FLORIDA RESIDENTS ONLY: Benefits reduce 50% at age 70, regardless of age at enrollment
BENEFITS (“OR” PRODUCT)
- Pays $400 Recuperative Accident daily cash benefit for up to 365 days OR
- Pays $200 Recuperative Sickness daily cash benefit for up to 365 days
- NORTH CAROLINA RESIDENTS ONLY: Pays $650 daily Recuperative Accident OR $300 daily Recuperative Sickness
- FLORIDA RESIDENTS ONLY: Pays $750 daily Recuperative Accident OR $375 daily Recuperative Sickness
FAMILY COVERAGE PERCENTAGES
Spouse
- Spouse with Child(ren) – 50% Recuperative Accident and Recuperative Sickness
- Spouse without Child(ren) – 60% Recuperative Accident and Recuperative Sickness
Dependent Child(ren)
- Each dependent child – 20% Recuperative Accident and Recuperative Sickness
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 Recuperative Care group accident and sickness insurance plan provides benefits if you are hospitalized due to a covered injury or sickness.
The Recuperation Sickness benefit is payable when you are confined to the hospital for a sickness. There is no pre-existing condition limitation for this benefit.
The Recuperation Accident benefit is payable when you are confined to the hospital due to a covered injury. Some common types of accidents that may be covered are slip and fall injuries, motor vehicle accidents, and sporting accidents. 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. 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.
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 purchase for both 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.”
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. Family insurance covers you, your spouse/domestic partner and/or dependent children at a percentage of your coverage 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.”
What if I’m in the hospital because of a pre-existing condition? What if I have (X) condition already? Does it pay for that?
“There are no exclusions for pre-existing health conditions.”
60-Day Trial or No Cost Period
Can I cancel / Can I get my money back?
“You have a 60-day no cost period to use the product before you will be billed for the first time. If you are not happy with this insurance for any reason, you may cancel at any time and all billing will stop.” FLORIDA RESIDENTS ONLY: The 60-day no cost period is NOT offered to Florida residents.
RATES AND BILLING
How much does this coverage cost?
“The cost is $24 per month for you or $36 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 change.”
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 do 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 or sickness.”
Do I have to use the cash benefits to pay medical bills?
“No. You can use your benefit payment for medical, family or personal expenses of any kind – or spend it in any way you want, for anything you need.”
ADDITIONAL QUESTIONS
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? Whose age is the reduction based on?
“There is no termination age; however, plan benefits amounts reduce by 50% at age 65 and by an additional 25% at age 75, regardless of age at enrollment. The age reduction is based on the age of the primary insured at the time of claim. Age reduction is only applied (even to the Spouse and Dependents) if the primary insured is over the applicable age.”
Why is there an age reduction?
“The age reduction helps ensure rates don’t change over the life of the coverage.”
What if I have other insurance?
“This insurance will pay all cash benefits due to a covered accident or sickness regardless of any other insurance you may have.”
Who provides this insurance?
“Minnesota Life Insurance Company is the underwriter. Minnesota Life is highly rated by the major independent rating agencies that analyze the financial soundness and claims-paying ability of insurance companies. For more information about Minnesota Life’s ratings, please visit their website at www.minnesotalife.com/ratings.”
Are there any exclusions? What isn’t covered?
“Yes, there are exclusions under this plan. Some 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. You can find the standard exclusions in the ‘Summary of Insurance Provisions’ document you received in the mail. Each claim is thoroughly evaluated to determine if a benefit is payable according to the terms of the policy. Exclusions vary by state. If you decide to enroll in this coverage, please carefully review the insurance document you receive to determine the exclusions specific to your state.”
Why does this product have an exclusion for illness and infections if it is supposed to cover sickness? What is the definition of “physical and mental infirmary”? How is this different from sickness?
“I understand your concern. If you look on your Terms and Conditions document under the definition for the In hospital Sickness benefit you will see that Exclusions 4, 7, and 8 do not apply to the Sickness benefit. They do have to be listed however because they do apply to the In Hospital Accident benefit.”
Exclusions 4, 7, and 8 do not apply to the Sickness benefit.
Who is the plan administrator?
“Franklin Madison is the plan administrator.”
Who do you work for?
“I am employed by [TLC & Associates] / [InteLogix].”