PRODUCT DESCRIPTION INFORMATION
What is this coverage? Can you tell me more about this coverage? What does this cover?
Recuperative Care provides cash benefits in the event the insured is hospitalized by a covered accident or sickness.
DEPENDENT and AGE QUESTIONS
- Insured, spouse, and domestic partner: 18 and older
- Dependent children under the age of 26
- No termination age for insured, spouse and domestic partner; however, benefits for all covered persons reduce by 50% at age 65 and by an additional 25% at age 75, regardless of age at enrollment
BENEFITS (“OR” PRODUCT)
- Pays $400 In-hospital daily benefit for each day in the hospital for up to 365 days for a covered accident OR
- Pays $200 In-hospital daily benefit for each day in the hospital for up to 365 days for a covered sickness
FAMILY COVERAGE PERCENTAGES
- Spouse/Domestic Partner – In-Hospital Daily Benefit 50%
- Dependent Child(ren) – In-Hospital Daily Benefit 25%
ADD ON BENEFITS:
- You only need to read the description for the benefit being asked about
Air Ambulance Transportation Indemnity – this benefit pays if an insured person requires the use of an ambulance service by air for transportation to or from a hospital, or from one hospital to another hospital for care and treatment of a covered sickness or accident.
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.
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, and activities like 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.”
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. The dependent child must be primarily dependent on the primary insured for maintenance and support and must be 1) under the age of 26, 2) under the age of 26 if enrolled as a full-time student at an institution of higher learning, or 3) classified as an incapacitated dependent child.”
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.”
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.”
MONEY BACK GUARANTEE
Can I cancel / Can I get my money back?
“You have a 30-day, 100% money-back guarantee. If you are not happy with this insurance for any reason, and you have not submitted a claim that has been paid (or will be paid), just let us know within 30 days of enrollment for a complete refund of your premium and the coverage will be cancelled back to its effective date. You may cancel at any time after that and all billing will stop.”
RATES AND BILLING
How much does this coverage cost? What are the rates?
MARKETING CALL ONLY – “The cost is $24.00 per month for you or $36.00 per month for you and your family.”
INSURED – CHECK ARTEMIS
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 We do not offer paper billing at this time.”
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? When will it be effective?
“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 would 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 sickness or injury.”
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 age cutoff, however, benefits will be reduced 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 the 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.”
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 sickness or injury regardless of any other insurance you may have.”
FOR CALIFORNIA RESIDENTS ONLY: Can I get this insurance if I don’t have major medical coverage?
“This is a supplement to health insurance and is not a substitute for major medical coverage. Lack of major medical coverage (or other minimum essential coverage) may result in additional payment with your taxes. Do you and all other individuals enrolling for coverage under the policy have comprehensive health benefits from an individual or group health insurance policy or an HMO or employer plan providing for essential coverage? IF NO, “I’m sorry, without comprehensive coverage, you are not eligible for coverage under a limited supplemental policy.”
Who provides this insurance?
“Federal Insurance Company, a Chubb company, is the underwriter.”
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 Recuperative Care plan offered to you through your financial institution.”
“I am employed by [TLC & Associates] / [InteLogix].”