PRODUCT DESCRIPTION INFORMATION
What is this coverage? Can you tell me more about this coverage? What does this cover?
Critical Illness and Injury Insurance pays directly to you to help with your recovery after the first time (initial occurrence) and second time (reoccurrence) you are diagnosed with invasive cancer, heart attack, stroke, paralysis, and coma.
DEPENDENT and AGE QUESTIONS
- Insured: U.S. resident age 18 or older.
- Dependent children: None, no coverage for dependents.
- No medical exam or health questions required.
- Coverage is guaranteed to age 64.
- Benefit reduction: Benefits are reduced 50% at age 65 or older.
- Termination age: Coverage terminates at age 90.
- Up to $100,000 lifetime benefit maximum.
BENEFITS
The coverage has one plan that pays cash benefits directly to you when you are diagnosed with the following five critical conditions.
| Covered Critical Illness | Initial Occurrence Benefit | Recurrence Benefit |
| Coma | $10,000 | $10,000 |
| Heart attack | $10,000 | $10,000 |
| Invasive cancer | $10,000 | $10,000 |
| Paralysis | $10,000 | $10,000 |
| Stroke | $10,000 | $10,000 |
Definitions:
Coma
A state of unconsciousness with no reaction to external stimuli or internal needs. The coma must last one or more consecutive days. A physician must diagnose the Insured as comatose.
Heart Attack
Death of a portion of the heart muscle resulting from a blockage of one or more coronary arteries. Angina and all other forms of acute coronary syndromes are not covered.
Invasive Cancer
A malignant tumor characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissue. The term cancer includes leukemia, lymphoma, sarcoma, and Hodgkin’s disease.
Paralysis
Paralysis refers to the total, permanent, and irrevocable loss of movement and includes quadriplegia; paraplegia; hemiplegia. Paralysis must be permanent with support by neurological evidence and must be present for more than 90 days. Paralysis due to stroke or psychiatric related causes is excluded.
Stroke
A cerebrovascular incident resulting in permanent death of brain tissue due to intracranial hemorrhage or cerebral infarction due to embolism or thrombosis in an intracranial vessel.
FAMILY COVERAGE AMOUNTS
Spouse and dependent children: No coverage; there is no coverage for Spouse or Dependent Children.
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 plan provides a benefit for covered critical illness and injury treatment costs for invasive cancer, heart attack, stroke, paralysis, and coma. The facts and circumstances of each claim are thoroughly reviewed to determine whether the illness or injury is covered and whether any policy exclusions apply.
In no event will we pay benefits where the insured’s illness or injury is caused or contributed by self-inflicted injury, suicide or attempted suicide, the use of drugs or alcohol, when in a motor vehicle accident where you are the driver and your blood alcohol level exceeds the legal limit; commission of a crime, assault 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. Please refer to your certificate of insurance for a complete list of exclusions.
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.
Pre-existing Condition Limitation
During the first 6-months after the original effective date of coverage or an increase in coverage, benefits are not payable for any covered loss that is the result of a pre-existing condition.
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.”
Both my husband and I have our names on this letter. Can we both sign up?
“No, there is no coverage for spouses; therefore, only one of you can enroll.”
What does dependent child mean?
“There is no coverage for dependent children for this product.”
Can my handicapped child be covered?
“No, there is no coverage for dependent children for this product.”
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?
“No, there is no family/dependent (spouse or children) coverage for this insurance plan.”
Can I be turned down for this insurance? Do I have to take a medical exam or answer a lot of health questions?
“No, your acceptance is guaranteed and you cannot be turned down for coverage as long as you enroll by age 64. Medical exams, blood tests or answering health questions are not required to enroll and / or keep this coverage.”
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?
“Your monthly premium is based on your age now with separate rates for Male vs. Female.”
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 critical illness 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?
“Yes, the age cutoff to enroll for this product is 64.”
“The benefits are reduced by 50% when the insured is age 65 or older.”
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.”
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 cash benefits due to a covered critical illness or injury regardless of any other insurance you may have.”
Who provides this insurance?
“Securian Life Insurance 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 Critical Illness and Injury Insurance plan offered to you through your financial institution.”
“I am employed by [TLC & Associates] / [InteLogix].”