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AGENT PRODUCT TRAINING (AHCP) 1_012011. Smart Solution Plus was designed with you in mind. Healthcare Reform presented an opportunity for Access Plans.

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Presentation on theme: "AGENT PRODUCT TRAINING (AHCP) 1_012011. Smart Solution Plus was designed with you in mind. Healthcare Reform presented an opportunity for Access Plans."— Presentation transcript:


2 Smart Solution Plus was designed with you in mind. Healthcare Reform presented an opportunity for Access Plans USA (AHCP’s sister company) to create a client-friendly product that would make up for the shortfall in major medical commissions. 2010 Major Medical Commissions 2011 Major Medical Commissions That’s an average difference (shortfall) of $245/policy $3500 avg. annualized premium 18% avg. agent commission rate $630 $3500 avg. annualized premium 11% avg. agent commission rate $385

3 VBA Smart Solution Plus First Year 30% Renewals 3%  Plan A  First Year: $126.00  Renewals: $12.60  Plan B  First Year: $198.00  Renewals: $19.80 First Year 25% Renewals 20%  Plan A (Plus)  First Year: $164.85  Renewals: $131.88  Plan B (Max)  First Year: $209.88  Renewals: $167.88 Agent Earning Potential

4 Earn MORE this year! Combination Sales… Offer your clients a SOLUTION. High Deductible Major Medical Plan (avg. $385 Commission) Smart Solution Plus Accident Plan (avg. $210 Commission) Colorado Bankers Critical Illness (avg. $385 Commission)

5 Close 2 Sales per Week… Increase your income by 60% in 2011! The OLD way… (selling just major medical) The BEST way… (Offer a solution!)

6 Getting Appointed To get signed-up to sell Smart Solutions Plus:  Go to  Click on the ‘Get Appointed’ menu. Find the Smart Solution Plus logo and click on the link provided  License copies must be provided. Agents may only sell SSP in states they have provided license copies for.  Email completed documents and licenses to  Your online sign-up capability should be active within 48 hours.  You will receive a welcome email to inform you that you’re ready to start selling.

7 Commissions Commission schedules should be provided to you by your Division President or by contacting AHCP Agent Services. Income Options:  3, 6, or 9 month advances available  3% admin charged on the gross advance total  Processed weekly  Agents must be in good standing to qualify for advance commissions “Good standing” refers to an overall debit balance projected to pay off within standard time. (currently 12 months)  EARNED- (no admin fee), processed monthly

8 Smart SolutionSmart Solution PlusSmart Solution Max Lifestyle & Discount Benefits 24-Hour Nurse Hotline  24-7 Physician Assistance  Patient Advocacy  Dental  Vision  Prescription  Hearing  Chiro/Alternative Health  Roadside Assistance  Everyday Savings  Insurance Benefits Accident Medical Expense-$5,000$10,000 Accidental Death & Dismemberment -$10,000$20,000 Premium Protection (Involuntary Unemployment Insurance) $1,500 ($500 per month) $1,500 ($500 per month) $1,500 ($500 per month) Monthly Cost ($5.00 Enrollment Fee) Individual/Family $29.95$54.95$69.95

9 We’ve made it easy! Online enrollment has never been easier.  Simply go to  Click on the “Sign-Up” option located at the top right corner of the screen or the button located on the home page.  Agent ID is required. Sales tools available online—  Go to  Click on Our Carriers, then on Accident  Select Smart Solution Plus  Brochure  Appointment Paperwork  Apply Online (get a quote)

10 Important information regarding Sign-up 1 st or 15 th effective dates (Insurance benefits) Immediately following sign-up, clients will receive:  Electronic confirmation, temporary card is included  Instructions to start using their discounts/savings benefits immediately. Within 7 business days, the client should receive a fulfillment kit in the mail.  The kit includes their permanent ID cards, key-ring card, fulfillment booklet (Membership Guide) specific to the plan they were signed up for.


12 Accident Medical Expense (AME) $5,000 or $10,000 ACCIDENT MEDICAL EXPENSE*  If your clients suffer from a covered injury and receive treatment within 90 days of the covered accident, the insurance company may pay up to the elected benefit amount for eligible medical expenses related to the accident.  All eligible medical expenses must occur within 52 weeks of the covered accident. Eligible medical expenses are those related to hospital room and board, general nursing care, surgery under general anesthetic, laboratory tests, x-rays, anesthesia, prescription drugs, therapeutic services and supplies, hospital emergency care, doctor’s visits (inpatient and outpatient), and dental treatment for injury to natural teeth.  Subject to a $100 deductible.  Benefits and deductible apply per incident per covered person.

13 Accidental Death and Dismemberment (AD&D) $10,000 or $20,000 ACCIDENTAL DEATH & DISMEMBERMENT*  If your clients are involved in a covered accident and sustain a covered injury which causes death or dismemberment within 365 days of the covered accident, the insurance company may pay the elected benefit amount.  If you sustain more than one loss as the result of the same accident, the insurance company will pay only one amount, the largest to which they are entitled.  Spouse and dependent children are covered at reduced amounts.  Newborn children or Adopted children must be added to policy within 31 days of birth or placement.

14 AME and AD&D Outline of Coverage Accidental Death  100% of Principal Sum Loss of:  Both Hands or Both Feet: 100% of Principal Sum  One Hand and One Foot: 100% of Principal Sum  One Hand or One Foot plus the loss of Sight of One Eye: 100% of Principal Sum  Sight of Both Eyes: 100% of Principal Sum  Speech and Hearing: 100% of Principal Sum  Speech or Hearing: 50% of Principal Sum  One Hand; One Foot; Sight of One Eye: 50% of Principal Sum  Thumb and Index Finger of the same Hand: 25% of Principal Sum  Hearing in One Ear: 25% of Principal Sum Exposure or Disappearance  100% of Principal Sum  If a Covered Person is exposed to weather because of an Accident and this results in a Covered Loss, Zurich will pay the applicable Principal Sum, subject to all Policy terms.  If the conveyance in which a Covered Person is riding disappears, is wrecked, or sinks, and the Covered Person is not found within 365 days of the event, Zurich will presume that the person lost his or her life as a result of injury. Zurich has the right to recover the benefit if they find that the Covered Person survived the event.

15 AME and AD&D General Exclusions A loss will not be a Covered Loss if it is caused by, contributed to, or results from:  Suicide or any attempt at suicide or intentionally self-inflicted Covered Injury or any attempt at intentionally self-inflicted injury.  War or any act of war, whether declared or undeclared.  Involvement in any type of active military service.  Illness or disease, regardless of how contracted, medical or surgical treatment of illness or disease; or complications following the surgical treatment of illness or disease; except for Accidental ingestion of contaminated foods.  Participation in the commission or attempted commission of a crime, any felony, an assault, insurrection or riot.  Being intoxicated.  a. A Covered Person will be conclusively presumed to be intoxicated if the level of alcohol in his or her blood exceeds the amount at which a person is presumed, under the law of the locale in which the Accident occurred, to be intoxicated, if operating a motor vehicle.  b. An autopsy report from a licensed medical examiner, law enforcement officer reports, or similar items will be considered proof of the Covered Person’s intoxication.  Being under the influence of any prescription drug, controlled substance, or hallucinogen, unless such prescription drug, controlled substance, or hallucinogen was prescribed by a Physician and taken in accordance with the prescribed dosage.  Travel or flight in any aircraft except as a fare-paying passenger on a regularly scheduled charter or commercial flight.  Release, whether or not Accidental, or by any person unlawfully or intentionally, of nuclear energy or radiation, including sickness or disease resulting from such release.  A cardiovascular event or stroke caused by exertion prior to or at the same time as an Accident.  Any condition for which the Insured is entitled to benefits under any Workers' Compensation Act, No Fault Auto Coverage or similar law.

16 AME and AD&D How to File a Claim Notice  Your client, or someone on their behalf, must give Zurich written notice of the Covered Loss within ninety (90) days of such Covered Loss, or as soon thereafter as reasonably possible. The notice must name the Covered Person who sustained the injury, Primary Policy holders name, and the Policy Number.  To request a claim form, your client, your clients beneficiary, or someone on their behalf may contact Zurich at 1-877-287-4805.  The notice must be sent to the address shown on the Schedule. If your client provides notice to you (the agent), or AHCP, it is considered notice to Zurich. Claim Forms  We will send the claimant Proof of Covered Loss forms within fifteen (15) days after We receive notice. If the claimant does not receive the Proof of Covered Loss form in fifteen (15) days after submitting notice, he or she can send Us a detailed written report of the claim and the extent of the Covered Loss. We will accept this report as a Proof of Covered Loss if sent within the time fixed below for filing a Proof of Covered Loss. Proof of Covered Loss  Written Proof of Covered Loss, acceptable to Us, must be sent within ninety (90) days of the Covered Loss. Failure to furnish Proof of Covered Loss within such time will neither invalidate nor reduce any claim if it was not reasonably possible to furnish the Proof of Covered Loss, and the proof was provided as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required.

17 AME and AD&D Payment of Claims Time of Payment  Zurich will pay claims for all Covered Losses, other than Covered Losses for which the Policy provides any periodic payment, immediately upon receipt of written proof of loss. Unless an optional periodic payment is stated or chosen, any Covered Loss to be paid in periodic payments will be paid at the end of each four-week period. The unpaid balance, which remains when Zurich’s liability ends, will then be paid when Zurich receive the Proof of Covered Loss. Who We Will Pay  In the event of DEATH, benefits pay to:  Spouse/Domestic Partner  Child(ren)  Parents  Brothers and sisters  The clients estate  All Other Claims, benefits pay to:  Covered Person. The Covered Person may direct in writing that all, or part of the Accident Medical Expense Benefit, if applicable, will be paid directly to the party who furnished the service. The direction may be changed by the Covered Person at any time up to the filing of the Proof of Covered Loss.  (Foreign Nationals are eligible for coverage however due to legal restrictions and jurisdiction surrounding payment of benefits, they must have a US Bank Account or name a US Citizen as the beneficiary.)

18 AME and AD&D Disclosure Insurance benefit payments are subject to definitions, limitations, exclusions and other provisions within the Certificate(s). May not be available in all states. Primary member must be 18 years or older. Underwritten by Zurich American Insurance Company located at 1400 American Lane, Schaumburg, IL 60196. The policy is the contract that specifically and fully describes your coverage. The description of the policy provisions gives a broad overview of coverage and does not revise or amend the policy.

19 Premium Protection (Involuntary Unemployment Assistance) $1500 (Cash in Hand) PREMIUM PROTECTION  There is no reason for your clients to cancel their health insurance or SSP coverage in the event they lose their job involuntarily.  This program is designed to help pay for medical insurance premiums or just to help make ends meet.  This program would be available for up to 3 months.  Proof of state unemployment assistance is required.

20 Premium Protection Disclosure Insurance benefit payments are subject to definitions, limitations, exclusions and other provisions within the Certificate(s). Underwritten by Lyndon Southern Insurance Company.

21 Value Added Services 24-Hour NURSE HOTLINE  Illness can strike at anytime, anywhere. Our registered nurses are available to assist your clients and their covered family members 24 hours a day, 365 days a year. 24-Hour PHYSICIAN ACCESS  Clients can save money by avoiding unnecessary and expensive trips to the doctor or hospital. They’ll receive quality health care whenever the need arises. Clients can connect with a physician for the treatment or diagnosis of common conditions, over the phone or through email. It’s fast, convenient, and reliable.  Not available to residents of OK. PATIENT ADVOCACY  This dedicated support channel handles everything from locating in- network providers to negotiating medical bills and setting up payment arrangements

22 Discounted Medical Products Disclosures  This discount medical, health, and drug plan is NOT insurance, a health insurance policy or a Medicare Prescription Drug Plan.  The Plan provides discounts for certain medical services, pharmaceutical supplies, prescription drugs or medical equipment and supplies offered by providers who have agreed to participate in The Plan.  The range of discounts for medical, pharmacy or ancillary services offered under The Plan will vary depending on the type of provider and products or services received.  The Plan does not make and is prohibited from making members’ payments to providers for products or services received under The Plan.  The Plan member is required and obligated to pay for all discounted prescription drugs, medical and pharmaceutical supplies, services and equipment received under The Plan, but will receive a discount on certain identified medical, pharmaceutical supplies, prescription drugs, medical equipment and supplies from providers in The Plan.  The Discount Medical Plan Organization (DMPO) is Alliance Health Card of Florida, Inc., P.O. Box 610810, Dallas, TX 75261.  You may call (866) 726-9673 for more information or visit for a list of providers.  The Plan will make available before purchase and upon request, a list of program providers and the providers’ city, state and specialty, located in the member’s service area.  The fees for The Plan are specified in the membership agreement.  The Plan includes a 30-day cancellation provision.  Note to MA consumers: The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00.

23 Discount Medical Products DENTAL savings  Save between 15%-50%on dental care.  Choose from a network of over 80,000 general dentists and specialists.  Discounts not available in AK, MT, ND, SD, VT, WA and WY. PRESCRIPTION savings  Save an average 31% off generic and 15% off brand name prescription drugs.  Choose from a network of over 60,000 participating retail pharmacies or have a 90-day supply of select medications delivered right to your door through our convenient mail order pharmacy. Chiropractic & Alternative Medicine  Enjoy discounts of 25% off usual and customary fees for services from a national network of complementary health care providers.  Choose from over 19,000 participating providers nationwide.  Shop our online store of health and wellness products and receive a 15% to 40% discount on most items.  Members can save at all participating chiropractors, massage therapists and acupuncturists. There is no limit to the number of visits, and services are not required to be medically necessary. VISION savings  Save 35% off normal retail prices on frames (complete pair) and 20% off lenses and lens add-ons.  Visit participating retailers such as LensCrafters, EyeMasters, Pearle Vision and other independent vision providers! In all, there are more than 45,000 providers in over 21,000 locations to choose from. HEARING savings  At any of our 1,500 locations you can save 20% off of conventional hearing aids, ear molds, repairs and related products (excluding batteries).  Not available to residents of IL.

24 Additional Discounts ROADSIDE ASSISTANCE  As a member discounted roadside assistance is just a phone call away should your car break down or you need any type of automotive help.  This benefit is available 24-hours a day, seven days a week. EVERYDAY SAVINGS  Shop more! Save up to 50% at any of our participating retailers.  Dine Out! Choose from over 60,000 restaurants.  As a member of AHCCA and Consumer Alliance USA, members have access to grocery coupons, discounted amusement park tickets, roadside assistance and more.  “Clip” coupons conveniently from our online catalog.  Log in to start saving today

25 Currently available in: Coming soon to:  Alabama  Arizona  California  Delaware  District of Col.  Georgia  Hawaii  Indiana  Iowa  Massachusetts  Michigan Product Availability  Arkansas  Florida  Idaho  Illinois  Kansas  Louisiana  Minnesota  Nebraska  Nevada  North Carolina  Oregon  South Dakota  Texas  Utah  Wyoming  Mississippi  Missouri  New Mexico  New York  North Dakota  Ohio  Oklahoma  Pennsylvania  South Carolina  Virginia  West Virginia  Wisconsin

26 Information and Assistance Website  Client Service  (866) 726-9673 Agent Services  (877) 228-8773 Product Information 

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