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Critical Illness Dental Accident. CRISIS RECOVERY Critical Illness Policy.

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Presentation on theme: "Critical Illness Dental Accident. CRISIS RECOVERY Critical Illness Policy."— Presentation transcript:

1 Critical Illness Dental Accident

2 CRISIS RECOVERY Critical Illness Policy

3

4 Critical Illness Policy Provides immediate cash for your customers when they are diagnosed with a covered medical crisis. They can use the money for: Treatment not covered by or limited by their existing ….medical insurance. Non-medical expenses resulting from their condition: …. travel, childcare, and spouse’s time off from work. Extended convalescence services or for rehabilitation. Mortgage, auto loans and credit card payments Or, any way you choose. There are NO restriction on how ….. they spend their money.

5 Crisis Recovery Five benefit level to choose from:. $10,000 $20,000 $30,000 $40,000 $50,000 Dependent Chldren's Benefit: $10,000 per child Provides up to $50,000 to help cover out-of-pocket medical expenses and the other costs associated with a covered critical illness. Crisis Recovery is designed to ease the financial pressure by providing a lump sum cash benefit paid directly to you upon diagnosis of a covered illness to help you cope with the high cost of recovering from a Medical Crisis.

6 Two Category of Benefits If you collect a benefit for the first diagnosed illness or procedure under this policy in one category of benefits and then have a second diagnosis of a condition or procedure in another category under this policy we will pay the maximum benefit to you again. If a partial benefit is paid (25%) the remainder of the benefit will be payable upon the diagnosis of another covered condition.

7 Two Category of Benefits CATEGORY ONE BENEFITS ConditionsPercent Paid Cancer (Internal Cancer)100% Non-Invasive Carcinoma In-Situ25% CATEGORY TWO BENEFITS Heart Attack100% Stroke100% Coronary Artery Bypass25% Angioplasty10% Pacemaker Implant- Single chambered30% Pacemaker Implant- Double chambered40% End Stage Renal Failure100% Organ Transplant (kidney)50% Organ Transplant (heart, lung, liver and pancreas) 100%

8 Policy Provisions Waiting Period The benefits of this Policy are payable for loss that begins more than 90 days after the Effective Date of coverage for each Insured person. If the Diagnosis is made within the first 90 days, we will pay 25% of the benefit payable as listed in Category One and Two of the policy. During the first 90 days after the Effective Date of coverage, Reinstatement date or for a second date of occurrence resulting in a Diagnosis or procedure in a Multiple Condition instance, We will pay 25% of the Percentage Benefit Payable listed in the Policy Schedule. Reduced Benefits Reduction of Benefits Due To Age Any benefits remaining at age 65 or older will reduce 50%. Guaranteed Renewable This Policy is guaranteed renewable to age 75 by the timely payment of premiums. It must be paid on or before its due date, or within the 31 days that follow. When an Insured’s coverage terminates at age 75, coverage for other Insured persons, if any, shall continue under this Policy.

9 Policy Provisions Attained Age Pricing In order to make this plan as affordable as possible, we used a pricing method that is called Attained Age Pricing. By using this method the cost of the plan is lower at the beginning and takes small incremental increases each year there after. This is in contrasts to a method called Issue Age Pricing where the premium starts out much higher but remains at the same level for several years or the life of the policy. Which method is better? We believe that Attained Age Pricing is better for the consumer since it’s more affordable up front and allows you to purchase the amount you need by paying less when your income is lower and as your income continues to grow you will be able to pay a little higher premium. In comparing this method to other insurance carriers that prices their product using Issue Age Pricing, we find that our method can save you as much as 20% to 30% (see graph) in the first 10 Years depending on your age.

10 Policy Provisions

11 Pre-Existing Sickness or Injury Provision The benefits of the policy will not be payable during the first 12 months that coverage is in force with respect to an insured person for a loss caused by a Pre-Existing Sickness or Injury disclosed or not disclosed in the application. This 12 month period is measured from the effective date of coverage for each insured person. A Pre-Existing Sickness or Injury means a Sickness or Injury which is Diagnosed by a legally qualified physician or for which medical advice or treatment was recommended or received from a legally qualified physician within 12 months prior to the effective date of coverage for each insured person.

12 CRISIS RECOVERY If you knew that you would be diagnosed with cancer in six months, would you buy this insurance? How do you know that you won’t be?

13 Crisis Recovery Approved States Critical Illness Availability AK OR NV AZ TX LA AR MO KS NE IA MS AL GA FL IL IN OH KY WV VA PA HI WI CA ID MT WY WA UT CO NM OK SD ND MN TN SC NC MI ME NY 4.13 All states listed except North Carolina has the Standalone 24HR Enhanced Accident Plan approved Approval Pending Release

14 Dental Choice Plus

15 Introducing a new type of “hybrid” dental insurance policy that combines traditional fully insured benefits with PPO discount pricing. Choice Plus Dental

16 Freedom of Choice Unlike many PPO plans that will not pay anything if you go outside their network, Dental Choice Plus will pay the non-network provider at the same rate as if they were in network. Your client will only be responsible for the non-network charges that are in excess of the pre-negotiated network fee schedule. Choice Plus Dental

17 Individual Dental Plan No waiting periods on Diagnostic and Preventive care benefits. Diagnostic & Preventive paid at 100% when using a network provider. Two plan options to choose from with Calendar Year Maximums benefits of either $1,500 or $2,000. Over 169,000 access points across the United States. eApplication enrollment Employer Sponsored Plan In addition to the key benefits list for individual plans, employer sponsored plans are available. Available for groups of 3 or more $25 application fee is waived List Bill eApplication enrollment Rates for ages 65+ Choice Plus Dental

18 Dental Choice Plus Benefits Reimbursement Method In/Out Standard Plan Pays** Yr. 1 / Yr. 2 / Yr. 3+ Enhanced Plan Pays** Yr. 1 / Yr. 2 / Yr. 3+ Diagnostic & Preventative No Wait100% / 100% / 100% Basic (Filings & Simple Extraction)Basic6 months 50% / 65% / 80% EndodonticMajorNo Wait 0%* / 25% / 50% PeriodonticsMajorNo Wait 0%* / 25% / 50% Oral SurgeryMajorNo Wait 0%* / 25% / 50% RestorationsMajorNo Wait 0%* / 25% / 50% OrthodonticsMajorNo Wait 0%* / 25% / 50% ProsthodonticsMajorNo Wait 0%* / 25% / 50% Co-Pay (Per Person, Per Visit) No more than 3 per person per calendar year $25 Thru age 64 $40 over age 65 $25 Thru age 64 $40 over age 65 Insurance Calendar Year Maximum per person per calendar year$1,500$2,000 Orthodontic and Prosthodontics Lifetime Maximum ($1,000 Lifetime Max, Limited to $350 per Calendar Yr.) $1,000 * Insured pays only the discounted pre-negotiated network provider rate. $25 Application Fee For Individual Applications. Application Fees are waived for employer sponsored plans **Annual coinsurance amounts are based on policy years. Choice Plus Dental

19 Good oral hygiene and regular dental care is important throughout your life Given the suspected link between periodontitis and systemic health problems, prevention is the first step to maintain good long-term health. Dental Choice Plus is economical because it focuses on benefits you need…not benefits you may never use. Diagnostic & Preventive Services are paid at 100% with only a $25 co-pay when using a network provider. No waiting periods or deductibles. Choice Plus Dental

20 Examples of Diagnostic & Preventive Services when receiving benefits through PPO Waiting Periods Amount Paid Routine oral exams - 1 exam per 6 month period No Waiting Period 100% Bitewing X-rays (up to a set of 4) - 1 set per Calendar Year No Waiting Period 100% Full Mouth X-rays (Panoramic Film or Full Series) - no less than 36 months apart No Waiting Period 100% Prophylaxis (cleaning and scaling of teeth) - 1 per Calendar Year No Waiting Period 100% Topical application of Fluoride for dependent children under 19 - 1 per Calendar Year No Waiting Period 100% Consultation - other than treating doctor No Waiting Period 100% Comprehensive Oral Exam No Waiting Period 100% Sealant - dependents under 14, one treatment per tooth no less than 36 months apart No Waiting Period 100% Space Maintainers - the initial appliance for dependent children under 13, including adjustments within the 6 month period immediately following installation No Waiting Period 100% Diagnostic & Preventative Services paid at 100% No Waiting Periods Dental Choice Plus focuses on providing the benefits you need to maintain good oral health at affordable prices Choice Plus Dental

21 The schedule applies to services provide by a participating General Dentist and is an extensive list of most common procedures. The purpose of this schedule is to establish the maximum fee that a General Dentist will charge for each listed procedure. Fee schedules are determined by the zip code of the participating provider. Participating Specialists do not charge according to this fee schedule but will give a 20% discount. Care PPO Schedule CI-5

22 If the annual calendar year maximum benefit is exhausted, you can still take advantage of the pre-negotiated network provider’s fee schedule as long as you use a participating network provider. With over 169,000 access points across the United States Care PPO pre-negotiated fee schedule will apply to give continued savings even after the insured benefits are exhausted. If you go to a participating network provider who resides in a higher cost area we will pay based on the point of service provider at no additional cost. Choice Plus Dental

23 www.careington.com/co/PAL PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

24 Provider Search PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

25 Provider Search PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

26 Provider Search PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

27 Provider Search Results For 75070 Step 4 PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

28 www.careington.com/co/PAL Administered by: Careington International Corporation 7400 Gaylord Parkway Frisco, TX 75034 Toll Free Service Line 855-332-1271 PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

29 October 1, 2013 Dental Choice Plus Zip Codes By State State ZipAreaZipAreaZipAreaZipArea AlabamaFloridaIndianaMississippi All3320-3224460-4666386-3912 Arizona3233467-47953923 All4324-3284Iowa3932 Arkansas3295All6394-3954 All6330-3316Kansas 396-3973 California33276604Missouri 9009333-3346661-6625630-6334 901-928 8 335-3374664-6794634-6513 930-9377338-3445Kentucky 6524 9388346-3494All3653-6583 9399Georgia Louisiana Nebraska 9408300-3104700-7015All3 94193115703-7083Nevada 942-94883124710-7114889-8905 9619313-3195712-71438915 949-95673994Michigan 8937 9578Illinois480-4835894-8969 95876006484-48548979 9597601-604548548987 96076054486-4918New Mexico 9619606-6085492-49610All6 Colorado609-6283497-4988North Carolina All662934998All10 State ZipAreaZipAreaZipAreaZipArea OhioPennsylvaniaTexas 430-43431823763679710 4354183-18547644798-7993 436-4393186376538853 440-4414187-18947665Utah 4423190-19267673840-8437 443-444219347685844-8478 445-4533194-19657694 Virginia 4544South Carolina77062016 455-459329057726220-2225 Oklahoma291-2926773-77452236 All329357757224-2363 Pennsylvania2946776-7784237-2384 150-1514295-2997779-7843239-2463 152-1543Tennessee785-7874West Virginia 155-156237027885All6 1573371-38037894Wisconsin 1582381-38527905530-5358 159-1663Texas79145379 1672733479255388 168-1773750-753579335398 1784754-75837944540-5498 179375957956Wyoming 180-1814760-76247965All8

30 October 1, 2013 Dental Choice Plus Rates By Area Standard ($1,500 Annual Benefit) Area2345678910 Individual17.3018.4019.5020.7022.0023.4024.9026.4028.00 Individual +Spouse31.4033.4035.5037.7040.1042.6045.3048.2051.20 Individual + Child(ren)32.3034.3036.5038.7041.2043.8046.5049.5052.60 Family47.5050.6053.8057.1060.8064.6068.7073.0077.70 Enhanced ($2,000 Annual Benefit) Area2345678910 Individual19.4020.6021.9023.2024.7026.2027.9029.6031.50 Individual +Spouse35.4037.7040.0042.5045.2048.1051.1054.3057.80 Individual + Child(ren)36.3038.6041.1043.6046.4049.3052.4055.7059.30 Family53.6057.0060.6064.4068.5072.9077.5082.4087.60

31 Choice Plus Dental Finally, a dental policy that covers the services you want at a price you can afford.

32 Dental Choice Plus Availability AK OR NV AZ TX LA AR MO KS NE IA MS AL GA FL IL IN OH KY WV VA PA HI WI CA ID MT WY WA UT CO NM OK SD ND MN TN SC NC MI ME NY 9.13 Approved States Approved Pending Release Filed Pending Approval

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34 BENEFIT SUMMARY 1 Unit2 Units Accidental Injury Benefit $ 2,000.00$ 4,000.00 Accidental Death Benefit $ 50,000.00$ 100,000.00 Ground or Air Ambulance $ 5,000.00$ 10,000.00 Hospital Income Benefit $ 150.00$300.00 Dismemberment Benefits Loss of Finger or Toe Single Loss Benefit Multiple Loss Benefit $ 500.00 $ 1,000.00 $ 2,000.00 Loss of Hand, Arm, Foot, Leg Single Loss Benefit Multiple Loss Benefit $ 5000.00 $ 10,000.00 $ 20,000.00 Loss of Site Single Loss Benefit (One Eye) Multiple Loss Benefit (Both Eyes) $ 5000.00 $ 10,000.00 $ 20,000.00

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36 This benefit pays the actual charges for ground or air ambulance transportation due to an accidental injury, up to the amount shown per unit: 1 Unit = $5,000 / 2 Units = $10,000 HOSPITAL INCOME BENEFIT If an insured is hospitalized for an accidental injury, we will pay a fixed amount per day, beginning the first day of confinement, subject to the number of units purchased. Payment will be made up to 30 days per hospital confinement resulting from any one accidental injury: 1 Unit = $150 a day / 2 Units = $300 a day

37 DISMEMBERMENT BENEFITS This benefit pays a fixed amount per unit if the Primary Insured suffers any of the following dismemberments as a result of accidental injury. Benefits are for the Primary Insured only. Loss of Finger or Toe1 Unit2 Units Single Loss Benefit $500 $1,000 Multiple Loss Benefit$1,000 $2,000 Loss of Hand, Arm, Foot, Leg Single Loss Benefit$5,000$10,000 Multiple Loss Benefit $10,000$20,000 Loss of Sight Single Loss Benefit (One Eye)$5,000$10,000 Multiple Loss Benefit (Both Eyes) $10,000$20,000

38 Optional Accident Disability Income Benefit 1 Unit2 Units Monthly Benefit $ 1,000.00$ 2,000.00 12 Months24 Months Two Benefit Period To Choose From Type 1Type 2 Only Two Occupational Classes If the Primary Insured incurs an accident disability, we will pay a monthly disability benefit, on a weekly basis, beginning the thirty first day, up to a maximum benefit period of 12 months or 24 months. This benefit applies only to the Primary Insured and pays up to 60% of the insured’s gross monthly income.

39 ACCIDENT PLAN1 Unit2 Units Insured$23.00$31.05 Insured & Spouse$44.28$56.93 Insured & Children$53.48$69.00 Family$74.75$94.88 Child Only$16.10$20.13 ACCIDENT DISABILTY INCOME RIDER1 Unit2 Units Type 1 - 12 months$10.35$20.70 Type 1 - 24 months$13.23$26.45 Type 2 - 12 months$19.55$39.10 Type 2 - 24 months$26.45$52.90

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42 1 or 2 units of accident coverage available Issue ages 0-75 Accident Plan Guaranteed renewable to age 80 $50,000 or 100,000 of Accidental Death Benefit Pays in addition to any other insurance Individual, Individual & Spouse, Single Parent, Family, and Children Only coverage available Pays in addition to worker’s compensation, employer’s liability or similar laws or coverage Optional Accident Disability Income Benefit for the Primary Insured Issue ages 18 – 64 Optional Accident Disability Rider Coverage 24 hours a day, anywhere in the world

43 Enhanced 24-Hour Accident Expense Approval Pending Release Approved States

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