Personal Accident Indemnity (PAI)

2

Preface

• Field Sales Guide – generic.

• State introduction packet via e-mail for state specifics.

• Slide numbers correspond to page numbers.

• Refer to Guide when calling Customer Call Center.

Policy Benefits

4

Personal Accident Indemnity Base Plan

• 24-hour coverage for death, dismemberment, or injury

• Set indemnity amount

• Guaranteed-issue on payroll

• Two levels

• No sickness benefits

Page 15

5

Wellness Benefit Emergency Treatment Benefit

• Both levels – $60 per policy per year

• Not payable first policy year

• Automated letters

Page 16

Physical Dental

Eye Exams Mammograms

Pap Smears Immunizations

PSAs Ultrasounds

Blood Screenings

Flexible Sigmoidoscopies

• Both Levels– $120 insured and spouse– $70 child

• Within 72 hours of accident

• Payable once per 24 hours

• Payable once per accident, per person

6

Follow-Up Treatment Initial Hospitalization Benefit Benefit

• Level 1 $25 per treatment

• Level 2 $35 per treatment

• Within 30 days of accident

• Outpatient basis

• Limit 6 treatments per accident, per person

• Not payable for same visit as Physical Therapy Page 17

Hospital Confinement

Intensive Care Unit Confinement

Level 1 $1,000 $1,500

Level 2 $1,000 $2,000

• Confined for 24 hours

• Within 30 days of accident

• Once per year, per person

• Paid in addition to other hospital benefits

7

Hospital Confinement Intensive Care Unit Benefit Confinement Benefit

• Level 1 $200 per day

• Level 2 $250 per day

• Confined at least 18 hours

• Within 30 days of accident

• 365 days per accident, per person

Page 18

• Both Levels $400 per day

• Within 30 days of accident

• Up to 15 days

• In addition to Hospital Confinement Benefit

8

Accident Specific Sum Major Diagnostic Benefit Exams Benefit

• See pages 25 & 26

• $25–$150,000

Page 19

• Level 1 $150

• Level 2 $200

• 3 exams: CT scan, MRI, or EEG

• Once per person, per year

• No lifetime maximum

9

Physical Therapy Benefit Rehabilitation Unit Benefit

• Level 1 $25 per treatment

• Level 2 $35 per treatment

• Within 30 days of accident

• Completed within 6 months

• Limit 10 treatments

• Not payable for same visit as Follow-up Benefit

Pages 19–20

• Level 1 $100 per day

• Level 2 $150 per day

• Confined in hospital and then transferred to Rehabilitation Unit

• Up to 30 days

• 60 days per year

10

Appliance Benefit Prosthesis Benefit

• Level 1 $100

• Level 2 $125

• Once per accident, per person

• Level 1 $500

• Level 2 $750

• Not payable for:– Hearing Aids– Wigs– Dental Aids

• Once per accident, per person

Crutches Wheelchairs

Leg Braces Back Braces

Walkers

Pages 20–21

11

Blood / Plasma Ambulance Benefit Platelets Benefit

• Level 1 $100

• Level 2 $200

• Not payable for immunoglobins

• Once per accident, per person

Ground Ambulance

AirAmbulance

Level 1 $150 $1,000

Level 2 $200 $1,500

• Within 72 hours of accident

Pages 21–22

12

Transportation Benefit Family Lodging Not for ambulance Benefit

• Level 1 $400

• Level 2 $600

• Over 100 miles

• Up to 3 round trips

• Parent accompanying child

• Level 1 $100 per night

• Level 2 $125 per night

• During time insured is confined

• Over 100 miles from home

• Up to 30 days per accident

Pages 22–23

13

Accidental Death Accidental Benefit Dismemberment

Insured/ Spouse

Child

Level 1 Common Carrier

$100,000 $15,000

Level 1 Other Accidents

$25,000 $7,500

Level 2 Common Carrier

$150,000 $25,000

Level 1 Other Accidents

$40,000 $12,500

• Occurs as a result of accident

• Within 90 days of accident

• Highest single benefit paid

• Death due to injuries

• Within 90 days of accident

Pages 23–24

14

• Waive up to 2 months’ premium

• Payroll deduction

• 6 consecutive months

• Notification within 30 days

• Insured re-establishes premium

Continuation of Coverage PAE compared to PAI

• Bold benefits increased

• May not be used as an advertising piece

Pages 24–26

15

Limitations and Exclusions

• Services by immediate family

• Under the influence

• Driving a taxi

• Extreme activities

• Illegal activity

• Self-inflicted

• Cosmetic or elective surgery

• Dental treatment

• War

• Serving in armed forces,

• Aviation

• Sporting activity for wage

Pages 33–34

16

Important Definitions

• Totally Disabled (80% loss of income)

• Base Pay Earnings

• Successive Periods of Disability

• Pregnancy and Childbirth

• Maternity Exclusion

• Pre-Existing Conditions

• Benefit/Elimination PeriodPages 47–50

17

Disability Riders

Page 51

• Off-the-Job Accident Disability Rider

• Spouse Off-the-Job Accident Disability Rider

• On-the-Job Accident Disability Rider

• Sickness Disability Rider

18

Disability Riders

• Guaranteed Renewable for Life

• Benefit triggers

• Age 70, hospitalization required

• With the exception of spouse rider:– Benefit periods must match– Accident elimination periods

must match

Page 51

• Payroll only

• Occ classes A, B, C and E

• Ages 18–64

• Not allowed with government allotment accounts

• Minimum income–$10,000

• Work 30 hours per week

19

Off-the-Job Accident Spouse Off-the-Job Disability Rider Disability Rider

• Primary insured only

• Minimum 1 unit $100

• Max 20 units $2000

• 0 or 7 day elimination

• 6 or 12 month benefit

• Available to associates– E classification

Page 51

• Minimum 1 unit $100

• Max 7 units $700

• One premium rate

• 0 day elimination/6 month benefit period

• Not available to associates

20

On-the-Job Accident Sickness Disability Disability Rider Rider

• Primary insured only

• Minimum 1 unit $100

• Max 10 units $1000

• 0 or 7 day elimination

• 6 or 12 month benefit

• Available to associates – E classification

Page 52

• Age banded 18-49 and 50-64

• Primary insured only

• Minimum 1 unit ($100)

• Max 20 units ($2000)

• 14 day elimination period

• 6 or 12 month benefit period

• Not available to associates

21

Aflac Associates and Taxation of Disability Disability Benefits

• May buy disability– 2+ years– Income verification

• Spouse/Sickness Riders

• Off-the-job disability rider

• On-the-job disability rider

• Application A-34004

• Paid by employer or pre-tax

• Interchangeable

• SmartApp®

• FICA

• Quarterly/annual reports

Pages 55–56

Administrative Guidelines

23

Eligibility Base Accident Plan

Page 77

• Issue ages 18–64 (no age bands)

• Occupational classes A, B, C, D, and E

• Payroll, direct, non-payroll/association

• Dependent children to age 19, 23 if full-time students (varies by state)

• Eligible for pre-tax

• Available for field force through account 00316

24

Advanced Effective Date Portability

Page 77

• Up to 90 days

• Over 60 days – Need form A-13072

• Direct at payroll rate – One month premium

through payroll deduction

• No conversions on direct

Setting Up the Account

26

Setting Up The Account

SmartApp®

SIC Approvals

Industry Classifications

Pages 85–88

Completing the Application

28

Applications

Complete in black ink

• A-34001 Payroll with Disability riders

• A-34001A Payroll BASE Accident only

• A-34002A Nonpayroll (base only)

• A-34004 Nonpayroll with Disability riders (associates only)

Page 91

29

How To Complete Conversions

• Job titles/duties are different!

• Incorrect premium is one of top reasons apps pend!

• 70% replacement questions

• Review question requirements

• Applications vary by state

Pages 92–115

• Use new business application

• Provide current policy number

• Additional units of disability added– Total units and premium

based on attained age

• Standard conversion commissions

Leave With Applicant

31

Page 119

• Replacement Notice – Varies by state– Form A-8691– Replacing existing competitor accident insurance– Available on SmartApp®

– Paper application duplicate

• Outline of Coverage

Leave With Applicant

Premium Rates

33

Types of Coverage Premium RatesRate Booklet M-RS065

Pages 127–131

• Individual

• Named Insured/Spouse Only

• Two-Parent Family

• One-Parent Family

• Payroll, Direct, Association

• Sickness Rider age banded

• Available on Premium Quote

• Premium Worksheet M-1018

• No registration fee

• Rates may vary by state

Commissions

35

Commissions

• Count toward contests and stock bonus

• Broker commissions prorated

Pages 135–136

1st Year Renewals

New Associate 26.00% 4.30%

Veteran Associate 22.70% 6.30%

Sales Support MaterialsClaims

37

Sales Support Materials Claims

Pages 139–146

• Brochures

• Rider Insert Pages

• Specific-Sum Insert Pages

• Mailer

• S-00198

• S-13270.1

• Continuing Disability

Off-the-Job Personal Accident Indemnity

39

Off-the-Job PAI

• Benefits same as the PAI– but only for accidents that occur off the job

• Administrative Guidelines identical to PAI Guidelines except:– On-the-Job Disability Rider not available– Not available for field force– Payroll Only– Premiums approximately 14% less

– Varies by industry classification

Pages 149–167

Review of the Consultative Sales Process

Marketing PAI and Off-the-Job PAI

42

New Accounts Business Survey Form

• Contact employer/owner

• Benefits specialists/HR personel

• The five buying decisions

• Business Survey– Form MMC-98-394-R

• Available on Associate Services, under Internet Accessible Forms

Pages 183–187

Underwriting ProcessIndustry Classification Guide

List of Forms for Selling PAI & Off-the-Job PAI

Thank You and Good Luck!!

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