PROPOSAL FOR EMPLOYEES OF Dynamix Physical Therapy PO Box 1004 Milan, TN PROPOSAL DATE: March 18, 2014

Transcription

1 Underwritten by Transamerica Life Insurance Company PROPOSAL FOR EMPLOYEES OF Dynamix Physical Therapy PO Box 1004 Milan, TN PROPOSAL DATE: March 18, 2014 PRESENTED BY: CARRIE VINGELEN 413 OLD TOWNE DRIVE BRENTWOOD, TN CCA09B-0912-TN

2 Why Should Employers Offer Critical Illness Benefits? As health care reform forces employers to rethink their benefits game plan, offering voluntary products that can enhance employer provided coverage is a must. The reality is that employees of all ages, lifestyles and income levels can face a serious illness at anytime. But many times, they are not prepared for the related expenses ranging from high deductibles in their major medical coverage, hospital bills and travel to out-of-town hospitals to paying for child care, credit card debt or housekeeping. Critical illness insurance can assist employees with the myriad of expenses associated with the initial diagnosis of a critical illness such as a heart attack, stroke, cancer or coronary artery disease. CriticalAssistance Advance will pay a lump sum if the insured is diagnosed for the first time for a covered critical illness CriticalAssistance Advance can help budget-conscious families who may not be able to withstand the financial shock of an unexpected illness by providing a lump sum payment if a covered individual is initially diagnosed with one of several critical conditions. Employee coverage is available up to $50,000 in $5,000 increments, and dependent coverage is available for 50 percent of the employee's elected benefit. Optional riders are also available to customize plans based on employer and employee needs. Highlights of CriticalAssistance Advance: Individual and family coverage available Guaranteed issue and group rates available, subject to group size and participation Offers a variety of enrollment methods including a simplified process for Guaranteed Issue amounts No physical exams or blood tests required 1 Fully portable if an employee leaves the group No Waiting Period Premiums collected through the convenience of payroll deduction See Plan Design for more details. 1 If offer is not guaranteed issue, acceptance will be based upon answers to questions on the proposed insured's application for insurance. CriticalAssistance Advance is a group voluntary critical illness insurance policy underwritten by Transamerica Life Insurance Company, Cedar Rapids, Iowa. Policy Form Series CPCI0400 and CCCI0400. Policy forms and number may vary and coverage is not available in all jurisdictions. Limitations and exclusions may apply. Please refer to the policy, certificate and riders for complete details. In the event of a conflict between the terms of this proposal and the policy, the policy will control. QT Transamerica Life Insurance Company Page 2 of 11

3 Employee Eligibility To be eligible for coverage, an employee must: be on active service, performing in the usual manner all of the regular duties of his or her occupation at one of the places of business where he or she normally works or at some location directed by the employer; and not be covered by any Title XIX program such as Medicaid. Spouse Eligibility To be eligible for coverage, a spouse must: be a legally married spouse, common law spouse, domestic partner, or civil union partner if legally recognized in the governing jurisdiction or as otherwise agreed upon between you and us; not be covered by any Title XIX program such as Medicaid. Child Eligibility To be eligible for coverage, a child must be through age of 25 and is: a natural child; a legally adopted child or child who has been placed for adoption; a stepchild or foster child; a grandchild living with the employee and dependent for support and maintenance; a child for whom the employee has been appointed legal guardian; not covered by any Title XIX program such as Medicaid. Minimum Participation At least 2 insured employees are required to establish and maintain an employer group. Other group types may require higher participation. Evidence of Insurability All applications are underwritten on an accept/reject basis. If an employee answers yes to the questions on the application, we will decline the application for all persons for whom coverage is being requested. If there is a yes answer to the questions for the spouse, the spouse only will be declined coverage. If there is a yes answer to the questions for a dependent child, that one child will be declined coverage. Underwriting Limits for groups with 20 benefit-eligible employee Guaranteed Issue Underwriting is only available the first time an employee is eligible to apply. Coverage applied for at a later date is subject to Simplified Issue Underwriting. Underwriting Guidelines for Plan 1 Guaranteed Issue (GI) Participation Guaranteed Issue (GI) Amount Simplified Issue (SI) Participation Simplified Issue (SI) Amount 10 issuable employee applications of a benefit-eligible class Other Considerations Please be aware of the following: $15,000 2 issuable employee applications of benefit-eligible class $50,000 Employees residing in California, Georgia, Massachusetts, Minnesota or Vermont are required to have major medical coverage in order to apply for CriticalAssistance Advance. Coverage cannot be issued to anyone who does not have comprehensive medical coverage. This proposal is based on employer groups with 20 eligible employees only and may not be available to other group types or sizes. Coverage and rates for employees residing in Maryland or New York may differ. QT Transamerica Life Insurance Company Page 3 of 11

4 Category 1 Percentage of Benefit Plan 1 Heart Attack 100% Included Stroke 100% Included Heart Transplant Surgery 100% Included Coronary Bypass Surgery 25% Included Angioplasty/Stent 5% Included Category 2 Percentage of Benefit Plan 1 Major Organ Transplant Surgery (excluding heart) 100% Included End-Stage Renal Failure 100% Included Burns (3rd degree or 50% coverage) 100% Included Coma 100% Included Loss of Sight, Speech, and/or Hearing 100% Included Miscellaneous Diseases 100% Included Paralysis Not due to Stroke - all 4 limbs 100% Included Paralysis Not due to Stroke - less than 4 limbs 50% Included Alzheimer's Disease 30% Included Optional Riders Plan 1 Recurrent Critical Illness Benefit Rider Benefit 50% Wellness Benefit Rider Annual Benefit $100 Elected Benefit - Employee coverage is available up to $50,000 in $5,000 increments. Dependent coverage is available for 50% of the employee's Elected Benefit. Lifetime Maximum Benefit - Total Critical Illness and Recurrent Benefits are limited to 3 times the Elected Benefit. QT Transamerica Life Insurance Company Page 4 of 11

5 Plan 1 Weekly Non-Tobacco Rates Category 1: Heart Attack, Stroke, Heart Transplant, Coronary Bypass Surgery, Angioplasty/Stent Category 2: Major Organ Transplant, End-Stage Renal Failure, Burns, Coma, Paralysis, Loss of Sight/Speech/Hearing, Alzheimer's Disease and Miscellaneous Diseases Optional Riders: Wellness Benefit Rider ($100) and Recurrent Critical Illness Benefit Rider (50%) Employee Age $10000 $15000 $20000 $25000 $ $2.07 $2.46 $2.85 $3.24 $ $2.37 $2.91 $3.45 $3.99 $ $3.31 $4.33 $5.34 $6.36 $ $4.84 $6.61 $8.39 $10.17 $ $7.49 $10.59 $13.70 $16.80 $ $8.39 $11.94 $15.50 $19.05 $ Parent Family $2.41 $2.82 $3.22 $3.63 $ $2.71 $3.27 $3.82 $4.38 $ $3.66 $4.69 $5.71 $6.74 $ $5.18 $6.97 $8.76 $10.55 $ $7.84 $10.95 $14.07 $17.18 $ $8.74 $12.30 $15.87 $19.43 $ Parent Family $3.41 $3.88 $4.36 $4.83 $ $3.87 $4.58 $5.28 $5.98 $ $5.28 $6.69 $8.10 $9.50 $ $7.52 $10.05 $12.57 $15.10 $ $11.26 $15.65 $20.05 $24.45 $ $12.69 $17.80 $22.91 $28.02 $33.13 The above rates reflect the addition of first occurrence coverage. Issue State: Tennessee Rate generation date: March 18, 2014 QT Transamerica Life Insurance Company Page 5 of 11

6 Plan 1 Weekly Tobacco Rates Category 1: Heart Attack, Stroke, Heart Transplant, Coronary Bypass Surgery, Angioplasty/Stent Category 2: Major Organ Transplant, End-Stage Renal Failure, Burns, Coma, Paralysis, Loss of Sight/Speech/Hearing, Alzheimer's Disease and Miscellaneous Diseases Optional Riders: Wellness Benefit Rider ($100) and Recurrent Critical Illness Benefit Rider (50%) Employee Age $10000 $15000 $20000 $25000 $30000 $2.25 $2.74 $3.22 $3.71 $4.19 $2.74 $3.46 $4.19 $4.92 $5.64 $4.47 $6.06 $7.65 $9.24 $10.84 $7.24 $10.21 $13.19 $16.17 $19.14 $12.06 $17.45 $22.84 $28.23 $33.61 $13.47 $19.56 $25.65 $31.74 $ Parent Family $2.60 $3.09 $3.59 $4.09 $4.58 $3.08 $3.82 $4.56 $5.30 $6.04 $4.81 $6.42 $8.02 $9.63 $11.23 $7.58 $10.57 $13.56 $16.55 $19.54 $12.41 $17.81 $23.21 $28.61 $34.01 $13.81 $19.92 $26.02 $32.13 $ Parent Family $3.57 $4.13 $4.68 $5.23 $5.79 $4.43 $5.41 $6.39 $7.37 $8.35 $6.90 $9.11 $11.33 $13.54 $15.76 $11.12 $15.45 $19.77 $24.10 $28.43 $18.20 $26.07 $33.94 $41.81 $49.68 $20.30 $29.22 $38.14 $47.06 $55.98 The above rates reflect the addition of first occurrence coverage. Issue State: Tennessee Rate generation date: March 18, 2014 QT Transamerica Life Insurance Company Page 6 of 11

7 Critical Illness Benefit CriticalAssistance Advance pays a lump sum benefit equal to the Elected Benefit multiplied by the applicable percentage shown above upon the first occurrence of a covered critical illness within each category. First occurrence means a critical illness that is diagnosed on or after the effective date. If the total benefit paid in a category is less than 100% of the Elected Benefit, we will pay upon the diagnosis of a different type of critical illness within the same category. The lump sum benefit is equal to the Elected Benefit multiplied by the applicable percentage shown above, not to exceed the remaining Elected Benefit for the category. Cumulative benefits paid within each category will not exceed 100% of the Elected Benefit. Recurrent Critical Illness Benefit Rider (Rider Form Series CRRCI400) If included in your plan, we will pay a lump sum Recurrent Benefit equal to the selected percentage multiplied by the Elected Benefit multiplied by the applicable percentage upon the diagnosis of a Recurrent Critical Illness. Recurrent Critical Illness means a covered critical illness that is not eligible for payment under the Critical Illness Benefit as a First Occurrence. Diagnosis must be made after the effective date and while coverage is in force. Total Recurrent Benefits paid within each category will not exceed the selected percentage of the Elected Benefit. Recurrent Benefits are subject to the Lifetime Maximum Benefit. Wellness Benefit Rider (Rider Form Series CRWEL400) If included in your plan, we will pay the selected amount per calendar year for each covered person when a charge is incurred for one of the following cancer screening tests: biopsy, blood test for triglycerides, bone marrow testing, breast ultrasound, CA 125 (blood test for ovarian cancer), CA 15-3 (blood test for breast cancer), CEA (blood test for colon cancer), chest x-ray, colonoscopy, fasting blood glucose test, flexible sigmoidoscopy, hemoccult stool specimen, mammogram, Pap test, PSA (prostate-specific antigen tests), serum cholesterol test to determine HDL/LDL level, serum protein electrophoresis (blood test for myeloma), stress test on a bicycle or treadmill, or thermography. This benefit is limited to one payment per calendar year per covered person (not subject to the Lifetime Maximum Benefit). QT Transamerica Life Insurance Company Page 7 of 11

8 How to Apply - Organization Your organization can apply for this insurance by providing us with your completed Life and Health Group Application and Agreement together with a copy of this proposal. Before approving, we may request additional information about your group. Upon approval, we will notify you when coverage becomes effective. Group Master Policy Effective Date Subject to our receipt and review of all necessary information, the group master policy takes effect on the date requested on the Life and Health Group Application and Agreement. There is no backdating of a policy. How to Apply - Employees An applicant should elect coverage that best meets his or her needs and those of his or her family. All questions on the application should be completed accurately. All applications are subject to our review and approval. Individual Coverage Effective Date Coverage is effective on the effective date requested on the Life and Health Group Application and Agreement or first day of the month following the date an individual's application is approved by us, whichever is later. The employee must be on active service for coverage to become effective. Beneficiary Employees designate their own beneficiaries. In community property states (AZ, CA, ID, LA, NM, NV, TX, WA, and WI), when someone other than the spouse is designated as the beneficiary, the spouse's consent is required. The employee will automatically be the beneficiary of any dependent coverage. Current Disability and/or Premium Waiver We do not provide coverage to an individual currently disabled on a premium waiver. In this case, it is assumed that the previous carrier, if any, should continue to provide the individual's coverage. Premium Payment Premiums are paid conveniently through payroll deduction. A bill is mailed to you each month. Grace Period A grace period of 31 days will be allowed for each premium payment after the first premium. Coverage will stay in force during this time. The coverage under the policy will terminate at the end of the grace period if the premium has not been paid. You must still pay all unpaid premiums. This includes the premium due for the grace period. QT Transamerica Life Insurance Company Page 8 of 11

9 We do not cover losses caused by, or as a result of, the following: Conditions other than those due to a covered Critical Illness. The covered person participating or attempting to participate in an illegal activity. The covered person intentionally causing self-inflicted injury. The covered person committing or attempting to commit suicide, whether sane or insane. The covered person's involvement in any period of armed conflict. Surgeries performed outside the United States or its Territories. Under no condition will we pay any benefits for losses or medical expenses incurred prior to the effective date. We may reduce or deny a claim or void coverage for loss incurred by a covered person during the first 2 years from the effective date of such coverage for any misstatements in the application which would have materially affected our acceptance of the risk or at any time for fraudulent misstatements in the application. Heart Attack - Diagnosis must be supported by 3 or more of the following indicators: typical chest pain suggestive of heart attack; new EKG changes indicative of myocardial infarction; diagnostic increase of specific cardiac markers typical for heart attack; or, confirmatory imaging studies. Stroke - Diagnosis must be based on documented neurological deficits and confirmatory neuroimaging studies. Stroke does not include cerebral symptoms due to Transient Ischemic Attack (TIA), Reversible neurological deficit, migraine, cerebral injury resulting from trauma or hypoxia, or vascular disease affecting the eye, optic nerve or vestibular functions. Heart Transplant Surgery - Being placed on the transplant list or undergoing surgery to receive a transplant of a human heart. Coronary Bypass Surgery - Angiographic evidence to support the necessity for this surgery will be required. This benefit does not include balloon angioplasty, laser embolectomy, atherectomy, stent placement, or other non-surgical procedures. Angioplasty/Stent - Coronary angioplasty must be performed by a physician who is also a board-certified cardiologist. This benefit is confined to the heart; therefore, angioplasty/stenting of renal arteries or other peripheral arteries are excluded from this benefit. Major Organ Transplant - Being placed on the transplant list or undergoing surgery to receive a transplant of a human heart, lung, liver, kidney or pancreas. End Stage Renal Failure - Chronic irreversible failure of both kidneys that requires treatment by renal dialysis or kidney transplant. Paralysis - Quadriplegia, paraplegia, or hemiplegia that is expected to last for a continuous 12-month period or longer from the date of diagnosis to determine if paralysis is permanent. A benefit will not be paid for paralysis that results from a stroke or psychiatric related causes. Burns - A full-thickness or third-degree burn covering at least 50% of the body surface. Coma - Lasting for 30 consecutive days with no reaction to external stimuli, no reaction to internal needs and the use of life support systems. Diagnosis must indicate that permanent neurological deficit is present. Loss of Sight, Speech, or Hearing - Total loss of sight in both eyes, total and permanent loss of speech, or total and irreversible loss of hearing in both ears that cannot be corrected by the use of a hearing aid or device. Miscellaneous Diseases - Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease), Encephalitis/Meningitis, Rocky Mountain Spotted Fever, Typhoid Fever, Anthrax, Cholera, Primary Sclerosing Cholangitis (Walter Payton's Disease), or Tuberculosis. Alzheimer's Disease - Requires the inability to independently perform 2 or more of the following activities: bathing, dressing, eating, toileting, transferring, or incontinence. QT Transamerica Life Insurance Company Page 9 of 11

10 Recurrent Critical Illness Benefit Rider A recurrence of the same type of critical illness is not considered a Recurrent Critical Illness unless the diagnosis for the prior occurrence was at least 12 months from the most recent diagnosis and the person has been Treatment Free for at least 12 months. Treatment Free means the person is no longer receiving care from a physician, nor regular office visits, or being prescribed medication for a critical illness, other than routine checkups or maintenance medication for that critical illness. Termination of Coverage Employee coverage will terminate on the earliest of: The date of the employee's death; The date on which the employee ceases to be eligible for coverage; The last date for which premium payment has been made to us; The last date on which employment terminates; The date the group master policy terminates; or The date the employee sends us a written notice to cancel coverage. Dependent coverage will terminate on the earliest of: The date the employee's coverage terminates; The last date for which premium payment has been made to us; The date the dependent no longer meets the definition of dependent; The date the group master policy is modified so as to exclude dependent coverage; or The date the employee sends us a written notice to cancel dependent coverage. We will have the right to terminate the coverage of any covered person who submits a fraudulent claim under the policy. Portability Option If an employee loses eligibility for this insurance for any reason other than nonpayment of premiums, coverage can be continued by paying the premiums directly to us within 31 days after termination. We will bill the employee directly once we receive notification to continue coverage. Termination of the Group Master Policy The policyholder may end the policy on any premium due date by submitting a 60-day advance written notice. A group will not be continued if it drops below the minimum required participation. The group master policy will be terminated and coverage of all remaining insureds will end, subject to the Portability Option. Other Insurance with Us An individual can only have one critical illness policy or certificate with us. If a person already has critical illness insurance with us, such person is not eligible to apply for this coverage. QT Transamerica Life Insurance Company Page 10 of 11

11 GROUP BENEFITS DISCLOSURE POLICY Transamerica Employee Benefits (TEB) is a unit of Transamerica Life Insurance Company and Transamerica Financial Life Insurance Company. TEB markets and administers voluntary insurance benefits through licensed insurance agents. These agents are typically appointed to sell our products, and products of other providers, and receive various forms of compensation from us for the services provided. We believe our compensation arrangements with our agents are conducted with honesty, fairness and integrity. In addition, we realize that having trusted relationships between our agents and our customers is essential to all involved. To ensure this trust continues and to address any concerns within the industry, we have outlined our policy on agent compensation disclosure. TEB's policy supports transparency and full disclosure of agent compensation to our customers and prospective customers. In addition, we have put controls in place to facilitate this disclosure and obligate our agents to disclose compensation information to customers: 1) when asked by a customer; 2) when receiving both a fee from the customer and compensation from TEB; and 3) when otherwise required by law. Agents must comply with all applicable laws in the sale of TEB products, including any pertaining to the disclosure of compensation information. TEB's Group Benefits Compensation Disclosure Notice (below) describes the various means by which agents may be compensated for the sale of our products. It is the responsibility of your agent to share specific information with you about his or her compensation arrangements with TEB. Accordingly, please direct any compensation disclosure questions directly to your agent. COMPENSATION DISCLOSURE NOTICE TO ALL POLICYHOLDERS Agents who sell and service our products are paid a commission. It varies by the type of insurance policy sold and the state where the policy was sold, and is based on a percentage of the premium received in the first year, and at policy renewal. Agents may receive advances or loans against anticipated commissions for cases sold or to be sold. These advances may or may not require the payment of interest, depending upon the agent's total business and historical experience with TEB. Agents may receive other compensation from TEB in the form of cash or non-cash awards or prizes, based upon a variety of factors that may include the level of premium written or earned, persistency and growth of premium, or other performance measures. Agents who manage, supervise or recruit other agents or wholesale our products and services to other agents, may receive commission overrides on business that results from their efforts. Some of our agents may receive additional payments for providing services in connection with the administration of our products. Fees for such services may be calculated on a per policy or per certificate basis or upon the premium volume associated with a specific case. TEB may additionally reimburse these agents/administrators for certain expenses, such as the cost of mailings. Agents may occasionally obtain exclusive rights to market TEB products or services to agents, employers, employees, or members of associations or unions. Certain groups or associations may also agree to endorse TEB's products to their members. TEB may pay a fee for these exclusive marketing rights or endorsements. See your proposed plan documents or policy certificate package for more information on any such arrangements. For up to date information regarding our compensation practices, please consult our website at: QT Transamerica Life Insurance Company Page 11 of 11