Michael Wargo, National Benefits Director Ruby Smith, Program Project Manager. Underwriting

Transcription

1 Enrollment Approval For: AB Representative: Prepared by: Clients of MEGA PBA Agencies (Individual Products) (Cases ME000-ME999, PB000-PB999) Michael Wargo, National Benefits Director Ruby Smith, Program Project Manager Stephen J. Salem Underwriting Date Prepared: November 09, 2011 Date Revised: Underwriting Offer The information in this letter will be used to set up this case for enrollment. Please review it carefully. The offer is contingent upon current rates and state regulations in effect at the time of application. An approved offer means no modifications may be made to the provisions of the offer including products or product design, face amount, eligibility, enrollment strategy, and participation. Any change in plan design requires written approval by Underwriting and may result in a withdrawal of the offer. If you have any questions or comments regarding the enclosed information, please call your AB Representative. We appreciate the opportunity to offer Allstate Benefits products to this account. American Heritage Life Insurance Company 1776 American Heritage Life Drive, Jacksonville, FL 32224

2 Page 2 of 7 Eligibility Full Time and/or Permanent Part-Time W-2 actively at work employees working 20 or more hours per week, (excluding temporary and seasonal employees). Individual Product Offering Universal Life (UL20/UL21) Horizon Term Accident Plan (AP2/AP3/AP6) Disability Income (DI-5) Supplemental Health Options Plan (SHOP) Individual Cancer Protection (CP10) Individual Critical Illness (CILP1) Underwriting Guidelines For AP2/3, SHOP, DI-5, UL20/21 and 20YT all eligible employees will be issued coverage on a Contingent Guaranteed Issue basis. Working spouses and dependent children will be considered under our Issue guidelines. For CILP1 and CP10 all eligible employees will be issued coverage on a Simplified Issue basis, and require Evidence of Insurability. A minimum of 3 applications from 2 unrelated individuals is required per Payroll Case. A unique CGI account number will be assigned to each individual employer group. Enrollment Strategy One on one enrollment with all eligible employees Accident Plans (AP2/AP3/AP6) Cannot be sold in conjunction with GVA Coverage Options Individual (Employee Only) o CGI- ages Spouse o SI- working spouses ages Sickness Disability Income (APDIR) limited to base plan units or less (1-3 units). Sickness Hospital Confinement (APHCR1) Outpatient Physician s Treatment (APOPTR1) Accident Enhancement (BER) Accident Extended Benefit- must match base plan units. Employee- Maximum 3 units up to 60% of monthly income. (Case size 3+) CGI is dependent on an actively at work question and CGI Replacement and Existing questions

3 Page 3 of 7 Universal Life Insurance (UL20/21) Cannot be sold in conjunction with GUL22 or GPTL Coverage Options Employee o CGI- ages o GI- ages (Cases 1,000+) Spouse o CGI- working spouses ages o SI- nonworking spouses Children o CGI- ages 0-18 o SI- over age 18 Children's Term Rider (UL-CTR) (State Variation Applies) Long Term Care Rider (UL-LTCR1) Critical Illness Rider (UL-CIR1)- Ages Premium Waiver Rider (UL-PW)- Ages Living Benefit Rider (UL-LBR) Accidental Death Benefit Rider (UL-ADB)- Ages Future Purchase Option Rider (UL-FPOR1)- Ages (Case size 3-49) (Case size ) (Case size 200+) (Case size 1,000+) Employee- Maximum $10.00 per week up to $150,000 face Working Spouse- Maximum $5.00 per week up to $100,000 face Child/Grandchild- Maximum $3.00 per week up to $50,000. Employee- Maximum $15.00 per week up to $150,000 face Working Spouse- Maximum $7.00 per week up to $100,000 face Child/Grandchild- Maximum $3.00 per week up to $50,000. Employee- Maximum $20.00 per week up to $150,000 face Working Spouse- Maximum $7.00 per week up to $100,000 face Child/Grandchild- Maximum $3.00 per week up to $50,000. (Available for UL20P only) Employee- GI Maximum $20.00 per week up to $150,000 face Working Spouse- Maximum $7.00 per week up to $100,000 face Non-Working Spouse- $5.00 per week up to $100,000 face amount Child/Grandchild- Maximum- $3.00 per week up to $50,000. (Available for UL20P only) CGI is dependent on an actively at work question and CGI Replacement and Existing questions

4 Page 4 of 7 Horizon Term (20YT) Cannot be sold in conjunction with GPTL Coverage Options Employee o CGI- ages Spouse o CGI- working spouses ages o SI- nonworking spouses Children's Term Rider (CTR) Premium Waiver Rider (PW)- Ages Living Benefit Rider (LBR) Accidental Death Benefit Rider (ADB)- Ages (Case size 3-49) Employee- Maximum $5 per week up to $150,000 face Working Spouse- Maximum $4 per week up to $100,000 face (Case size ) Employee- Maximum $8 per week up to $150,000 face Working Spouse- Maximum $4 per week up to $100,000 face (Case size 200+) Employee- Maximum $10 per week up to $150,000 face Working Spouse- Maximum $5 per week up to $100,000 face CGI is dependent on an actively at work question and CGI Replacement and Existing questions Disability Income (DI-5) Cannot be sold in conjunction with GVDI Coverage Options Employee o CGI- ages Working Spouse o SI- ages Accidental Death & Dismemberment Rider (State Variation Applies) On-the-Job Rider (Case size 3-49) (Case size 50+) Employee- Maximum 60% of income up to $3,000 monthly benefit. Working Spouse- Maximum 60% of income up to $3,000 monthly benefit. Employee- Maximum 60% of income up to $5,000 monthly benefit. Working Spouse- Maximum 60% of income up to $5,000 monthly benefit. CGI is dependent on an actively at work question and CGI Replacement and Existing questions

5 Page 5 of 7 Supplemental Health Options Plan (SHOP) Cannot be sold in conjunction with GVS Coverage Options Employee Employee + Spouse Employee + Child(ren) Family Basic Benefit Base Policy 2 Units ($100 per day) (Case size 3+) Hospital Intensive Care Unit Benefit Waiver of Premium Initial Hospitalization (2-10 units) Inpatient Physician s Benefit Rider (max. of 4 units) Surgery and Anesthesia Rider (max. of 4 units) Outpatient Physician s Benefit Rider ( max. of 3 units) Outpatient Emergency Accident Rider (max. of 2 units) At Home Nursing Benefit Rider (max. of 1 unit) Transportation Rider (max. of 1 unit) Accident Disability Income Rider (max. of 6 units) Issue Ages (60 in Texas) CGI is dependent on an actively at work question and CGI Replacement and Existing questions Cancer Protection (CP10) Cannot be sold in conjunction with GVC Coverage Options Employee Family Intensive Care Rider Wellness Benefit Rider Cancer Initial Diagnosis Rider Cancer Enhancement Rider (CER2) Underwriting Levels Simplified Issue Simplified Issue(SI) SI is dependent on an actively at work question and SI Replacement and Existing questions

6 Page 6 of 7 Individual Critical Illness (CILP1) Cannot be sold in conjunction with GVCI Coverage Options Employee Employee + Spouse Employee + Child(ren) Family Note: Tobacco use question is required for each enrollee for rate classification. Critical Illness Cancer Rider Wellness Benefit Rider Recurrence Benefit Rider Underwriting Levels Simplified Issue Simplified Issue(SI) SI is dependent on an actively at work question and SI medical questions on the evidence of insurability form Replacement and Existing questions

7 Page 7 of 7 EMPLOYER AND PRODUCER OBLIGATIONS/ENROLLMENT PROCESS In order to support this proposed plan and as a condition of this offer, an effective communication and enrollment strategy is required to ensure minimum participation is achieved. The employer must allow access to employees and encourage attendance during the established enrollment period. Contingent guaranteed issue underwriting is only available with a one on one enrollment strategy. EXPIRATION OF UNDERWRITING OFFER If the signed and dated offer letter is not received within 90 days, the offer will expire. If the offer is accepted, the enrollment must be completed and applications received within the 6 month period following offer acceptance. If this enrollment requirement is not met, the agreement will expire. REVIEW PROCESS This offer will be reviewed on a periodic basis and remains in effect subject to our review of the participation, persistency, experience and overall case success. We may request current case information and census listing eligible individuals to complete our review. Although we do not anticipate doing so, we reserve the right to withdraw or modify this offer at any time. Factors such as experience OR non-adherence to conditions could make this necessary. The offer will not be withdrawn or modified without prior notification. LICENSING INFORMATION All enrollers and commissionable entities must be licensed and appointed in all states where the enrollment is being conducted. Thank you for choosing Allstate Benefits to meet the insurance needs of your employees. We look forward to a mutually beneficial, on-going relationship. OFFER ACCEPTANCE I accept the offer outlined above. Signature of Broker of Record or Enrolling Entity/ Date Signature of Employer/Date This is a brief summary of coverages and underwriting rules provided under this underwriting offer. The policy, riders, or provisions may vary or be unavailable in some states. Policies have exclusions and limitations which may affect any benefits payable. See the actual policy or contact your representative for complete details on provisions and availability