ACCIDENT INSURANCE features, benefits, and exclusions

Transcription

1 features, benefits, and exclusions This presentation contains a brief description of policy benefits. See the policy in your state for complete details of policy benefits and exclusions/limitations..

2 Why Combined? We are a 94 year old Company Part of the Chubb family of companies Ø Financial Strength $59 Billion in Assets Ø International Company doing business in over 50 countries Ø Rated A+ by AM Best Ø innovative Product Development Ø Ease of Doing Business October 5,

3 Health Care Facts 8.8 million school-age children, ages 0-19 are injured each yearly Produced by: National Center for Injury Prevention and Control, CDC Data Source: NEISS All Injury Program operated by the Consumer Product Safety Commission for numbers of injuries. Bureau of Census for population estimates., 2013 October 5,

4 Health Care Facts 4 in 10 people are treated in emergency rooms each year for accidents. 4 in 10 people are treated in emergency rooms each year for accidents. Source: Na+onal Safety Council, Injury Facts, October 5,

5 Health Care Facts The The average cost of a hospital stay is $35,000 4 in 10 people are treated in emergency rooms each year for accidents. Source: Na+onal Discharge Survey, 2010 Table, Number and Rate of Hospital Discharges October 5,

6 Health Care Facts Over 41% of Americans report having a hard time covering medical expenses even with medical insurance 4 in 10 people are treated in emergency rooms each year for accidents. Source: Commonwealth Fund, 2014 October 5,

7 Health Care Facts Health care costs are rising Health insurance premiums are increasing Employer Benefits are decreasing Deductibles and co-payments are increasing Many small employers stopped offering health insurance 4 in 10 people are treated in emergency rooms each year for accidents. October 5,

8 Important things to consider Accidents can strike anyone, anywhere, anytime It s relatively easy to show the need for supplemental protection People need supplemental insurance to pay benefits that major medical policies may not October 5,

9 The policy itself provides benefits for accidents only It does not provide benefits for sickness Provides coverage for accidents, on or off the job It is intended to supplement comprehensive heath insurance policies... not replace them Benefits are paid directly to the insured, and they can use the money in any way they choose October 5,

10 Individual and Spouse: age Children Under Family Coverage: birth to under 27 years Benefits are the same for the insured, spouse, and children Covered 24 hours per day, 7 days a week, EVERY day of the year... on or off the job. It is es+mated that 2/3 of accidents happen off the job* *Na+onal Safety Council, Injury Facts, 2015 Edi+on October 5,

11 Specific benefits for covered accidents Hospital, ICU, and rehabilitation admission Hospital, ICU, rehabilitation confinement Emergency room treatment Urgent care or initial doctor visit Follow-up treatment and physical therapy Recovery while disabled Outpatient surgery Sports package Ambulance transportation Transportation (nonambulance) Major diagnostic exam and x-ray Concussion Coma October 5,

12 Additional features for covered accidents: October 5,

13 Three Plans Available: Pick the plan that s just the right fit for your customer s lifestyle and budget. Standard (Good) Choice (Better) Preferred (Best) October 5,

14 Hospital Admission When the insured has a covered accident, on or off the job, and is admitted to the hospital as an inpatient, we will pay: Hospital Admission (AdmiHed within 6 months) Hospital Admission - ICU (AdmiHed within 30 days) Hospital Admission - Rehab Unit (AdmiHed immediately aoer confinement) $1,000 $1,000 $1,250 $2,000 $2,000 $2,500 $1,000 $1,000 $1,250 Note: All benefits shown are per accident unless otherwise indicated. October 5,

15 Hospital Confinement From the very first day they are confined overnight as an inpatient, and for each day they hospitalized, we pay: Hospital Confinement (Confined within 6 months. 365 day maximum benefit period.) Hospital Confinement - ICU (Confined within 30 days. 30 day maximum benefit period.) Hospital Confinement - Rehab Unit (Confined immediately aoer hospital confinement. 30 day maximum benefit period.) $200/day $275/day $375/day $400/day $550/day $750/day $120/day $165/day $225/day Note: Hospital does not include a nursing home or convalescent care facility. October 5,

16 Emergency Room When the insured requires emergency room treatment within 72 hours of accidental injury, we can help by paying: Emergency Room Treatment (Only once per covered person per accident.) $75 $100 $150 October 5,

17 Urgent Care or Initial Doctor When the insured receives initial treatment within 60 days of a covered accident, we pay either: Urgent Care Treatment (Only once per covered person per accident.) OR Initial Doctor s Visit (Only once per covered person per accident.) $50 $75 $125 $50 $75 $125 October 5,

18 Follow-up Treatment & Physical Therapy When the insured receives follow-up treatment that is prescribed by a physician, within 90 days of a covered accident, we pay: Accident Follow-up Treatment (Maximum of 3 visits per covered person per accident.) $20/visit $25/visit $50/visit When the insured is prescribed by a physician and starts physical therapy, within 60 days of a covered accident, we pay: Physical Therapy (Maximum of 6* visits per covered person per accident.) $20/visit $25/visit $50/visit October 5,

19 Recovery While Disabled Following hospital confinement, while the insured recovers at home and is disabled; for up to 7 days, we pay: Recovery While Disabled (Maximum of 7 days of missed work while recovering immediately after hospital confinement) $35/day $50/day $100/day October 5,

20 Outpatient Surgery The majority of surgeries are performed on an outpatient basis. When this occurs within 90 days of the injury, we pay: Outpatient Surgery $200 $200 $300 October 5,

21 Sports Package Benefit If the insured sustains an injury as the result of a covered accident, while participating in an organized sporting activity, we pay an additional: Sports Package (Limited to $1,000 per covered person in any 12 month period.) 25% up to $1,000 25% up to $1,000 25% up to $1,000 *This benefit is not applicable to the Accidental Death Benefit or the Common Carrier Death Benefit October 5,

22 Ambulance Transportation For one trip to/from the hospital or between medical facilities, within 48 hours of injury, for air ambulance, the insured is paid: Air Ambulance $750 $1000 $2000 And for ground ambulance, one trip within 90 days of injury, the insured is paid: Ground Ambulance $100 $120 $200 October 5,

23 Transportation Non-Ambulance And, when the insured requires treatment more than 100 miles from home that will require hospital confinement, we pay up to a maximum of 3 trips at: (*Not ground or air ambulance) Transportation Benefit (Maximum of 3 trips per covered accident.) $200 $300 $600 October 5,

24 Diagnostic Exam and X-Ray For diagnostic exams scheduled by a physician, within 180 days after a covered accident, we pay: Major Diagnostic Exam (Once per 12 month period.) $75 $100 $200 For an x-ray, within 30 days of a covered accident, we pay: X-Ray $15 $20 $40 October 5,

25 Concussion If they sustain a concussion and are diagnosed within 72 hours, we pay: Concussion (Once per 12 month period.) $50 $60 $100 October 5,

26 Coma If within 30 days of a covered accident, the injury results in a coma lasting 7 or more consecutive days, we will pay: Coma (Must require intubation for respiratory assistance.) $6,000 $7,500 $12,500 October 5,

27 Blood, Plasma & Platelets When blood and blood plasma is needed within 90 days of the injury, the insured is paid: Blood, Plasma and Platelets $150 $200 $300 October 5,

28 Appliances For medical equipment like crutches or wheelchairs, within 90 days of the injury, we pay: Appliances $50 $75 $100 October 5,

29 Fractures We pay a benefit for fractures diagnosed within 90 days of injury: Fracture Ankle (open) Fracture Body of vertebrae (open) Fracture Hand, wrist (open) Fracture Leg (open) Fracture Skull (open) $200 $300 $800 $750 $1,000 $2,000 $200 $300 $800 $200 $300 $800 $750 $1,000 $2,000 October 5,

30 Dislocations We pay a benefit for dislocations diagnosed within 90 days of injury: Dislocation with anesthesia Ankle/Foot Dislocation with anesthesia Elbow Dislocation with anesthesia Hip Dislocation with anesthesia Knee Dislocation with anesthesia Shoulder $750 $1,000 $2,000 $200 $300 $800 $750 $1,000 $2,000 $750 $1,000 $2,000 $200 $300 $800 October 5,

31 Tendon, Ligament, & Rotator Cuff If the insured sustains tears, ruptures or severs a tendon, ligament or rotator cuff and it is repaired within 60 days of a covered accident, we pay: Tendon, Ligament, & Rotator Cuff (Repair of 1) $250 $400 $750 Tendon, Ligament, & Rotator Cuff (Repair of more than 1) $450 $600 $1,125 October 5,

32 Herniated Disc & Knee Cartilage If the insured sustains a herniated disc in the spine, or torn knee cartilage as a result of a covered accident, and is treated by a physician within 60 days, we pay: Herniated Disc (Repaired within 365 days of covered accident) Knee Cartilage (Repaired within 60 days of covered accident) $300 $400 $750 $300 $400 $750 October 5,

33 Burn & Skin Graft If the insured sustains burns and is treated within 72 hours, we pay: Second Degree Burn (Covering 10% or more of body surface) Third Degree Burn (Covering between 3%-10% of body surface) Third Degree Burn (Covering more than 10% of body surface) $600 $750 $1,000 $1,200 $1,500 $2,000 $6,000 $7,500 $10,000 If the burn victim requires a skin graft and is treated within 1 year of the accident, we will pay 25% of the applicable burn benefit amount. October 5,

34 Emergency Dental If dental extraction or a crown is required within 60 days of a covered accident, we will pay: Emergency Dental - Extrac^on $40 $50 $100 Emergency Dental - Crown $160 $200 $400 October 5,

35 Eye Injury If the insured sustains eye injury and requires surgery or removal of a foreign object, within 90 days after a covered accident, we will pay: Eye Injury $150 $200 $300 October 5,

36 Lacerations If a laceration occurs and is repaired by a physician within 72 hours of a covered accident, we pay: Lacera^ons Not requiring s^ches Lacera^ons Not more than 5 cen^meters and repaired by s^ches Lacera^ons Between 6-15 cen^meters and repaired by s^ches Lacera^ons Over 15 cen^meters and repaired by s^ches $15 $20 $30 $30 $40 $60 $120 $150 $250 $250 $300 $500 October 5,

37 Loss of Finger, Toe, Hand, Foot or Sight If a finger, toe, hand or foot must be amputated, or for a loss of sight, within 90 days after a covered accident, we will pay: Loss of 1 finger or toe Loss of 2 or more fingers or 2 or more toes (or combination of 2 or more fingers/toes) Loss of 1 hand, 1 foot, or sight in 1 eye Loss of both hands, both feet, sight in both eyes (or combination of 2 or more) $450 $600 $1,000 $1,000 $1,200 $2,000 $3,500 $5,000 $10,000 $7,500 $10,000 $20,000 October 5,

38 Prosthetic Device or Artificial Limb When an injured person requires a prosthetic device or artificial limb due to the loss of hand, foot or eye sight, and receives it within 1 year of a covered accident, we pay: One prosthetic device or artificial limb More than one prosthetic device or artificial limb $250 $500 $1,500 $500 $1,000 $3,000 October 5,

39 Internal Organ Loss If at least 50% of a covered organ is removed within 90 days after a covered accident, we will pay: Internal Organ Loss (Once per covered accident) $2,000 $2,500 $2,500 Covered organs include: bladder, esophagus, gall bladder, genitals, kidney, large intestine, liver, lungs, ovary, pancreas, small intestine, spleen, stomach, thyroid, and uterus. October 5,

40 Abdominal or Thoracic Surgery If the insured undergoes abdominal or thoracic surgery within 72 hours of a covered accident, we will pay: Abdominal or Thoracic Surgery $550 $750 $1,500 October 5,

41 Companion Lodging When confined to a hospital more than 100 miles from their residence, we pay for one companion s lodging up to 30 days: Companion Lodging Benefit (30 day maximum benefit) $75/night $100/night $150/night October 5,

42 Accidental Death & AD Common Carrier If this happens within 90 days of the accident, we pay the insured s beneficiary: Accidental Death Accidental Death Common Carrier $20,000 $30,000 $50,000 $40,000 $60,000 $100,000 October 5,

43 Other Key s Non-Cancellable and Guaranteed Renewable for Life We cannot change the premium There is NO reduction in benefits due to age. Return within 30 days after receipt for a full refund. Available to people ages Minimum Household income of $15,000/year October 5,

44 Exclusions and Limitations No Benefits are payable for injuries sustained for the following: For sickness While intentionally committing self inflicted injuries or trying to commit suicide or a felony While under the influence of alcohol or a controlled substance While serving in the armed forces or being exposed to war For dental treatment (unless treatment is due to injury of sound, natural teeth) October 5,

45 Commission Paid: Example Commissions Earned (New Customer) Agent First Year (45%) 6 Months advanced upon Issue $ months paid monthly as earned $95.62 Total first year commission $ Assumption: $425 per app (new sale) 1 app/week = $9,945 annually October 5,

46 Premium Structure There is only one age bracket Rates are the same for males and females Various family rate combinations available Three plans to choose from October 5,

47 Accident Plan Consumer Video October 5,

48 Questions October 5,