and s for Individual Life Products Name Description /Feature Must be Applied For Separately from Base Policy Products with Availability Issue Ages Indemnity AG Secure Lifetime GUL II 18-80 Access Indemnity Lifetime Builder III and LifeStage UL 18-75 LTC Indemnity Athena UL, Athena IUL, IL Optimizer II, IL Legacy II 20-75 for 1% and 2% ; 20-70 for 3% for Indemnity Asset Builder Index UL and Foundation Builder Index UL 18-65 Indemnity Bicentennial UL Freedom 2013, Founders Plus UL 20-80 Care LTC Reimbursement Accumulation UL 09, Accumulation VUL 09, Protection UL 12, Protection IUL 13, UL-G 13, Protection VUL 12, Accumulation IUL 11, Premier Life 20 75 s Indemnity VUL One 2012, LifeReserve Indexed UL Accumulator, LifeGuarantee UL 2013 20-80 Indemnity Promise Whole Life, Promise WL 120, PWL Select 10, PWL Select 20, and PWL Select 65 18-70 LTC Indemnity. The rider may also be added after policy issue with evidence of insurability. YourLife Accumulation VUL, YourLife Current Assumption UL, YourLife No Lapse Guarantee UL, YourLife Protection VUL, YourLife Single Premium UL, YourLife IUL 21-80 s Indemnity Automatically added, but insured can opt out. Pacific Indexed Performer LT, Pacific Indexed Accumulator 4, Pacific Prime VUL, Pacific Prime IUL, Pacific Prime UL-NLG, Pacific Select VUL, Prime UL, Versa Flex Pro II CV, Versa Flex Pro II DB, Versa Flex NLG 20-75 Advance Indemnity UL Flex II UL Accumulation II 20-75 ExtendCare Indemnity Advantage Choice UL, Custom Choice UL, Indexed Choice UL 20-80 Indemnity ProClassic UL 20-80 Access and Terminal Illness Indemnity Universal Protector, Founders Plus UL 20-80 Care LTC Indemnity TransACE 2012 18-80
and s for Individual Life Products Name Minimum Face Amounts Maximum Amount of Coverage Period Elimination Period $50,000 Maximum chronic illness benefit is $1.5M. The Monthly Amount percentage (2% or 4% capped at the IRS maximum, or the IRS 12 months. Annual recertification is required. maximum per diem amount in effect at the time Amount of total months will depend on amount claim begins) is selected at contract issue. Total that is accelerated. benefit amount can be any percentage from 50% to 100% of death benefit elected at issue. 90 consecutive days Access There is no minimum policy Face Amount other than the Minimum Face Amount of the underlying base policy. Some state variations apply. Can accelerate up to 2% of face, selected at issue. The resulting amount is subject to IRS per diem. It is also subject to insured's age at time of benefit period (there is a net amount at risk multiplier that takes into effect age and wellness rider). period is 12 months. Monthly or annual payout. period depends on how much is accelerated - generally lasts around 44 months. Annual total payout is determined each year and can change. Re-certification required each year. 90 consecutive days $200,000 The Amount percentage (1%, 2% or 3%) is selected at contract issue. The resulting amount cannot exceed $50,000 of monthly benefit. Not to exceed the initial face amount. The Amount percentage (1%, 2% or 3%) is selected at contract issue. The clients are not required to submit receipts for expenses actually incurred. Recertification is required after every 12-month period in order to continue receipt of benefits. 90 days for The benefit amount percentage Is up to 2% of the face amount, but subject to the HIPAA monthly benefit max (currently $320/day). Must be selected at issue. Not to exceed the initial face amount. period is in 12 month increments. Increments can be 2, 3 or 4 year coverage periods. Selected at issue. 0 home care / 90 facility care The benefit amount percentage Is up to 2% of the face amount, but subject to the HIPAA period is in 12 month increments. monthly benefit max (currently $320/day). Must period depends on amount accelerated. be selected at issue. Not to exceed the initial face amount. Care There is no minimum policy Face Amount other than the Minimum Face Amount of the underlying base policy. Some state variations apply. For most products, the minimum face amount is $50,000. The Amount percentage (1%, 2% or 4%) is selected at contract issue. The resulting amount cannot exceed $50,000 of monthly benefit. Not to exceed the initial face amount. 1%, 2%, or 4% of the DB can be accelerated. s continue until recovery, lapse, death, surrender, or DB is fully accelerated. Care Continuation (LTCCR) can double the benefit. ly 100 days s There is no minimum policy Face Amount other than the Minimum Face Amount of the underlying base policy. Some state variations apply. The LTC is given by indemnity by the monthly maximum determined by illustration calculation. Max is $500k for 2 year benefit, or $750k for a 3 year benefit. 12 months. Annual recertification is required. Amount of total months will depend on amount that is accelerated. A maximum 90% of the policy's eligible death benefit up to $5mil can be accelerated over the 12 months. Annual recertification is required. life of the policy. We will pay once during the 12 Amount of total months will depend on amount month claim period of to 24% of the eligible that is accelerated. death benefit in either a lump-sum or monthly payment (Total Control Account). 90 Days The benefit amount percentage Is up to 2% of the face amount, but subject to the HIPAA Contract Minimum Face Amounts Apply. monthly benefit max (currently $320/day). Must A minimum of 50 monthly benefit payments will can be 10-100% of face. LTC rider amount must be selected at issue, however, the rider can be be made over the lifetime of this rider. match death benefit in NY, KY and Virgin Islands added after issue. Not to exceed the initial face amount. 90 days s Product minimum face amount. Can accelerate the lesser of 2% of the death benefit or 125% of the IRS per diem. The maximum total death benefit that can be accelerated is $1.5 million. It is possible to accelerate 100% of the death benefit. Depends on how much is accelerated. Maximum is 24% of face amount (per year) or 125% of the IRS limit. Advance Product minimum face amount. Annual maximum accelerated benefit - lesser of 25% of face amount at initial elector OR annualized per diem maximum. Lifetime maximum accelerated benefit - lesser of 75% of face amount at initial election or $1,000,000. 12 months. Annual recertification is required. 90 consecutive days ExtendCare The maximum monthly benefit is $9,900. 100% of the face amount can be accelerated, but must not exceed $5 million. Maximum monthly benefit options: $1,000; $2,500; $5,000; $7,500 (available only with $150,000 minimum face amount). A lesser Monthly amount of at least $250 may be requested if you do not require entire Maximum Monthly amount. A Period lasts 12 months. Before each Period, the insured must select the amount to be paid for each month of that Period. Each month within a given Period will have the same ADB payout amount, but a new payout amount can be selected before the next Period. period is 12 months. Monthly or annual payout until the lesser of 90% of the preaccelerated death benefit or $1MM is reached. Annual total payout is determined each year and can change. 3 months or 12 months (elected at issue) 3 months or 12 months (elected at issue) Access The Maximum monthly benefit under the rider is 2% of the death benefit amount at the time of claim, not to exceed the lesser of: The monthly equivalent of the IRS Per Diem Limit at the time of claim; or The monthly equivalent of the IRS Per Diem Limit on the policy issue date, compounded annually at 4%. Once payments begin, they will continue until the earliest of: the date the death benefit is reduced to $0; the policyowner requests that the benefit payments stop; or annual recertification is not received. Care $25,000 ( for Select Risk class) The benefit amount percentage Is up to 2% of the face amount, but subject to the HIPAA monthly benefit max (currently $310/day). Must be selected at issue. Not to exceed the initial face amount. Indemnity LTC. 12 months. 90 days
and s for Individual Life Products Name Start of Elimination Period Payment Model Residual Is payment sent to owner or insured? Starts on the day the company receives Certification Monthly, Annual lump sum. Indemnity model. Total benefit amount can be any percentage from 50% to 100% of death benefit elected at issue. If the insured chooses less than 100%, there will be a residual death benefit. Access The effective date on which the Insured is certified to be Chronically Ill in a written certification by a Licensed Physician. Monthly, Annual lump sum or One-time lump sum. Indemnity model. Even if the lien balance reaches its maximum, guaranteed death benefit of $20,000 will be paid. Starts once the Insured starts to receive long term care services. Monthly. Indemnity model. Residual death benefit not available. for Day 1 Monthly Reimbursement Residual death benefit not available. Monthly indemnity or annual lump sum (discounted amount), or one-time lump sum. Residual death benefit not available. Care On first "Date of Service", example: first date of treatment or care. Monthly Reimbursement The LTCCR provides a residual death benefit of the lesser of $25K or 10% of initial DB. s Monthly or one-time lump sum Remaining death benefit not accelerated, or $10,000. The Waiting Period begins when we receive the physician's certification that the Insured has a. Monthly or annual lump sum The remaining death benefit not accelerated. Starts on the first date the Insured receives qualified care. Monthly. Lesser of HIPAA daily maximum and MBA. Indemnity model. At least 10% of the quantity, base policy Specified Amount minus policy indebtedness. s Annual or Monthly Residual death benefit not available. Advance The effective date on which the Insured is certified to be Chronically Ill in a written certification by a Licensed Physician. Annual lump sum. Indemnity model. Greater of 25% of face amount at initial election or $10,000. ExtendCare Begins on the date receives written certification. Annual or Monthly stated accelerated amount. Indemnity model. Residual death benefit not available. Begins on the date receives written certification. Annual or Monthly stated accelerated amount. Indemnity model. will not allow more than 90% of the DB accelerated leaving at minimum 10% residual. Access payments are available as monthly payments or as an annual lump sum. If the maximum benefit amount is accelerated (100% of death benefit), the policy will terminate. If a partial benefit payment is claimed, the life insurance policy can continue with a reduced death benefit and lower premiums. Death benefit is reduced proportionately. Care The first day that the Insured has been certified as a chronically ill individual and qualified expenses are incurred by the insured in accordance with the Insured's plan of care. Annual or Monthly Equal to the lesser of 10% of the policy face amount from inception less any outstanding policy loans, or $10,000.
and s for Individual Life Products Name International Coverage Guidelines Underwriting Class Restrictions Initial assessment of eligibility and annual re-certification must be made by a licensed health care practitioner in the United States. Once eligibility is established benefits are paid on an indemnity basis and the insured need not reside in United States to collect benefits. Table 4. Access International coverage available, however, annual recertification is required by a US licensed physician. Any facility or home health care service must also be US licensed. Table 4 or better. International coverage available, however, annual recertification is required by a US licensed physician. Any facility or home health care service must also be US licensed. Standard Non-Tobacco or Better. No permanent or temporary Flat Extra premiums permitted. for Yes, for home care and nursing home care. Up to Table 16 International coverage is available. Must return back to US for recertification. The max age the client can be is 80 and the max table the client can receive is a table 6 Care Insured must reside in US to receive rider benefits. No rating below 175% will be eligible for the LTC rider. s International coverage available. Insured does not have to reside in the US, however the annual certification must be done by a US licensed physician. Table D or better. There are no international restrictions. Table D or Better with no Flat Extra. Available with Elite, Preferred, and Standard with no more than a $5 Flat Extra. International coverage available, however, annual recertification is required by a US licensed physician. Facility or home care service does not need to be US licensed. does not require insured to return to US for recertification. Policy DB and LTC are rated separately. You may apply for rider if base contract is rated at least Table E. The LTC rider may also be rated up to Table E. The YourLife Single Premium UL with the LTC rider offers simplified underwriting. s Can receive benefit, however must come back to US for annual recertification. Table Rating E or better. Advance Insured must reside in US to receive rider benefits. Table 3 or better and flat extra ratings (temporary or permanent) up to $7.50 per $1,000 on the base policy. Allowed on table shaved cases, trust cases and business cases that are fully underwritten. ExtendCare Insured can reside outside of the US. The licensed health care provider must meet the requirements defined in section 1861 (1) of the Social Security Act. It does not include the owner, insured or family member. Up to and including Table 4. Insured can reside outside of the US. The licensed health care provider must meet the requirements defined in section 1861 (1) of the Social Security Act. It does not include the owner, insured or family member. Up to and including Table 4. Access International coverage is available. Must meet certification and recertification requirements by a licensed healthcare practitioner in the US. Table D or better, or with a total flat extra rating of $25 per $1,000. Care Insured must reside in US to receive rider benefits. Preferred Nonsmoker, Standard Nonsmoker and Standard Smoker.
and s for Individual Life Products Name Underwriting Process ADL Guidelines The rider is underwritten separately from the base product. It is possible that the insured is eligible for the base product but not the rider. The insured qualifies if they are unable to perform 2 of the 6 ADL's for a period equal to or greater than the Elimination Period or require substantial supervision from threats to health and safety due to a severe cognitive impairment. Must be certified by a qualified practitioner. This condition must also be expected to be permanent. Access No extra underwriting. added automatically. This condition must also be expected to be permanent. Inability to perform 2 ADL's must be signed off by physician. The rider will be subject to age and amount requirements or as deemed appropriate by Underwriting. underwriting will be used to As long as the insured cannot perform 2 of the 6 ADL's, the insured can ensure that appropriate LTCS rider limits are not exceeded. Pre-qualification does not represent approval of LTCSR. It is a means to screen receive the benefit. If the insured no longer qualifies, the benefit stops. eligible clients, who will be subject to underwriting. Application Questionnaire form ICC 12--LTC, LTC-2012 or state variation must be If the insured qualifies again at a later date, the benefit begins again. completed and submitted with the application for the applicable life insurance policy. If the proposed insured is eligible for Medicaid, the LTCS The elimination period must only be satisfied once. requires a daily will not be issued. If the proposed owner s assets are less than $30,000, the LTCS will not be issued. The base policy will be issued log/note from care provider or facility. subject to policy amendment. for Fully Underwritten Qualifies if the insured is unable to perform at least two Activities of Daily Living. The certification must also state that the insured is under a plan of care which describes services that are likely needed for the rest of their life. The insured s condition and need for care must be recertified annually. Fully Underwritten Qualifies if the insured is unable to perform at least two Activities of Daily Living. The certification must also state that the insured is under a plan of care which describes services that are likely needed for the rest of their life. The insured s condition and need for care must be recertified annually. Care underwrites for morbidity when the rider is elected, separate from mortality underwriting of the base policy. As long as the insured cannot perform 2 of the 6 ADL's, the insured can receive the benefit. If the insured no longer qualifies, the benefit stops. If the insured qualifies again at a later date, the benefit begins again. The elimination period must only be satisfied once. s There is a pre-screening questionnaire which if the insured answers yes to any of the questions, they will be declined for the rider. The rider is underwritten separately from the base product. It is possible that the insured is eligible for the base product but not the rider. This condition must also be expected to be permanent. No additional underwriting. Automatically issued if meet age and risk requirements on base policy. To exercise the rider the insured must be chronically ill which is defined as being permanently un able to perform 2 of the 6 ADLs without substantial assistance from another individual, or requiring substantial supervision to protect the Insured form threats to health and safety due to permanent severe cognitive impairment. The life insurance policy and LTC rider are underwritten separate, not bundled. This is so the lower risk class is not forced on the client for both As long as the insured cannot perform 2 of the 6 ADL's, the insured can contracts. The life insurance policy and LTC rider will be assigned the same underwriter. There are 5 tables, and there is the ability to dial down receive the benefit. If the insured no longer qualifies, the benefit stops. the LTC amount to provide flexibility in complicated situations. If the insured qualifies again at a later date, the benefit begins again. s Additional health questionnaire for any insured 61 or over. Insured's that are preferred or better get rider automatically added to policy. Table F or lower do not qualify. For Standard to Table E, each case is reviewed individually. This condition must also be expected to be permanent. The client must recertify annually. Advance No additional underwriting. Automatically issued if meet age and risk requirements on base policy. Qualifies if the insured has been unable to perform for a period of at least 90 consecutive days, without substantial assistance, two or more ADL's due to loss of functional capacity that is expected to be permanent; Or has required substantial supervision for a period of at least 90 consecutive days for protection from threats to health and safety due to permanent cognitive impairment. ExtendCare Underwriting included in base policy, except for cognitive testing. This condition must also be expected to be permanent. The client must recertify annually. Underwriting included in base policy, except for cognitive testing. This condition must also be expected to be permanent. The client must recertify annually. Access Satisfactory evidence is received, including certification by a licensed health care practitioner, that the insured is chronically ill and is not An additional application supplement and a policyholder disclosure must also be completed and signed with the product application. An RX expected to recover from the chronic illness. Chronically ill means check will be obtained and an additional requirement may be necessary in some cases. There is also an additional underwriting requirement. It being unable to perform without hands-on assistance from another is possible for a client to be offered a life insurance policy but be declined for Access. individual at least 2 ADL's for a period of at least 90 days or requiring continual supervision from another individual to protect the insured from threats to health and safety due to a severe cognitive impairment. Care The rider is fully underwritten for all issue ages and risk classes. The maximum rider coverage available per insured life is $1 million. The carrier will obtain info regarding the insured's health status and underwriting risk class from the basic policy application, a supplemental application, the Medical Information Bureau (MIB), telephone interview, a prescription benefit manager report, a cognitive screening text via telephone interview and an on-site face-to-face assessment, as applicable, depending on the issue age of the proposed insured. As long as the insured cannot perform 2 of the 6 ADL's, the insured can receive the benefit. If the insured no longer qualifies, the benefit stops. If the insured qualifies again at a later date, the benefit begins again. The ADL's are described in detail in the LTC rider guide.
and s for Individual Life Products Name Recertification Requirements Charge Structure Guaranteed vs. Current Charges Annual recertification is required. Varies by accelerated benefit amount option, issue age, gender and underwriting class; the monthly charge will not exceed the Maximum Monthly Charge shown in the policy schedule. Guaranteed Access Client must submit a physician statement annually to prove qualification. is free until triggered. benefits will accrue with interest and the total (benefits plus interest) will be offset from the death benefit. The accrued interest is the cost of the rider. There is no cost to add this rider. benefits will accrue with interest and the total (benefits plus interest) will be offset from the death benefit. The accrued interest is the cost of the rider. Recertification forms are mailed annually at which time the carrier request copies of the daily logs or champion sheets from the Long Term Care provider to show the insured is still receiving the proper care to qualify for the benefit. Charge is a level rate determined at the time of issue, based on issue age, gender, smoker status, underwriting class and benefit % elected. The charge is debited on a monthly basis and is applied to the "net amount at risk". Use current charges up to the guaranteed maximum charges. for Annually by a licensed healthcare provider. Charge is a rate per 1000 of long term care net amount at risk, based on issue age, gender, smoker status, underwriting class and benefit period elected. The charge is deducted from the Policy Value on a monthly basis. Current charges equal guaranteed for 1st 5 policy years; thereafter, guaranteed charges can be as much as 50% higher than current charges. Must return to the US for recertification. Charges at issue. Charge is a level rate determined at the time of issue, based on issue age, gender, smoker status, underwriting class, and benefit % selected. The charge is debited monthly. available with guaranteed products. Accumulation products utilize current charges up to the guaranteed maximum charges. Care Require a Plan of Care to be renewed with the carrier every 12 months. This must be evaluated and submitted by a physician. Charge is a level rate determined at the time of issue, based on issue age, gender, smoker status, underwriting class and benefit % elected. The charge is debited on a monthly basis and is applied to the "net amount at risk". Guaranteed only s Annual recertification is required for monthly benefit option. A physician must fill out and submit the Medical Assessment Plan of Care document. Charges at issue. Charge is a level rate determined at the time of issue, based on issue age, gender, smoker status, underwriting class, and benefit % selected. The charge is debited monthly. available with guaranteed products. Accumulation products utilize current charges up to the guaranteed maximum charges. After the initial exercise, the policy owner must re-certify within 12 months of the previous claim that the Insured is still meeting the rider requirements. If this is not done by the end of the current claim period a new waiting period will begin. There is no charge for the rider unless it is exercised. If the rider is exercised there is a $150 fee at the time of each annual exercise and a Life Expectancy Fee that is deducted from the policy death benefit at the time of each exercise. The LE Fee is determined by multiplying the ECB payment amount by a factor made up of The ECB Interest Rate and The ECB Life Expectancy Factor. Non-Guaranteed- The ECB Interest rate used for the Life Expectancy fee is the greater of the current yield of 90 day Treasury Bills and the current maximum statutory adjustable policy loan interest rate. Annual recertification required but reserve right to recertify sooner than 12 months if case requires (ex. If illness is expected to only last 7-8 months). pays for costs, and will contact with facility or doctor directly. Charges at issue. Charge is a level rate determined at the time of issue, based on issue age, gender, smoker status, underwriting class, and benefit % selected. The charge is debited monthly. available with guaranteed products. Accumulation products utilize current charges up to the guaranteed maximum charges. s Annual exam, and qualification approved by physician. The rider is free until exercised. At the time of exercise, the death benefit and cash value will be reduced proportionately based on a reduction factor. Have both current and guaranteed factors. Maximum charges are disclosed in the contract. Advance Annual recertification required. Claim form is sent to insured/owner to No charge up-front. benefit request is discounted at point get Physician certification that within the preceding 12 months that the of claim. insured meets the ADL or severe cognitive impairment standard. Use current charges up to the guaranteed maximum charges. ExtendCare Annual exam, and qualification approved by physician. Annual exam, and qualification approved by physician. Charge is an annually increasing rate determined at the time of issue, based on issue age, gender, underwriting class, face amount and rider benefit selected. The charge is debited from account value on a monthly basis. When chronic illness benefits are triggered, policy charges will continue to be assessed against the account value. Waive deductions during benefit period if it would cause policy to lapse. Charge is an annually increasing rate determined at the time of issue, based on issue age, gender, underwriting class, face amount and rider benefit selected. The charge is debited from account value on a monthly basis. When chronic illness benefits are triggered, policy charges will continue to be assessed against the account value. Waive deductions during benefit period if it would cause policy to lapse. available with guaranteed products. Accumulation products utilize current charges up to the guaranteed maximum charges. available with guaranteed products. Accumulation products utilize current charges up to the guaranteed maximum charges. Access Annual recertification by a physician. Charges very by issue age, duration, band, gender and UW class. There is an additional charge for this rider. It will generally add 5-20% to the lifetime no-lapse premium. Current is set to guaranteed. Care Monthly proof of loss must be submitted by claimant to continue to receive LTC benefits. Reserve right to re-assess insured for qualification. May require annual reassessment while benefit being paid. Can be more frequent for certain situations, but not more frequent than 90 days. Monthly rider charge is a guaranteed level rate determined at the time of issue based on age, sex, underwriting class, smoker status, and face amount band. The rider monthly charge is calculated as the LTC rider rate per thousand times the number of thousands of LTC rider coverage (LTC specified amount). Guaranteed only (only offer rider on a guaranteed product).
and s for Individual Life Products Name Claims Process A written request for benefits must be submitted to carrier. Upon receipt of the request, a claim form is mailed within 15 working days. If the claim form is not sent within this 15-day period, and proof that the insured is chronically ill is submitted in a format other than carrier claim form, the proof will be deemed to have complied with the claim requirement. Such proof must include, but is not limited to, a Certification or Re-certification statement signed by a Licensed Health Care Practitioner certifying that the Insured is Chronically Ill. Access There are 2 forms that need to be completed. Access Request #18199 and Access Attending Physician's Statement #18203. Once submitted and approved the carrier will make monthly payments. When a claim is submitted, it should be sent to: Equitable Life Insurance Company Special Claims Division P. O. Box 1047 Charlotte, NC 28201. When a claim is made, a Care kit is sent out that contains all of the paperwork needed to submit a claim. The amount of the Monthly Payment a client wishes to receive should be specified on Page 6 of the Claimant s Statement. The limits for the policy are specified in a letter that is sent out with the LTCS rider kit. If no amount is specified, will send the maximum Monthly Payment at issue for which the client is eligible under the terms of the rider. for should contact carrier to file claim. will provide owner with paperwork and procedure that is shown in detail in the contract. should contact carrier to file claim. will provide owner with paperwork and procedure. Care To file a request for s, someone must first notify the carrier that the Life Insured is currently receiving or plans to receive services covered by the LTC rider. The notice must include: the person s name filing the request and the Life Insured s name, the policy number, and the type of care the Life Insured is receiving or plans to receive. When the carrier receives the notice of request for s they will send out claim forms for filing a Proof of Loss. Once the carrier receives back the completely filled out claim forms for Proof of Loss, they will then decide if the Insured has met all the criteria for an approval of the request, and if not will deny the request and provide the Insured with a written explanation of the reasons for the denial. s Must fill out and submit (to the address on the form), the Authorization to Obtain and Disclose Information for Evaluation of Claim form The client must provide proof in writing from a physician that the Insured has a chronic illness to our claims department. The physician must be someone other than the owner, insured, or family member. Each additional request for an accelerated death benefit payment but be made in writing no more frequently than once every 12 months. Call into the claims department. will mail form, page for insured, page for Dr., page for provider, that will need to be submitted. A case manager will be assigned and will follow up. The doctor will be expected to answer what is wrong, and how long it's expected to last. s Must submit a claim form. Must receive written certification from a licensed health care practitioner that the insured is chronically ill and is expected to be permanent. Claimant may request a pay-out frequency of annual or monthly. Re-certification is required every 12 months. Advance Request for acceleration is made. Claim for is sent to insured/owner to get physician certification that within the preceding 12 months that the insured meets ADL or cognitive impairment standard. Claim is received with internal medical staff to see if any clarification needed. A new certification is required for each additional annual request. We reserve the right to obtain a second medical opinion. Once claim is approved, check is sent out the following day. ExtendCare Claim must be filed with the insurer. Insured must have a licensed health care provider sign-off on the Physician's Statement Claim Form, at the owner's expense. Insured and licensed health care provider must also fill out the Insured's Statement Claim Form. Once a Plan of Care and Elimination Period is met, benefits may be sent to the owner. Claim must be filed with the insurer. Insured must have a licensed health care provider sign-off on the Physician's Statement Claim Form, at the owner's expense. Insured and licensed health care provider must also fill out the Insured's Statement Claim Form. Once a Plan of Care and Elimination Period is met, benefits may be sent to the owner. Access should contact carrier to file claim (800-496-1035). will send owner a claim form and letter providing benefit and policy quotes and outlining impact of benefit payment on policy. Claim form must be completed by policyowner and the insured's attending physician. Additional information may be requested, including a personal interview with the insured. Once all conditions for eligibility have been satisfied and the claim approved, benefit payment will be made beginning with the monthly policy date on or following the date all conditions for eligibility have been satisfied. Care Claim requirements include notifying us of claim, completing the claim form, providing us with medical records, physician's orders, and proof of receiving qualifying LTC services. A face-to-face assessment of the insured's condition is usually performed a licensed health care practitioner before a claim is approved. Once a claims is approved and the 90 day elimination period has been met, benefits are paid out immediately.
and s for Individual Life Products Name What is the impact on the policy once the client is on claim? payments reduce death benefit dollar for dollar, up to the elected percentage of the death benefit Access The benefit is taken similar to a variable loan and will accrue interest at the current rate and reduce the death benefit by that amounts. The LTCS is reflected in the Extended No Lapse Guarantee, the Enhanced No Lapse Guarantee, Commissionable Target Premium, Minimum Initial Premium and No Lapse Guarantee Premium. The monthly LTC rider charge will reduce the sum of premiums paid toward the 7 Pay limit, if applicable (i.e. if the policy is not a MEC and is within a 7 Pay testing period). The monthly LTC rider charge will reduce the sum of premiums paid toward the guideline premium limit. s accelerated under this rider are treated as a lien (Accumulated Lien Amount) against the death benefit and reduce the cash surrender value. The lien increases with each LTCS Payment. The Accumulated Lien Amount will not accrue interest. A portion of each benefit payment is applied toward any outstanding loan and accrued loan interest. for All charges are waived (except premium load and loan interest) when the insured is on claim for Home Care, Assisted Living Facility, Nursing Home or Bed Reservation benefits. Dollar-for-dollar reduction of death benefit. Proportionate reduction of cash value. Care Dollar-for-dollar reduction of death benefit. Proportionate reduction of cash value. s Death benefit will be pro-rated down with each benefit payment. This includes base and supplemental term. Most of the policy values will be pro-rated down, as applicable for the base policy, including, account values, shadow account values and guidelines. Surrender charges will be waived. Existing loans are paid proportionately with each benefit payment. charges will stop. The total death benefit will be reduced dollar for dollar by the ECB payment plus the rider charge. The combination of the death benefit will be reduced proportionately including Base Policy, PAIR, AI, and FTR. ECB payments also reduces the policy's cash surrender value proportionately except if the FTR on the policy is not paid up. Future premiums will be recalculated to reflect the lower face amount of insurance. Dollar-for-dollar reduction of DB, in all states except NY, KY, Virgin Islands, CSV keeps being invested. CV continues to be invested, but should you cash policy in, cv, surrender charges, cumulative benefits been paid are subtracted, and that becomes CSV. in exception states, cv reduced prorate. In cases of loans, does not withhold from or reduce the monthly benefit amount. Instead, the total amount available for LTC benefits is reduced by the loan amount. s Death benefit is reduced, including charges (not dollar-for-dollar). Advance Dollar-for-dollar reduction of death benefit. Proportionate reduction of cash value. ExtendCare Dollar-for- dollar, up to 100% of the death benefit. Dollar-for- dollar, up to 100% of the death benefit. Access payments reduce death benefit dollar for dollar. Once claim begins, all policy and rider charges are waived. Policy charges will resume if client comes off claim within 25 months, however rider chargers to not resume. Withdrawals are not allowed while policy is on claim. While on claim, the policy is protected from lapse through waiver of policy and rider charges. If claim continues for 25+ months, the policy is permanently protected from lapse, even if the client later comes off claim. Care The amount of benefits paid will be deducted from the death benefit at time of death and from the net cash value in the event of surrender. payments will also reduce the amount available for any future policy loans or partial surrenders under the policy. While LTC benefit is being paid, LTC rider monthly charges are waived but other policy charges will continue. However while the insured is on claim, the policy will not lapse, even if accumulation value is not sufficient to cover policy charges.
and s for Individual Life Products Name Is the policy/rider paid up? The Policy's monthly deductions and the continuation guarantee account's monthly deductions, if any, will be waived beginning on the date Monthly s begin under this and will continue while the condition for Eligibility for s are met. Access The insured would continue to pay premiums on the policy. The policy will pay out until the death benefit is reduced to $20,000, then the policy is paid up. While on Claim: Premiums will not be accepted into the policy. Base policy charges will continue to be deducted from the policy (COIs, per $1,000 charge, policy fee, etc.) unless the policy includes the DDW/DPW riders and policy charges are being waived under the DDW/DPW riders. LTCS rider charges will be waived. As long as the policy is on LTCS rider claim, the policy cannot lapse regardless of policy values. If policy comes off LTC claim, premiums may be required to keep the policy inforce. for All charges are waived while on claim and the benefits would continue until the LTC Pool is depleted or client recovers. While on claim, once the policy account value is insufficient to cover monthly deduction charges, will waive all charges going forward. Care Unless the Waiver of Monthly Deductions rider or Disability Payment of Specified Premium rider is also in effect, all policy and rider charge deductions continue while on claim. If the insured is on claim and the death benefit is being accelerated then premiums due would be on a lesser face amount since the insured already accelerated a portion of the death benefit. s Once acceleration benefit payments begin, monthly deductions continue within the policy. If values are insufficient to take deductions, will waive the deductions that would cause the policy to lapse and will provide full lapse protection. Even if the insured no longer qualifies for the benefit, or chooses to stop acceleration, once acceleration has begun, the policy will not lapse as long as the rider is in force. No additional premiums will be required unless otherwise agreed upon by and the policy owner. Loan repayments will continue to be accepted. Loans and withdrawals taken after acceleration of the death benefit has begun will terminate the rider and the lapse protection. Policy is not paid up. Policy would lapse if premiums aren't paid. There is a no lapse provision, which guarantees the policy cannot lapse. There is a waiver on rider charge. The rest of charge will be taken from policy value. Once policy value runs out, then they waive all cost, guarantee policy cannot lapse. This guarantee applies to all type claims for care. Additionally, if the insured dies while on claim and receiving LTC benefits, even if the policy has $0 CV, will still pay the remaining DB to the beneficiary. s Policy is not paid up. Policy would lapse if premiums aren't paid. Advance Policy is not paid up. Policy would lapse if premiums aren't paid. ExtendCare Premiums are suspended and the policy cannot lapse while on claim. Premiums are suspended and the policy cannot lapse while on claim. Access After 25+ months on claim, yes. Care While LTC rider benefits are being paid out, rider charges are waived, but the policy and other rider charges will continue to be assessed even if the TransACE policy threshold value becomes negative. However, the policy will not lapse while the insured is on LTC claim, so there is not requirement to pay any premium while on claim. (if in policy first 5 years, premium is still required). If benefit period ceases with only partial benefit paid and the NLG was in effect at the time of claim, then the policy threshold will reset to zero, and premiums must be paid going forward. If all rider amount has been accelerated, all other riders will terminate, no other premiums must be paid, and then beneficiary will receive residual benefit at time of insured's death.