ASC Training
Assurant Supplemental Coverage
Assurant Supplemental Coverage (ASC) for
Dental, Accident and Critical Illness.
• These products have been introduced in several states
(refer to the Agent site for details).
• Why are we selling ASC?
 It is an existing product we already sell.
 We want to increase sales.
 We want to make it easier for agents to sell.
 We want to provide win/win opportunities for
ourselves, agents and our customers.
How are ASC products sold?
Supplemental products can be sold as:
• Standalone
 Each product is sold individually.
• Bundled
 Any or all of the 3 products are sold together in a
combination at one time.
• Integrated
 An integrated application is an ASC dental plan sold
with an IM product.
 ASC Accident intergrated with Access Fundamentals
 Accident and critical illness cannot be integrated with
an IM application.
Quoting/Submission of ASC Products in EASE
• Each of the 3 ASC products requires demographic
information, authorizations, and limited health history
details that vary slightly between products.
• When 2 or 3 products are quoted and sold together, all
information from the applicant will be gathered in one
seamless process without duplicating questions.
• Although there is a single submission process, each product
application submitted will receive a distinct eight digit
application number (same as our existing IM and Health
Access business).
Quoting/Submission of ASC Products in EASE
(cont.)
• The applicant will be provided with the application
number for each product they submitted.
• Each application will be reviewed and issued
independently.
• ASC applications are subject to Instant Issue logic subject
to rules specific to each product.
 For bundled submissions, each application that passes
Instant Issue logic will be approved, even if others do
not pass.
Call in Path
Applicants may NOT call in to provide their
initial health history interview on standalone
or bundled ASC applications!
Business Rules
• Many of the current IM mandates will NOT apply to the ASC
products because they are Not Major Medical Plans.
• Refer to State Mandates for specific details.
• The following provisions apply:
 ESB (on accident and dental)
 Civil Union (in applicable states)
• The following provisions do NOT apply:
 HIPAA
 GINA
 COGO
 Continuity/Pre-x
• The following provisions MAY apply:
 Health Replacement Form (on accident only in select states)
 Life Replacement Form (on critical illness only in select
states)
Business Rules (cont.)
• Effective dates:
 The first available effective date will be one day after
the application signature date.
 There is no conditional receipt on the ASC apps but, we
will honor the requested effective date (regardless of
billing type/money collected) unless:
- The application is not received within 10 days of
date signed
- OVS info not submitted within 10 days of date signed
- The issue date is > 30 days from date signed
 If any of the above conditions are not met, the approval
date will be date of issue.
Business Rules (cont.)
 Files will be closed after 31 days from the signature
date of the application if open requirements cannot be
obtained (same as IM guidelines).
 Once a file is closed, it may NOT be re-opened (same as
Health Access guidelines).
 A new application would be required if the applicants
would like to continue.
Counter Offers and Final Actions for ASC
Products
• Counter offers on ASC plans include the following:
 Risk class changes are available for Critical Illness only:
- Risk class options are Standard (smoker) or
Preferred (non-smoker)
 Partial declines available only on Critical Illness (if a
primary applicant is declined on an accident or dental
plan, all applicants should be declined)
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There are no HIPAA counter offers.
There are no amendments, ratings, SERs, CSDs or AOAs.
Applications will not be Conditionally Issued.
When a counter offer is accepted, all applications will be
Standard Issue, even if an applicant was removed.
Dental Insurance Eligibility
• Primary and spouse are eligible up Age 0-64 at purchase and
guaranteed renewable to age 70, see state specific mandates. (This
means the effective date can be the day before the applicants 64th
Birthday) for standalone, integrated and bundled submissions.
 On a standalone submission, the primary can be a minor child as
long as they are 1 month or older.
 On an integrated IM/Dental application, the primary must be 19
years of age or older.
• Dependent age guidelines may vary, therefore, please refer to State
Mandates.
• If the primary is ineligible, the Entire Application will be Declined.
• IM rules for Employer Sponsored Business (ESB) apply for Dental.
Dental Insurance Underwriting
• The contract is with the primary only. Therefore, an
application signed by the primary (or parent/legal
guardian of minor primary) is required in order to issue the
policy.
• Underwriting is on an accept/reject basis. This means we
will not apply riders, ratings, or CSDs.
• The only risk class available is Standard.
• There will be no MIB, RX, or ICR checks.
Dental Insurance Underwriting
• Underwriters will assess risk based on responses by all
applicants to the Citizenship and the Occupation
questions.
– Citizenship/Residency –IM rules apply
– There are no special UW guidelines for the Dental
Accident Insurance
Can Be Standalone or Bundled
• Pays a flat benefit for each covered benefit under the plan.
• It is designed to help cover the expenses associated with an
accident.
• It pays regardless of other coverage in place; there is no
coordination of benefits.
• There are no co-pays or deductibles.
• There are no network requirements; an insured may visit any
hospital or doctor.
Accident Eligibility
• The product is available to a primary, spouse, and/or
dependents based on age requirements.
• The contract is with the primary only (age 18 through 64This means the effective date can be the day before the
applicants 65th birthday ). Therefore, an application signed
by the primary is required.
• Dependent age guidelines may vary, therefore, please
refer to State Mandates.
• If the primary is Ineligible, the entire application will be
Declined.
• IM rules for Employer Sponsored Business (ESB) apply for
Accident.
Accident Underwriting
• Underwriting is on an accept/reject basis.
 Underwriters will not apply riders, ratings, or CSDs.
 MIB and Rx check will not be used.
 Decision is made based on limited medical and nonmedical information including:
• Height and weight
• Adverse driving history
• Back, neck, and joint disorders
• Age
• Standard is the only available risk class.
Accident Paper Application
We will use the information from the
application to determine eligibility based on
other coverage and will review build and
limited medical questions.
Reviewing Adverse Responses for Accident
• Height/weight out of range
–Decline
–No action on build for dependents
• DUI question answered adversely
–Decline
Critical Illness Eligibility
• Primary and spouse are eligible starting at age 18 through 59 (This
means the effective date can be the day before the applicants 60th
birthday).
• Dependent children are NOT eligible and cannot be quoted.
 If dependent children are included on a paper application, they will
be removed from the application.
• There are ineligible industries, occupations and recreational activities
that can be viewed by the applicant or agent in EASE.
 These details may be viewed in the Agent Guide or in the
processing manual.
• Employer Sponsored Business (ESB) rules do NOT apply for Critical
Illness.
• Underwriting is on an Accept/Reject basis.
 Underwriters will not apply riders, ratings, or CSDs.
Critical Illness Underwriting
• Available risk classes are standard or preferred.
 Applicants are eligible for preferred rates if
they do not use tobacco. (Question is asking
within the last 12 months)
 Height and weight and medical history are not
considered for preferred rates.
• Review process will utilize new guidelines for
Critical Illness added to the UW Manual.
 Underwriters will only review conditions that
are required to be disclosed on the application.
 MIB and Rx check will be used
Critical Illness Underwriting Cont.
• Applicants may have more than on CI policy however, they
CANNOT exceed $100K in benefits.
Example:
 A UW receives a new application for CI
 The Other Coverage tab indicates the applicants have a current CI
policy with Colorado Bankers.
 Current benefit amount is $25K.
 Not replacing.
 The UW needs check to verify the current benefit amount and the
requested benefit amount do not exceed the max benefit of $100K.
• The Life Replacement Form will be required from all
Applicants Replacing Critical Illness Policies.
ASC-Underwriting Overview
Critical Illness Application
• We will use information from the
application to determine eligibility due to
benefit amounts of other coverage.
• We will also review the
declined/postponed/rescinded/reformed
question.
Critical Illness/Life Policy
• Individual guaranteed renewable CI policy on a term life
chassis (has term life coverage as part of the policy)
providing a lump-sum benefit for 15 first-ever diagnosed
critical illnesses and procedures:
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Advanced Alzheimer’s Disease
Blindness, Deafness, Loss of Limbs
Cancer Type A & B, Coma
CABG, MI, Heart Valve Surgery
ESRD (kidney failure)
Major Burns, Major Organ Transplant
Paralysis, Stroke
Critical Illness/Life Policy
• Issue Ages 18 through 59.
• Eligible for critical illness until age 65.
• Eligible for term life benefit until age 85.
• A death benefit is included.
• Eligible: Primary only/Primary & Spouse
• MIB and Rx checks will be done on every applicant.
Ineligible Occupations = Decline:
These occupations prevent the issuance of Critical Illness
coverage. Other occupations not listed may also result in
the applicant being ineligible for coverage.
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Armed Forces personnel
Asbestos workers
Boxers, prize fighters and mixed martial artists
Crop dusters
Off-shore oil and natural gas workers
Professional motor vehicle racers
Stunt person/stunt flyers
Underground miners
Ineligible Occupations (cont.):
• Ineligible occupations:
• Adult entertainers/dancers
– Air traffic controllers
– Circus/carnival/amusement park performers/workers
– Commercial fisherman/crew
– Explosive workers
– Professional athletes
– Divers
– Horse trainers
– Loggers
– Long haul truckers
– Rodeo
– Ski instructors, etc.
Ineligible Avocations = Decline:
More than one time participation in the past
5 years or planned future participation in:
• Boxing
• Parkour or Free-running
• Extreme sports
Other Ineligible Conditions = Decline:
• DUI/DWI in the past 5 years
• Three or more moving violations in the past 5 years
• Pending felony charges or conviction in the past 10
years.
Q13 List of declinable conditions (Always
see GLs). We pay benefits for these
conditions:
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Stroke, TIA
Peripheral vascular/arterial disease
Crohn’s disease/Ulcerative colitis
COPD/Emphysema
Pulmonary fibrosis/Cystic fibrosis
Alzheimer’s disease, Dementia
Systemic Lupus Erythematosus
Diabetes
Leukemia, Melanoma, Non-Hodgkin’s Lymphoma,
AIDS/HIV, Multiple Sclerosis, ALS, Paralysis, Organ or
Stem Cell Transplant
Q13 Additional conditions that may/may not
be a declinable condition; see guidelines:
• Heart disorders
• Liver disorders, excluding fully recovered
Hepatitis A
• Kidney disorders, excluding kidney stones
• Blood disorders
• Tuberculosis (TB)
• Cancer or Tumor, Skin Cancer (2 or more
occurrences), Hodgkin lymphoma
• Alcoholism, Alcohol or Chemical Dependency, or
Drug or Alcohol Abuse
• Bipolar, Schizophrenia, or Chronic Depression
Build Table (Accept/Decline; no preferred
option):
See Build Table
Build Table:
ASC Cancer and
Heart/Stroke
ASC Cancer and Heart/Stroke
• The Assurant Supplemental Coverage (ASC) Cancer and
Heart/Stroke plan is a fixed indemnity plan which
provides coverage for life threatening conditions such as
cancer, heart attack, and stroke.
• Applicants can choose coverage for Cancer only,
Heart/Stroke only, or Cancer and Heart/Stroke — paying
for only those conditions they’re most concerned about.
• Add Cancer and Heart/Stroke to a Portfolio or AHA plan
in a single process, with no more than two additional
questions for Cancer and four questions for Heart/Stroke.
Product Information
• Coverage is available for primary, spouse, and dependent children.
• Primary and Spouse/Domestic Partner – Age 18 through 64
• Dependents – Unmarried children through age 25 (may vary
by state).
• Pre-existing applies to this plan. Additionally, there is a benefit
waiting period:
• Cancer (90 days – may vary by state)
• Heart/Stroke (30 days – may vary by state)
• ESB, HIPAA and Health Care Reform do not apply.
• Applicants right to examine is 30 days (rather than the usual 10
days).
• Applicants may have a CHS plan and remain eligible for an HSA plan.
Product Information
• The billing methods currently available for other ASC
products will be available for CHS.
– Note: Direct bill will not be available for ASC
products submitted electronically as of the May
implementation. Paper submissions still will include
the direct bill option.
• When applicants provide their email address, they will be
automatically enrolled in eDelivery.
Electronic Submissions
• Integrated interviews may be completed online or as
a call-in.
• Stand Alone or Bundled interviews must be
completed online.
• The call-in path is not available for stand alone or
bundled submissions.
Paper Submissions
• Paper applications are accepted for stand alone
Cancer and Heart/Stroke submissions.
• Integrated paper submissions are not available.
– AHA – paper applications are not accepted.
– Portfolio – both the Portfolio and CHS
applications must be completed.
• Stand alone CHS quotes can be created in EASE or a
CHS rate sheet can be submitted with the paper CHS
application.
Paper Application Packets
• CHS application packets include:
– Tip Sheet with applicant instructions on how to
complete the application, who should sign the
application, etc
– Rate Sheet for manual calculation of premium rates
– Application
– Billing Page
– Any state required forms, such as Health
Replacement forms
• Paper application packets will be available on the
Supplemental tab of Find-a-Form as of the
implementation.
CHS Integrated with AHA
• Health questions and authorizations for both AHA
and CHS must be completed.
• Risk is assessed for each product separately based on
the health information provided for each product.
– Both applications may be accepted.
– If one is accepted, the other may be declined.
CHS Integrated with a Portfolio Plan
• Health questions for the Portfolio plan only must be
completed.
• Risk is assessed for both products based on the
information provided on the Portfolio plan.
– If the Portfolio plan is issued, the CHS plan will
be issued.
– If the Portfolio plan is not issued, the CHS plan
will be marked incomplete.
– Any applicants eligible for the CHS plan may reapply.
Risk Philosophy
• Risk assessment will be based on health history, MIB,
pharmacy check information, and ICR information.
• There is no AOA required for CHS.
• GINA does not apply
Underwriting
• When CHS is submitted stand alone or bundled or is
integrated with AHA, all applicants must be eligible
for the application to be issued.
– Each application is decided separately.
– An application will be issued when all applicants
are acceptable based on eligibility and health
criteria.
– When an application is incompleted, any
applicants who are eligible may reapply.
– For electronic submissions, the underwriting
decision will be presented in EASE or IM
Consumer, as happens today for AHA
submissions.
Underwriting Outcomes
• Instant issue logic will run for electronic and manual
registry applications.
• CHS submissions may result in standard issue,
decline, or incomplete status when submitted stand
alone, bundled, or integrated with AHA.
• CHS may result in standard issue, incomplete, or
automated counter offer (risk class) when integrated
with a Portfolio product.
Key Points to Remember!
• CHS may be integrated with a Portfolio plan, with
AHA plans, purchased as stand alone, or bundled
with other ASC products.
• The philosophy for underwriting CHS is
Accept/Reject.
• Systems have been enhanced to allow point of
submission underwriting for this product.
Questions ?