ManhattanLife Lighthouse Series OmniFlex ™ Short-Term Care
Agent Guide For Agent use only
This is a Short Term Facility Care Insurance Policy Underwritten by: ManhattanLife Insurance and Annuity Company and Standard Life and Casualty Insurance Company
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Thank You from ManhattanLife! First of all, thank you for taking the time to read our Short-Term Care Agent Guide! We realize that you have many carrier and product options to choose from and we sincerely thank you for choosing ManhattanLife!
Who We Are Who is ManhattanLife? Since 1850, we’ve defined our brand with our commitment to standing by policyholders and producers with diligence and compassion. For over 170 years we’ve been a private and closely held company by choice. And as an independent, we have always been free to make decisions that align with our values and core mission — helping policyholders attain and sustain health, wealth and security throughout their lives. We demonstrate this commitment by striving to honor claims and pay benefits with professionalism and care. For our producers, we are a reliable and independent partner. We stay agile and open minded about customizing products or innovating new policies to meet our policyholders’ evolving needs. With a national footprint and licenses to sell in every state and U.S. territory, we are everywhere you want us to be. The Company’s longevity as staying independent in the marketplace is remarkable considering the robust merger and acquisition activity the industry has experienced in modern times. To put its staying power in context, the current average age of S&P 500 Index companies is less than 20 years old. By contrast, operating successfully for over 170 years as an independent is a testimony to ManhattanLife’s enduring history and an indicator of the reliability of our future. The Purpose The purpose of this Agent Guide is to provide insights into the benefits available with Short-Term Care. In addition, this agent guide should provide direction on topics such as state availability, submitting applications, underwriting process, application fees & rates, preventing processing delays and much more.
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Why Short-Term Care? With the cost of Long-Term Care insurance (LTCi) services continuing to rise and health eligibility requirements making it more difficult to qualify, ManhattanLife has developed OmniFlex™ Short-Term Care insurance (STCi) to address the growing need for coverage with an affordable solution. Being financially prepared to pay for facility-based care, rehabilitative or professional home health care services can be a major concern for a growing segment of the population. ManhattanLife’s new OmniFlex™ STCi plan is designed to financially help individuals who are faced with the physical challenges caused by an injury, illness or medical condition. Working with ManhattanLife Working with ManhattanLife has never been easier! One of the tools that will make your life easy is our Agent Resource Center, or as we refer to it, ARC. ARC was developed to ensure producers have easy access to all the brochures, applications and forms that may be needed need. ARC is also where you will find your policy and commission information.
We like to say ManhattanLife Direct 2.0 is where you make your money and ARC is where you protect it! Here you can find all of our up to date marketing and training collateral. Additional resources include: •Product Availability Grids •Policyholder List • Trainings
•Social Media Collateral •Commission Earnings •Ordering Supplies
Please visit https://producer.manhattanlife.com/ and start exploring today!
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Table of Contents Base Plan Highlights & Optional Benefits...........................................6 Availability.......................................................................................6 Base Plan Highlights.......................................................................6 Optional Benefits.............................................................................6 Product Availability Map.....................................................................7 Application Fee & Rates.....................................................................7 Submitting Paper Applications...........................................................8 Easy Upload Feature..........................................................................8 Required Forms..................................................................................8 Required Application Information......................................................9 Top Reasons for Application Delays...................................................9 Bank Draft Authorization Form...........................................................10 Policy Issue Guidelines.......................................................................11 Underwriting.......................................................................................11 Health Questions.............................................................................12 Telephone Interviews......................................................................12 Pharmaceutical Information............................................................12 Medications/Therapeutic Use Reference..........................................13 Situations Requiring a New Application.............................................19 Eligibility Questions............................................................................19 Ineligible Conditions........................................................................19 Application Status..............................................................................20 Declined Appeals................................................................................20 Application Status Codes...................................................................20 Application Assistance.......................................................................20 Amendments/Endorsements.............................................................21 Withdrawn Policies.............................................................................21 Methods of Payment..........................................................................21 Bank Draft.......................................................................................22 Direct Bill.........................................................................................22 Forms of Payment Not Acceptable.................................................22 Claims.................................................................................................22 Restoration of Benefits...................................................................22 Contact Us..........................................................................................23 ManhattanLife Marketing Department...............................................23 Fax Numbers......................................................................................23
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Agent Guide | Short Term Care
ManhattanLife
Base Plan Highlights & Optional Benefits One of our main goals when creating the Short-Term Care offering was to provide benefit flexibility, giving insureds the ability to create a plan tailored to their specific needs. A multitude of base benefit levels, multiple benefit and elimination periods and several optional benefits.
Availability
Issue Age
45 - 89
Underwriting Policy Type
Simplified Issue
Guaranteed Renewable
Base Plan Highlights
Facility Care
Facility Care Daily Benefit
$50 - $400
Elimination Period
0, 20, 60, or 90 days
Benefit Period
90, 180, 270 or 360 days
Lifetime Maximum Benefit Period
2x Benefit Period
Bed Reservation Benefit
10 days (Lifetime Max 20 days) Built-in Benefits
$10 Generic / $25 Brand $300 Policy Year Max
Prescription Drug Benefit
Waives Elimination Period on Facility Care or Home Health Care Benefits to receive 50% level of accumulated Daily Benefit — perfect for care provided by a spouse, family or friends Restores Facility Care or Home Health Care benefits after the 180 days out of care need is satisfied, up to lifetime max benefit period
Fast-50 ™
Restoration of Benefits
*$25 One-time Policy Fee Applies
Optional Benefits
Home Health Care
Home Health Care Daily Benefit
$50 - $300
Elimination Period
0, 20, 60, or 90 days
Benefit Period
90, 180, 270 or 360 days 2x Benefit Period Simple Inflation Benefit
Lifetime Maximum Benefit Period
If chosen, Simple Inflation applies to Facility Care as well as Home Health Care, if the Home Health Care Rider is also elected Hospital Indemnity
5% Simple Inflation
Daily Benefit Benefit Period
$50 - $300
3, 6 or 20 days
Lifetime Maximum Benefit Period
180 days
See policy for details and definitions.
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Product Availability Map
Scan this QR Code to view the Product Availabilty Map Click on this QR Code to download the Product Availability Map on Resource One
Application Fee & Rates Application Fee A one-time application fee of $25 is applicable for new policy submissions. Rates Short-Term Care rates vary by state and age. Consult the state-specific rate schedule for pricing details. Spousal Discount A 10% Spousal Discount is available to eligible individuals applying for OmniFlex Short-Term Care. To qualify for the discount, the following criteria must be met by the two individuals applying for coverage: • The two must be married. • The two must live at the same address. • The two must both apply and be issued a policy. The 10% Spousal Discount is a reduction from the individual price for each policyholder in the same household.
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Agent Guide | Short Term Care
ManhattanLife
Submitting Paper Applications As stated above, we always suggest submitting applications through ManhattanDirect, as we have found processing times are generally quicker. We do, however, understand there may be times when this simply isn’t possible. In the event a paper application has to be submitted, the agent needs to complete the application with the applicant actively engaged throughout the process. The agent can either be at the same physical location as the applicant/owner, or the application can be processed over the phone. Regardless of how the application process takes place, both the applicant/owner and the agent must physically sign the document. Therefore, if the application is completed over the phone, the agent must fax or send the application to the applicant/owner to obtain their signature before submitting it to ManhattanLife for processing. Below are options for getting paper applications to ManhattanLife for processing. • Easy Upload – Can then provide the info below on Easy Upload process • Fax – 1-713-583-2738 Attention: New Business • Mail – P.O. Box 925568 Houston, TX 77292 OR Overnight/Specialty Mail: 10777 Northwest Freeway STE 600 Houston, TX 77092 Easy Upload Feature The Easy Upload tool can be used to upload applications rather than mailing or faxing them. Please note currently Easy Upload will only accept PDF files. Therefore, the application must be scanned and converted to a PDF to be attached. There are step- by-step instructions located in the “Help” section found to the left of the Easy Upload area within the Agent Resource Center. It should be noted that in order to submit via Easy Upload, you must be logged into our ManhattanDirect 2.0 system The Easy Upload feature can be found on the home page of the Agent Resource Center(ARC) and was created to enable the submission of paper applications, rather than mailing or faxing
them. The Easy Upload feature can be found at the following URL: https://producer.manhattanlife.com/life/account/login.aspx?AsAgent Required Forms Completed Application (pages 1-5)
Whether completing a paper application, or utilizing ManhattanDirect 2.0, please remember only current state-approved applications may be used when applying for coverage. If there is a question as to what application is available, please call our Marketing Department to confirm the correct application form number. Sales & Marketing Hotline: 1-888-441-0770. Email: marketingmail@manhattanlife.com A copy of the completed application will be attached to the policy, becoming part of the contract.
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Required Application Information Whenever possible we highly recommend utilizing our ManhattanDirect 2.0 enrollment platform, as paper submissions often have undue delays. If an application is submitted with incomplete, unclear, or missing information critical to the risk evaluation process, a new application may be required, or an amendment to the application will be issued. Critical information includes, but is not limited to: • Complete residential address • Eligibility questions • Applicant’s signature • Agent’s signature • Agent Number Top Reasons for Application Delays • The application is received at the administrative office more than 30 days from the signature date, or if the signature date is in the future. • Pending Agent Appointment. ManhattanLife practices “Just in Time” appointments and processing of applications. What does this mean? This means that we will not run a background check and solidify appointments until your 1st piece of business is submitted. This could result in a 24-48 hr delay for this initial deal, so please keep that in mind. • Signature stamps are not allowed on applications. Please ensure a physical signature is captured. • Date of birth • Plan selection • Correct Premium • Bank draft date/Policy effective date • If the amount quoted on the application is less than the modal premium we calculate, we will contact the agent to verify that it is acceptable to process the bank draft for the amount that we have calculated. We will amend the modal premium. • Provide all medication information and history. • Information listed on application does not align with Personal Health Interview (PHI).
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Agent Guide | Short Term Care
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Bank Draft Authorization Form If client’s elects to pay premiums via bank draft, please ensure the bank draft authorization form is submitted along with the paper application.
Please check the box beside the name of your insurance company.
q ManhattanLife Insurance and Annuity Company
q Manhattan Life
q Family Life
q Standard Life and Casualty Company q Western United
AUTHORIZATION TO HONOR DEBITS DRAWN BY COMPANY REFERENCED ABOVE To: ____________________________________________________ (Print Name and Address of Financial Institution where Account is maintained) As a convenience to me, I hereby request and authorize you to pay and charge to my account debits drawn on my account by and payable to the order of – the company referenced above - provided there are sufficient collected funds in said account to pay the same upon presentation. This authorization will remain in effect until revoked by me in writing, and until you actually receive such notice I agree that you shall be fully protected in honoring any such debit. This arrangement shall terminate immediately upon the closing of my account with you or upon receipt by you of notice of my bankruptcy. I agree that your treatment of and rights in respect to each such debit shall be the same as if it were signed by me. I further agree that if any such debit be dishonored, whether with or without cause and whether intentionally or inadvertently, you shall be under no liability whatsoever, even though such dishonor results in the forfeiture of insurance. Account Title: ________________________________________ Account Number: ______________________________________ ABA Routing Number: ___________________________________ Date of Withdrawal: ______________________________________ (Cannot select the 29 th , 30 th , or 31 st ) Account Type : Checking Savings Policy Number: __________________________________________ Signature(s) X X
INDEMNIFICATION AGREEMENT
To: Financial Institution named on this form. In consideration of your compliance with the request and authorization of the depositor: THE COMPANY REFERENCED ABOVE AGREES THAT: 1. It will indemnify and hold you harmless from any liability to any person having an account with you arising out of the payment by you of any debit drawn by the company referenced above to its own order in the account of such person, or from any liability to any such person or to any owner or beneficiary of any policy issued by the company referenced above in respect of which such a debit is drawn by the company referenced above, provided there are sufficient funds in such account to pay the same upon presentation, whether or not such claim or liability asserted against you be based upon the forfeiture, or alleged forfeiture of a policy the premiums on which is sought to be collected by the company referenced above by such debit; and, 2. It will refund to you any amount erroneously paid by you to the company referenced above on such debit if claim for the amount of such erroneous payment is made by you within twelve months from the date of the debit on which such erroneous payment was made.
President
PAYMENT OPTION AUTHORIZATION SIGNATURE(S) For individuals wishing to have their monthly premiums collected via electronic ACH, please ensure correct routing and direct deposit account information is listed. ACH information can be found on the bottom of the insureds check.
PLEASE ATTACH A VOIDED CHECK Return the completed form to: P.O. Box 925688 Houston, Texas 77292-5688
Comments:
BKDFT 0509
The Bank Draft authorization form can be found at: ManhattanLIfe.com > File A Claim > Individual and Worksite > Health & Accident
**Make sure Signature on the Bank Draft Authorization matches the signature card at the bank.**
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Policy Issue Guidelines The policy issued is specific to the state of residence. The applicant’s state of residence controls the application, forms, premium, and policy issued. If an applicant has more than one residence, the state where the federal income taxes are filed should be considered the state of residence. Multiple Policies An individual can only have one ManhattanLife Short-Term Care Insurance policy in place at any given time. Replacements A replacement takes place when an applicant wishes to exchange an existing ManhattanLife OmniFlex™ Short-Term Care policy for another OmniFlex™ Short-Term Care policy of lesser (downgrade) or greater (upgrade) value. An upgrade will be processed via a new paper application, including Underwriting. A $25 application fee applies. Downgrades will be processed via email or written request sent to the following: Email: TBD Address: TBD Underwriting The goal of ManhattanLife and group of companies is to issue insurance policies as quickly and efficiently as possible, while ensuring proper evaluation of each risk. To accomplish this goal, writing agents may be contacted via email to advise him/her of any problem(s) with an application. Complete applications will be reviewed and processed within 48-72 hours. It is very important to ensure the entire application is filled out completely, including all health questions. This greatly helps reduce processing timeframes. If you (agent) or insured are unsure about past medical conditions, impairments, or terminology, please provide any additional comments that could provide additional insight to our underwriters.
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Agent Guide | Short Term Care
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Underwriting Continued Health Questions • Health Questions Part I – If any answers to questions 1-5 on Part 1 of the application health questions is “Yes”, the client IS NOT eligible for coverage. • Health Questions Part II – If any answer to question 1 on Part II of the application health questions is “Yes”, any Simple Inflation benefit IS NOT available, and the applicant will be limited to a MAXIMUM $100 daily benefit on the base Policy, Home Health Care Rider, and Hospital Indemnity Rider.) • Prescription Drug Questions Part III – Please be as through as possible when completing this section. Telephone Interviews There may be instances when a telephone interview is necessary to verify information within the application. In the event we are unable to complete a phone interview, additional medical records may be required. * Any deviations from the application and information gathered during a Phone Interview could result in processing delays. Please be aware that agents and/or an agent’s representative may not be present or on the line while a phone interview is being conducted. Pharmaceutical Information Standard Life has implemented a process to support the collection of pharmaceutical information for underwritten Short Term care applications. To obtain the pharmaceutical information, the Authorization and Certification section must be signed by the applicant. Prescription information noted on the application will be compared to the additional pharmaceutical information received. This additional information will not be solely used to decline coverage.
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Medications/Therapeutic Use Reference These medications are a list of prescription drugs and their common therapeutic use. These prescription drugs are not limited to the treatment of the conditions indicated. This list is by no means complete since it would be impossible to list every medication in an easy reference guide. Mirapex/Pramipexole & Requip/Ropinirole-complete Phone Health Interview & verify diagnosis, if used to treat restless leg syndrome and dose/frequency < 4mg QD, may be considerable. Truvada/Emtricitabine Tenofovir-complete Phone Health Interview & verify diagnosis & how prescribed, if used as a preventative measure only, may be considered. • Medications in red will result in a decline. • Medications in teal will require a Phone Health Interview to determine diagnosis.
LIMITED BENEFITS
MEDICATION
CONDITION
DECLINE
Abilify
Schizophrenia/Bipolar Disorder
Y
Abiraterone Acetate
Cancer
Y
Aggrenox Albuterol
Prevent Blood Clot/Stroke
Y Y
Asthma/COPD
Alkeran
Cancer
Y
High Blood Pressure/ Congestive Heart Failure
Altace
Y
Anastrozole
Breast CA
Y
Antabuse
Alcoholism
Y
Anemia in pts w/Chronic Renal Failure & CA Chemotherapy
Aranesp
Aricept
Alzheimer's Disease/Memory Loss
Y Y
Arimidex
Breast CA
Aripiprazole
Schizophrenia/Bipolar
Y
Atacand Atrovent Avastin Avonex
Heart Failure/High Blood Pressure
COPD/Asthma
Y
Cancer
Y
MS
Y
Azathioprine
Prevent Kidney Transplant Rejection/RA
AZT
HIV/AIDS
Y
Benazepril Benztropine Bevacizumab
CHF/Renal Failure/High Blood Pressure
Parkinson's Disease
Cancer
Y
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LIMITED BENEFITS
MEDICATION
CONDITION
DECLINE
Bicalutamide
Prostate CA
Y
Breo
COPD/Asthma
Y
Bumex
Fluid Retention/CHF
Busulfan Carbidopa Carvedilol
Leukemia
Y Y
Parkinson's Disease
CHF/High Blood Pressure
Y
Casodex CellCept
Prostate CA
Y
Transplant Anti-Rejection/Lupus
Y
Chlorambucil
Leukemia
Y
Chlordiazepoxide Chlorpromazine
Anxiety/Alcoholism
Y Y
Schizophrenia
Dry Eyes/Organ Transplant Rejection/RA/ Psoriasis/Nephrotic Syndrome
Ciclosporin
Clonazepam Clopidogrel
Seizures/Panic Disorder
Y Y Y Y
Prevent Blood Clot/Stroke
Clozapine
Schizophrenia Schizophrenia
Clozaril
Cogentin
Parkinson's Disease Alzheimer's Disease
Cognex
y
Combivent
COPD
Y
Comtan
Parkinson's Disease
Copaxone
MS (injection)
Y Y
Coreg
CHF/High Blood Pressure
Cyclophospha-mide
Cancer
Y
Dry Eyes/Organ Transplant Rejection/RA/ Psoriasis/Nephrotic Syndrome
Cyclosporine
Cytoxan
Cancer
Y
Daclatasvir
Hepatitis C Hepatitis C
Y Y
Daklinza
Anemia in pts w/Chronic Renal Failure & CA Chemotherapy
Darbepoetin Alfa
Y
Darunavir Diazepam
HIV
Y
Anxiety/Alcohol Withdrawal/Muscle Spasms
Y
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LIMITED BENEFITS
MEDICATION
CONDITION
DECLINE
Diovan
Heart Failure/High Blood Pressure
Diuril
Fluid Retention/CHF
Y
Donepezil
Alzheimer's Disease/Memory Loss
Y
Eliquis
Prevent Blood Clot/Stroke in pts w/A Fib
Y Y
Enalapril
CHF/High Blood Pressure
Entacapone
Parkinson's Disease
Entresto Erlotinib Eulexin Exelon Extavia Femara
Chronic Heart Failure
Y Y Y Y
Cancer
Prostate CA
Alzheimer's Disease
MS
Y
Breast CA
Y
Fluoxetine
Panic Disorder/Depression
Y Y
Fluphenazine
Schizophrenia/Psychosis
Fosinopril
Heart Failure/High Blood Pressure
Galantamine
Alzheimer's Disease
Y
Gengraf Geodon Gleevec
Prevent Organ Transplant Rejection
Y Y
Schizophrenia/Bipolar
Leukemia
Y
Haldol
Mood Disorders/Schizophrenia
Y Y Y
Harvoni Heparin Hexalen Hydrea
Hepatitis C
Prevent Blood Clots (injection)
Ovarian CA
Y
Sickle Cell Anemia/Cancer/Blood Disorders
Hydroxychloro-quine
RA/Lupus
Y
Hydroxyurea
Sickle Cell Anemia/Cancers/Blood Disorders
Hygroton
Fluid Retention/CHF
Imuran
Prevent Kidney Transplant Rejection/RA
Indapamide Interferon Ipratropium
High Blood Pressure/CHF
MS/Hepatitis C
COPD/Asthma
Y
Keytruda
Lung Cancer
Y
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LIMITED BENEFITS
MEDICATION
CONDITION
DECLINE
Klonopin Lamictal
Panic Disorder/Seizures
Y Y Y Y
Seizures/Bipolar Disorder
Latuda
Bipolar Disorder/Schizophrenia
Ledipasvir Letrozole Leukeran Levodopa
Hepatitis C
Breast CA
Y Y
Leukemia
Parkinson's Disease
Librium
Anxiety/Alcoholism
Y Y Y
Lisinopril Lithium Lodosyn Lotensin Loxitane
CHF/High Blood Pressure
Manic Depressive Disorder/Bipolar Disorder
Parkinson's Disease
High Blood Pressure/CHF/Renal Failure
Schizophrenia
Y Y
Lozol
High Blood Pressure/CHF
Lupron
Prostate CA (injection)
Y
Lurasidone Maraviroc
Bipolar Disorder/Schizophrenia
Y
HIV
Y
Tx of loss of appetite/wt loss d/t AIDS, advanced Breast CA, Endometrial CA
Megace
Y
Mellaril
Schizophrenia
Y
Memantine
Alzheimer's Disease
Y
Acute Lymphocytic Leukemia/Ulcerative Colitis/Crohn’s
Mercaptopurine
Y
Methotrexate
Cancer/RA
Y
Midamor Mirapex Monopril
High Blood Pressure/CHF
Y
RLS/Parkinson's Disease
Heart Failure/High Blood Pressure
Mycophenolate
Transplant Anti-Rejection/Lupus
Y
Myleran
Leukemia
Y Y
Namenda
Alzheimer's Disease
Navane Neoral
Schizophrenia
Y Y Y
Prevent Organ Transplant Rejection
Olanzapine
Schizophrenia/Bipolar Disorder
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LIMITED BENEFITS
MEDICATION
CONDITION
DECLINE
Olysio
Hepatitis C
Y Y
Peg-Intron
Hepatitis C (injection)
Pembrolizumab
Lung Cancer
Y
Permax
Parkinson's Disease
Perphenazine
Schizophrenia
Y Y Y
Plaquenil
RA/Lupus
Plavix
Prevent Blood Clot/Stroke
Pramipexole
RLS/Parkinson's Disease
Prezista Proair Procrit Prograf Prolixin Prozac
HIV
Y
Asthma/COPD
Y
Anemia in pts w/Renal Failure, HIV, CA
Prevent Organ Transplant Rejection
Y Y Y Y
Schizophrenia/Psychosis
Panic Disorder/Depression
Pulmicort
Asthma/COPD
Acute Lymphocytic Leukemia/Ulcerative Colitis/Crohn’s
Purinethol
Y
Quetiapine Ramipril Razadyne
Bipolar Disorder/Schizophrenia
Y Y
CHF/High Blood Pressure
Alzheimer's Disease
Y
Rebif
MS
Y
Reminyl Requip
Alzheimer's Disease
Y
RLS/Parkinson's Disease
Rheumatrex
Cancer/RA
Y
Rilutek Riluzole
ALS ALS
Y Y Y Y
Risperdal
Schizophrenia/Bipolar Disorder Schizophrenia/Bipolar Disorder
Risperidone Rivastigmine
Alzheimer's Disease
Y Y Y Y
Ropinirole
RLS/Parkinson's Disease
Sacubitril/ Valsartan
Chronic Heart Failure
Selegiline
Depression/Parkinson's Disease
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LIMITED BENEFITS
MEDICATION
CONDITION
DECLINE
Selzentry
HIV
Y
Schizophrenia/Bipolar Disorder/Major Depression
Seroquel
Y
Simeprevir
Hepatitis C
Y
Sinemet
Parkinson's Disease
Sofosbuvir
Hepatitis C Hepatitis C
Y Y Y
Sovaldi
Spironolactone
High Blood Pressure/CHF/Edema
Tacrine
Alzheimer's Disease
Y
Tacrolimus Tamoxifen
Prevent Organ Transplant Rejection
Y
Cancer Cancer
Y Y
Tarceva Tasmar Tegretol
Parkinson's Disease
Seizures/Bipolar Disorder
Y
Tetrabenazine
Huntington's Disease/Chorea
Y
Thorazine Tolcapone
Schizophrenia
Y
Parkinson's Disease
Trexall Valium Vasotec Xeloda
Cancer/RA
Anxiety/Alcohol Withdraw/Muscle Spasm
Y Y
CHF/High Blood Pressure
Colon/Breast CA
Y Y
Xenazine Zaroxolyn
Huntington's Disease/Chorea
Fluid Retention/CHF
Y Y Y Y Y
Zestril
CHF/High Blood Pressure
Ziprasidone
Schizophrenia/Bipolar Disorder
Zoloft
Panic Disorder/Depression/PTSD
Zyprexa
Schizophrenia/Bipolar Disorder
Zytiga
Cancer
Y
Medications/Therapeutic Use Reference Want instant access to this medication list on your phone? Scan this QR!
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Situations Requiring a New Application A new application is required if white-out or liquid paper has been used on the application, or a change was made to the application and not initialed by the applicant. If the incorrect state-approved application was submitted. Only the most recent state- approved application will be accepted. If the status of the available application is in question, please call Sales & Marketing to confirm the application form number. Eligibility Questions Ineligible conditions include: For the Base Plan • Acquired Immunodeficiency Syndrome (AIDS), Human Immunodeficiency Virus (HIV), Arthrogryposis Dysfunction-Cholestasis (ARC). • Eligible for Medicaid, or on early Medicare due to disability or are disabled. • Receiving assistance or supervision to perform activities of daily living such as bathing, dressing, eating, toileting, getting in or out of bed, or having an inability to control bowel or bladder function. • Received home health care services, or confined in a rehabilitation facility, nursing facility, or assisted living facility. • Being treated or have been diagnosed by a medical professional for Alzheimer’s Disease, dementia, Parkinson’s disease (stage 4 and 5), Huntington’s Chorea, or cognitive impairment. • Receiving treatment by a medical professional for diabetic complications resulting in neuropathy, proliferative retinopathy, kidney disease or failure, renal insufficiency, or kidney dialysis. • Been advised to have tests, treatment or surgery that has not been performed or for which test results are pending within the last 12 months. *Note: Answering “No” to all the medical questions on the application does not guarantee acceptance. The underwriter reviews the applicant’s entire medical history when making their decision.*
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Application Status For your convenience, you may access https://producer.manhattanlife.com/life/account/ login.aspx?AsAgent at any time to verify the processing status of a submitted application. Declined Appeals If the applicant wishes to appeal his/her declined application, a written request must be submitted by the applicant to the Underwriting Manager within 60 days of the decision. If more than 60 days have passed since the decline, the applicant will be required to submit a new application and a telephone interview will be completed. All appeals require medical records pertaining to the condition for which the applicant was declined. It is the responsibility of the applicant to obtain his/her medical records, as Standard Life does not make such requests. Medical records must be submitted to the Underwriting Department directly from the physician’s office and will not be accepted if submitted by the applicant or agent. Please note that Standard Life does not reimburse any fees associated with obtaining medical records or other supporting documentation pertaining to the requested appeal. The written request and medical records may be faxed to 1-713-583-2738 and directed to the attention of the Short-Term Care Underwriting Manager. The request and records may also be mailed to the physical address or post office box noted on page 25 of this Guide. Application Status Codes • Data Entry: In the process of being keyed into the computer system • Pending Agent Appointment: Application processed, but pending agent appointment • Pending PHI: Pending telephone interview with applicant • Withdrawn: Application closed due to insufficient information or documentation. The application can also be withdrawn at the insured or agent’s request. • Declined: Not eligible for coverage Application Assistance If you have any questions about the application or about how to answer any of the questions on the application, please call Standard Life at 1-800-672-4535
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ManhattanLife
Amendments/Endorsements An Amendment and/or Endorsement to the application will be generated for the following reasons: • Any question left blank or answered incorrectly (as determined by a telephone interview). • An error or unclear answer for the plan selection and/or underwriting risk classification. • An error or unclear answer for the date of birth, sex, and/or address. • An error or unclear answer for the modal premium. Withdrawn Policies Applicants who wish to withdraw an issued policy can return the insurance policy indicating they do not wish to keep the insurance policy or may be in the form of a signed letter or other signed written statement. An applicant with a withdrawn insurance policy should be encouraged to return the insurance policy. To receive a full refund of premium, the request to not take the insurance policy must either be post- marked (if sent via mail) or received by the Company (if faxed) within the 30-day free look window. A full refund of the premium for withdrawn insurance policies will be processed 21-days after the date the check was deposited (to ensure the check has cleared the bank). If the applicant requests the refund prior to that, the applicant’s financial institution will be contacted to verify the check has cleared. The refund check and a letter confirming the insurance policy was withdrawn will be mailed to the applicant. A copy of the letter will also be mailed to the writing agent. **Any commissions paid to the writing agent(s) will be reversed. Methods of Payment
The method of premium payment should be selected on page 5 of the application with the modal premium written in the designated field. The modal premium does not include the insurance policy fee (if applicable). The available premium payment modes are as follows:
The amount of each modal premium is calculated by multiplying the annual Policy premium by the applicable modal factors. The modal premiums for Your Policy are shown on the Policy Schedule. Premium Payment Mode Modal Factor Semi-Annually 0.52 Quarterly 0.25 Monthly 0.0833
Direct bill* Annual Semiannual Quarterly
Bank Draft Annual Semiannual Quarterly Monthly
**ManhattanLife 2.0 defaults to Monthly.**
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Agent Guide | Short Term Care
ManhattanLife
Methods of Payment - Continued Bank Draft Pay initial and renewal premiums by bank draft A completed Bank Draft Authorization form must accompany the application. If drafting from a checking account, a voided check must be submitted. If the applicant wishes to draft from a savings account, the Bank Draft Authorization form must be filled out in its entirety. If the information provided is incomplete or unclear, Standard Life will require proof of the routing number and account number from the financial institution. NOTE: If the initial EFT is returned non-sufficient funds (NSF), a second attempt will be made on the 5th business day after we are notified by the Bank. If the second attempt is unsuccessful, payment will be called due, the policy will transition to quarterly direct bill mode, and the initial premium will be required to activate the coverage. If the initial premium is drafted successfully and any renewal premiums are returned NSF, a second attempt will be made on the 5th business day after we are notified by the Bank. If the second attempt is unsuccessful, payment will be called due, and the policy will transition to quarterly direct bill mode. Direct Bill • Acceptable forms of payment: • Personal checks • Electronic bill pay (from applicant) • Business check (business owner must be applicant or spouse of applicant) • Employer-paid retiree benefits (“retiree” or “retirement benefits” should be stated on the memo line) The Following Forms of Payment are NOT Acceptable: • Temporary checks • Personal checks from any individual outside of the applicant’s immediate family (immediate family is considered as spouse, parent, child, sibling) • Business check from a business not owned by the applicant or spouse • Third party checks Claims Restoration of Benefits Some policyholders and agents have been confused when reading the policy language related to restoration of benefits. It is important to note and acknowledge that ManhattanLife is administering this benefit as outlined below. • After receiving facility care, or home health care benefits, if the insured has not received any benefits for 180 days, we will restore their benefit period to its original benefit period. • This restoration of benefits is regardless of whether or not the insured has used their entire benefit period. • The insured would still be subject to the lifetime maximum benefit period outlined in the policy.
AGT-STC 0125
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Agent Guide | Short Term Care
ManhattanLife
Contact Us New business, claims, administration, and overnight mailing address: Standard Life and Casualty Insurance Company 10777 Northwest Freeway Houston, TX 77092 or P.O. Box 925568 Houston, TX 77292 Toll-free number: 1-800-672-4535 Option 1: Direct dial extension Option 2: Standard Life contact information Option 3: Commissions Option 4: Application status Option 5: Customer Service: Policyholder Services, Billing & Premiums. Option 6: Marketing Option 7: Provider benefits, eligibility, and claims status Option 8: PHI - Option 2 for OmniFlex™ Short Term Care Option 9: Pre-Qual - Option 2 for OmniFlex™ Short Term Care Website: www.manhattanlife.com
ManhattanLife Marketing Department Call 1-888-441-0770 for Marketing Support, Agent Licensing, Agent Portal Assistance or Supplies. Marketing Support and Agent Licensing Fax: 1-713-821-6512 For direct access to the Agent Resource Center portal: https://producer.manhattanlife.com Fax Numbers: New Business/Customer Service/Underwriting Fax: 1-713-583-2738 For additional information that has been requested, please include application number Claims Fax number: 1-713-583-0677 To ensure quick processing, please include the policy number on any claims inquiries.
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Underwritten by: ManhattanLife Insurance and Annuity Company 10777 Northwest Freeway, Houston, TX 77092 Standard Life and Casualty Insurance Company PO Box 510690; Salt Lake City, UT 84151-0690
Thank you again for taking the time to learn about our Short-Term Care product. Should you have any additional questions or need more clarity, please do not hesitate to reach out to Sales & Marketing directly at: 888-441-0770 or marketingmail@manhattanlife.com
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