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 175 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 175 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, the underwriting process, application fees, 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 health-related services can be a major concern for a growing segment of the population, whether it’s facility-based care, rehabilitative or professional home health care. 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 simpler! One of the tools that will make your life easy is our Agent Resource Center or ARC, as we often refer to it. ARC was developed to ensure producers have easy access to all the brochures, applications and forms that may be needed. ARC is also where you will find 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 material. 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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Agent Guide | Short Term Care
ManhattanLife
Table of Contents Base Plan Highlights & Optional Benefits...........................................6 Availability.......................................................................................6 Base Plan Highlights.......................................................................6 Optional Benefits.............................................................................6 Product Availability Map.....................................................................7 Application Fee & Spousal Discount..................................................7 Submitting Paper Applications...........................................................8 Easy Upload Feature..........................................................................8 Required Forms..................................................................................8 Required Application Information......................................................9 Top Reasons for Application Delays...................................................9 Policy Issue Guidelines.......................................................................10 Underwriting.......................................................................................10 Pre-Determination Request.............................................................11 Health Questions.............................................................................11 Telephone Interviews......................................................................11 Pharmaceutical Information............................................................11 Situations Requiring a New Application.............................................12 Eligibility Questions............................................................................12 Application Status..............................................................................13 Appealing a Declined Application.......................................................13 Application Status Codes...................................................................13 Application Assistance.......................................................................13 Endorsements. ...................................................................................14 Withdrawn/Not Taken........................................................................14 Methods of Payment..........................................................................15 Bank Draft.......................................................................................15 Direct Bill.........................................................................................15 Forms of Payment Not Accepted....................................................15 Claims.................................................................................................15 Restoration of Benefits...................................................................15 Contact Us..........................................................................................16 ManhattanLife Marketing Department...............................................16 Fax Numbers......................................................................................16
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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. This allows for a multitude of base benefit levels, elimination periods and 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 and/or Home Health Care (if coverage applies) 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 Availability Map Click on this QR Code to download the Product Availability Map on Resource One
Application Fee & Spousal Discount 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 ManhattanLife always recommends submitting applications through ManhattanDirect 2.0, 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 telephone. 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 telephone, 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 – Please see the Easy Upload Feature section below for instructions. • Fax – 1-713-481-8216 Attention: New Business • Mail – P.O. Box 924408 Houston, TX 77292 or Overnight/Specialty Mail: 10777 Northwest Freeway STE 500 Houston, TX 77092 Easy Upload Feature The Easy Upload tool can be used to upload applications rather than mailing or faxing them. Please note that currently Easy Upload will only accept PDF files. Therefore, the application must be scanned and converted to a PDF to be attached. There are instructions located in the “Help” section found to the left of the Easy Upload area in the Agent Resource Center. It should be noted that in order to submit via Easy Upload, you must be logged into our 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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Agent Guide | Short Term Care
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Required Application Information Whenever possible we highly recommend utilizing our ManhattanDirect 2.0 enrollment platform, as paper submissions often have often cause 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 first 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. • Premium check from any third-party payor. • Date of birth • Plan selection • Correct Premium • 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. • Information listed on application does not align with Prescription Drug History.
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Agent Guide | Short Term Care
ManhattanLife
Policy Issue Guidelines The policy issued is specific to where the application is signed. Laws, limitations and regulations may apply and vary by state. 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 Short-Term Care policy for any ManhattanLife company Short-Term Care policy of lesser or greater value, or a policy with an external company. Internal replacements with a benefit increase require a newly completed application and will be subject to full underwriting. For internal replacements, we will use the same underwriting criteria; however, we will also use our claims database to assist in determining the risk of an applicant. Benefit decrease do not require an application and can be done at any time with submission of the request in writing. Benefit decreases do not require a new application and can be done at any time via a written request. 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 Can agents submit a pre-determination request for the Short-Term Care product? Yes. If you are curious about whether your client will qualify for a Short-Term Care policy, simply send the below details to stcunderwriting@manhattanlife.com and let us guide you! • Name (Nice to have, but not required) • Age • Health History, Diagnosis Dates • Prescription history • Date of your last physical examination Please provide details on any other information we may need. Information such as date of onset/diagnosis, severity, treatment details, and any limitations caused is very helpful. 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 thorough 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 Telephone interview, the application will be declined or withdrawn. * Any deviations from the application and information gathered during a Telephone 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 underwriting 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 pharmaceutical information received. Pharmaceutical information provided for the underwriting process will not be the sole factor in determining if coverage is approved.
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Agent Guide | Short Term Care
ManhattanLife
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 at 1-888-441-0770. 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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Agent Guide | Short Term Care
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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. Appealing a Declined Application 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: • Fax – 1-713-481-8216 Attention: New Business • Mail – P.O. Box 924408 Houston, TX 77292 Application Status Codes • Pending Review: New Application in process • 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 • Pending Info: Additional information is needed to complete underwriting. • Underwriting: Application is being reviewed for risk assessment. 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 1-800-879-6542
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Agent Guide | Short Term Care
ManhattanLife
Endorsements An 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/Not Taken An application that has not completed the underwriting process or has not been issued can be withdrawn by contacting ManhattanLife. If an applicant wishes to no longer be covered under an issued policy, they can return the insurance policy in the form of a signed letter or other signed document, therein indicating they do not wish to keep the policy. An applicant with a withdrawn insurance policy should be encouraged to return the insurance policy. To receive a full refund of the 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. Once the original premium check has been cleared by the bank, a full refund of the premium will be issued. 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 terminated 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.
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Methods of Payment The method of premium payment should be selected on 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.**
Bank Draft Pay initial and renewal premiums by bank draft. A completed Bank Draft Authorization form must accompany the application and be filled out in its entirety. Direct Bill Acceptable forms of payment: • Personal checks • Electronic bill pay (from applicant) The Following Forms of Payment are NOT Accepted: • Temporary checks • Employer-paid health coverage for current employees • Business check from a business not owned by the applicant or spouse • Third party checks Claims Restoration of Benefits 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.
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Agent Guide | Short Term Care
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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 924408 Houston, TX 77292 Toll-free number: 1-800-879-6542 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: 1-713-481-8216 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 all 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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