Frequently Asked Questions – Specified Disease Rider General Product Updates What states are currently available?
AL, AR, AZ, FL, GA, KY, LA, MI, MO, NC, NE, NV, OK, SC, SD, TN, WI, WV, WY Specified Disease Rider Overview What deductible options are available under the Specified Disease Rider? $25,000, $50,000, $75,000 and $100,000 What are the Calendar Year and Lifetime Maximums? Calendar Year Maximums: $250,000 and $500,000 Lifetime Maximum: $2,000,000
Where can I find details about the conditions covered? Covered conditions are listed in the Specified Disease Rider brochure. • Amputation • Amyotrophic Lateral Sclerosis (ALS) • Angioplasty • Cancer (Internal) • Coronary Artery Bypass Surgery • End Stage Renal Failure • Heart Attack Eligibility & Underwriting Can the Rider be added after the base policy is approved?
• Heart Valve Surgery • Implantable Cardiac Defibrillator • Joint Replacement • Major Organ Failure/Organ Transplant • Pacemaker Implant • Ruptured Aneurysm • Stroke (Ischemic or Hemorrhagic)
Yes. A new application must be submitted and will be subject to underwriting. A pre-existing condition period applies for the first 12 months. The Rider’s effective date will align with the base policy’s paid-to-date.
Do I need to wait until the policy anniversary date to add the Rider? No, the Rider can be added at any time once underwriting approves the request. What is the process for adding the Rider after policy approval?
To add the Specified Disease Rider to an existing policy, a new application must be submitted that references the current policy number. This notation must be included with the submission. The application may be submitted through 2.0 or by using a paper application.
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Frequently Asked Questions – Specified Disease Rider Eligibility & Underwriting If the Rider is declined, will the base coverage remain active? Yes, the base policy stays active. The only exception is if underwriting uncovers undisclosed information on the original application. Is the Rider available for children? The Rider is not available for child-only coverage. However, dependents can be covered until age 26 if included under a parent’s policy. What health conditions make a Specified Disease applicant uninsurable? Applications should not be submitted if the applicant has been diagnosed, treated or tested abnormally for any of the conditions listed in the Uninsurable Health Conditions section for the last 10 years. What about uninsurable procedures or surgeries? Applicants with procedures such as angioplasty, coronary bypass, dialysis or stent placement are uninsurable. What additional rules apply to the Specified Disease Rider underwriting? Certain musculoskeletal, joint and autoimmune diseases are ineligible (e.g., rheumatoid arthritis, ankylosing spondylitis). Conditions like asthma, diabetes and high blood pressure have specific control and medication requirements. Can an applicant who is currently pregnant apply? No. Applications will be declined if the applicant, or any of the applicants’ dependents (spouse or child(ren) under the age of 26), whether applying for coverage or not, is currently pregnant or in the process of adopting a child. How does the network discount work with the Specified Disease Rider? The network discount applies to the Affordable Choice base policy. This means the discount is applied to services considered under the AFC policy, regardless of whether they are covered. ManhattanLife does not apply the discount to the rider itself, as the rider pays benefits that are already accounted for under the base policy. In other words, the network discount has effectively already been factored in. Deductible How are expenses/benefits handled if the deductible has not been met? The insured will pay the deductible to the provider until the full deductible is met. In an instance where the claim is more than the deductible, the insured will fulfill the deductible and ManhattanLife will pay the remaining to the provider (deductible payment from insured is not required for ManhattanLife to pay). Example #1: If an insured has a $50,000 deductible and a $35,000 Specified Disease claim, the full $35,000 is owed to the provider from the insured, and no benefits are paid from ManhattanLife. Example #2: If an insured has a $50,000 deductible and an $80,000 Specified Disease claim, the client would pay the $50,000 deductible and ManhattanLife would pay the remaining $30,000 of the claim to the provider.
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Frequently Asked Questions – Specified Disease Rider
Policyholder Experience Does the insured present a different ID card for the Specified Disease Rider? No. The insured will continue to use their Affordable Choice (AFC) ID card. No separate Rider card will be issued. Are benefits linked to the First Health PPO network discounts? Yes. Members are encouraged to use First Health PPO providers for additional savings, though it’s not required. Is there a separate commission structure for the Rider? There are no additional commissions when adding the Specified Disease Rider. However, since the Rider increases premium, agents will see larger commissions and renewals. Is the Rider required with Affordable Choice? No. The Rider is optional — applicants can choose whether to include it. Real-Life Scenarios Scenario 1: Adding Rider After Policy Issuance Agent Sarah helps a client who already has an Affordable Choice policy but now wants to add the Specified Disease Rider for extra protection. Sarah explains that the Rider can be added anytime post-approval, but it requires underwriting. She guides the client through submitting through 2.0 or a paper application and During a client meeting, Agent James walks a customer through the different deductible levels ($25k to $100k) and the calendar year and lifetime maximums associated with the Specified Disease Rider. The client wants to understand the financial limits before deciding on the rider. James also points them to the brochure listing covered conditions. Scenario 3: Addressing Eligibility Concerns clarifies that the base policy remains active if the Rider is declined. Scenario 2: Explaining Deductibles and Maximums Agent Maria receives an application from a client who has a recent history of coronary bypass surgery. She refers to underwriting guidelines and explains that the client is uninsurable for the Rider due to their surgery history. Maria suggests focusing on base Affordable Choice coverage while keeping the Rider optional for future consideration.
Underwritten by: ManhattanLife Insurance and Annuity Company 10777 Northwest Freeway, Houston, TX 77092
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