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Personal Cancer Indemnity

This document outlines the key aspects of the Personal Cancer Indemnity (PCI) insurance policy provided by Aflac. It highlights cancer statistics, including risks for men and women in the U.S., and emphasizes the importance of regular screenings for early detection. Detailed benefits cover out-of-pocket expenses, wellness benefits, first-occurrence payments, hospitalization, and various treatment-related expenses including advanced therapies. Additionally, it outlines specific provisions and the application process, making it a vital resource for agents in the field to assist clients effectively.

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Personal Cancer Indemnity

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  1. Personal Cancer Indemnity

  2. Field Sales Guide • M-1071 • Standard information only. • Refer to state-specific introduction package for variations. • Page numbers on slide match those in book. Page 9 Personal Cancer Indemnity

  3. Introduction

  4. Cancer Facts • In the United States: • Men: 1-in-2 lifetime risk of developing cancer. • Women: 1-in-3 risk. • Regular screening exams could increase survival rate. Page 15–16 Personal Cancer Indemnity

  5. Why AFLAC’s PCI? • Out-of-pocket costs (copayments and deductibles). • Additional expenses not necessarily covered by major medical. • Wellness Benefit promotes early detection! Page 16 Personal Cancer Indemnity

  6. Policy Provisions

  7. Important Provisions • 30-day waiting period. • Effective date. • Diagnosis date. Page Personal Cancer Indemnity

  8. Policy Benefits

  9. PCI Highlights • All benefits are indemnity. • Three distinct plan levels. • Simplified application process. Page 23 Personal Cancer Indemnity

  10. Mammogram Breast Ultrasound Pap Smear ThinPrep Biopsy Flexible Sigmoidoscopy Hemocult Stool Specimen CEA CA 125 PSA Thermography Colonoscopy Virtual Colonoscopy Chest X-ray Cancer Screening Wellness Benefit Payable once per person per calendar year Page 24 Personal Cancer Indemnity

  11. First-Occurrence Benefit • One-time payment made upon the diagnosis of internal cancer: • Insured/Spouse Child Level 1 $1,500 $2,250 Level 2 $2,000 $3,000 Level 3 $5,000 $7,500 • Internal cancer includes melanomas classified as Clark’s Level III and higher or a Breslow measurement (thickness) greater than 1.5 mm. Page 25 Personal Cancer Indemnity

  12. Hospital Confinement Medical Imaging Benefit Benefit • Level 1: $200 days 1–30 • $400 days 31+ • Levels 2 & 3: $300 days 1–30 $600 days 31+ • Pays for initial diagnosis or follow-up evaluation of internal cancer. • Level 1 $100 • Level 2 $150 • Level 3 $200 • Once per person per year Page 26 Personal Cancer Indemnity

  13. Radiation and Anti-Nausea Benefit Chemotherapy Benefit • Level 1 $100 • Level 2 $125 • Level 3 $150 • Level 1 $200/day • Levels 2 & 3 $300/day • Radiation Therapy • Must Be FDA or NCI Approved • Not Payable Same Day as Experimental Treatment Page 27 Personal Cancer Indemnity

  14. Experimental Treatment Immunotherapy Benefit Benefit • Level 1 $200/day • Levels 2 & 3 $300/day • Must be NCI approved • Not payable same day as Radiation and Chemotherapy • Level 1 $300 • Lifetime maximum $1,500 • Level 2 $400 • Lifetime maximum $2,000 • Level 3 $500 • Lifetime maximum $2,500 • Not payable for medications paid by R&C or Experimental Benefits Page 28 Personal Cancer Indemnity

  15. Nursing Services Benefit Surgical/Anesthesia Benefit • Benefits listed in Schedule of Operations • Procedures through same incision considered one • Additional 25% paid for anesthesia • Excludes skin cancer and reconstructive surgery • Level 1 $100 • Level 2 $125 • Level 3 $150 • Payable only for days when Hospital Confinement paid Pages 29–30 Personal Cancer Indemnity

  16. Outpatient Hospital Skin Cancer Surgery Surgical Benefit Benefit • All Levels: • Biopsy $100 • Excision of skin lesion $100 • Flap or graft $375 • Excision with flap or graft $600 • Level 1 $200 • Levels 2 & 3 $300 Pages 30–31 Personal Cancer Indemnity

  17. Prosthesis Benefit • Surgically implanted • Level 1 $2,500 • Level 2 $3,000 • Level 3 $3,000 • Non-surgically implanted • Level 1 $200 • Level 2 $225 • Level 3 $250 • Lifetime maximum of 2 each • Not payable for TRAM Flap procedure Page 31 Personal Cancer Indemnity

  18. Reconstructive Surgery Benefit • Facial Reconstruction • Level 1 $625 • Levels 2 & 3 $700 • Additional 25% paid for anesthesia • TRAM Flap • Level 1 $2,500 • Levels 2 & 3 $3,000 • Breast Reconstruction • Level 1 $625 • Levels 2 & 3 $700 • Breast Symmetry • Level 1 $325 • Levels 2 & 3 $350 Page 32 Personal Cancer Indemnity

  19. Inpatient During a covered confinement; benefit is multiplied by the number of days confined Level 1 $50 Level 2 $100 Level 3 $150 Outpatient During outpatient treatment in physician’s office, clinic, hospital, or ambulatory surgical center Level 1 $200 Levels 2 & 3 $250 Blood and Plasma Benefits Pages 32–33 Personal Cancer Indemnity

  20. Second Surgical Opinion NCI Evaluation/Consult Benefit Benefit • Level 1 $200 • Level 2 $250 • Level 3 $300 • Not payable same day as NCI Evaluation/ Consultation Benefit • $500 benefit • Additional $250 transportation/lodging costs • If more than 50 miles from home • Payable at Aflac Cancer Center • Not payable same day as Second Opinion Benefit Page 33 Personal Cancer Indemnity

  21. Ambulance Benefit Transportation Benefit • More than 50 miles from home • Level 1 $.40 per mile • Limit $1,200 • Levels 2 & 3 $.50 per mile • Limit $1,500 • Treatment for dependent child • 2 adults to accompany child • $200 ground • $1,000 air • Limit 2 trips per confinement Page 34 Personal Cancer Indemnity

  22. Lodging Benefit Transplantation Benefit • More than 50 miles from home • Level 1 $50 • Levels 2 & 3 $60 • Limit of 90 days per year • Payable once per person • Bone Marrow • $10,000 inpatient/outpatient • $1,000 for donor • Stem Cell • Peripheral stem cell • Level 1 $2,500 • Levels 2 & 3 $5,000 Pages 34–35 Personal Cancer Indemnity

  23. Extended-Care Facility Benefit • Within 30 days of hospital confinement • $100 per day for confinement • Limited to same number of days Hospital Confinement paid • Not payable on same day as Hospital Confinement • If extended-care stays separated by 30 days, second stay not covered unless again confined to hospital • Limit of 365 days per person Page 35 Personal Cancer Indemnity

  24. Hospice Benefit Home Health Care Benefit • First day • Level 1 $500 • Levels 2 & 3 $1,000 • Each day thereafter • All Levels $50 • Not payable same day as Home Health Care • Limit of $12,000 per person • $50 per visit • Within 7 days of hospital release • Authorized by physician • Licensed/certified person • Limit • 10 visits per hospitalization • 30 visits per year per person Page 36 Personal Cancer Indemnity

  25. Waiver of Premium Continuation of Benefit Coverage Benefit • Disability for at least 90 days • Inability to perform usual job • 2 or more ADLs if unemployed • Waived if receiving Hospice Benefits • Up to two months • Payroll deduction • 6 consecutive months • 30 days notification • Insured re-establishes premium payment Page 37 Personal Cancer Indemnity

  26. Optional Riders

  27. Building Benefit Rider Return of Premium Benefit Rider • Increases the FOB by $100 • per unit purchased • Builds until age 65 or internal cancer diagnosed • Issue ages: • 18–70 payroll • 18–64 nonpayroll • Cash value based on AP • Benefit is less any claims paid, including Wellness • Begins after 5 years; maximum refund at 20 years • Not eligible as pre-tax or employer-paid • Issue ages: 18–59 Page 67 Personal Cancer Indemnity

  28. Specified-Disease Benefit Rider • Benefits for hospital confinement due to listed diseases • 10 new diseases added • Issue ages: • 18–70 on payroll • 18–64 on non-payroll Page 67 Personal Cancer Indemnity

  29. Administrative Guidelines

  30. Administrative Guidelines • Payroll: 18–70 • Nonpayroll: 18–64 • Available to: • field force • government allotment • Dependent children to age 25 • Eligible for pre-tax • ROP Rider • Advanced Effective Date • Payment Modes • Domestic Partners • 1099 Workers Page 77 Personal Cancer Indemnity

  31. Completing the Application

  32. Applications and Forms • Payroll Application A-75001 • Nonpayroll Application A-75002 • Payroll Cancer History Form A-75030P • Nonpayroll Cancer History Form A-75030D • Conversion Application • Application to Remove Skin Cancer Exclusion Rider A-90030R Pages 94–111 Personal Cancer Indemnity

  33. Direct on SmartApp®

  34. Direct on SmartApp® Bank Draft Authorization • Bank draft and credit card only • Drafted immediately • Effective date • Draft date • Transit/ABA and account numbers • Separate BDA for each application Page 115 Personal Cancer Indemnity

  35. Sales Support Material

  36. Sales Support Materials • Brochures • A-75175 Level 1 – A-75275 Level 2 – A-75375 Level 3 • Insert Pages • A-75075 Building Benefit Rider • A-75076 Return of Premium Rider • A-75077 Specified-Disease Rider • A-59276 NCI-Designated Cancer Centers • Mailer • A-75080 Page 121 Personal Cancer Indemnity

  37. Leave With the Applicant

  38. Leave with the Applicant • Brochure/Insert Page(s) • Guide to Health Insurance for People with Medicare - if applicable • Replacement Notice, if required by state • A-8691, if applicable • Outline of Coverage, if required by state • Applicant must acknowledge receipt of outline on the application or business will be returned • A-75125 Level 1 A-75225 Level 2 A-75325 Level 3 Page 125 Personal Cancer Indemnity

  39. Premium Rates

  40. Types of Coverage Premiums • Individual • One-Parent Family • Under age 25, and qualified by IRS) • Two-Parent Family • named insured, spouse, dependent children • M-RS068 • Payroll, Direct, and Association rates • Premium Quote and SmartApp® • Premium Worksheet M-1061 Pages 129–133 Personal Cancer Indemnity

  41. Commissions

  42. Commissions • ROP rider has a separate commission package • PCI production eligible for: • stock bonus • nationally sponsored contests Page 137 Personal Cancer Indemnity

  43. Claims

  44. Claims • Cancer • S-2029 (see S-3087) • Pathology report required for first claim • Wellness • Automated letters sent annually after first claim • Specified-Disease • Use form S-2029 • Return of Premium • Submit written request to Claims • Waiver of Premium • Use form H-C0019 Page 145 Personal Cancer Indemnity

  45. Consultative Sales Process

  46. Marketing PCI

  47. Commitment Objective • What do you want to accomplish? • Set a clear commitment objective before the meeting. • Something that will move the sales process forward. Page 154 Personal Cancer Indemnity

  48. List of Forms for Selling PCI

  49. PCI Forms • Leave with applicant: • Brochure and NCI insert page • Rider Insert Pages • Outline of Coverage • Obtain from applicant: • Application • Cancer History Form • Replacement Notice • Statement of Understanding • if effective date advanced more than 60 days • Mailed with policy packet: • Welcome Letter • Policy • Selected Riders • Privacy Forms • Copy of Application • Replacement Notice, if applicable Page 170 Personal Cancer Indemnity

  50. PCI Forms • Additional forms • Mailer A-75080 • Field Sales Guide M-1071 • Guide to Health Insurance for People with Medicare A105712004 • Rate Booklet M-RS068 • Premium Worksheet M-1061 • Reinstatement Application A-75003 • Transmittal M-0018R • Payroll Account Acknowledgement Form M-0138 • Request for Change Form H-L0046 • Claims Instruction Sheet S-3087 • Claim Form S-2029 Page 170 Personal Cancer Indemnity

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