Benefit Payments
A policyholders benefit amount is based on income, what is the minimum and maximum one could be eligible for
$500-$6,000
What does total disability benefit period mean?
The total time Aflac will pay a policyholder in the event of a covered sickness or injury.
What does elimination period mean?
The time that a policy holder must be off work before benefits will be paid.
What is the minimum length of time that a policyholder has to be off of work before the waiver of premium benefit is even considered?
90 consecutive days.
This rider pays $1,000 every 5 years while the policy is in force (up to five times), less any disability claims paid or $100, whichever is greater.
Aflac Value Rider
A policyholder calls you to file a disability claim because they were off of work for a total of 15 days due to a covered sickness. Their policy has a 0/7 elimination period, how many days will this policy pay benefits for?
8 days.
The second number is always sickness.
15 total days off of work, minus the 7 day elimination period, equals 8 days of benefits.
What is the minimum annual salary to qualify for Short- Term Disability?
$9,000
What are the 5 lengths of time for a total disability benefit period?
3, 6, 12, 18, or 24 months
The shortest elimination period for a covered accident is ____ days
zero
For premiums to be waived, Aflac will require an employer's statement (or proof of your inability to preform ____ or more ADLs) and a Physician's statement cerifying your inablitily to preform said duties or activities.
3
Activities of Daily Living
-Bathing
-Maintaining Continence
-Transferring (moving between a chair, bed,or wheelchair)
-Dressing
-Toileting
-Eating
Allows you to purchase additional units of disability coverage to add to your existing short-term disability policy.
Additional Units of Disability Benefit Rider
Policyholder has a 0/30 elimination period and is out of work for 10 days because of a covered accident, policyholder only works 3 days per week. How many days will this policy pay benefits for
10 days
What is maximum guaranteed issue (GI) dollar amount that any one person is eligible for
$4,000
This is the highest dollar amount a policy holder can qualify for without underwriting questions and additional approval from HQ.
Benefit amounts over $4,000 require underwriting questions and additional approval from HQ.
This benefit pays one-half of the daily disability benefit.
Partial Disability benefit.
If your covered sickness or off-the job injury causes your partial disability within 90 days of your last treatment for your covered sickness or off-the job injury. Only payable up to 3 months
The shortest elimination period for a covered sickness is ____ days
Aflac will pay benefit after the seventh day.
Minimum amount of hours worked per week on average to be eligible for a disability policy
19 hours
Provides benefits if a disability is caused by a covered on the job injury while coverage is in force. Available even with workers compensation. Benefits payable up to the total disability benefit period selected. Benefit subject to elimination period shown in the policy schedule and income requirements
Disability Benefit for On-the-Job Injury Rider
Policyholder is out of work for a full month due to a covered on the Job injury, their max benefit amount they are eligible for, for an off the job injury was $2,500. Assuming they enrolled in the max eligible on the job amount (covered by workers compensation) what does this benefit amount pay
$1,200
A policyholder is employed at 2 different employers and is offered Aflac at both. Are they able to combine income and get a single disability policy
No, a policyholder can only have one disability policy and cannot combine income.
Separate Periods of disability, resulting from unrelated causes and not separated by your returning to work at a full-time job for ______ working days during which you are performing the material and substantial duties of such job, are considered a continuation of the prior disability.
14
What does a longer elimination period do to the premium of a disability policy
It reduces the price, the longer the elimination period the less expensive the policy will be.
An illness, disease, infection disorder, or injury for which, within the 12 month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment.
Pre Existing Condition
Frank is the owner of a business and does not have workers compensation for himself, but has a disability policy that has a benefit for $2,000 off the job coverage. How much is he eligible for on the job?
$2,000
If someone is not covered by workers compensation, they are eligible for the total benefit amount for on-the job coverage
Policyholder has been off of work for the maximum GI benefit period and has a benefit amount of $1,000 per month, what does this pay
$6,000
The maximum GI benefit period is 6 months
How is the benefit payment taxed at the end of the year?
It is not taxed at the end of the year as long as it is payroll deducted on and after-tax basis.
Separate Periods of disability, resulting from the same or a related condition and not separated by _______ days or more, are considered a continuation of the prior disability.
180
A policyholder has a company paid 6 month disability policy with another carrirer that pays 72% of her income (maximum amount allowed) but wants longer coverage. What is her option for an Aflac disability policy
Jan could do a 180/180 elimination period with either a 12, 18, or 24 month benefit period.
What is the maximum period of disability allowed for disability due to childbirth? Noncesarean? Cesarean?
Six weeks for noncesarean
Eight weeks for cesarean
If Peter is eligible for $1,100 off the job, how much is he eligible for on the job
$500
The on the job benefit is 50% of the eligible off the job benefit. If that amount ends in $50 it is rounded down to the closest hundred.
Policyholder was paid for 66 days on his disability policy, from 7-21-2018 to 9-24-2018 at a rate of $73.33 per day. If policyholder returns to work on Monday, he would owe Aflac the overpayment amount of $586.64 for the 8 days the he has already been paid for. If he were to come back on light duty and make less than this percentage of his pre-disability income, he would be eligible for partial-disability, that pays out at $36.67 per day which is 50% of his total disability amount. Either one has to be verified by a doctor with further documents.
80%