bsc specialty benefits insurance-master
TRANSCRIPT
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Blue Shield of California BSC Specialty Benefits insurance
eLearning
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course goal
learn The goal of this course is to educate the BSC staff of the Specialty Benefits Insurance plans, characteristics, processes and product line.
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agenda
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SectionOne
SectionTwo
SectionThree
SectionFour
ProductAssessme
nt
SectionOneintroduces you to the BSC Specialty Benefits Insurance plan overview and shows how the products support it
SectionFourdescribes the Life Insurance plans and Accidental Death & the Dismemberment (AD&D) family of products
There is an Assessmentatthe end of the course
SectionTwodescribes Dental plan family of products
SectionThreedescribes Vision plans
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Section 1Introduction to Blue Shield of California Specialty Benefits
insurance eLearning
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BSC specialty benefits
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Sweeten the deal for your clients by offering the convenience of comprehensive coverage, all in one place. Blue Shield’s specialty benefits offer affordable dental, vision, life insurance and accidental death & dismemberment (AD&D) plans supported by the same dedicated customer service we’re known for.
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learning objectives
After completing this section, you will be able to:
Define the different types and characteristics of the following BSC specialty benefits insurance plans in this overview
• BSC specialty benefits insurance plans overview• dental plans• vision plans• life insurance plans and accidental death &
dismemberment (AD&D)
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BSC business strategy
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SpecialtyBenefits
DentalPlans
VisionPlans
Life&AD&DInsurance
Our Mission is to ensure all Californians have access to high-quality healthcare at an affordable price.
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some terms you should know
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INO
dualoption
HMO
PPOout-of-networ
k
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benefit solutions savings & rate guarantees
Benefit Solutions helps save on plan premiums when fully insured mom-voluntary dental, vision and life insurance coverage is added, where savings is earned off medical rates for each specialty product added, and secure a two-year guarantee on dental, vision and insurance plans.
This program is available for groups with 101 to 249 employees seeking to combine medical coverage with dental, vision and life insurance, and is also available for larger groups up to 1,000 members and wish to add new dental coverage to existing Blue Shield medical plans.
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knowledge check
You will now be presented with a Knowledge Check activity. This self-check is not graded and will help you measure what you have learned in this section to help prepare you for the final assessment.
After selecting your answer to each question, click SUBMIT.
Click NEXT to begin.
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Next
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question slidesQuestions in notes:
1. What is an INO?a) An international organizationb) An in-network organizationc) Elmo’s sisterd) An out-of-network organization
2. What is meant by ‘dual option’?a) Plans allow you to choose two plans that you can offer your employees
instead of just one.b) Confusion about a choice between two plansc) A fork in the roadd) The lesser of two evils
3. The benefits solutions program is available for groups between ___e) 200 - 1000f) 50 - 100g) 101 - 249h) None of the above
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summary
In this section you learned:
• basic Specialty Benefit terms• BSC ‘chassis’ products• BSC strategy• an overview of Specialty Benefit products linked to strategy
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Section 2Dental plans
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dental plans
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As easy as 1, 2, 3 Blue Shield offers flexible dental plan options to fit clients’ needs and budgets.
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learning objectives
After completing this section, you will be able to define the different types and characteristics of the following BSC specialty benefits dental insurance plans:• dental plan product overview• BSC Dental
• HMO plans• PPO plans• INO (in-network only) plans
• flexible Dental plans• benefit Solutions• large network plans• dual options• orthodontic coverage
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dental plan overview
Advantages worth smiling aboutBenefitsolutionsYour clients can save on their medical plan when they add fully insured,non-voluntary dental, vision, or life insurance coverages. With Benefit Solutions, your clients can earn up to 1.75% off medical rates when specialty products are added.
AccesstolargenetworksThe dental PPO and dental INO (in-network only) networks include more than 37,000 provider locations in California and 297,500 nationwide, and the dental HMO network includes more than 24,000 provider locations in California.
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dental plan overview
Advantages worth smiling aboutPlanchoiceYour clients have a choice of dental PPO, INO, HMO, Voluntary, and Dual Option plans. PPO and INO voluntary plans include a 12-month waiting period for Major and Orthodontic services.
OrthodonticcoverageoptionPPO and INO plans with orthodontic coverage include a $1,000 calendar-year maximum for children and adults. HMO plans include specific member copayments for orthodontic coverage.
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BSC dental
Dental plansWhile you help your clients consider their options, remember that dentalcoverage is an essential part of a benefits package. It can help your clients maintain a happy, healthy workforce, which helps their bottom line. Groups with 101+ or more eligible employees can select any Blue Shield Core Accounts dental plan with or without our health plans.
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HMO plans
Dental HMO plans• our dental HMO plans offer your clients several ways to help
protect their bottom line while safeguarding their employees’ oral health
• within our three dental HMO plan families, your clients can choose between the basic, plus, and deluxe plans
• there is also a voluntary plan available for clients looking to offer a quality plan with no employer contributions
• this portfolio helps simplify dental coverage for your clients by offering lean, middle, or rich benefit designs
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HMO plans
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PPO plans
Dental PPO plansOur wide range of affordable dental PPO plans gives your clients’ employees options to choose any dental provider they want, and also save money by using a participating provider.
Choose from a range of plans:• richer benefit plans (SmileSMSpectrumPremierPlusand SmileSM
SpectrumPremierplans)• middle benefit plans (SmileSMSpectrumplans)• leaner benefit plans (SmileSMBasicand SmileSMBasicVoluntary)
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PPO plans
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PPO plans
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INO plans
Dental in-network only(INO) plansEmployers can select from a range of options that best suit their business needs and budget.
Our SmileSMIn-NetworkOnly(INO)DentalPlan*network includes all the same providers as the dental PPO network. Members can access covered services from any provider in the INO network.† There is no coverage for services received outside of this network.* Underwritten by Blue Shield Life.† Dental providers in and out of California are available through a contracted dental plan administrator.‡ Voluntary dental INO plans have a 12-month waiting period for major and orthodontia services.# The following additional or enhanced periodontal benefits are available for women during pregnancy: One additional routine adult prophylaxis (including one additional periodontal
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INO plans
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INO plans
The Dental INO plan has four configuration options:• voluntary or contributory• $1,500 or $2,500 calendar-year benefit maximum• endodontics and periodontics (surgical or complex) covered at
either 50% or 80%• with or without orthodontia
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flexible dental plans
Blue Shield offers flexible dental plan options to fit your clients’ needs and budgets:
• $1,000, $1,500, or $2,000 calendar year maximum (dental PPO and dental in- network only)
• with or without orthodontic coverage (dental PPO and dental in-network only)
• access in- and out-of-network (dental PPO) or in-network access only (dental HMO or INO)
• customized to your clients’ needs or turn-key portfolio plans• no claim forms required when members receive services from
network providers• no copayment for covered diagnostic and preventive care• all plans include oral cancer screening
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benefit solutions
Benefitsolutions
Your clients can save on their medical plan when they add fully insured,non-voluntary dental, vision, or life insurance coverages.
With Benefit Solutions, your clients can earn up to 1.75% off medical rates when specialty products are added.
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large network plans
Accesstolargenetworks
The dental PPO and dental INO (in-network only) networks include more than 37,000 provider locations in California and 297,500 nationwide, and the dental HMO network includes more than 24,000 provider locations in California.
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dual options
Dualoptiondentalplans
Help your clients offer the dental dual option to provide employeeswith choices between dental plans, including voluntary plans. The participation and contribution requirements vary, depending on the mix of plans offered. For example, when offering two non-voluntary plans, the requirements are 50% employee participation and 50% employer contribution. There are no employee participation or contribution requirements when offering two voluntary plans.
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orthodontic coverageOrthodonticcoverageoption:PPO and INO plans with orthodontic coverage include a $1,000 calendar-year maximum for children and adults. Voluntary plans include a 12-month waiting period for Orthodontic services.
HMOplansincludespecificmembercopaymentsfororthodonticcoverage(seebelow)andarenotsubjecttoawaitingperiod.
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knowledge check
You will now be presented with a Knowledge Check activity. This self-check is not graded and will help you measure what you have learned in this section to help prepare you for the final assessment.
After selecting your answer to each question, click SUBMIT.
Click NEXT to begin.
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Next
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question slidesQuestionsinnotes:1. Benefit Solutions, your clients can earn up to ____ off medical rates
when specialty products are added a) 10%b) 1.75%c) 2.0%d) 0.5%
2. PPO and INO plans with orthodontic coverage include a ____ calendar year maximum for children and adults
a) $2,000b) $5,000c) $1,000d) $1,500
3. The dental INO plan has ____ configuration optionse) 4f) 7g) 10h) 3
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summary
Inthissectionyoulearned:• basic dental terms• BSC ‘chassis’ products• BSC strategy• dental products linked to strategy
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Section 3Vision plans
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vision plans
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Vision coverage is an essential part of a comprehensive benefits package that can help your clients maintain a happy, healthy workforce and increase employee productivity.
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learning objectives
After completing this section, you will be able to define the different types and characteristics of the following BSC specialty benefits vision insurance plans:
• Why sell vision • About BSC Vision Plans • Blue Shield vision portfolio
• easy-to-choose• rich plan benefits• contact lens benefits
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some terms you should know
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easy-to-
chooseplans
Lasik
richplan
benefits
BSC
visionplans
vision
portfolio
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why sell vision?Visioncoverageis an essential part of a comprehensive benefits package that can help your clients maintain a happy, healthy workforce and increase employee productivity, which helps their bottom line.
ReturnoninvestmentVision benefits offer a positive return on investment by increasing workforce productivity. More than 90% of adults report using digital devices more than two hours a day, putting them at risk for digital eye strain. Digital eye strain is the physical eye discomfort felt by many individuals after two or more hours in front of a digital screen.
VisionCareisvaluedbyemployeesAccording to research from Brill Street + Company, 92% of Millennials reported that health, dental and vision insurance coverage is influential or very influential to them when considering an employer.
Visionexamscanprovideearlydetectionofmanychronicconditionsreducingoverallcostofhealthcare.a comprehensive eye exam can detect heart disease, hyper-tension, high blood pressure and diabetes in addition to well known screenings for glaucoma, cataracts, and other vision impairments.
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BSC vision care plans offer moreSatisfydemandsforabigprovidernetworkwith one of California’s largest networks of ophthalmologists, optometrists and opticians:
• more than 6,725 in California• 25,049 locations nationwide
Easeaccesstocareissueswith member choice. Members have access to private practice eye care providers as well as the convenience of retailers like Lens Crafters, Target and Wal-Mart Optical and For Eyes Optical, warehouse clubs and wholesalers like Sam’s Clubs and Costco.
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BSC vision care plans offer moreVisionandLASIKdiscountprogramsare available to all Blue Shield members including:
• discount LASIK surgery programs that let members save up to 20% on at surgery centers throughout California using one of our discount program providers: QualSight LASIK or NVISION Laser Eye Centers
• vision plan members can receive a 20% discount off the published retail prices when they use a participating California provider in the Discount Vision Program network for services and supplies such as routine eye examinations, frames and lenses, extra pairs of glasses, non-prescription sunglasses, and tints and coatings
• MESVisionOptics.com to access the online network provider to purchase contact lenses online using your benefits or get great savings on Plano sunglasses, readers and other accessories
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BSC vision plans
Returnoninvestmentvision benefits offer a positive return on investment by increasing workforce productivity. More than 90% of adults report using digital devices more than two hours a day, putting them at risk for digital eye strain. Digital eye strain is the physical eye discomfort felt by many individuals after two or more hours in front of a digital screen.
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Blue Shield vision portfolio
Satisfydemandsforabigprovidernetworkwith one of California’s largest networks, with more than 6,725 ophthalmologists, optometrists, and opticians in California, and 25,049 locations nationwide. Voluntary plans are also available to groups with no minimum employer contribution requirements. A minimum of 10 participating employees when purchased with medical or 25% of eligible employees for groups without medical.
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Blue Shield vision portfolio
Easy-to-choose vision plansOur vision plan portfolio offers plan options that provide a wide range of benefit levels to help you easily find the right vision plan for your clients’ needs.
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easy to choose vision plans
Our vision portfolio is designed to help you simplify plan selection and provide the benefits that are right for your clients.
Step1:SelectaBenefitFrequency:
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Exam Frequency
Lens Frequency
Frame Allowance Frequency
Standard 12 months 24 months 24 monthsPlus 12 months 24 months 12 months
Deluxe 12 months 12 months 12 months
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easy to choose vision plans
Step2:Selectacopaymentamount:
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Exam CoPay
Materials CoPay
Option 1 $0 $0Option 2 $0 $25Option 3 $15 $25
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easy to choose vision plans
Step3:Selectaframeallowanceamount:
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Frame Allowance
Option 1 $120Option 2 $130Option 3 $150
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rich plan benefits
RichplanbenefitsIn addition to 100% standard lens coverage and annual comprehensive exams on all plans, vision plans with $130 and $150 frame allowances provide additional coverage for the most popular lens options: progressive lenses, anti-reflective coating, and photochromic lenses that provide additional sun protection.
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Lasik needs
LASIKneeds offered with discount programs that let members save up to 20% on LASIK surgery at surgery centers throughout California using one of our discount program providers: QualSight LASIK or NVISION Laser Eye Centers.
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easy to choose vision plansStep4:Choosetoenhancethe$150 frame allowance planswiththeadditionofaContactLensplans:
• Contact Lens plans include a frame allowance, a contact lens allowance, and coverage for a Contact Lens Fitting and Evaluation with the annual eye exam.
• Without the Contact Lens plan buy-up, contact lenses are available in lieu of frames.
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Exam CoPay Materials CoPay
Frame Allowance
Contact Lens Allowance
Vision Standard 15/25/150/120 $15 $25 $150 $120
Vision Standard 0/0/150/120 $0 $0 $150 $120
Vision Plus 15/25/150/120 $15 $25 $150 $120
Vision Plus 0/0/150/120 $0 $0 $150 $120
Vision Deluxe 15/25/150/120 $15 $25 $150 $120
Vision Deluxe 0/0/150/120 $0 $0 $150 $120
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contact lens benefits
ContactlensbenefitMembers don’t have to choose between contact lenses or glasses, because both are covered with our contact lens plans. Our with Contacts plans cover network contact lens services (evaluation and fitting) and up to $120 of contact lens materials as well as a frame allowance during the benefit year or service interval.
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knowledge check
You will now be presented with a Knowledge Check activity. This self-check is not graded and will help you measure what you have learned in this section to help prepare you for the final assessment.
After selecting your answer to each question, click SUBMIT.
Click NEXT to begin.
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Next
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question slidesQuestionsinnotes:1. Which is a Lasik vision plan discount program provider?
a) Lens Craftersb) QualSite LASIKc) Sight for Sore Eyesd) Costco
2. Rich plan benefits include ____.a) Progressive lensesb) Pink eye treatmentsc) Designer glassesd) Colored contacts
3. Contacts plans cover network contact lens services ____ and up to $120 of contact lens materials as well as a frame allowance during the benefit year or service interval.
e) Evaluationf) Fittingg) Both a & bh) None of the above
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summary
In this section you learned: • basic vision terms• BSC ‘chassis’ products• BSC strategy• vision products linked to strategy
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Section 4Life Insurance Plans
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life insurance and AD&D insurance plans
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Life insurance and accidental death and dismemberment (AD&D) insurance are integral parts of a comprehensive benefits package and are time-honored ways to help employees protect their families from the financial challenges that can arise from the death or disability of a loved one.
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life plans
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Our life insurance portfolio helps you simplify plan selection and provides the benefits that are right for your clients.
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learning objectives
After completing this section, you will be able to define the different types and characteristics of the following BSC specialty benefits life insurance plans:
• Basic Group Term Life Insurance• Basic Group Term Benefit Plan Designs
• Flat Amount• Multiple of Salary• Graded Schedule
• Supplemental Life Insurance
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some terms you should know
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gradedschedul
e
flat
amount
multipl
eofsalary
benefitsolutio
ns
quickmatch
program
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easy-to-choose life insurance plans
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Life insurance and accidental death and dismemberment (AD&D) insurance are integral parts of a comprehensive benefits package and are time-honored ways to help employees protect their families from the financial challenges that can arise from the death or disability of a loved one.
Basic life insurance, underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life), is an affordable way for your clients to provide their employees with added security during uncertain economic times. Life insurance is available to groups with or without medical coverage.
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Blue Shield life advantages
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HereareafewoftheadvantagesoflifeinsurancewithBlueShield:• benefit solutions• quick match program• two-year rate guarantee• the stability you want• the strength you need• value for your money• ease of administration• customer satisfaction
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basic group term life insurance
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BasicgrouptermlifeandAD&DinsuranceBlue Shield Life offers life insurance plan options with comprehensive coverage for life and AD&D, with or without a Blue Shield medical plan.
For clients who want to enhance their benefits program by helping theiremployees get higher levels of life insurance, Blue Shield Life also offerssupplemental term life insurance and supplemental AD&D coverage.
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group term life insurance benefits
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Grouptermlifeinsurancebenefitsinclude:
• basic term life insurance amounts are on a fully guaranteed-issue basis
• waiver of premium provision for continued life insurance of employees who are totally disabled before age 65
• accelerated death benefit (ADB) 50% to $250,000, for groups with a minimum benefit amount of $15,000
• minimum coverage amount of $15,000• maximum coverage amount is determined at the discretion of Blue
Shield Life underwriting• age reduction to 65% of the original amount at age 65; to 50% of
the original amount at age 70. All benefits terminate at retirement
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life insurance plan designs
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BlueShieldplandesignsinclude:
• flat amount
• multiple of salary
• graded schedule
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flat amount life insurance plan
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FlatamountAll employees are covered at the same flat amount, e.g., $25,000.
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multiple of salary life insurance plan
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Multipleofsalary All employees are covered for the same multiple of salary up to a maximum amount, e.g., two times annual salary to a maximum of $150,000 (higher amounts are available with Underwriting approval).
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graded schedule life insurance plan
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Gradedschedule Employees can be divided into classes (up to five) that have different levels of benefits. The benefit amount for each class must be no more than 2.5 times that of the next lower class.
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supplemental term life insurance
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SupplementallifeinsuranceSupplemental term life insurance is a 100% employee-paid benefit that helps employees and their dependents gain extra protection to fit their personal insurance needs. While basic group term life insurance may meet some employees’ financial protection needs, others may needhigher levels of life insurance.
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knowledge check
You will now be presented with a Knowledge Check activity. This self-check is not graded and will help you measure what you have learned in this section to help prepare you for the final assessment.
After selecting your answer to each question, click SUBMIT.
Click NEXT to begin.
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Next
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question slidesQuestions in notes:1. Which is an advantage of life insurance with Blue Shield?
a) Tax free incentivesb) Ease of administration c) Extending payments to the family petd) None of the above
2. Blue Shield plan designs include ____.a) Round amountb) Multiple accountsc) Graded scheduled) Monthly salary
3. Group term life insurance benefits include ____. e) A minimum coverage amount of $15,000f) waiver of premium provision for continued life insurance of employees
who are totally disabled before age 75g) Domestic partner coverage, only if legally married in Vermonth) Basic term life insurance amounts are not on a fully guaranteed-issue
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summary
In this section you learned: • basic life insurance terms• BSC ‘chassis’ products• BSC strategy• Life insurance products linked to strategy
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Section 5Accidental death &
dismemberment (AD&D) plans
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learning objectives
After completing this section, you will be able to define the different types and characteristics of the following BSC specialty benefits Accidental Death & Dismemberment (AD&D) insurance plans:
• AD&D Benefits• Supplemental AD&D Insurance
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AD&D benefits
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Accidentallossoflife• 100% of principal sum (equal to the basic life amount)
Partialbenefitsforaccidentallossoflimbs:100% of the principal sum• complete and irrecoverable loss of the sight in both eyes • loss of hearing in both ears
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AD&D benefits (continued)
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Partialbenefitsforaccidentallossoflimbs(continued):50% of the principal sum• loss of one hand by severance at or above the wrist • loss of one foot by severance at or above the ankle • complete and irrecoverable loss of the sight in one eye • loss of hearing in one ear • loss of speech • any combination of two or more of the losses (under 50% or 100% of the principal sum)
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AD&D benefits (continued)
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Partialbenefitsforaccidentallossoflimbs(continued):25% of the principal sum• loss of a thumb and index finger of one hand by complete
severance at or above the metacarpophalangeal joints • loss of all four fingers of one hand by complete severance at or
above the metacarpophalangeal joints
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AD&D benefits (continued)
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Partialbenefitsforaccidentallossoflimbs(continued):12.5% of the principal sum• loss of all the toes of one foot by complete severance at or above
the metatarsophalangeal joints
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AD&D benefits (continued)
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Forthetotalparalysisof:50% of the principal sum• upper/lower limbs of one side (hemiplegia)
75% of the principal sum• both lower limbs (paraplegia)
100% of the principal sum• both upper and lower limbs (quadriplegia)
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AD&D benefits (continued)
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AD&Dpolicyprovisions:• seat-belt/air-bag benefit• special education benefit• repatriation benefit• disappearance benefit• felonious assault benefit• exposure benefit• comatose benefit• common carrier benefit• surgical reattachment benefit
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supplemental AD&D insurance
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While the accidental death & dismemberment (AD&D) coverage included in the basic term life insurance plan may meet some employees’ needs in the event of a major accident, others may want supplemental coverage as well.
Supplemental AD&D is available to active full-time employees who work at least 30 hours per week, and spouses/domestic partners and children.
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supplemental AD&D insurance
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Employees, spouse and children must have Blue Shield supplementallife insurance to add supplemental AD&D coverage.
Supplemental AD&D benefit amounts are available in the same benefit amounts as supplemental life for employee, spouse/domesticpartner and children.
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knowledge check
You will now be presented with a Knowledge Check activity. This self-check is not graded and will help you measure what you have learned in this section to help prepare you for the final assessment.
After selecting your answer to each question, click SUBMIT.
Click NEXT to begin.
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Next
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question slidesQuestions in notes:1. Partial AD&D benefits paid for accidental loss of ____
a) Bowelsb) Headc) Limbsd) Torso
2. Supplemental AD&D is available to active full-time employees who work at least __ hours per week, and spouses/domestic partners and children
a) 24b) 30c) 40d) 15
3. Which of the following is an AD&D benefit? e) Felonious assault benefitf) Semi-unconscious syndrome benefitg) Both a & bh) None of the above
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summary
In this section you learned:
• basic accidental death & dismemberment (AD&D) insurance terms• BSC ‘chassis’ products• BSC strategy• AD&D insurance products linked to strategy
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Final Assessment Review
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final assessment reviewQuestions in notes:
1. What is an INO?a) An international organizationb) An in-network organizationc) Elmo’s sisterd) An out-of-network organization
2. What is meant by ‘dual option’?a) Plans allow you to choose two plans that you can offer your employees
instead of just one.b) Confusion about a choice between two plansc) A fork in the roadd) The lesser of two evils
3. The benefits solutions program is available for groups between ___e) 200 - 1000f) 50 - 100g) 101 - 249h) None of the above
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final assessment reviewQuestions (continued):4. Benefit Solutions, your clients can earn up to ____ off medical rates when specialty products are added
a) 10%b) 1.75%c) 2.0%d) 0.5%
5. PPO and INO plans with orthodontic coverage include a ____ calendar year maximum for children and adultse) $2,000f) $5,000g) $1,000h) $1,500
6. The dental INO plan has ____ configuration optionsi) 4j) 7k) 10l) 3
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final assessment reviewQuestions (continued):7. Which is a Lasik vision plan discount program provider?
a) Lens Craftersb) QualSite LASIKc) Sight for Sore Eyesd) Costco
8. Rich plan benefits include ____.e) Progressive lensesf) Pink eye treatmentsg) Designer glassesh) Colored contacts
9. Contacts plans cover network contact lens services ____ and up to $120 of contact lens materials as well as a frame allowance during the benefit year or service interval.
i) Evaluationj) Fittingk) Both a & bl) None of the above
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final assessment reviewQuestions (continued):10. Which is an advantage of life insurance with Blue Shield?
a) Tax free incentivesb) Ease of administration c) Extending payments to the family petd) None of the above11. Blue Shield plan designs include ____.e) Round amountf) Multiple accountsg) Graded scheduleh) Monthly salary
12. Group term life insurance benefits include ____. i) A minimum coverage amount of $15,000j) waiver of premium provision for continued life insurance of employees
who are totally disabled before age 75k) Domestic partner coverage, only if legally married in Vermontl) Basic term life insurance amounts are not on a fully guaranteed-issue
basis89
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final assessment reviewQuestions (continued):13. Partial AD&D benefits paid for accidental loss of ____
a) Bowelsb) Headc) Limbsd) Torso
14. Supplemental AD&D is available to active full-time employees who work at least __ hours per week, and spouses/domestic partners and children e) 24f) 30g) 40h) 15
15. Which of the following is an AD&D benefit? i) Felonious assault benefitj) Semi-unconscious syndrome benefitk) Both a & bl) None of the above
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thank youWe hope you learned exactly what you needed, quickly & easily.
Check out other lessons in the expanding Facets eCourse Library!
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