This document provides an overview of Blue Shield of California's (BSC) specialty benefits eLearning course. The course aims to educate BSC staff about BSC's specialty benefits insurance plans, including their characteristics, processes, and product lines. The document outlines the course agenda which covers dental plans, vision plans, life insurance plans, and accidental death and dismemberment plans over four sections. Section one introduces BSC's specialty benefits insurance plan overview. Section two describes the dental plan family of products. Section three describes the vision plans. Section four describes the life insurance plans and accidental death and dismemberment insurance. There is an assessment at the end to evaluate learning.
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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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BSC specialty benefits
5
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)
learn
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BSC business strategy
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Specialty Benefits
Dental Plans
Vision Plans
Life & AD&D
Insurance
Our Mission is to ensure all Californians have access to high-quality
healthcare at an affordable price.
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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 slides
Questions in notes:
1. What is an INO?
a) An international organization
b) An in-network organization
c) Elmo’s sister
d) 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 plans
c) A fork in the road
d) The lesser of two evils
3. The benefits solutions program is available for groups between ___
a) 200 - 1000
b) 50 - 100
c) 101 - 249
d) 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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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
learn
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dental plan overview
Advantages worth smiling about
Benefit solutions
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.
Access to large networks
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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dental plan overview
Advantages worth smiling about
Plan choice
Your 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.
Orthodontic coverage option
PPO 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 plans
While you help your clients consider their options, remember that dental
coverage 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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PPO plans
Dental PPO plans
Our 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 (SmileSM Spectrum Premier Plus and SmileSM Spectrum
Premier plans)
• middle benefit plans (SmileSM Spectrum plans)
• leaner benefit plans (SmileSM Basic and SmileSM Basic Voluntary)
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INO plans
Dental in-network only(INO) plans
Employers can select from a range of options that best suit their business
needs and budget.
Our SmileSM In-Network Only (INO) Dental Plan*
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
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
Benefit solutions
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
Access to large networks
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
Dual option dental plans
Help your clients offer the dental dual option to provide employees
with 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 coverage
Orthodontic coverage option: 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.
HMO plans include specific member copayments for orthodontic
coverage (see below) and are not subject to a waiting period.
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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 slides
Questions in notes:
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) $2,000
b) $5,000
c) $1,000
d) $1,500
3. The dental INO plan has ____ configuration options
a) 4
b) 7
c) 10
d) 3
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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
learn
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some terms you should know
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easy-to-
choose
plans
Lasik
rich plan
benefits
BSC
vision
plans
vision
portfolio
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why sell vision?
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, which helps their bottom line.
Return on investment Vision 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.
Vision Care is valued by employees According 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.
Vision exams can provide early detection of many chronic conditions
reducing overall cost of healthcare. 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.
ADDING VISION MAKES SMART BUSINESS SENSE
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BSC vision care plans offer more
Satisfy demands for a big provider network with
one of California’s largest networks
of ophthalmologists, optometrists
and opticians:
• more than 6,725 in California
• 25,049 locations nationwide
Ease access to care issues with 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 more
Vision and LASIK discount programs are 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
Return on investment vision 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
Satisfy demands for a big provider network with 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 plans
Our 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.
Step 1: Select a Benefit Frequency:
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Exam
Frequency
Lens
Frequency
Frame
Allowance
Frequency
Standard 12 months 24 months 24 months
Plus 12 months 24 months 12 months
Deluxe 12 months 12 months 12 months
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rich plan benefits
Rich plan benefits
In 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
LASIK needs 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 plans
Step 4: Choose to enhance the $150 frame allowance plans with the
addition of a Contact Lens plans:
• 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
Contact lens benefit
Members 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 slides
Questions in notes:
1. Which is a Lasik vision plan discount program provider?
a) Lens Crafters
b) QualSite LASIK
c) Sight for Sore Eyes
d) Costco
2. Rich plan benefits include ____.
a) Progressive lenses
b) Pink eye treatments
c) Designer glasses
d) 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.
a) Evaluation
b) Fitting
c) Both a & b
d) None of the above
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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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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
learn
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some terms you should know
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graded
schedule
flat
amount
multiple
of salary
benefit
solution
s
quick
match
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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Here are a few of the advantages of life insurance with Blue Shield:
• 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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Basic group term life and AD&D insurance
Blue 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 their
employees get higher levels of life insurance, Blue Shield Life also offers
supplemental term life insurance and supplemental AD&D coverage.
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group term life insurance benefits
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Group term life insurance benefits include:
• 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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multiple of salary life insurance plan
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Multiple of salary
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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Graded schedule
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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Supplemental life insurance
Supplemental 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 need
higher 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 slides
Questions in notes:
1. Which is an advantage of life insurance with Blue Shield?
a) Tax free incentives
b) Ease of administration
c) Extending payments to the family pet
d) None of the above
2. Blue Shield plan designs include ____.
a) Round amount
b) Multiple accounts
c) Graded schedule
d) Monthly salary
3. Group term life insurance benefits include ____.
a) A minimum coverage amount of $15,000
b) waiver of premium provision for continued life insurance of employees who are
totally disabled before age 75
c) Domestic partner coverage, only if legally married in Vermont
d) Basic term life insurance amounts are not on a fully guaranteed-issue basis
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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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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
learn
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AD&D benefits
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Accidental loss of life
• 100% of principal sum (equal to the basic life amount)
Partial benefits for accidental loss of limbs:
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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Partial benefits for accidental loss of limbs (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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Partial benefits for accidental loss of limbs (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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Partial benefits for accidental loss of limbs (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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For the total paralysis of:
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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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 supplemental
life 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/domestic
partner 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 slides
Questions in notes:
1. Partial AD&D benefits paid for accidental loss of ____
a) Bowels
b) Head
c) Limbs
d) 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) 24
b) 30
c) 40
d) 15
3. Which of the following is an AD&D benefit?
a) Felonious assault benefit
b) Semi-unconscious syndrome benefit
c) Both a & b
d) 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
Questions in notes:
1. What is an INO?
a) An international organization
b) An in-network organization
c) Elmo’s sister
d) 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 plans
c) A fork in the road
d) The lesser of two evils
3. The benefits solutions program is available for groups between ___
a) 200 - 1000
b) 50 - 100
c) 101 - 249
d) None of the above
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final assessment review
Questions (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 adults
a) $2,000
b) $5,000
c) $1,000
d) $1,500
6. The dental INO plan has ____ configuration options
a) 4
b) 7
c) 10
d) 3
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final assessment review
Questions (continued):
7. Which is a Lasik vision plan discount program provider?
a) Lens Crafters
b) QualSite LASIK
c) Sight for Sore Eyes
d) Costco
8. Rich plan benefits include ____.
a) Progressive lenses
b) Pink eye treatments
c) Designer glasses
d) 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.
a) Evaluation
b) Fitting
c) Both a & b
d) None of the above
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final assessment review
Questions (continued):
10. Which is an advantage of life insurance with Blue Shield?
a) Tax free incentives
b) Ease of administration
c) Extending payments to the family pet
d) None of the above
11. Blue Shield plan designs include ____.
a) Round amount
b) Multiple accounts
c) Graded schedule
d) Monthly salary
12. Group term life insurance benefits include ____.
a) A minimum coverage amount of $15,000
b) waiver of premium provision for continued life insurance of employees who are
totally disabled before age 75
c) Domestic partner coverage, only if legally married in Vermont
d) Basic term life insurance amounts are not on a fully guaranteed-issue basis
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final assessment review
Questions (continued):
13. Partial AD&D benefits paid for accidental loss of ____
a) Bowels
b) Head
c) Limbs
d) 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
a) 24
b) 30
c) 40
d) 15
15. Which of the following is an AD&D benefit?
a) Felonious assault benefit
b) Semi-unconscious syndrome benefit
c) Both a & b
d) None of the above
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thank you
We hope you learned exactly what you needed, quickly & easily.
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