National General Accident & Health Product Guide

NGAH-PRODUCTGUIDE

National General Accident & Health

Product Guide

For agent use only. Not for distribution to consumers.

National General Accident and Health markets products underwritten by

National Health Insurance Company, Time Insurance Company, Integon National

Insurance Company, and Integon Indemnity Corporation.

NGAH-PRODUCTGUIDE

Thank you for your interest in

National General Accident & Health

We make it easy for you to find sales success by providing easy-to-use

online sales tools that help you get quotes and land sales fast.

We are committed to your success and will make every effort to provide you with the products and resources you

need, so you can focus on helping your customers and grow your business.

Our broad portfolio of short term medical, ﬁxed-beneﬁt medical, dental and supplemental products gives you

the opportunity to sell all year long. With solutions in nearly every state, you have the opportunity to meet more

needs with more customers, no matter where you choose to focus your business.

It’s important to remember these products pay limited beneﬁts; they do not constitute comprehensive health

insurance coverage (often referred to as major medical coverage) and do not satisfy the requirement of Minimum

Essential Coverage under the Affordable Care Act.

This guide is your sales planning tool — it contains useful information to help you help your clients through the

purchase process.

Short Term Medical (STM)

National General Foundation Health

(NGFH)

Fixed-beneﬁt medical

Accident Fixed Beneﬁt (AFB)

AcciMED

Accident Medical Expense (AME) and

Accidental Death and Dismemberment (ADD)

Cancer and Heart/Stroke (CHS)

Critical Illness - Term Life (CI/TL)

Dental Indemnity Insurance

Dental PPO Insurance

Hospital Expense Protection

Plan Enhancer

Accident Medical Expense (AME) only; or

AME plus riders for Sickness Hospitalization

and Cancer and Heart/Stroke

TrioMED

Accident Medical Expense (AME), Critical

Illness (CI) and Accidental Death and

Dismemberment (ADD)

VitalGuard

Accidental Death and Dismemberment (ADD)

Not all products are available in all states.

1 Not all riders are available in all states

Why work with us?

Industry-leading technology

& sales platforms – with

simpliﬁed sales solutions for

every consumer segment

National General Accident & Health is a one-stop solution

Competitive product portfolio

of supplemental, short-term,

ﬁxed-beneﬁt medical, and dental

coverage options

Direct access to an extensive

product portfolio — providing a

broad range of opportunties in

today’s insurance market

Short Term Medical is a great ﬁt for

customers who are:

Why sell Short Term Medical and National General Foundation Health?

» Between jobs

» Waiting for new employee

beneﬁts to kick in

» Waiting for Medicare

National General Foundation Health is a great ﬁt

for those who:

» Don’t have the budget for major

medical plans

» Don’t want to pay for beneﬁts they

don’t need

» Missed Open Enrollment and still need

help paying health care expenses

» Still in need of help paying for health

care expenses because they missed

Open Enrollment

NGAH-PRODUCTGUIDE

95% of adults say they

value keeping their

mouth healthy

Why Dental?

Everybody needs dental care, why not increase your sales

opportunities by adding National General Accident & Health

Dental Insurance to your portfolio.

There are two options to choose from — to help you ﬁt the

needs of more customers.

Dental PPO — with three different beneﬁt levels to choose from and

access to the Careington Maximum Care Dental Network.

Dental Indemnity with an optional network savings card — pays cash beneﬁts to help make dental care more

affordable and provides the option to add the Maximum Care Discount network savings card for more savings

on both dental and vision services.

Why supplemental?

Many customers get stuck with high-deductible, comprehensive

health plans that force them to pay large amounts of health care

expenses out-of-pocket. Supplemental coverage helps them bridge

the gap.

Customers can use the cash beneﬁts in any way they need.

63% of Americans don’t

have enough savings to

cover a $500 emergency

* Source: https://www.forbes.com/sites/maggiemcgrath/2016/01/06/63-of-americans-dont-have-enough-savings-to-cover-a-500-

emergency/#1f1ca0df4e0d - pulled 03/24/2017

http://www.ada.org/en/publications/ada-news/2016-archive/january/hpi-publishes-oral-health-facts-for-every-us-state

NGAH-PRODUCTGUIDE

National General Accident & Health markets products underwritten by National Health Insurance Company (NHIC),

Integon National Insurance Company (INIC), Integon Indemnity Corporation (IIC) and Time Insurance Company

(TIC). These underwriting companies follow a “Just-in-Time” appointment process, except in states that require

pre-appointment.

Once you receive your initial appointment with us, whenever you submit business for the ﬁrst time in a new state,

we will automatically submit a request for appointment within the time frame required by that state.

As appointments are processed, you will receive an email notiﬁcation conﬁrming your appointment in a particular

state. If you sell in multiple states, you will receive an email each time you become actively appointed in a state.

In order to solicit our products, you must first complete an online application:

» Your Sales Representative will provide a personalized link, or you can call (888)376-3300

» Applications are accepted electronically

» If you hold active licenses in pre-appointment states at the time of your registration, the

company will submit a request to the state for appointment. Pre-appointment states will remain

blocked until your appointment conﬁrmation has been received for those states.

Increase your income

With commission rates dropping on most major medical sales, you need a way to make sure

your income stays strong. Add our limited medical, short-term, and supplemental coverage

plans to your portfolio and help customers get more coverage while you increase your earnings.

Agent Appointments

NGAH-PRODUCTGUIDE

Agent Back Office

Agent Back office is our online portal that’s available to help you manage your National General

Accident & Health book of business. You can view production and policy status for all

product sales.

You can ﬁnd each set of credentials in your welcome email.

Once logged in you can:

» View production and policy status

» View customer contact information and

policy details

» Access Help documents, such as Agent

Product Guide, State Variations, and the Product

Availability grid

Note: Agents/Agencies with downlines will have access to view all customers/policies under their hierarchy.

There are many ways to sort your customer information for simple viewing and exporting.

Commissions

You access your commission statements in two different systems. All commissions are paid via ACH.

Go to http://www.eagentcenter.com and then:

» Enter company ID: NGIS

» Enter your user name: your NPN

» Enter your password: Last 6 digits of SS#

or TIN

For NHIC products (includes

INIC and IIC)

Short Term Medical, TrioMED, AcciMED,

VitalGuard, National General Foundation Health,

Hospital Expense Protection and Dental PPO.

For TIC products

Plan Enhancer, Accident Fixed-Beneﬁt, Cancer and Heart/

Stroke, Critical Illness - Term Life, and Dental Indemnity.

» Register using the code that was sent to you in a

Welcome email from AMR: NoR[email protected]

» Once registered, you will have access to view your TIC

commission statements

NOTE: If you assign commissions to your agency, then you

should log in with your Agency’s NPN and the last 6 numbers

of TIN to view commission statements.

LIST BILL: Commisisons are not paid until premium has been

collected. Premium is collected on the 15th of the month.

Go to https://insuranceservices.actmanre.com/

NationalGeneral/default and then:

» View if customer attestations have been

completed or not

» Easily export all production to .csv ﬁle

NGAH-PRODUCTGUIDE

Exceptions:

» In the state of Florida, these products are underwritten by Integon Indemnity Corporation

» In the states of Colorado, Connecticut and New York, these products are underwritten by

Integon National Insurance Company

Products and Marketing

National General Accident & Health Advertising, Promotions

and Marketing Policy

NATIONAL GENERAL ACCIDENT AND HEALTH (“NGAH”) is committed to assuring that advertising and

sales promotion materials for NGAH products are clear as to purpose, and truthful and fair as to content

and presentation.

To ensure advertising, promotion and marketing clarity, any advertising materials, whether created by our

home ofﬁce staff or by NGAH marketers, must have written approval from NGAH’s Legal and Compliance

and Marketing Departments prior to use.

Always refer to your agent agreement for details regarding advertising best practices and work with your

NatGen sales representative to acquire all appropriate approvals.

Ready to use Marketing Materials

Marketing materials can be found on our Carrier website, www.NGAH-NHIC.com

Brochures are also available on our quoting platform, www.QuoteNatGen.com

• Accident Fixed-Beneﬁt

• Critical Illness - Term Life

Products underwritten by Time Insurance Company include:

• Plan Enhancer

• Dental Indemnity

• Cancer and Heart/Stroke

• Short Term Medical

• TrioMED

• VitalGuard

Products underwritten by National Health Insurance Company include:

• National General

Foundation Health

• AcciMED

• Hospital Expense Protection

• Dental PPO

How to get started with List Bill

List Bill Account Agreements can be found on our carrier web site NGAH-NGIC.com,

under Agents/Agent tools.

• The form must be completed by you and your List Bill client, then submitted to NGAHListBill.com

• Once an account is set up, you are provided a List Bill Account number. This number will be

required on the demographics section of QuoteNatGen.com

• From there, all you have to do is submit the applications — the rest is handled by us

List Bill plans are only allowed to have effective dates on the 1st of the month. Premiums are drafted on the 15th

of that same month. ACH bank draft is the only accepted method of payment.

NGAH-PRODUCTGUIDE

Quoting and Enrolling

You can quote NGAH products and complete the enrollment process on our online quoting

platform, QuoteNatGen.com. Agents are provided a unique URL, at time of appointment, to

use when enrolling clients

Underwriting

entity

Product

Available

effective dates

Standard or Guaranteed Issue

NHIC STM Standard Issue

Any day of the month Requires Health Eligibility questions

NHIC STM Guaranteed Issue

Any day of the month Guaranteed issue

NHIC

National General

Foundation Health

1st or the 15th* Requires Health Eligibility questions

TIC Accident Fixed-Beneﬁt

Any day of the month Guaranteed issue

NHIC AcciMED

1st or the 15th* Guaranteed issue

TIC

Plan Enhancer

• Accident Medical

Expense

• Accident

Medical Expense

with optional CHS or

SIP riders

Any day of the month

The Accident Medical Expense policy and Accident

Medical Expense with the CHS rider are guaranteed

issue.

The Accident Medical Expense policy with the SIP rider

requires Health Eligibility questions

TIC

Cancer and Heart/

Stroke

Any day of the month Requires Health Eligibility questions

TIC

Critical Illness - Term

Life

Any day of the month Requires Health Eligibility questions

TIC Dental Indemnity

Any day of the month Guaranteed issue

NHIC Dental PPO

Any day of the month Guaranteed issue

NHIC

Hospital Expense

Protection

Any day of the month Requires Health Eligibility questions

NHIC TrioMED

1st or the 15th*

$2,500; $5,000 and $10,000 options - Guaranteed issue

$15,000 and $30,000 critical-illness options - Require a

Health Eligibility question

NHIC VitalGuard

1st or the 15th* Guaranteed issue

Product effective dates and policy issue requirements:

Product availability varies by state.

All products are subject to preexisting condition limitations and exclusions, and/or ﬁrst ever diagnosis.

List Bill plans are only allowed to have effective dates on the 1st of the month.

* Must apply by the 25

of the month for a 1

-of-the-month effective date, and by the 9

of the month for a 15

-of-the-month effective date

NGAH-PRODUCTGUIDE

Product Initial enrollment age: Age coverage ends:

Short Term Medical

Primary: 60 days to 64 years

Spouse/Domestic Partner 14 years to 64 years

Dependent child: 60 days to 25 years

Primary/Spouse/Domestic Partner: At 65 years

of age

Dependents: At 26 years of age

STM Guaranteed Issue

Primary: 60 days to 64 years

Spouse/Domestic Partner: 14 years to 64 years

Dependent child: 60 days to 25 years

Primary/Spouse/Domestic Partner: At 65 years

of age

Dependents: At 26 years of age

AcciMED, TrioMED, and

VitalGuard

Accident Fixed-Beneﬁt

(AFB)

Primary: 18 years to 64 years

Spouse/Domestic Partner: 18 years to 64 years

Dependent child: Birth to 25 years

Primary/Spouse/Domestic Partner:

• AcciMED/TrioMED: 65 years of age

• VitalGuard: 70 years of age

Dependents: at 26 years of age

NOTE: AFB plans are renewable for life

National General

Foundation Health

Hospital Expense

Protection

Primary: 18 years to 64 years

Spouse/Domestic Partner: 18 years to 64 years

Dependent child: Birth to 25 years

Primary/Spouse/Domestic Partner: At 65 years

of age

Dependents: At 26 years of age

Plan Enhancer

(AME coverage only and

AME with optional CHS/

SIP riders)

AME coverage only

Primary: Birth to 64 years

Spouse/Domestic Partner: 14 years to 64 years

Dependent child: Birth to 25 years

AME with CHS/SIP riders

Primary and Spouse/Domestic Partner: 18

years to 59 years

Dependent child: Birth to 25 years

AME Coverage only

Primary/Spouse/Domestic Partner: At 75 years

of age

Dependents: At 26 years of age

AME with CHS/SIP riders

Primary/Spouse/Domestic Partner: At 65 years

of age

Dependents: At 26 years of age

Critical Illness - Term Life

Primary and Spouse/Domestic Partner: 18

years to 59 years

No Child Coverage

Primary/Spouse/Domestic Partner

To end of term or

• Term Life at 85 years of age

• Critical Illness at 65 years of age

Cancer and Heart/Stroke

Primary and Spouse/Domestic Partner: 18

years to 64 years

Dependent Child: Birth to 25 years

Primary/Spouse/Domestic Partner: At 75 years

of age

Dependents: At 26 years of age

Dental Indemnity

Primary and Spouse/Domestic Partner:

• Primary: Birth to 70 years*

• Spouse: 14 years to 70 years*

• Dependent child: Birth to 25 years

• 64 years in MD, MA, NJ, NC, OH, SD, UT

Primary and Spouse/Domestic Partner:

• At age 70 in : MD, MA, NJ, NC, OH, SD, UT

• At age 75: All other dental states

• Dependents: At 26 years of age

Dental PPO

Primary and Spouse/Domestic Partner: 18

years to 74 years

• Dependents: Unmarried children 25 years

(may vary by state)

Primary/Spouse/Domestic Partner: at 85 years

of age

• Dependents: at 26 years of age

ember Eligibility

Enrollment age requirements by product

Note: For child-only plan submission, please list the youngest applicant as the primary.

All applicants must legally reside in the United States.

* 64 years in MD, MA, NJ, NC, OH, SD and UT

NGAH-PRODUCTGUIDE

L.I.F.E. Association

Many NHIC products are issued on an Association Contract and are only available

through a LIFE Association Membership

• LIFE Association Memberships vary by product:

» Select level: Sold with Dental PPO, or can be purchased separately

» Preferred level: Sold with TrioMED and AcciMED

» Prime/Sterling levels: Sold with STM, NGFH, and HEP

• LIFE Association Memberships are always billed separately from the insurance premium.

However, when sold with TrioMED, the membership fees are billed with the insurance premium

• When quoting STM, National General Foundation Health, Hospital Expense Protection, and

Dental PPO, the membership fees will display as a separate line item

• Membership fees are always billed monthly — no matter how the insurance premium

billing is set up

• Membership fees are non-refundable

• Memberships do not end when the policy is terminated. Memberships must be canceled

separately by calling our members services team

• LIFE Association memberships are also available as stand-alone products.

Call 888-781-0585 for more information

LIFE Association Memberships are optional in:

Colorado, Connecticut, Maryland, Missouri, New Mexico,

Oregon, and South Dakota

LIFE Association Memberships are not available in:

Iowa, Kansas, Maine, Montana, Utah or Wisconsin

Memberships

LIFE Association is a non-proﬁt, members-only organization which

provides you with lifestyle-related beneﬁts and discounts.

NGAH-PRODUCTGUIDE

Application Submission

Application acceptance veriﬁcation

Upon submission of the application, a “You’re almost done” page will be displayed. Your client is required to

complete the application acceptance veriﬁcation

Note: This is in addition to the agent authorization acknowledgment which was checked on the application

prior to submission.

Your client must complete one of the three options for the application

veriﬁcation process:

1. Upon application submission, your client receives an email from us (memberservices@nhicadmin.

com) for each product purchased. This email includes the link to VIPmemberbeneﬁts.com/verify —

where your client is directed to read and e-sign their application acceptance. One Authorization Form

includes all purchased products; customers only need to sign once. For List Bill, the agent is not cc’d

on the welcome emails.

Note: While all applicants receive this email notice, your client only needs to complete one method for

the application veriﬁcation.

2. If your client is with you, you can share the link from the “You’re almost done” page. From there,

your client will be directed to VIPmemberbeneﬁts.com/verify to read and e-sign the application

acceptance.

3. You can select the voice veriﬁcation process. While you have your client on the phone, dial the

number provided on the “You’re almost done” page under the Voice Veriﬁcation option. You both will

be connected to a recorded phone line. You must read the entire veriﬁcation to your client, and then

your client will be asked to acknowledge the application acceptance.

For options 1 and 2, your clients will need their Member ID to register on VIPMemberbeneﬁts.com to

access, read, and sign the authorization form. Member IDs are provided in the “You’re almost done”

page and in the email sent to the email address listed on the application. It is important to ensure the

email address provided is accurate.

NGAH-PRODUCTGUIDE

Billing

Initial premium and LIFE Membership due payments are drafted upon submission of the application,

regardless of the plan’s effective date

If the initial payment fails to process, an error message that says, “The application has been received.

Please contact member services at 888-781-0585 to complete your payment and reference member’s

ID,” will appear in the quoting system. When this happens, the application has been received and

doesn’t need to be submitted again. However, in order to activate coverage, the customer must call us

to provide a new payment method and authorization for the charges to be processed.

Available payment methods include:

• ACH Bank Draft

• Credit Card (Visa, Mastercard, or Discover)

Cash and checks are not accepted forms of payment.

1. Future payments will be withdrawn monthly from the customer’s account ﬁve business days prior to

each plan’s corresponding effective day.

» For example: If the applicant requests an effective date of 1/15/2017, the subsequent withdrawal

dates will be 2/10/2017, 3/10/2017, 4/10/2017, and so on

2. On daily rates for Short Term Medical, the full term’s premium will be drafted at time of submission of

application, regardless of the plan’s effective date

Future Payments

» TIC Products [sold prior to 9/15/16] - NATIONAL GENERAL 866-387-0484 NY

» TIC Products [sold 9/15/16 and later] - NGIC 888-781-0585

» NHIC Products - NGIC 888-781-0585

Charges on clients’ bank statements will appear as:

National General

888-781-0585

Charges on clients’ credit card statements will appear as:

All plans are entitled to a 31-day grace period. The grace period begins the day after the plan’s premium

due date and ends 31 days after the due date.

Policy lapses

Failed Payments

NGAH-PRODUCTGUIDE

Failed Credit Card draft — We will attempt to draft again every Friday for the duration of the grace period of

31 days

Failed ACH draft — The client must call Member Services to provide valid billing information

» If we are still unable to process payment, coverage will be canceled back to the last paid-through date

Your client should also log in to www.vipmemberbeneﬁts.com to update their billing information

» Your client must still contact member services to have the draft reprocessed to avoid a lapse

in coverage or cancellation

Failed billing attempts on future payments

» We will not attempt to redraft failed ACH payments

Customer notiﬁcations

» When payments are declined, National General will notify the insured via email. The email includes

instructions on how to log into VIPMemberbeneﬁts. com and update billing information.

» The agent of record is cc’d on the email communication

Members should call to cancel their plan. Once we receive notice, we will cancel as of their

paid-to date for that coverage period.

For example, if the plan has an active date of the 1st of the month, and the member calls to

cancel on the 28th, we will cancel the plan on the last day of the current month.

Please note, any claims submitted for services received after the cancellation date will not

be processed.

Policy cancellation notice requirements:

Remind your clients:

If you sell our plans with other carriers’ plans, your customers

must call us directly to cancel National General Accident &

Health plans.

NGAH-PRODUCTGUIDE

What to expect after the sale

ID Cards

After the application authorization is complete, your client will have access to electronic STM Medical ID

cards in VIPMemberbeneﬁts.com

» The electronic ID cards can be downloaded and used until the permanent ID cards arrive in the mail

The Permanent ID Card should arrive in the mail in about 7-10 business days from time of submission

» NOTE: This is your clients Medical ID card, remind your clients to always present the Medical ID card

when visiting the doctor

Dental

» ID cards should arrive in the mail in about 5-7 business days after submission

» Electronic ID cards are not available for Dental Indemnity

» PPO Dental electronic ID cards can be downloaded and used until the permanent ID cards arrive in the mail

Short Term Medical plans:

Policy fulfillment

During the application process, providing your client’s email address means that your client agrees to

opt-in to receive their policy, and/or certiﬁcate of issuance, and other correspondence electronically.

If the applicant prefers to have the policy mailed, please call us at (888)781-0585.

Note: All other plan administration correspondence will be sent to the email address provided at time of

application.

Email Requirements

» All applicants are required to provide a valid email at time of application. If your client does not

have an active email address they cannot apply for coverage with us.

» In these instances, we recommend your clients create an email address with a valid email

service provider. It’s important to provide a valid email address. All customer communications

are sent to the email address provided on the application.

National General Foundation Health:

» The electronic ID cards can be downloaded and used until the permanent ID cards arrive in the mail

» Permanent ID cards should arrive in the mail in about 5-7 days from time of submission

List Bill plans:

» ID cards are mailed after the premium is drafted on the 15

day of the month following the effective

date — 2 weeks after the policy date

» Electronic ID cards can be downloaded and used until the permanent ID cards arrive in the mail

NGAH-PRODUCTGUIDE

Products

Approx. Processing Time Frame –

Electronic Fulfillment

Dental Indemnity

Dental PPO

NG Foundation Health

5 business days

STM 10 business days

Accident Fixed-Beneﬁt

Plan Enhancer

Accident Medical Expense

Accident Medical Expense w/riders

Critical Illness/Term Life

Cancer and Heart/Stroke

5 business days

TrioMED

AcciMED

VitalGuard

14 business days

The convenience of electronic documents

» Policy documents are accessible whenever customers need them

» Customers can view them at their convenience

» They can save and print them based on their needs

If paper delivery is requested, policy packets will arrive via USPS within 7 business days

from time of request.

List Bill: Policy documents are not sent until after the premium is drafted

When the policy is available, your client will receive an email from [email protected].

» The member must register using their member ID and email address used for enrollment

» Once registered, the member may log in and view documents

All active members, whether or not they choose electronic delivery, as long as policy fulﬁllment was

completed through National General Accident & Health, will have access to view their policy documents at

NGAHDocuments.com.

NGAH-PRODUCTGUIDE

L.I.F.E. Association Membership Benefits

For NHIC plans sold through the LIFE Association, about 5 days following the plan’s effective date, your client

will receive an email from [email protected] with a membership-speciﬁc URL. This email

includes information regarding how to access the LIFE Association Membership beneﬁts and copies of their

LIFE Membership cards.

Please note, LIFE Association membership programs and services vary by state and membership level. Not all

programs and services are available to all members or in all states. If your clients have questions about their

LIFE membership, they should call the number on their LIFE Membership card.

The link provided in the email is also where your clients will go to register for Telemedicine Services,

WellCard Savings card and get access to LIFE Association member programs and discounts.

Registering for Telemedicine services

• Your client must register for access to Telemedicine services

• Clients should click on the My Telemedicine link in the beneﬁts list on the

LIFE home page

» Then, they must complete the online registration form

• When clients need medical advice, they can call the number provided to schedule

a consultation

Registering for WellCard savings discounts

• Your client must register for access to WellCard Savings discounts

• Clients should click on the WellCard Savings Card image on the LIFE home page

» Then, they must complete the online registration form

• Upon registration, an email will be sent from WellCard Savings

» The email includes the WellCard member cards

» The WellCard Savings member cards must be presented at participating pharmacies

to receive the discounted pricing

NOTE: The LIFE Association membership will not automatically terminate when the policy terminates. Remind

customers they must call to cancel their membership if they no longer want the membership after their policy

termination and/or expiration date.

This Plan is NOT Insurance. It is a discount medical program. Payment must be made at time of service. This

program is powered by Access One Consumer Health, Inc. (not afﬁliated with AccessOne Medcard http://www.

accessonedmpo.com/). Void where prohibited by law.

NGAH-PRODUCTGUIDE

After your client has registered on www.VIPMemberbeneﬁts.com, your client will have access to the Member

Portal to:

» Make changes to contact, payment and billing information

» View billing and payment history

» For STM and National General Foundation Health plans, this is

where clients can access electronic ID cards

» Access copies of the LIFE Association Membership cards

» Get answers to frequently asked questions

» Request copies of policy fulﬁllment and ID cards

Member Portal

Note: This is a separate site

and requires a separate

registration and log in than

www.NGAHDocuments.com

where clients go to access

plan documents

Updating payment information for automatic payments

Over the phone:

» The caller must be the account owner or an authorized signatory on the account

Online:

The customer should log into VIPMemberbeneﬁts.com

» Select the “View” button under “Your Payment Method”

» Select “add ACH Bank Draft”

» Enter the new information

Premium changes

If National General makes any changes to a customer’s monthly premium amount, the customer will be notiﬁed

of the new amount and the reason for the change. Email notiﬁcations are sent to the email address on record.

Policy Administration

Policy cancellations

Supplemental Policies can be canceled in the ﬁrst 30 days of the policy effective date for a full refund

Short Term Medical policies can be canceled in the ﬁrst 10 days of the policy effective date for a full refund.

If a member calls to cancel their plan after the free look period, we will cancel as of their paid-to date for that

coverage period. For example, if the plan has an active date of the 1st of the month, and the member calls to

cancel on the 28th, we will cancel the plan on the last day of the current month.

Please note, any claims submitted for services received after the cancellation date will not be processed.

Important Information: If members have more than one policy with us and/or a LIFE Association Membership,

they must cancel each plan individually or be speciﬁc about which plan(s) they want to cancel. We are not

responsible for canceling coverage that was not issued by Time Insurance Company, National Health Insurance

Company, Integon National Insurance Company, or Integon Indemnity Corporation.

NGAH-PRODUCTGUIDE

Rules for adding and removing dependents

Product Adding Dependents Removing Dependents

Short Term Medical — for plans sold

prior to April 1, 2017 with durations

greater than 3 months

New members must apply for their

own policy

Removal of dependents is allowed

in instances:

• When replacement coverage

has been issued

• Active military duty

• Medicare/Medicaid eligible

• Of divorce or death*

Short Term Medical — for plans sold

after April 1, 2017 with durations of

less than three months

New members must apply for their

own policy

Removal of dependents is allowed

in instances of:

• Active military duty

• Medicare/Medicaid eligible

• Divorce or death*

National General Foundation Health

New members must apply for their

own policy

Removal of dependents is allowed

Dental PPO, Dental Indemnity, AME,

AFB, CHS, CI/TL

New members must apply for their

own policy

Removal of dependents is allowed

TrioMED/AcciMED

New members must apply for their

own policy

Primary must reapply for coverage

to include all requested

dependents

For most products, the Primary Insured, Covered Spouse or Agent can request to have a Newborn or Adopted

Child added to the policy by contacting member services. Members have 31 days from date of birth or adoption

to request the dependent be added to the policy.

Adding a newborn or adopted child to Short Term Medical, National General

Foundation Health, and Hospital Expense Protection plans

Note: All applicants are required to answer the following question during the initial enrollment process:

» Are you or any applicant now pregnant, an expectant father, in process of adoption, or undergoing infertility

treatment?

Upon receiving a request to add a Newborn or Adopted Child, customers may be asked the following questions:

» When did you ﬁnd out that you were pregnant or an expectant father?

The Newborn child will be added to the policy, however claims may be held for review based upon the child’s

birth date relative to your policy effective date.

If it’s found the applicant was pregnant or an expectant father at the time in which the applicant applied, the

newborn won’t be added and there is a possibility that the primary insured may be removed from the policy,

back to the initial effective date.

* Documentation is not requird in instances of death.

NGAH-PRODUCTGUIDE

Outline of coverage guidelines

Some states have a legal requirement to provide the state approved Outline of Coverage to the applicant at the

point of sale. It is the agent’s responsibility to make sure the applicant is provided with the Outline of Coverage,

when required.

Product

States in which agents must provide an outline

of coverage to the applicant at point of sale

Short Term Medical Kansas

Accident Fixed-Beneﬁt

California, Georgia, Idaho, Maine, Montana, Nevada, Oklahoma, Oregon,

South Carolina, South Dakota and Texas

Plan Enhancer — AME only and AME

with rider(s)

Georgia, Louisiana, Maine, Michigan, Montana, Nevada, Oklahoma,

Oregon, South Carolina, Texas, West Virgina and Wisconsin

National General Foundation Health

and Hospital Expense Protection

Idaho

Cancer and Heart/Stroke

Florida, Montana, Nevada, Oklahoma, Oregon, South Carolina, Texas,

Washington*, West Virginia, and Wisconsin

*Washington requires the disclosure form (describing coverage) be left with the applicant.

Critical Illness - Term Life

TrioMED

AcciMED

Vital Guard

Not required

Dental Indemnity

California, Georgia, Idaho, Massachusetts, Montana, Ohio, Oklahoma,

Oregon, South Carolina, South Dakota, Texas, Washington,

West Virginia and Wisconsin

Dental PPO Idaho, Georgia, Illinois, Massachusetts and Missouri

Quote NatGen platform provides a link to the Outline of Coverage allowing the agent to email the document to

the applicant.

NGAH-PRODUCTGUIDE

Replacement Guidelines

If existing accident/health coverage must be replaced, the following states require that a replacement form be

completed and submitted with the application. A copy of the completed replacement form should be left with the

applicant. It is your responsibility to provide the form to the applicant.

A copy of the completed replacement form should be completed by the applicant and mailed to us. QuoteNatGen

provides a link to the Replacement Notice allowing you to email the document to the applicant. Replacement forms

are also available on VIPMemberbeneﬁts.com.

Product Replacement form States

Accident Fixed-Beneﬁt Colorado, Idaho, Massachusetts, Oregon and South Carolina

Plan Enhancer – AME and AME with

optional rider(s)

If existing coverage is being replaced by

the AME plan with a Cancer and Heart/

Stroke and/or Sickness Hospitalization

rider, the following states require a

replacement form to be completed and

submitted with the application

Colorado and Oregon

Arkansas, Florida, Illinois, Iowa, Maine, Oklahoma, South Carolina, Texas,

Utah, West Virginia and Wisconsin

Cancer and Heart/Stroke

Arkansas, Colorado, Delaware, Florida, Illinois, Iowa, Oklahoma,

Oregon, South Carolina, Texas, Utah, Washington, West Virginia and

Wisconsin

Critical Illness - Term Life No replacement is allowed

Dental Indemnity

Arkansas, Colorado, Connecticut, Delaware, Florida, Idaho, Illinois, Iowa,

Maine, Massachusetts, New Jersey, Oklahoma, Oregon, Pennsylvania,

South Carolina, Texas, Utah, Virginia, Washington, West Virginia and

Wisconsin

Short Term Medical Utah

AcciMED, TrioMED, VitalGuard, National

General Foundation Health, Hospital

Expense Protection and Dental PPO

No replacement forms required

NGAH-PRODUCTGUIDE

Supplemental Claims

Supplemental claims payments are generally made to the policyholder to help offset the cost of services or

events in their lives. For your customer to receive claim payments, they will have to submit a completed claim

form with all required information. Additional information may be needed depending on each individual case.

Failing to submit all of the needed information will result in a delay in the claims processing.

Accident Fixed-Beneﬁt Claims

Please make sure your customer begins the claims process soon after treatment begins or it may impact the

payment of their claims. Remember, many of the beneﬁts require treatment within 72 hours of the accident.

Since this product has many recovery beneﬁts, the customer may send in multiple claim forms related to the

original accident. This will ensure the process is started immediately and also enable the customer to begin

receiving the cash beneﬁts as quickly as possible.

Plan Enhancer Claims

Please make sure your customer begins the claims process soon after treatment begins or it may impact the

payment of their claims. Remember, beneﬁts require treatment within 7 days of the accident. To submit a claim

on an Accident Medical Expense plan, your customer should include their Explanation of Beneﬁts (EOB) from

the medical insurance carrier along with a completed Accident Medical Expense claim form. If your customer

does not have other coverage, they must submit itemized bills with the Accident Medical Expense claim form.

Plan Enhancer: Sickness Hospitalization (SIP) rider claims

Please make sure your customer begins the claims process right after discharge from the Inpatient Hospital

Admission, or it may impact the payment of their claims. Remember, the SIP rider only pays beneﬁts for

inpatient hospital admission due to a sickness as deﬁned in the policy. To submit a claim on the SIP rider,

customers should send the itemized bill, including the diagnosis and procedure codes from the facility, along

with a completed Sickness Hospitalization claim form. Additional information may be required in some cases.

Cancer and Heart/Stroke Claims

For a Cancer and Heart/Stroke claim, the customer and physician will need to complete the Critical Illness

claim form and provide medical details. Additional information may be requested by us depending on each

individual case. Use this form for both Cancer and Heart/Stroke policies and Plan Enhancer’s Cancer and

Heart/Stroke rider.

Agents will have access to information such as claims status and, if applicable, the claim paid date by calling

the claims’ Third Party Administrators (TPAs). Please note, certain information about your client’s claim is

protected by law.

It may take up to a week to process new policies into the claims systems

Claims

Claims may be pended for investigation as to whether the pre-existing exclusion applies and/or whether the

policyholder made material misrepresentations at the time of application.

NGAH-PRODUCTGUIDE

Dental Indemnity and PPO Claims

Dental claims can be paid to the provider, and most often are, if the dental ofﬁce and the policyholder agree to

assign beneﬁts. When dental beneﬁts are assigned to the dentist, the dental ofﬁce will submit the claim and

payment will be made directly to the provider.

NOTE: If the customer prefers to receive the beneﬁts directly, or the dental ofﬁce does not accept an assignment of beneﬁts, they

can submit the bill or statement from the dentist, including the procedure codes and other pertinent details about the treatment.

Also, the customer must include the policy number, the name of the Primary insured and the name of the insured treated. The

address for submission of the claim can be found on the back of their ID card.

Hospital Expense Protection

The Hospital Expense Protection plan is a supplemental limited-medical plan with beneﬁts for inpatient

hospital admissions and other medical expenses depending on the level of coverage selected. Hospital

Expense Protection claims are paid directly to the policyholder. The policyholder is required to submit the

Fixed-Beneﬁt Medical Claim Form and follow the directions to get the claim processed. These beneﬁts will

be paid to the insured and are not dependent on other coverage the person may have. Please instruct your

client to submit these claims as soon as possible after receiving services. The contract requires the claim to

be submitted within 90 days of the covered loss.

National General Foundation Heath

National General Foundation Health (NGFH) is a limited-medical plan with ﬁxed beneﬁts for ofﬁce visits, labs,

outpatient services, and other medical expenses.

The insured should always present their ID card at time of service. NGFH claims can be paid to the provider,

and most often are, if the provider and policyholder agree to assign beneﬁts. In most cases, in order to get

the network discount, it is required that the insured assign the beneﬁts.

» If an insured must ﬁle their own NG Foundation Health claim, please direct them to the Fixed-Beneﬁt

Medical Claim Form on NGAH-NGIC.com and follow the directions to get the claim processed.

Note: The NGFH contract requires the claim to be submitted within 90 days of the covered loss.

Critical Illness - Term Life Claims

The critical illness beneﬁts are coupled with a Life Insurance policy. Therefore, there are two possible types of

claims for this product. For a life claim, we will need a certiﬁed copy of the death certiﬁcate accompanying the

Loss of Life claim form. For a critical illness claim, the customer will need to complete the Critical Illness claim

form and provide medical detail, which may include medical records. Additional information may be requested

depending on each individual case.

NGAH-PRODUCTGUIDE

Short Term Medical Claims

The customer must present their ID card at time of service.

» Claims are paid directly to the provider

» If an insured must ﬁle their own Short Term Medical claim, they can call claims customer service at

866-596-5817 for instructions and claim forms.

Claim forms

Please remind your client to read the instructions on the claim forms and submit the required information in

order to expedite the processing of the claim.

To submit a claim, your client must:

» Download a claim form from the National General Accident & Health website under Member Forms:

https://ngah-ngic.com/claims.php

» TIC products-use the forms under TIC Claim forms dropdown

» For NHIC, IIC, or INIC products-use the forms under NHIC Claim forms dropdown

» Call the appropriate Claims Administrator

Directions on where to submit the claim is indicated on the claim form.

TrioMED, AcciMED and VitalGuard Claims

Accident Medical Expense and Accidental Death and Dismemberment Claims

Please make sure your customer begins the claims process soon after treatment begins or it may impact the

payment of their claims. To submit a claim on an Accident Medical Expense plan, your customer should include

their Explanation of Beneﬁts (EOB) from the medical insurance carrier along with a completed Accident Medical

Expense claim form. If your customer does not have other coverage, they must submit itemized bills with the

Accident Medical Expense claim form. Additional information may be needed depending on each individual case.

Critical Illness Claims

The critical illness policy pays beneﬁts based on three categories of serious illnesses. For the critical illness claim,

the customer will need to complete the Critical Illness claim form and provide medical detail, which may include

medical records.

NGAH-PRODUCTGUIDE

State Rewrite

Colorado

A maximum of 2 plans with any carrier in 12 months before a

6-month gap is required for another STM plan

Connecticut

• Limited to 1 STM plan

• No Rewrites allowed

Idaho

• Limited to 1 STM plan

• No Rewrites allowed

Kansas Limited to 1 Rewrite

Maine

Combined total of the new plan and any prior polices cannot

exceed 24 months

Maryland

There must be at least a 63 day gap in coverage from any health

insurance plan in order to obtain a NGAH STM policy

Michigan

Limited to 185 days of STM coverage with us in any 365 day

period (185 days of coverage does not need to be consecutive)

Missouri

There must be at least a 63 day gap in coverage from any health

insurance plan in order to obtain a NGAH STM policy

Nevada

Limited to 185 days of STM coverage with Us in any 365 day

period (185 days of coverage does not need to be consecutive)

North Dakota Limited to 1 Rewrite

Oregon

60-day gap in coverage required after 12 consecutive months of

Short Term Medical coverage

South Dakota

There must be at least a 63-day gap in coverage from any health

insurance plan in order to obtain a NGAH STM policy

Tennessee

The applicant must wait 30 days from the last day of coverage

before reapplying for a new STM plan

Wisconsin

There must be at least a 63 day gap in coverage from a NGAH

STM in order to obtain another NGAH STM policy

All other states No rewrite rules apply

Short Term Medical Rewrite Rules

NGAH-PRODUCTGUIDE

Contact I

nformation

For beneﬁts, claims and coverage information, customers should contact National General Accident & Health

Customer Service by:

P: 888-781-0585

E: memberser[email protected]

For Time Insurance Company plans sold prior to October 1, 2016:

P: 866-387-0484

Fax: 844-279-1983

E: [email protected]

Mail all inquiries to:

National General Accident & Health

P.O. BOX 1070

Winston-Salem, NC 27102-1070

For Short Term Medical, National General Foundation Health, and Dental PPO plans, customers should

refer to the back of their ID cards to locate network providers.

NGAH-PRODUCTGUIDE

Fair Credit Reporting Act

Federal law requires that a notice be given to any Applicant experiencing adverse action. The notice states

that a consumer report was reviewed as part of the enrollment process.

Notice of Insurance Information Practices

To issue an insurance plan, National General Accident & Health needs to obtain information about the

people proposed for insurance. Some of this information will come from the application, and some will

come from other sources.

All information collected by National General Accident & Health may, in certain circumstances, be

disclosed to third parties without the proposed insured’s speciﬁc authorization. The proposed insured has

the right to access and correct collected information that may relate to a claim or civil criminal proceeding.

The notice is part of the application/enrollment form for insurance.

HIPAA Privacy

As a business associate of National General Accident & Health, and as a representative working on

behalf of each applicant, it is your responsibility to protect the conﬁdential information you collect.

Health Insurance Portability and Accountability Act (HIPAA) privacy and security regulations require that

you, as a business associate, have physical, administrative and technical safeguards in place to protect

this information.

Please refer to the National Health Insurance Company privacy notice found at NGAH-NGIC.com

to understand how protected health information is handled at National General and how insureds

can exercise their individual rights under HIPAA. Please contact the National General Privacy Ofﬁce

immediately if you are aware of any breach of protected health information.

Important Information for You and Your Client

National General relies on your client’s answers to the application questions, and these answers have a

signiﬁcant impact on their eligibility for a plan. Information that is not completely and accurately disclosed

may result in plan rescission. If your client provided you with any health history information that would

require a response of “yes” to a health question, you are required to disclose that information to us. The

applicant must disclose his or her full and complete medical information — obtaining all the required

authorizations at the time of application submissions is critical. Clients should contact National General if

they think of any additional information that should have been disclosed.

Important Information

NGAH-PRODUCTGUIDE

National General Holdings Corp. (NGHC) is a publicly

traded company with approximately $2.5 billion in annual

revenue. The companies held by NGHC provide personal

and commercial automobile insurance, recreational vehicle

and motorcycle insurance, homeowner and ﬂood insurance,

self-funded business products, life, supplemental health

insurance products, Short Term Medical, and other niche

insurance products.

National General Accident & Health, a division of NGHC, is

focused on providing supplemental and short-term coverage

options to individuals, associations and groups. Products

are underwritten by Time Insurance Company (est. in 1892),

National Health Insurance Company (incorporated in 1965),

Integon National Insurance Company (incorporated in

1987) and Integon Indemnity Corporation (incorporated in

1946). These four companies, together, are authorized to

provide health insurance in all 50 states and the District

of Columbia. National Health Insurance Company, Integon

National Insurance Company and Integon Indemnity

Corporation have been rated as A- (Excellent) by A.M. Best.

Each underwriting company is ﬁnancially responsible for its

respective products.