AIS Funeral/Burial Expenses Programoperations Manual

Insight. Experience. Commitment. /

AIS Funeral/Burial Expenses ProgramOperations Manual

December 2013 /

Table of Contents

Funeral and Burial Program Expenses Overview 3

Underwriting Process 7

Application 9

AIS Funeral & Burial Insurance Declaration 14

Claims 15

AIS Funeral & Burial Insurance Premium Process 16

AIS Funeral & Burial Insurance Claim Process 17

Funeral & Burial Expenses ProgramOverview

The AIS Burial program is a master term insurance policy and remains in force provided community member is listed on the band roll and the premium has been paid. The coverage is in force 24 hours per day, 365 days per year, and covers the insured member anywhere in the world. Proof of death is required before the maximum benefit amount of $2,500 Canadian, is paid for loss of life or death of the insured member and the death benefit will automatically be paid to the Chief and Council burial trust account.

Enrolment in the program is completed from community members’ enrolment records or the band roll and Council is both the owner of the policy and the premium payer.

The plan’s simplified “guaranteed issuance” design ensures that:

•All community members will be insured regardless of health from 5 days of age to 71,

•Individual community members will not be asked individual health questions and no individual underwriting applications are required

•One master application is completed, signed and submitted by Chief and council along with a copy of current band roll and the annual premium payment.

The benefits of the AIS Burial Insurance Programwill ensure:

•controlled and uniform burial benefits for all registered community members

•fixed monthly premium costs,

•increased cash flow,

•controlled burial costs,

The Aboriginal Benefit membership program provides specific benefits to Community Members. Coverage is in effect as long as the CommunityMember is an active CommunityMember of the First Nation band within the meaning of the Indian Act that is recognized by Indian and Northern Affairs Canada. Enrollment in the program is completed from the Community Member’s enrollment records or the band roll. Benefits are purchased by the Chief and Council of the First Nation provided at no cost to the Community Member.

Funeral/ Burial Expense

If a Covered Event occurs, We will reimburse the Chief and Council of the First Nation for the CommunityMember’s Benefits which are payable, up to the Maximum Benefit Amount shown in Section III, Limit of Liability.

In the event of a CommunityMember’s death, benefits will be payable for Funeral/Burial Expense services or supplies which include funeral services or supplies arranged through benefit provider or contracted funeral parlor.

Services or supplies include but not limited to; embalming or cremation services, transporting the body from the funeral home to the burial grounds, casket, vault, flowers, announcements, room rental, cost of officiating party.

Definitions

Administrator means Jamic Administrators, Inc. (JAI) and can be contacted at 1 855 660 3198 or by email at

Beneficiary means Chief and Council of the First Nation
Benefits means the benefits provided in the program as listed under the coverage in Section 1

Community Member means any person between the ages of 5 days old and 71 years old who is enrolled in the program and registered on a “Band List” maintained by the Department of Indian and Northern Affairs Canada or the Participating First Nation in accordance with the provisions of the Indian Act, whose premium has been paid

Company refers to Certain Underwriters at Lloyd’s, London (Jubilee, Syndicate 5820)

Covered Event refers to the death of a CommunityMember during the period of coverage

Funeral/Burial Expense refers to reimbursement for funeral/burial expense supplies or services for the deceased CommunityMember

Legally Qualified Physician means a physician practicing within the scope of his or her license and recognized as a physician in the place where services are rendered

Pandemic means an epidemic resulting from a sudden outbreak that becomes very widespread and affects a whole region, continent or the world

Summary of Benefits means the Summary of Benefits provided to the Community

Territory means the Canadian Provinces

We, Usand Our refer to the Company providing this membership program.

Limit of Liability

Funeral/Burial Expense

We will pay for one (1) Covered Event per CommunityMember as reflected on under Section I being up to a maximum of C$ 2,500.

Term of Coverage

Coverage begins on the effective date, for the Community Members that are listed as Community Members.
Coverage begins on the date of membership for Community Members that are added after the effective date.
Coverage will terminate at 12:01 am on the anniversary date of the effective date.
The CommunityMember’s coverage is worldwide 24 hoursa day, 7 days a week.

General Exclusions and Limitations

Payment will not be made for an event:

Resulting from an act of declared or undeclared war
While participating in maneuvers or training exercises of an armed service
To which a contributory cause was the commission of or attempt to commit a felony or being engaged in an illegal occupation
From ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel or radioactive toxic explosion or other hazardous properties of any explosive nuclear assembly or nuclear component thereof
Resulting from a Pandemic.

General Provisions

Notice of Claim: Notice of claim must be reported within forty-five days (45) days after a Covered Event occurs or as soon as it is reasonably possible. Someone on the CommunityMember’s behalf may give the notice. The notice should be given to the Administrator and should include sufficient information to identify the Member. Please contact the Administrator at 1 855 660 3198 or by email at .

Claim Forms: When notice of claim is received by the Administrator forms for filing proof of loss will be furnished. If these forms are not sent within 15 days, the proof of loss requirements can be met by sending a written statement of what occurred. This statement must be received within the time given for filing proof of loss.

Proof of Loss: Proof of loss of life or death must be provided within 90 days after the date of the Covered Event or as soon as is reasonably possible before the maximum benefit is paid. Proof must, however, be furnished no later than 12 months from the time it is otherwise required, except in the absence of legal capacity. Proof shall include evidence of the death of the CommunityMember and the cause of death and any other information that may be reasonably required to establish the validity of the Covered Event. In the event for loss of life or death of the member the final expense benefit will automatically be paid to the Chief and Council burial trust account.

Proof of Loss information includes the following:

original or notarized copy of the death certificate or the funeral director’s statement of death;
current enrollment information confirming deceased was insured under the Aboriginal Funeral/ Burial Expense Program
copy of the burial/funeral expense receipts

Time of Payment of Claims: The Administrator will pay the claim after receipt of acceptable proof of loss, final within 30 days

Legal Actions: No legal action for a claim can be brought against us until 60 days after we receive proof of loss. No legal action for a claim can be brought against us more than 3 years after the time required for giving proof of loss. This 3 year time period is extended from the date proof of loss is filed and the date the claim is denied in whole or in part.

Concealment and Misrepresentation: The entire coverage will be void, if before, during or after a loss, any material fact or circumstance relating to this cover has been concealed or misrepresented.

CareNav 24/7 Special Assistance Services

CareNav 24/7 Special Assistance Services provides you with the knowledge to assist you in understanding your diagnosis and treatment options.

CareNav provides the member diagnosed with a serious illness and their treating physicians with world-renowned professional specialists, CareNav offers the finest medical knowledge to confirm or modify a diagnosis and provide the best treatment options. For program detail please see Summary of Benefits

This is a contractual liability policy covering the reimbursement of Funeral/Burial Expenses incurred by First Nation and is underwritten by Certain Underwriters at Lloyd’s, London (Jubilee, Syndicate 5820), herein referred to as the Company. Please refer to the Summary of Benefits for specific Community Member information.

Annual Renewal

There will be a common renewal date.
Each renewal you will provide an updated listing of Band Members and the new premium will be calculated.
Adjustments for new members added or any members removed from the listing during the prior policy year will be adjusted at renewal.
Based on the payment election (annually in advance the new premium will become payable with renewal based on the revised member listing.

Benefit Limits

In force in the amount of $2,500 for each Community Member and $5,000 for each Chief listed on the band roll with all proceeds payable to the Aboriginal Trust.

Number of Members: / Total Annual premium Due:

Claims Process

Original or notarized copy of the death certificate or the funeral director’s statement of death
Current enrollment information confirming deceased was insured under the Aboriginal Funeral/Burial Expense Program
Copy of the Funeral/Burial receipts

Underwriting Process

Underwriting Protocol for Burial Program

Dictated by the Underwriting Guidelines

Pricing

Rating will be based on the carrier approved net rating matrices and rating spreadsheets provided by AIS.

Gross Commissions at 30%
15% Payable to Partner Broker
15% Retained by AIS
$2,500 @ $16.76
$5,000 @

New Business (AIS Timelines)

In order to ensure service standards the Partner Broker agrees to the following process:

The partner broker or their designate will forward all appropriate AIS underwriting applications.
AIS partner broker or their designate will forward a completed submission package to AIS, underwriter and Underwriting Assistant (UA) and upon receipt it is date stamped at AIS. Each submission forwarded to AIS will include and be immediately checked by the Underwriting Assistant (UA) for the following:

a completed and signed AIS burial program application and any other applications as required.
a community band roll currently dated

AIS will date stamp (either electronically or manually as received) and store the submission within the client relationship management software and set the prospect or renewal up in powerbroker.

AIS underwriter or their UA to review all documentation against the underwriting submission checklist, to ensure submission is complete and immediately notifies (same day as received) the partner broker by email of any missing information and will advise that no quotation will be released until information has been received and abeyances for 5 days UA advises the sub broker that all missing or additional information is to be directed to the UA and updates the submission checklistand reabeyances for any additional information required. If the submission is complete UA creates client file and advises underwriter by email noting any abeyances.
As soon as all underwriting information is received by AIS underwriting a quotation is prepared using the approved rating formulas
A proposal will be forwarded by AIS to the partner broker within 24 hours of receipt by email.
All proposals are to be delivered to the prospective community and abeyanced.
Partner broker will advise AIS with binding instructions as soon as confirmation is received from the client and AIS advises underwriters immediately and provides assigned policy numbers as per the underwriting agreement.
AIS will within 24 hours of receipt of binding confirmation from the partner broker and a copy of the proposal will provide declaration pages that will be sent electronically to partner broker.

Within 10 days of binding the partner broker will provide to client:

all insurance documents,

On or about the 5th day of each month AIS will prepare a reporting bordereaux for insurers providing details of the past months activity including but not limited to:

List of all new clients bound
List of all endorsements issued

Renewal Business (AIS Timelines)

A completed and signed AIS burial application

Partner broker or their designate will provide to each client:

A renewal application,

Partner broker or their designate will provide to AIS, no more than 30 days prior to renewal and no less than 15 days prior to renewal:

A signed renewal application including and current dated band roll

AIS underwriter or their UA to review all documentation against the underwriting submission checklist, to ensure submission is complete and immediately notifies (same day as received) the partner broker by email of any missing information and will advise that no quotation will be released until information has been received and abeyances for 5 days UA advises the sub broker that all missing or additional information is to be directed to the UA and updates the submission checklistand reabeyances for any additional information required. If the submission is complete UA creates client file and advises underwriter by email noting any abeyances.

As soon as all underwriting information is received by AIS underwriting a quotation is prepared using the approved rating formulas

A proposal will be forwarded by AIS to the partner broker within 24 hours of receipt by email.

All proposals are to be delivered to the prospective community and abeyance.

Partner broker will advise AIS with binding instructions as soon as confirmation is received from the client and AIS advises underwriters immediately and provides assigned policy numbers as per the underwriting agreement.

AIS will within 24 hours of receipt of binding confirmation from the partner broker and a copy of the proposal will provide declaration pages that will be sent electronically to partner broker.

Within 10 days of binding the partner broker will provide to client:

all insurance documents,

Endorsements and policy changes are prepared by AIS within 48 hours of receipt.

On or about the 5th day of each month AIS will prepare a reporting bordereaux for insurers providing details of the past months activity including but not limited to:

List of all new clients bound
List of all endorsements issued

Application

Page 1 of 17Insight. Experience. Commitment.

Section 1: General Information

Community Name:
Mailing Address:
Location of Community:
Contact’s Name:
Title:
Telephone: / Cell: / Fax:
Email:

Section 2: Quote Information

Benefit Amount: / Annual Premium Quoted:
Term: / From: to: / Band Roll Population:

Section 3: Community Member Data Worksheet

Community Name:
Group Address:
Administrator Name:
Administrator Phone: / Fax:
Funding Services Officer Name:
Telephone: / Cell: / Fax:

Attach band roll or complete the following for all community members to be insured

(attach additional sheets as required).

Member’s Name / Date of Birth / Gender Premium / Band Roll # / Gross

Section 4: Personal Information Consent

The information collected on this application for this benefit is required for the purposes processing this application. It may also be used to administer the benefit, investigate any claims that may be made under this program, and for the provision of products and services. This information, and information in existing files, may be used by the administrator in the event of a claim. Subject to legal and contractual requirements, the applicant may refuse to consent to the collection, use, or disclosure of the community member’s personal information for specific purposes by contacting the administrator at 1 855 660 3198.

Section 5: Declaration and Signature

The applicant represents that the above statements and facts are true and that no material facts have been suppressed or misstated.

Completion and execution of this application confirms enrollment in the program.

Applicant Name (please print) / Applicant Signature
Title / Date
Agent/Broker Name (please print) / Agent/Broker Signature
Agent/Broker Address
Date

Information

The Band Member listing provided for development of the initial quotation will be updated if required.
The designated authorized person from the Band Council will determine the effective date of the plan and sign the amendment to add their Band to the program.
Pricing will be confirmed based on the new Band Member listing. Adjustments will be calculated at renewal.
A deposit cheque equal to the first year’s premium will be included.

Annual Renewal

There will be a common renewal date.
Each renewal you will provide an updated listing of Band Members and the new premium will be calculated.
Adjustments for new members added or any members removed from the listing during the prior policy year will be adjusted at renewal.
Based on the payment election (annually in advance the new premium will become payable with renewal based on the revised member listing.

Benefit Limits

In force in the amount of $2,500 for each Community Member and $5,000 for each Chief listed on the band roll with all proceeds payable to the Aboriginal Trust.

Number of Members: / Total Annual premium Due:

Claims Process

Original or notarized copy of the death certificate or the funeral director’s statement of death
Current enrollment information confirming deceased was insured under the Aboriginal Funeral/Burial Expense Program
Copy of the Funeral/Burial receipts

Agent/Broker Name (please print) / Agent/Broker Signature
Agent/Broker Address
Date

Council Resolution

Page 1 of 17Insight. Experience. Commitment.