ethics aflac
Splitting commissions or using SIT codes for contest qualification is _____________.
not allowed
incentive programs include __________.
promotions, contests, sweepstakes
Alicia, an Aflac producer, is receiving Aflac disability benefits. Her care provider indicated an interest in Aflac coverage. Alicia is not sure if she is allowed to write business while on disability. She should ____________.
review the insurance fraud and prohibited practices document
Anti-Money Laundering (AML)
Cash value accruing products, such as Whole Life, are potential vehicles for money laundering. Money laundering is the process of concealing the existence, illegal source, or application of income derived from criminal activity.
Lump Sum Critical Illness (LSCI)
Lump Sum Critical Illness (LSCI) is designed to provide a lump sum payment to assist with costs associated with covered critical illness events. The benefits are payable as a lump sum, once per person, per lifetime, excluding subsequent event coverage.
Cancer/Specified-Disease
The Cancer/Specified Disease plans help with the costs of cancer treatment. The plans offer a broad definition of cancer that is designed to provide multiple benefits.
Privacy Incidents
A privacy incident, also known as a breach, is an impermissible acquisition, access, or use or disclosure of protected health or financial information that can put a person's finances or reputation at risk. HITECH requires a producer to notify Aflac Headquarters as soon as they discover a privacy incident.
Accident
Aflac's Accident plans help reduce the financial impact of a covered accident by providing cash benefits.
Information Security Frameworks
An information security framework defines how information is managed and secured with a focus on lowering risks and vulnerabilities.
Contest and Contest Manipulation
Contests are designed to reward producers for product sales, recruiting, and persistency. Aflac has a zero tolerance policy regarding contest manipulation. Failing to comply with state regulations or circumventing company policy to qualify for a contest is contest manipulation, and it's strictly prohibited.
Critical Illness/Specified Health Event
Critical Illness/Specified Health Event plans help with the costs of treatment if you experience a covered health event, such as a heart attack, stroke or paralysis.
Cross Border sales
Cross Border Sales is defined as the sale of insurance products or services to an applicant outside of the applicant's state of residence. The application must be taken on the approved application of the resident state of the applicant.
Cybersecurity Best Practices
Don't share your password with anyone. This includes your coordinator, administrator, or other producers. Remember, you are responsible for all transactions that take place using your User ID and password. • Don't set passwords that are easy to guess or that contain "Aflac" or "duck." • Make passwords complex and try using a passphrase containing upper and lower case letters, numbers, and special characters. • Don't tape your passwords to your laptop or computer. • Make sure no one is "shoulder surfing" when you enter your password on your devices. • Consider using multi-factor authentication when available. This requires multiple verification steps before being permitted to access an account. For example, in addition to username and password, multi-factor authentication also requires a passcode.
Needs based
Examples of need-based insurance sales strategies: • Asking your customer about their current insurance coverage • Taking time to learn about a customer's insurance needs and financial objectives and obligations • Using salary illustration to show the impact of premium payments on take-home pay • Recommending an insurance product or combination of products that meet the customer's insurance coverage and financial needs
Define Fraud
Fraud is an act of cunning, deception, or artifice to cheat or deceive another person for profit or to gain an unfair or dishonest advantage.
Health Care
HIPAA established health care fraud as a federal criminal offense. Health care fraud may lead to higher premiums and out-of-pocket expenses, reduced benefits and coverage.
Hospital Confinement Indemnity
Helps ease the financial burden of hospital stays due to a covered accident or illness by providing cash benefits.
The NIST Cybersecurity Framework contains a lot of practical guidance and is adaptable by organizations of all sizes. There are five functions that make up the core tenant of the framework:
Identify. Assists in developing an organizational understanding of managing cybersecurity risk to systems, people, assets, data, and capabilities. 2. Protect. Limit and contain the impacts of potential cybersecurity events and outlines safeguards for delivery of critical services. 3. Detect. Defines the appropriate activities to identify the occurrence of a cybersecurity event in a timely manner. 4. Respond. Includes appropriate activities to take action regarding detected cybersecurity event to minimize impact. 5. Recover. Identifies appropriate activities to maintain plans for resilience and to restore services impaired during cybersecurity incidents
What counts as a contest?
Incentive programs include: • Promotions - "Hit and get it". o Triple Crown. o Convention. • Contest - Games of skill. o President's Club. • Sweepstakes - Games of chance. o Randomly selected winners from pool of contestants
Current Contest Rules
Incentive programs run by 1099s are not allowed excepting those where the monetary value is less than $100 per qualifier per each annual quarter. In addition, the program(s) must be conducted within the field incentive program guidelines available on the Rewards and Recognition page of Field Force Services.
Malware
Malware is a catchall term that encompasses a wide variety of threats that refer to malicious code used to gain access to networks, as well as to steal or destroy data.
Ransomware
Ransomware is a form of malware that can lock you out of your digital folders or files through encryption. This is followed by a ransom demanding payment that ranges from a few hundred dollars to thousands, typically in bitcoins, to unlock and restore access to the data. Often the attacker threatens to destroy or publicize the encrypted data unless you pay
Common Controls
Regular Security Awareness Training (attending and deploying to staff). • Implementing Access Controls. • Applying Encryption (while information is stored and during transfers). • Implementing Multifactor Authentication. • Routinely Testing Systems. • Creating and Preserving Audit Trails. • Applying Physical Security (locks, personnel, etc.) • Timely Application of Updates and Patches.
Replacements
Replacing a policy must be in the best interest of the policyholder. Valid reasons for replacing a policy include improved health status, rate changes, as well as the need for increased coverage.
Short-Term Disability 2
Short-Term Disability (STD) insurance can be paid by either the employer or the employee. It provides a source of income if the covered person becomes disabled due to a covered accident or illness. A policyholder's spouse and dependents are not eligible for disability on the base policy.
What is Social Engineering?
Social engineering is a technique used by attackers to manipulate people into exposing data, spreading malware, or giving access by disclosing login credentials. These attacks are accomplished through actual communications between the attacker and victim.
Claims Fraud
Some examples of claims fraud are: • Withholding or not disclosing relevant documentation or information related to a claim. • Assisting policyholders or providers in submitting fraudulent claims. This includes fabricated medical records, authorizations, and other altered documents.
Protected, Personal, Financial Information Examples
Some examples of customer personal/protected information include: • Names (when used with health or financial info) (full, or initial and last). • Credit/card numbers. • Past, present, and future claim related data.
Physical Security Best Practices
Store mobile devices in secure areas when not in use. • Be mindful of your surrounding when discussing confidential information. • Never leave your work laptop or other devices outside or in your car. • Avoid connecting to public Wi-Fi when conducting business or personal transactions. • Be careful who you allow access to your building or work area. • Avoid setting devices to remember passwords or PII information. • Keep anti-virus software updated.
Responsibilities
The Aflac producer is responsible for • Obtaining and maintaining required licenses. • Paying applicable state fees. • Requesting and obtaining appointments. • Requesting appointments by submitting a copy of his/her license to Field Contracting (FC). • Sending a copy of their licensing to FC in order to be appointed in non-resident states. • Maintaining state licensing requirements by complying with state and federal laws and through state-certified continuing education programs. • Maintaining Errors and Omissions insurance coverage
Commonly Required Cybersecurity Tasks
When it comes to the current state of laws that govern cybersecurity in the United States there is no "one" law that governs all.
Examples of need-based selling are ____________.
asking your customer about their current insurance coverage, using salary illustration to show the impact of premium payments on take-home pay
Fraud is an intentional act, omission or violation of trust designed to _____ others, resulting in the victim suffering a loss and/or the perpetrator achieving a gain.
deceive
What counts as a gift?
A gift is defined as something of value.
Gift Policy
Giving gifts? All gifts require pre-approval, except Aflac-branded items worth less than $25.
Term Life
Term insurance provides coverage for a specific length of time. If the policy/certificate holder dies during the term, the death benefit is paid in full. If the policy/certificate holder does not die and the term has been reached, the policy/certificate will either terminate, can be renewed for another term, or can be converted to a Whole Life policy or certificate.
Aflac Dental Insurance - Supplemental Plan
The Aflac Dental Insurance - Supplemental Plan provides benefits for periodic checkups and cleanings, x-rays, fillings, crowns and more. Aflac only requires policyholders to meet waiting periods once; however, if the policy lapses and is reinstated, all waiting periods start over.
As an Aflac producer, you are relieved of the responsibility for continuing education that is required by some jurisdictions.
false
You ______________ a Suitability Notice to potential policyholders in all U.S. states and territories.
will need to explain
Contests are designed to reward producers for product sales, recruiting, and persistency. Aflac has a ________ policy regarding contest manipulation
zero tolerance
WAIT Method
1) Who is the sender? Do I recognize the sender? Am I expecting this email? 2) Action Required? Do I need to click on a link or open an attachment? 3) Incentive or Consequence? Is there a persuasive reason for the action? 4) Time Limit? Is there an expiration date? Is there a sense of urgency?
Fraud
- an intentional act, omission or violation of trust designed to deceive others, resulting in the victim suffering a loss and/or the perpetrator achieving a gain.
Prohibited Practice
- includes acts that violate the procedures, industry codes, branding or security as outlined in the Prohibited Practices document.
completing applications
Aflac producers must complete product applications accurately and according to state requirements. Producers must ask applicants every question and ensure that the applicant reads the documents in their entirety, including all disclosure statements. Aflac underwriting standards require each proposed policy/certificate holder to sign applications or enrollment forms in the producer's presence.
Additional Training
As an Aflac producer, you'll be expected to complete additional courses related to the products that you'll be selling.
Where is Protected Information?
At Aflac, protected information can be found on: • Applications. • Reinstatement forms. • Premium deduction authorizations (PDA). • Emails. • Faxes. • Everwell. • Reports. • Claim forms. • Account invoices. • Correspondence. • Census data. • Laptops. • Electronic devices such as USB/Flash Drive.
VAS
Value-added services are non-insurance items or services offered to an insured, potential insured, or employer that are not a benefit explicitly offered in a policy contract.
Consequences
Violating any of the guidelines, processes or rules in this training or related documents, will be subject to administrative action up to and including termination. Fines and/or chargebacks to you or your hierarchy may also occur.
Respect/Harassment
We should treat everyone we encounter with the same respect and care that we expect in return. We create environments that are free from discrimination and harassment. This means refraining from inappropriate conduct toward other people, whether they are our Aflac teammates or external contacts.
___ is NOT a valid reason for replacing a policy.
declining health status
Individuals representing Aflac cannot participate in any portion of the sales process, _________________, until they're appropriately licensed and appointed.
including soliciting and negotiating
Prohibited Practices include acts that _______ the procedures, industry codes, branding or security as outlined in the Prohibited Practices document.
violate
Advertising Compliance
Advertising Compliance is Aflac's regulatory entity that ensure all of Aflac's advertising, and all advertising done by producers and brokers on behalf of Aflac, is compliant with laws and regulations governing the sale and marketing of insurance
Aflac Dental Insurance (network)
Aflac Dental insurance plans are flexible, affordable dental coverage with more than 275,000 access points across the U.S. Features • Standard and custom plan designs. • Preventive and diagnostic services covered at 100%. • Includes basic and major services. • Optional orthodontia benefit.
The Players: Trust, SIU, DOIs
Aflac Trust is a dedicated team of professionals who educate field force members and employees to identify fraud indicators. Aflac Trust works closely with SIU, the Special Investigations Unit.
Aflac Vision Insurance (network)
Aflac Vision Insurance plans offer comprehensive vision benefits accessible through an extensive network of independent providers and national retailers
Do Not Contact
Aflac maintains a Do Not Contact List of businesses that have requested they not be contacted by Aflac agents. Contacting any of the businesses, accounts or brokers on the Do Not Contact List for which you are not the servicing agent is a prohibited practice.
Aflac's Field Oversight Enforcement Committee (FOEC)
Aflac's FOEC meets on a regular basis to review all producer misconduct and fraud. The FOEC takes disciplinary action up to and including termination
Juvenile Life
Aflac's Juvenile Term Life insurance policy/certificate is designed to provide protection for people ages 0 through 24 years. Age 0 means the latter of 14 days or the date released from the hospital after birth. Juvenile Term and Whole Life offer varying face amounts - $10k, $20k, or $30k.
Consequences of Fraud and Sanctions
Aflac's position regarding fraudulent activity and prohibited practices includes: • Aflac will take appropriate action, up to and including the termination of your agreement. • Termination of commissions, including first-year commissions and renewals. • Aflac will charge back bonuses, advanced commissions, contests, awards, and prizes that were granted based on fraudulent business. If Aflac discovers an agent or coordinator won a contest or reward based on invalid business, we'll charge the agent for the amount of the contest winnings, as well as charge back their hierarchy. • Reporting of the fraud to the department of insurance which may lead to revocation of your license and substantial fines. • Repayment of losses incurred by Aflac. • Prosecution by federal and/or state authorities. Committing prohibited practices and failure to submit claims will result in administrative action, up to and including termination.
What is protected information?
Aflac's privacy policy helps protect Customer Protected Health Information (PHI) and financial information from intentional and accidental unauthorized use, access, or disclosure.
How do I get approval to give gifts?
Agents should submit gift requests for amounts greater than $25, non-branded Aflac merchandise, all gift cards and all raffles to [email protected].
Tracking
All contests, both Worldwide Headquarters and field-run, must be tracked and you must keep records of activity. These records must be available to Aflac and state regulators for three years. The following information must be included: • Contest timeframe • Qualifying criteria (such as AP, accounts, productive recruits, etc.) • Monetary value of each prize awarded
Limitations and Exclusions
Although individual products may have specific limitations and exclusions, there are some that span across multiple products. Usually, benefits will not be paid for pre-existing conditions, claims in which fraud is committed, an injury, treatment, or loss that is caused by, or occurs as a result of, a covered person:
Privacy Best Practices
Do not disclose PHI, financial information, or any personal information unless you have received the proper authorizations to do so—this applies whether it is communicated orally or in writing. • Before sending emails, double check that you are sending the email to the correct person(s). • You must use your @us.aflac.com to conduct business. You are not permitted to use your personal email address. • Check to ensure you provided the correct policy number, name, and transmittal when submitting claims or other correspondence. • Shred all documents that include health and financial data and use a secure recycle bin. • Only conduct enrollments in secure, private locations. • Before you leave an office, enrollment site, or other location, check to ensure no confidential information has been left behind. • Cover personal/confidential information when you leave your workstation. This includes both digital and stationary information. • It's important to keep a clean desk. Keeping your desk clean complies with the basic privacy principles for safeguarding personal information, and reduces the opportunity for theft or loss.
Duplicates
Duplicate coverage exists when two or more like policies or riders covering the same person are in force simultaneously.
Conflict of Interest
During the sale of insurance coverage, a situation that arises in which a producer's self-interest interferes with their obligation to act in the best interests of a customer is called a conflict of interest
Chargebacks
If Aflac discovers a producer or coordinator won a contest or reward based on invalid business, Aflac will charge the producer for the amount of the contest winnings, as well as charge back their hierarchy. Chargebacks apply to all contests to include Worldwide Headquarters and field-run contests.
Regulatory Inquiries and reporting incidents and complaints
If an Aflac producer is contacted, visited, questioned, or detained by any state, local, or federal agency, the producer must immediately contact Aflac Compliance. When a market conduct examination is implemented, Aflac requires complete cooperation with Market Conduct examiners.
Short-Term Disability
If you are an Aflac producer and have disability coverage, you need to be aware of and follow the rules surrounding disability coverage. Producers who are out on total disability are not allowed to actively produce, write, or solicit new business or resume coordinator responsibilities while receiving Aflac disability benefits. Doing so is a prohibited practice and is disability insurance fraud.
Breach Management
In accordance with the HIPAA HITECH Omnibus Final Rule, business associates, such as Aflac producers, their employees, and their subcontractors, are required to abide by certain guidelines in the Privacy and Security Rules.
The Impact of Privacy Breaches*
In the United States, there were 2,037 publicly reported breaches through June 30, 2020, a 52% decrease compared to the first six months of 2019 and 19% below the same time period for 2018.
What is Phishing?
Phishing is an attack sent through fake emails that appear to be from a trusted source, such as a well-known business or a colleague
Policy Delivery
Policies must be delivered according to state regulations and depends on the type of policy.
Aflac's Understanding Insurance Fraud and Prohibited Practices guide includes _______________.
Policy administration and claims administration prohibited practices and Corrective actions and FAQs
Privacy Laws
Privacy is the right of an individual to control the use and disclosure of his or her personal information. Aflac, Aflac producers, their employees, and subcontractors are required by law to protect our customers' personal information.
Aflac Vision Insurance - Supplemental Plan
The Aflac Vision Insurance - Supplemental Plan helps with the costs of eye exams, treatments and vision-correction materials.
CCPA (Consumer Credit Protection Act)
The rights are: • Right to know when and what personal information a business collects, sells, or discloses, including third parties who purchased or received their data. • Right to receive a copy of specific information shared. • Right to demand deletion of specific consumer information. • Right to opt-out. • Freedom from discrimination based on choice of sharing information.
Claims
When assisting with policyholder claims, every state has strict claims-handling laws that insurance companies and agents who help file claims must follow. Failure to submit a claim to Aflac Worldwide Headquarters on the same calendar day it is received from the policyholder is a prohibited practice.
Reporting Fraud
When you suspect or determine that someone has engaged in insurance fraud or prohibited practices, it is your responsibility to report the activity immediately the Special Investigations Unit.
Whole Life
Whole Life is often referred to as "permanent insurance" because it never expires, as long as premium payments are maintained. Whole Life insurance builds cash value and may help provide the insured with the "peace of mind" that as long as premium payments are maintained, he or she will always be insured.
Suitability
You will need to explain a Suitability Notice to potential policyholders in all U.S. states and territories. The Suitability Notice form is short but must be signed by the proposed policyholder after you have explained the form and had a brief discussion about it. You must ensure: • The customer understands the impact of the premium on his or her paycheck or income. • The customer believes the impact that the total Aflac premium for this coverage, and any other Aflac coverage, has on his or her paycheck or income is appropriate. • The customer believes his or her existing health insurance coverage, with Aflac and/or with other carriers, is suitable. Be sure to let the proposed insured know that they can contact Aflac and/or other insurance carriers to assist him in evaluating the suitability of insurance coverage. Selling policies that the customer cannot afford, doesn't want, or doesn't need is a prohibited practice.
One way Susan, an insurance sales producer, keeps her enrollments up and increases her sales is to encourage her customers to replace existing coverage with a new version of the same product every two years. She doesn't consider whether the coverage is suitable for the customers and uses misleading information to make the sale. This is ________.
called churning and is a prohibited practice
Bob, a new insurance sales producer, provides a customer misleading information to get the customer to surrender a current policy with another carrier in order to sell coverage with his carrier and generate first year commissions. This is ___________.
called twisting and is a prohibited practice
If Aflac discovers a producer or coordinator won a contest or reward based on invalid business, Aflac will charge the producer for the amount of the contest winnings, as well as ____________.
charge back their hierarchy
Contest manipulation will result in ____
chargebacks and disciplinary action up to and including termination
During the sale of insurance coverage, a situation that arises in which a producer's self-interest interferes with their obligation to act in the best interests of a customer. This is called a ______________.
conflict of interest
Twisting -
refers to using misleading information about the benefits of a customer's existing policy with another carrier to get the customer to surrender that policy and buy Aflac coverage. The intent is to generate first year commissions.
Churning -
refers to using misleading information to get a customer to replace an existing Aflac policy with another Aflac policy. The primary goal is to increase commission or sales.
We create environments that are free from discrimination and harassment. This means ______________________ toward other people, whether they are our Aflac teammates or external contacts.
refraining from inappropriate conduct
Jaron, an Aflac producer, is preparing to conduct a virtual face-to-face enrollment on his laptop. Jaron is concerned his customers may not be able to initial and sign the applications. Jaron wonders if he is allowed to enter the initials and signature for the customers. He should ___________.
review the insurance fraud and prohibited practices document
Contacting any of the businesses, accounts or brokers on the Do Not Contact List for which you are not the servicing agent is a prohibited practice
true