American General Life Companies

FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC 1

List Bill (Salary Allotment) Processing for

Supplemental Accident & Health Insurance Products

General Guidelines for List Bill

2FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

• Must be properly licensed and appointed with American General Life prior to requesting list bill (salary allotment) or submitting business

• Establish list bill/salary allotment prior to any solicitation• Contact Barbara Fisher barbara.e.fisher@aglife.com 217-541-7751• Salary allotment information including acceptable group minimums can be found on

eSstation: https://estationsecureho.americangeneral.com/Producer/Inforce/PaymentServices

• Make sure Illustrations are run with the appropriate modal frequency• Make sure policy benefits on application match illustration• Employees must be the primary proposed insured for a list bill case (spouse and children

can be added)• Policy effective dates cannot precede the application completion date – backdating of

Accident & Health applications is not allowed• Electronic Funds Transfer (EFT) and Credit Card payment options are not available• Policies issued after the list bill generation date will be added to the following list bill with

any back premium due included.• Any questions regarding list bill process should be directed to the above mentioned

contact. Additional material is also available in Forms Depot (through eStation)

3FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

Choose the Payment Frequency Mode that matches the List Bill generation Frequency

eConnections Processing of List Bill for Accident Expense Plus®/AG Accident Choice PlusSM

4FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

On the first page of app submission select the drop down box of the payment options/Payment Method

eConnections Processing of List Bill for Accident Expense Plus/AG Accident Choice Plus

5FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

Select “List Bill” from the drop down. Insert List Bill number provided from the List Bill unit

eConnections Processing of List Bill for Accident Expense Plus/AG Accident Choice Plus

6FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

On the Summary page you will see “ListBill” as the payment method

eConnections Processing of List Bill for Accident Expense Plus/AG Accident Choice Plus

7FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

An additional page for signature will be required. Information for completion will be handled by the List Bill unit after policy is issued and known deductions, if any, are calculated

eConnections Processing of List Bill for Accident Expense Plus/AG Accident Choice Plus

8FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

eConnections Processing of List Bill for Accident Expense PlusAG Accident Choice Plus

Proposed insured “clicks” to sign the authorization form. This form is required regardless of whether the list bill is employer paid / employee paid or a combination

9FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

Paper Application Processing of Accident & Health New Business

• Illustrate based on the billing frequency (Annual, Semi-Annual, Quarterly, Monthly)

• Does not effect or determine payroll deduction amount or frequency; corresponds only with billing frequency the list bill is generated

• An Employee Payroll Deduction Authorization Form D B813-A should be signed by proposed insured and submitted with application.

• Employees must be primary proposed insured for a list bill case (spouse and children can be added)

10FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

Completion of Form D B813-A

Indicates Required Field

Completion of Form D B813-A (continued)

11FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

Indicates Required Field

Paper Application Completion:Accident Expense Plus

12FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

A) Check “Frequency of Modal Premium”, disregard “(bank draft only)” statement if choosing monthly. This should match the frequency of the list bill generation.

B) Choose “List Bill” from the Method selections. You must provide the List Bill Number for it to process correctly. Policy will be issued on a quarterly direct bill. If you don’t have the number, call the Salary Allotment Unit.

Paper Application Completion:AG Accident Choice Plus

13FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

A) Check “Frequency of Periodic Payment”, disregard “(bank draft or Recurring Credit Card only)” statement if choosing monthly. This should match the frequency of the list bill generation.

B) Choose “List Bill” from “Method of Payment”. Must provide “List Bill Number” to process. Policy issued on quarterly direct bill. If no number, call Salary Allotment Unit.

Paper Application Completion:EmergencyCare Plus®

14FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

A) Check “Frequency of Modal Premium”, disregard “(bank draft only)” statement if choosing monthly. This should match the frequency of the list bill generation.

B) Choose “List Bill” from “Method”. Must provide List Bill Number to process. Policy issued on a quarterly direct bill. If no number, call Salary Allotment Unit.

Paper Application Completion: CriticalCare Plus®

15FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

A) Check “Frequency of Modal Premium”. For Monthly, check “Other” and insert “Monthly” in space provided. This should match the frequency of list bill generation.

B) Choose “Add to existing Salary Allotment account no.” Must provide List Bill Number to process. Policy will be issued on quarterly direct bill. If no number, call Salary Allotment Unit.

Additional Resources for Accident & Health Products

16FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC

• Contact your Regional Vice President:– Bob Clancy, Western US Regional Vice President: (303) 750-3545

– Jamie Leon: Eastern US Regional Vice President: (443) 547-7959

• Health Care Reform Video Series on You Tube: www.youtube.com/americangeneralco

Important Information

Policies issued by: American General Life Insurance Company, 2727-A Allen Parkway, Houston, Texas 77019. The United States Life Insurance Company in the City of New York, One World Financial Center, 200 Liberty Street, New York, New York 10281. Accident Expense Plus—Policy Form Number 07120; 07120N; AG Accident Choice Plus—Policy Form Number 11120; CriticalCare Plus—Policy Form Number 05130; EmergencyCare Plus—Policy Form Number 04120. The underwriting risks, financial and contractual obligations and support functions associated with products issued by American General Life Insurance Company (AGL) or The United States Life Insurance Company (US Life) are the issuing insurer’s responsibility. US Life is authorized to conduct insurance business in New York. Policies and riders not available in all states. American General Life Companies, www.americangeneral.com, is the marketing name for a group of affiliated domestic life insurers, including AGL and US Life.

Important Note: All benefits payable are subject to the terms and conditions of the policy, including benefit durations, limitations and exclusions. Not all benefits and exclusions apply in every state. Please consult the policy form and outline of coverage for details. There will be a charge for each rider selected. See the rider for details regarding the benefit descriptions, limitations and exclusions. Guarantees are subject to the claims-paying ability of the issuing company. Comprehensive medical coverage may be required in some states in order to apply for or maintain the policy.

©2013. All rights reserved. AGLC106729

17FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC