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团队建设 · 约 24 分钟Team Building · 24 min

生前福利：不必等到身故才能用

Living Benefits: You Don't Have to Die to Use It

传统寿险最大的心理障碍是「我买了，但我用不到」，生前福利条款要解决的正是这句话。 但决定客户满不满意的，不是它保什么，而是 实际能拿到多少、谁拿不到、以及哪些事它根本不赔。 这三件事讲清楚，理赔那天才不会出事。

The mental block with traditional life insurance is "I paid for it and I'll never use it," and living benefit riders exist to answer that. But what determines whether a client is satisfied isn't what's covered but how much actually arrives, who is excluded, and what it plainly does not pay for. Get those three right and claim day doesn't become an argument.

幻灯片 · 45 页 · 每页下方附详细讲解Slides · 45 pages · full presenter notes under each ↓ 跳到全文↓ Skip to the full article

生前福利Living Benefits

Presented by Team Rise

各位伙伴好，我们是 Team Rise。欢迎来到这一堂生前福利的培训，英文叫 Living Benefits， 条款上的名字叫提前给付附约，Accelerated Benefit Riders，简称 ABR。今天这一堂，我们把生前福利从头到尾完整讲一遍。

Hello everyone, we're Team Rise. Welcome to this session on living benefits. In the contract they're called accelerated benefit riders, or ABRs. Today we'll take living benefits from start to finish.

很多客户，甚至我们自己的伙伴，对人寿保险的理解还停留在「人走了，家人才拿到钱」。 但国家人寿（National Life Group，简称 NLG）的保单，不是只有身故那天才有用：人还活着、但得了符合条件的重病， 就可以把一部分身故金提前拿出来用。这就是「生前福利」四个字的意思。

Many clients, and plenty of our own partners, still think of life insurance as "the family gets money after I'm gone." A National Life Group (NLG) policy isn't only useful on the day of death. While the insured is still alive, a qualifying serious illness lets them draw part of the death benefit early. That's what "living benefits" means.

今天分成五段。第一段，生前福利是什么，和医疗保险有什么不同。第二段，五大项条款，逐项讲触发条件， 中间穿插一个慢性疾病的真实理赔案例和合同原文。第三段，讲边界：哪些不赔、谁拿不到、额度怎么封顶、税怎么算。 第四段，讲最关键的一件事：打折理赔，实际能拿到多少；再和同业逐项比较，看高级护理条款 PCC。 第五段，真实理赔和理赔流程，五份表格一份一份看。

There are five parts. One: what living benefits are and how they differ from health insurance. Two: the five riders one by one, with a real chronic illness claim and the contract language along the way. Three: the boundaries, meaning what isn't covered, who can't get it, how the caps combine and how the tax works. Four: the single most important point, the discount, meaning what actually arrives; then a rider-by-rider comparison with other carriers and the Premium Chronic Care rider. Five: real claims and the claims process, form by form.

先把最重要的一句话放在前面：生前福利是打折提前兑现身故金，不是另外多给一笔钱。 条款写的是上限，实际能拿到多少，要到理赔时由保险公司按病情、年龄、剩余寿命计算，签单时谁都给不出这个数。 这句话今天会反复出现。课程结束时，你应该能独立向客户讲清楚：生前福利赔什么、不赔什么、怎么赔、大概会打多少折。

The most important sentence goes first: living benefits pay the death benefit early and at a discount; they are not extra money on top. The rider states a cap. What actually arrives is calculated by the carrier at claim from the condition, age and remaining life expectancy, and nobody can give that number at the point of sale. You'll hear that sentence more than once today. By the end you should be able to explain to a client, on your own, what living benefits cover, what they don't, how they pay and roughly how deep the discount runs.

互动设计Interaction

开场问一句：「客户问过你『生病能赔多少』吗？你当时怎么回答的？」请一两位伙伴说说。 讲完第 29 页那个真实算例之后，再请他们按今天的口径重新回答一次。

Open with: "Has a client ever asked you how much an illness would pay? What did you say?" Ask one or two partners. After the worked claim on slide 29, have them answer again the way we cover it today.

为什么选择国家人寿？Why National Life?

我们的角色Our role 代理商Agency Agency / Broker 同时签约多家保险公司：Foresters、F&G、Corebridge …Contracted with many carriers: Foresters, F&G, Corebridge … 全美 1,295 家代理商与国家人寿签约1,295 agencies nationwide contract with National Life

经纪人培训 & 销售 →Agent training & sales →

← 提供产品← Products

承保公司The carrier National Life 1848 年成立，178 年Founded 1848, 178 years 互惠寿险公司里生前福利条款最全The fullest set of living benefits among mutual life insurers IUL 销量第一（Wink 2024 年第四季度）No. 1 in IUL sales (Wink, Q4 2024)

全美寿险公司共 719 家（ACLI 2025）。我们站在客户这一边，从中挑最合适的那一家There are 719 life insurers in the US (ACLI 2025). We sit on the client's side and pick the best fit

先讲清楚我们在这件事里的角色。我们是代理商，英文叫 Agency 或 Broker。我们的工作，是站在客户这一边， 帮客户从市场上众多的保险公司里，挑出最适合他的那一家、那一款产品。左边这个圈就是我们： 同一家代理商，会同时签约很多保险公司，比如 Foresters、F&G、Corebridge。

First, our role. We're an agency, a broker. Our job is to sit on the client's side and pick, from the many carriers in the market, the one company and the one product that fit them best. The circle on the left is us: one agency is contracted with many carriers at the same time, such as Foresters, F&G and Corebridge.

右边是真正「提供产品」的保险公司，也就是国家人寿这样的承保公司。它负责设计产品、承担理赔风险， 最后把理赔款付给客户。两边的关系是双向的：保险公司把产品交给代理商，代理商负责培训经纪人、把产品卖出去。 全美有 1,295 家代理商和国家人寿签约，我们是其中之一。

On the right is the company that actually supplies the product: the carrier, such as National Life. It designs the product, carries the claim risk and pays the claim. The relationship runs both ways: the carrier gives products to the agencies, and the agencies train agents and sell. Some 1,295 agencies across the US are contracted with National Life, and we're one of them.

全美一共有 719 家寿险公司，这是美国寿险协会 ACLI 2025 年的统计。那为什么讲生前福利，我们主讲国家人寿？ 三个有出处的理由：第一，1848 年在佛蒙特州成立，到今天 178 年；第二，在互惠寿险公司里， 五大项生前福利再加上生育条款全部做齐的，只有它一家，下面全文第十二节有逐层筛选的表； 第三，按行业数据机构 Wink 2024 年第四季度的报告，它的指数型万能险 IUL 销量排第一。

There are 719 life insurers in the US, per the American Council of Life Insurers' 2025 figures. So why, when we talk living benefits, do we lead with National Life? Three reasons, each with a source. One: it was founded in Vermont in 1848, 178 years ago. Two: among mutual life insurers, it is the only one with all five living benefits plus the fertility rider; section twelve of the article below narrows it down step by step. Three: by Wink's Q4 2024 report, it ranks first in indexed universal life sales.

接下来每一页，我们都用具体的条款、具体的案例来讲。条款上的优势要讲，同业比我们强的地方，后面也会照实讲。

Every slide from here uses specific contract language and specific cases. We'll cover where National Life is stronger, and we'll also say plainly where other carriers do better.

讲师提醒Presenter note

原稿这一页写的「IUL 公司历史第一悠久」「售后服务第一」找不到出处，不要讲； 「737 家保险公司」是旧数字，按 ACLI 2025 年是 719 家。「生前福利最齐全」要加上范围：互惠寿险公司里。

The original slide's "oldest IUL company" and "No. 1 in service" have no source, so don't say them. "737 insurers" is an old figure; ACLI's 2025 count is 719. "The fullest living benefits" needs its scope: among mutual life insurers.

举例：Amy，35 岁，每月存 $800，存 15 年Example: Amy, 35, $800 a Month for 15 Years

从第一个月存钱起，两个账户同时生效From the first month's deposit, both accounts are in effect

理财账户 · 现金价值Cash Value Account

  • 按标普 500 记息，演示假设 7%，非保证Credited off the S&P 500; 7% is an illustration assumption, not a guarantee
  • 存钱灵活：什么时候存、存多少可以调Flexible funding: timing and amount can change
  • 满足前提时可免税取钱（7702 + 保单贷款）Tax-free access when the conditions are met (§7702 + policy loans)
  • 退休后可作为补充收入，金额不保证A supplementary retirement income, amount not guaranteed
指数 +30% 的年份，按封顶记Index up 30%: credited at the cap11%
指数 −30% 的年份，不记负数Index down 30%: never negative0%

保险账户 · 保额 $100 万Insurance Account · $1M Face

  • 身故理赔 $100 万Death benefit of $1,000,000
  • 生病时，可打折提前动用一部分：If ill, part of it can be advanced at a discount:
    • 末期疾病（绝症）Terminal illness
    • 慢性疾病（护理）Chronic illness (care)
    • 重大疾病（重疾）Critical illness
    • 重大伤害（重伤）Critical injury
    • 阿兹海默（老年痴呆）Alzheimer's

我们先用一个例子，把整张保单的结构讲清楚。客户 Amy，35 岁女性，每个月存 $800，存 15 年，保额 $100 万。 从她存钱的第一个月开始，这份保单里其实同时启动了两个账户：左边是理财账户，也就是现金价值 Cash Value； 右边是保险账户，也就是保额 Face Amount。

One example first, to make the structure of the policy clear. Our client Amy is 35. She puts in $800 a month for 15 years, with a $1,000,000 face amount. From her very first month, two accounts start working inside this one policy: on the left the cash value account, on the right the insurance account, the face amount.

先看左边。这部分按标普 500 的表现记息，但钱本身不在股市里。演示表上常用 7% 作为假设利率， 请大家一定说清楚：这是演示假设，不是保证，更不是「平均保底回报率」。真正保证的只有一件事：指数那一格不记负数。 下面两张小卡片就是规则：指数涨 30% 的年份，按封顶记，比如 11%；指数跌 30% 的年份，记 0%，不往下扣。 另外三点：存钱灵活；满足前提的时候可以免税取钱，依据是税法 7702 条加上保单贷款，前提是保单一直有效、不变成 MEC； 退休以后可以用保单贷款补充收入，但能拿多少要看保单表现，不是保证的终身收入。

The left side first. It's credited by reference to the S&P 500, but the money isn't in the market. Illustrations commonly assume 7%; say plainly that it's an illustration assumption, not a guarantee, and certainly not an "average guaranteed return." The one guarantee is that the index bucket is never credited a negative number. The two cards show the rule: in a year the index rises 30%, the credit is capped, say at 11%; in a year it falls 30%, the credit is 0%, nothing taken away. Three more points: funding is flexible; when the conditions are met, money can come out tax-free under IRC §7702 plus policy loans, provided the policy stays in force and never becomes a MEC; and in retirement, policy loans can supplement income, but how much depends on how the policy performs. It is not a guaranteed lifetime income.

今天的重点在右边。Amy 不在了，家人拿到 $100 万身故理赔。人还活着的时候，遇到末期疾病、慢性疾病、 重大疾病、重大伤害或者阿兹海默，可以把这 $100 万保额提前动用一部分。这五项就是今天要讲的五大项生前福利。 提前动用的钱是从身故理赔里扣的，而且要打折，不是另外多给。

Today's focus is the right side. If Amy dies, her family receives $1,000,000. While she's alive, a terminal illness, chronic illness, critical illness, critical injury or Alzheimer's lets her draw on part of that face amount early. Those five are the five living benefits we cover today. What's drawn early comes out of the death benefit, at a discount; it isn't paid on top.

所以这张图要记住：一份保单，左手是会累积的现金价值，右手是保障；生前福利，就是把右手这笔钱， 在客户最需要的时候，打个折提前送到他手上。

So remember the picture: one policy, with accumulating cash value in one hand and protection in the other. Living benefits take the protection in that second hand and, at a discount, put it in the client's hands early, when they need it most.

合规提醒Compliance note

原稿这一页写的「7% 平均保底年回报率」「取钱免税」「生病理赔 $30–90 万」都不能这样讲。 7% 是演示假设，保证的只是不记负数；保单贷款只在保单维持到身故时不产生所得税； 生前福利能拿多少，由公司在理赔时按当时情况计算，签单时没有这个数。

The original slide's "7% average guaranteed return," "tax-free withdrawals" and "illness pays $300k–900k" can't be said that way. 7% is an illustration assumption, and the only guarantee is no negative credit; policy loans are free of income tax only if the policy stays in force to death; and what a living benefit pays is computed by the carrier at claim, so there is no number at the point of sale.

30 年生前福利进化史Thirty Years of Living Benefits

1991首推末期疾病，门槛为 12 个月预期寿命First terminal illness rider, at 12 months' life expectancy 1997首推慢性疾病，末期疾病放宽到 24 个月Chronic illness introduced; terminal widened to 24 months 2000首张独立慢性疾病条款，等待期 5 年First standalone chronic rider, 5-year waiting period 2003推出重大疾病条款Critical illness rider launched 2007慢性疾病等待期缩短到 2 年Chronic waiting period cut to 2 years
2013末期和慢性的额度从 $100 万提高到 $150 万Terminal and chronic caps raised from $1M to $1.5M 2015扩展重大疾病，首推重大伤害Critical illness expanded; first critical injury rider 2017慢性疾病等待期缩短到 30 天Chronic waiting period cut to 30 days 2023新增阿兹海默条款Alzheimer's rider added

这一页是一条时间轴，讲国家人寿在生前福利这件事上三十多年的演进。我们顺着年份念一遍。

This slide is a timeline of more than thirty years of National Life's living benefits. Let's read it year by year.

1991 年，首推末期疾病条款，理赔门槛是预期寿命 12 个月以内。1997 年，推出慢性疾病， 同时把末期疾病的门槛放宽到 24 个月。2000 年，推出第一张独立的慢性疾病条款，当时等待期是 5 年。 2003 年，推出重大疾病条款。2007 年，慢性疾病的等待期从 5 年缩短到 2 年。

In 1991, the first terminal illness rider, with a threshold of 12 months' life expectancy. In 1997, chronic illness was introduced and the terminal threshold widened to 24 months. In 2000, the first standalone chronic illness rider, with a five-year waiting period at the time. In 2003, the critical illness rider. In 2007, the chronic waiting period came down from five years to two.

2013 年，末期和慢性的额度从 $100 万提高到 $150 万。2015 年，扩展重大疾病的病种，并首推重大伤害条款。 2017 年，慢性疾病的等待期再从 2 年缩短到 30 天，这是幅度最大的一次。2023 年，新增阿兹海默专项条款。

In 2013, the terminal and chronic caps rose from $1 million to $1.5 million. In 2015, critical illness was expanded and the first critical injury rider launched. In 2017, the chronic waiting period dropped again, from two years to 30 days, the biggest single change. In 2023, a dedicated Alzheimer's rider was added.

从一项末期疾病，到今天的五大项；等待期从 5 年压到 30 天；额度提到 $150 万。这条时间轴想说的就一句话： 生前福利这件事，国家人寿做得早，而且一直在改。讲的时候也提一句：同业一直在追，比较的时候要说清楚是哪一年的资料。

From one terminal rider to five riders today; waiting periods from five years to 30 days; caps up to $1.5 million. The timeline makes one point: National Life started early on living benefits and has kept improving them. Add one line when you present it: other carriers keep catching up, so always say which year a comparison comes from.

讲师提醒Presenter note

原稿演讲备注里的年份顺序和幻灯片对不上（备注把 2003 和 2007 两件事对调了），以幻灯片为准，就是这一页上的写法。 全文第十一节还多一条：2008 年进入纽约州。

The original speaker notes don't match the slide's years (they swap the 2003 and 2007 events). Follow the slide, as shown here. Section eleven of the article adds one more entry: New York in 2008.

医疗保险 vs. 生前福利Health Insurance vs. Living Benefits

医疗 / 健康保险Medical / health insurance

  • 报销制，不付现金给你Reimburses bills; no cash to you
  • 承担大部分医院相关费用Covers most hospital-related costs
  • 有自付额（deductible），也有最高自付限额（out-of-pocket maximum）Has a deductible and an out-of-pocket maximum

生前福利Living benefits

  • 理赔现金，打到你的账户Pays cash, into your account
  • 用途不限：房贷、车、生活开支、医疗、教育Any use: mortgage, car, living costs, medical, education
  • 提前打折理赔身故金（Death Benefit）An early, discounted payment of the death benefit

不是二选一：医疗险付账单，生前福利补收入Not either/or: health insurance pays the bills, living benefits replace income

这一页解决客户最常见的一个疑问：「我已经有医疗保险了，还要生前福利干嘛？」 我们要让客户明白，这是两样完全不同的东西，不是二选一，而是互相补位。

This slide answers the most common client question: "I already have health insurance. Why would I need living benefits?" The client needs to see that these are two different things. It's not either/or; they cover different gaps.

先看左边，医疗保险。它的逻辑是报销制，不会给你现金。你去医院看病、做手术，它帮你承担大部分和医院相关的费用， 但你要先付自付额 deductible，一年里自己掏的钱有一个最高自付限额 out-of-pocket maximum。 说白了，医疗保险管的是账单，钱付给医院，不付到你手上。

On the left, health insurance. It reimburses; it doesn't hand you cash. When you see a doctor or have surgery, it covers most of the hospital-related costs, but you pay the deductible first, and there's an out-of-pocket maximum on what you pay in a year. Put simply, health insurance deals with the bills. The money goes to the hospital, not to you.

再看右边，生前福利。它是理赔现金，钱直接打到客户的账户里，用途没有限制：还房贷、付车贷、日常开支、 看病、孩子的学费都可以。它的本质，是把未来的身故金打个折，在客户生病的时候提前给他。

On the right, living benefits. It pays cash, straight into the client's account, and there's no restriction on use: the mortgage, the car loan, living costs, medical bills, a child's tuition. In substance, it takes the future death benefit, discounts it, and pays it while the client is ill.

为什么两样都要？一个人生了大病，医疗险把医院账单付掉了，但他可能半年、一年不能上班， 房贷、车贷、家里的开销一样要付。医疗险不管这些，生前福利管。所以给客户的一句话是： 医疗保险付医院的账单，生前福利补的是生病期间家里的现金。两个都有，保障才完整。

Why both? Someone with a serious illness has the hospital bills paid by health insurance, but may be off work for six months or a year, and the mortgage, car payment and household costs still come due. Health insurance doesn't touch those; living benefits do. The line for the client: health insurance pays the hospital, living benefits put cash back into the household while you're ill. With both, the protection is complete.

合规提醒Compliance note

不要说生前福利可以代替医疗保险，也不要把它叫做重疾险或长期护理险。它是寿险保单上的提前给付条款， 用掉的部分会从身故金里扣掉。

Don't say living benefits can replace health insurance, and don't call them critical illness or long-term care insurance. They are accelerated benefit riders on a life policy, and whatever is used comes out of the death benefit.

生前福利背后的数据The Data Behind Living Benefits

1/4+美国人的死亡由心脏病或中风造成of US deaths are from heart disease or stroke约 28% · CDC 2024About 28% · CDC 2024
约 40%~40%美国人一生中会被诊断出癌症of Americans will be diagnosed with cancer美国癌症协会American Cancer Society
1/365 岁的美国人会活过 90 岁of 65-year-old Americans will live past 90美国社会安全局估算Social Security estimate
740 万7.4M65 岁以上美国人患有阿兹海默症Americans 65+ live with Alzheimer's阿兹海默症协会 2026Alzheimer's Association 2026

一张只保身故的保单，错过了概率最高的那些风险A policy that pays only at death misses the risks most likely to happen

出处：CDC FastStats，2024 年死亡数据（心脏病 683,491 人、中风 166,852 人，全部 3,072,666 人）； American Cancer Society，Lifetime Probability of Developing or Dying From Cancer（男 39.9%、女 39.0%）； Social Security Administration 长寿估算；Alzheimer's Association，2026 Alzheimer's Disease Facts and FiguresSources: CDC FastStats, 2024 deaths (heart disease 683,491, stroke 166,852, all causes 3,072,666); American Cancer Society, Lifetime Probability of Developing or Dying From Cancer (men 39.9%, women 39.0%); Social Security Administration longevity estimates; Alzheimer's Association, 2026 Alzheimer's Disease Facts and Figures

上一页讲生前福利和医疗保险的区别，这一页讲为什么需要它。四个数字，每一个都有出处，讲的时候把出处一起带上。

The last slide set living benefits against health insurance; this one is why they matter. Four numbers, each with a source. Quote the source when you use them.

第一个，超过四分之一。按美国疾控中心 CDC 2024 年的死亡数据，全美约 307 万人死亡， 其中心脏病约 68.3 万、中风约 16.7 万，两项合计约占 28%。心脏病和中风正好对应重大疾病条款里的心脏病发作、中风、心脏骤停。

First, more than a quarter. In the CDC's 2024 death data, about 3.07 million Americans died; heart disease accounted for about 683,000 and stroke for about 167,000, together roughly 28%. Heart disease and stroke map directly onto the heart attack, stroke and cardiac arrest items in the critical illness rider.

第二个，约 40%。美国癌症协会估算，美国男性一生中被诊断出癌症的概率约 39.9%，女性约 39.0%， 差不多每五个人里有两个。癌症是重大疾病条款里的第一项。数字出自美国癌症协会网站的终身患癌概率页面，按 2018、2019、2021 年的发病数据计算，2025 年 1 月更新；同一页还写着，一生中死于癌症的概率男性约 17.2%、女性约 16%。

Second, about 40%. The American Cancer Society estimates the lifetime probability of a cancer diagnosis at about 39.9% for men and 39.0% for women, roughly two in five. Cancer is the first item in the critical illness rider. The figures come from the American Cancer Society's lifetime probability page, based on 2018, 2019 and 2021 incidence data and revised January 2025; the same page puts the lifetime risk of dying from cancer at about 17.2% for men and 16% for women.

第三个，三分之一。按美国社会安全局的估算，今天 65 岁的美国人，大约三个里有一个会活过 90 岁。 活得长是好事，但活得越久，需要人照顾的那几年就越可能出现，这正是慢性疾病条款对应的情况。

Third, one in three. By the Social Security Administration's estimate, about one in three Americans who are 65 today will live past 90. Living long is good news, but the longer we live, the more likely there are years when we need care, which is what the chronic illness rider is for.

第四个，740 万。阿兹海默症协会 2026 年的报告估计，全美 65 岁以上约有 740 万人患有阿兹海默症。 对应的就是后面要讲的阿兹海默条款。

Fourth, 7.4 million. The Alzheimer's Association's 2026 report estimates about 7.4 million Americans aged 65 and over are living with Alzheimer's. That's the Alzheimer's rider we'll come to.

四个数字放在一起，结论很直接：对大多数人来说，生一场需要花钱的大病，或者老了需要人照顾， 比在工作年龄突然身故更常见。一张只在身故时才赔的保单，正好错过了概率最高的那些风险。 但讲完数字，一定要接回开场那句话：这些条款是打折提前动用身故金，不是另外的保险金。

Put the four together and the conclusion is direct. For most people, a costly serious illness, or needing care in old age, is more likely than dying suddenly during working years. A policy that pays only at death misses the risks most likely to happen. But once you've given the numbers, tie them back to the opening line: these riders advance the death benefit at a discount; they are not additional insurance money.

讲师提醒Presenter note

原始资料的这一页页脚标着 For Agent Use Only，所以不要把原页截图给客户。 要跟客户讲数据，就引用这里列的原始出处；这些数字每年更新，用之前查一下最新一年的版本。 讲数据是为了让客户看清风险，不要用来吓客户。

The original version of this slide is marked For Agent Use Only, so don't screenshot it for clients. When you share the data with a client, cite the original sources listed here; the figures are updated every year, so check the latest edition first. The data is there to help clients see the risk, not to scare them.

末期疾病（绝症）Terminal IllnessTerminal Illness

绝症险（Terminal Illness）Terminal Illness 经医生出具证明，患有可合理预期会在 24 个月或更短时间内导致死亡的疾病或慢性病A physician certifies an illness or condition reasonably expected to cause death within 24 months or less

无等待期，一次性支付No waiting period, paid as a lump sum

最高理赔额度 $1,500,000Maximum benefit $1,500,000

五大项的第一项：末期疾病，英文 Terminal Illness，俗称绝症。

The first of the five: terminal illness.

什么样的病算末期疾病？由医生出具证明，患有可以合理预期在 24 个月，也就是 2 年以内导致死亡的疾病或慢性病。 常见的例子：晚期、已经转移的癌症；渐冻症 ALS 的后期；末期肝硬化、肝癌；末期心力衰竭；末期肾衰竭、已经放弃透析的。 关键不是病名，而是医生能不能证明「预期寿命 24 个月以内」。

What counts? A physician certifies an illness or condition that can reasonably be expected to cause death within 24 months, two years. Typical examples: advanced, metastatic cancer; late-stage ALS; end-stage cirrhosis or liver cancer; end-stage heart failure; end-stage kidney failure where dialysis has been stopped. What matters isn't the name of the disease but whether a physician can certify a life expectancy of 24 months or less.

这一项有四个特点要记住。第一，没有等待期，诊断下来就可以申请。第二，一次性支付，不是分期，是一笔到账。 第三，理赔金客户自由使用。第四，最高额度 $150 万。注意 24 个月这个数字：国家人寿用的是 24 个月， 不少同业是 12 个月，后面的同业对比表里会看到，比较的时候别默认一样。

Four features to remember. One, no waiting period: the claim can be filed once diagnosed. Two, a lump sum, not instalments. Three, the client can use the money freely. Four, the maximum is $1.5 million. Note the 24 months: National Life uses 24, and many carriers use 12, as the comparison tables later show. Don't assume they match.

末期疾病是五项里最容易理赔的一项：只要医生的证明成立，就符合条件。它也是折扣最小的一项， 因为预期寿命短，保险公司提前付钱、要折现的年数就少。很多家庭就是用这笔钱，在最后两年里安排治疗、照顾和家里的事。

Terminal illness is the most straightforward of the five to claim: once the physician's certification stands, the condition is met. It's also the one with the smallest discount, because with a short life expectancy there are few years to discount. Many families use this money to arrange treatment, care and household matters in those final two years.

讲师提醒Presenter note

「最容易理赔」说的是触发条件清楚，不是「一定赔」。承保时评级在 Table 4 / Express Standard 2 以上的保单， 只能拿末期疾病这一项（见第 22 页）。

"Most straightforward" means the trigger is clear, not that payment is certain. A policy rated Table 4 / Express Standard 2 or worse at underwriting gets the terminal rider only (see slide 22).

慢性疾病（护理）Chronic IllnessChronic Illness

  • 连续至少 90 天无法独立完成 6 项「日常生活行为」中的 2 项For at least 90 days, unable to perform 2 of the 6 activities of daily living
    • 洗澡、自控（大小便）、穿衣、吃饭、如厕、移动Bathing, continence, dressing, eating, toileting, transferring
  • 或者认知障碍：需要他人持续监督，以防对自身健康和安全造成威胁Or cognitive impairment: needs constant supervision to protect their own health and safety
    • 记忆受损，认不清人物、地点或时间，推理或抽象思维能力下降Memory loss, can't place people, places or time, impaired reasoning
每月可提前支取Advance each month面额 2%2% of face
每次理赔Each claim covers一年One year
等待期Waiting period30 天30 days
最高理赔额度Maximum benefit$1,500,000

剩余的保额在身故时支付The remaining face is paid at death

第二项：慢性疾病，英文 Chronic Illness，可以理解为「需要长期护理的状态」。怎么才算？两条路，满足任何一条都可以。

The second: chronic illness, which you can think of as needing long-term care. There are two routes, and either one qualifies.

第一条路：连续至少 90 天，无法独立完成六项日常生活行为里的任何两项。六项是：洗澡，自己洗不了； 自控，大小便失禁；穿衣，自己穿不了衣服；吃饭，不能自己进食；如厕，不能自己上厕所；移动，比如从床上挪到轮椅上。 六项里有两项做不到，而且连续 90 天，就符合。

Route one: for at least 90 consecutive days, unable to perform any two of the six activities of daily living. The six are bathing; continence, meaning bladder and bowel control; dressing; eating; toileting; and transferring, such as moving from bed to a wheelchair. Two of the six, for 90 days in a row, qualifies.

第二条路：认知障碍。需要别人持续看着，否则会对自己的健康和安全造成威胁。比如短期或长期记忆受损， 认不清人、地点、时间，推理和抽象思考能力下降。阿兹海默早期、严重失忆，常常走的是这一条。

Route two: cognitive impairment. The person needs someone watching over them constantly, or they'd be a danger to their own health and safety: short- or long-term memory loss, not recognizing people, places or time, declining reasoning. Early Alzheimer's and severe memory loss often qualify this way.

怎么赔？每个月可以提前动用保单面额的 2%，每次理赔管一年，也就是连续 12 个月、每月 2%。 比如 $100 万保额，每月动用 $2 万保额，一年动用 $24 万保额，然后打折付给客户，实际到手少于 $2 万一个月。 剩下的保额在身故时支付。等待期 30 天，最高额度 $150 万。每年要重新认证一次，因为有人过了一段时间会恢复， 这是一个动态评估的过程。

How does it pay? Each month, up to 2% of face can be advanced, and each claim covers a year: twelve months at 2%. On a $1 million policy that's $20,000 of face a month and $240,000 a year, paid after the discount, so less than $20,000 actually arrives each month. The remaining face is paid at death. The waiting period is 30 days, the cap $1.5 million. The condition is recertified every year, because some people recover; it's an ongoing assessment.

合规提醒Compliance note

慢性疾病条款不是长期护理险，不要这样叫，也不要说它可以代替长期护理险。 「每月 2%」是动用的保额，不是到手金额，到手要打折。

The chronic illness rider is not long-term care insurance. Don't call it that or say it can replace LTC. "2% a month" is face consumed, not cash received; what arrives is discounted.

慢性疾病（护理）案例A Chronic Illness Claim

一位北加州的巴士司机客户，两张保单A bus driver in Northern California, with two policies

早年Earlier在 Nationwide 买了 $100 万保额，另外付费附加长期护理险 LTCBought $1M of coverage from Nationwide, with a long-term care (LTC) rider at extra cost 2018年底在国家人寿买了 $110 万保额，慢性疾病条款免费附带Late in the year, bought $1.1M from National Life, with the chronic illness rider at no cost 2024-06-13工作过度疲劳，头晕跌倒，左脚趾骨骨折，在 Kaiser 就诊Exhausted at work, fainted and fell, fracturing a left toe; treated at Kaiser 2024-09-17向国家人寿提出慢性疾病理赔Filed a chronic illness claim with National Life 2024-11-06收到国家人寿的理赔支票，保单仍然有效Received National Life's claim check; the policy stays in force

同一个人、同一件事：一家赔了，一家拒了One person, one event: one carrier paid, one declined

讲一个真实的慢性疾病理赔案例。客户是北加州的一位巴士司机，名字我们不写。

A real chronic illness claim. The client is a bus driver in Northern California; we don't use his name.

他早年在 Nationwide 买过一张 $100 万保额的保单，另外附加了长期护理险 LTC，这部分是每个月额外付费的。 2018 年底，他又在国家人寿买了一张 $110 万保额的保单，慢性疾病条款是免费带的，不用额外付钱。

Years earlier he had bought a $1 million policy from Nationwide with a long-term care rider, which cost extra every month. Late in 2018 he also bought a $1.1 million policy from National Life, where the chronic illness rider came at no extra cost.

2024 年 6 月 13 日，他当天工作过度疲劳，头晕跌倒，左脚趾骨骨折，在 Kaiser 就诊。 9 月 17 日向国家人寿提出慢性理赔，11 月 6 日收到理赔支票，从申请到拿到支票大约七周。 注意日期：从受伤到申请隔了三个多月，正好过了「连续 90 天」这道门槛。

On June 13, 2024, exhausted after a day's work, he fainted, fell and fractured a left toe, and was treated at Kaiser. He filed a chronic claim with National Life on September 17 and received the check on November 6, about seven weeks from filing to payment. Note the dates: more than three months passed between the injury and the claim, just past the "90 consecutive days" threshold.

这里要和第 21 页「不赔清单」对上：脚趾骨折本身是不赔的。这笔理赔赔的不是骨折， 而是这次受伤之后，他连续 90 天以上没办法独立完成两项日常生活行为，由医护人员认证。条件满足的是「失去自理能力」，不是「受了伤」。 这两句话在客户听来差别很大，一定讲清楚。

Tie this to the "not covered" list on slide 21: a broken toe on its own is not covered. What paid here wasn't the fracture. After the injury he couldn't perform two activities of daily living for more than 90 consecutive days, certified by a health professional. The condition met was the loss of independence, not the injury. To a client those sound very different, so make it clear.

然后是这个案例真正的看点：同一个人、同一件事，国家人寿赔了，Nationwide 拒赔了。下一页看为什么。

Then the real point of the case: one person, one event; National Life paid and Nationwide declined. The next slide shows why.

讲师提醒Presenter note

原稿这一页有客户手拿支票的合照，网页上不放；客户姓名、原来在哪个团队都不写。 讲的时候也只说「一位客户」。

The original slide has a photo of the client holding the check; it isn't used here. The client's name and former team aren't given. When presenting, say "a client."

慢性疾病（护理）案例：两种结果The Claim: Two Outcomes

国家人寿：顺利理赔National Life: paid

  • 保额 $110 万$1.1M face
  • 一年 12 个月：2% × 12 = 24%12 months: 2% × 12 = 24%
  • $110 万 × 24% = $26.4 万保额额度$1.1M × 24% = $264,000 of face
  • 实际提前理赔 $112,182（约 42.5%）Advance actually paid: $112,182 (about 42.5%)
  • 剩余保额 $110 万 − $26.4 万 = $83.6 万Remaining face: $1.1M − $264,000 = $836,000

Nationwide：理赔被拒Nationwide: declined

  • 没有依照医嘱持续治疗Treatment not continued as prescribed
  • 没有服药Medication not taken
  • 医生建议注射治疗但未执行Recommended injections not carried out
  • 缺乏完整的治疗记录进行追踪No complete treatment record to follow

先看国家人寿这边怎么算。保额 $110 万。慢性疾病每月最多动用 2%，一次理赔管一年，2% × 12 = 24%。 $110 万 × 24% = $26.4 万，这是这一年可以动用的保额额度。打折之后，客户实际拿到 $112,182， 剩下的 $110 万 − $26.4 万 = $83.6 万保额还在，保单继续有效。

National Life's side first. Face of $1.1 million. Chronic illness allows up to 2% a month, and one claim covers a year: 2% × 12 = 24%. $1.1 million × 24% = $264,000, the face available to use this year. After the discount, the client actually received $112,182, and $1.1 million − $264,000 = $836,000 of face remains, with the policy still in force.

这里大家要注意：$26.4 万是动用的保额，实际到手 $112,182，大约是 42.5%。差的那部分不是被扣掉了， 而是「打折理赔」：保险公司提前把未来的钱付给你，要折现。这个机制第 26 到 29 页会完整讲。

Note this: $264,000 is face consumed; what arrived was $112,182, about 42.5%. The difference wasn't withheld. It's the discount: the carrier is paying future money today, so it discounts it. Slides 27 to 30 cover that mechanism in full.

再看 Nationwide 那边，拒赔理由四条：第一，没有依照医嘱持续治疗；第二，没有服药； 第三，医生建议注射治疗，但他没有做；第四，缺乏完整的治疗记录可以追踪。

Now Nationwide. Four reasons for the decline: treatment wasn't continued as prescribed; medication wasn't taken; the doctor recommended injections and he didn't have them; and there was no complete treatment record to follow.

你看出来了吗？这四条都不是「他病得不够重」，而是「他没有按护理计划接受治疗、没留下记录」。 Nationwide 的长期护理附加险要求被保险人持续接受「合格的长期护理服务」，他没做到，所以拒赔。 接下来三页，我们看两边的合同原文，对比一下为什么国家人寿能赔。

Do you see it? None of the four says he wasn't ill enough. They say he didn't follow a plan of care and didn't leave a record. Nationwide's long-term care rider requires the insured to keep receiving "qualified long-term care services"; he didn't, so it declined. The next three slides put the two contracts side by side to show why National Life could pay.

互动设计Interaction

先别翻页，问大家：「如果这位客户只有 Nationwide 那一张，你在他受伤第一天能提醒他什么？」 答案：按医嘱治疗、按时吃药、每一次看诊和护理都留记录。

Before moving on, ask: "If this client had only the Nationwide policy, what could you have told him on day one?" Answer: follow the treatment plan, take the medication, and keep a record of every visit and every bit of care.

慢性疾病（护理）案例分析：国家人寿条款Case Analysis: National Life's Definition

国家人寿慢性疾病条款原文 Chronically Ill，附手写中文批注：连续至少 90 天在他人实质性协助下无法进行两项日常生活行为，或因严重认知障碍需要他人持续监督 / National Life's Chronically Ill definition with handwritten Chinese notes: unable to perform two activities of daily living without substantial assistance for at least 90 days, or requiring substantial supervision due to severe cognitive impairment

实质性协助 = 动手帮忙（Hands-on）或在旁待命（Standby）Substantial assistance = hands-on or standby assistance

这三页是两边合同的原文，上面的手写字是中文批注。手机上看不清的伙伴，我把重点念一下。

These three slides show the two contracts in their own words; the handwriting is Chinese annotation. For anyone on a phone who can't read it, here are the key points.

国家人寿对 Chronically Ill，慢性疾病状态的定义，满足下面任意一条：第一，被保险人因为功能丧失， 连续至少 90 天，在没有他人实质性协助的情况下，无法进行至少两项日常生活行为；第二，因为严重认知障碍， 连续至少 90 天需要他人实质性的监督，以防威胁到自己的健康和安全。

National Life defines chronically ill as either of two things. One: because of a loss of functional capacity, for at least 90 consecutive days the insured cannot perform at least two activities of daily living without substantial assistance from another person. Two: because of severe cognitive impairment, for at least 90 days the insured needs substantial supervision to protect them from threats to their health and safety.

什么叫「实质性协助」？条款写得很清楚：动手帮忙 Hands-on Assistance，或者在旁待命 Standby Assistance，两种都算。 动手帮忙，就是没有别人的身体协助，这件事他做不了；在旁待命，下一页有定义。

What is "substantial assistance"? The contract is specific: hands-on assistance or standby assistance, either one. Hands-on means he can't do the activity without another person's physical help. Standby is defined on the next slide.

请注意这个定义里没有的东西：它没有要求「必须按护理计划持续接受某种服务」。它看的是功能丧失本身， 由持照医护人员认证。这就是这个案例里国家人寿能赔的原因。

Notice what this definition does not contain: no requirement to keep receiving a particular service under a plan of care. It looks at the loss of function itself, certified by a licensed health professional. That's why National Life could pay in this case.

慢性疾病（护理）案例分析：六项日常生活行为Case Analysis: The Six Activities of Daily Living

国家人寿条款原文：Standby Assistance 待命协助的定义，以及洗澡、自控、穿衣、进食、如厕、移动六项日常生活行为的定义，附手写中文批注 / National Life contract text defining standby assistance and the six activities of daily living (bathing, continence, dressing, eating, toileting, transferring), with handwritten Chinese notes

这一页是国家人寿条款里两个定义。

This slide shows two definitions from National Life's contract.

上面一段是「待命协助」Standby Assistance：另一个人在一臂之内，随时准备用身体去阻止他受伤。 条款举了三个例子：他进出浴缸或淋浴间的时候，有人随时准备扶住他，防止摔倒； 他吃饭的时候，有人随时准备把卡在喉咙里的食物取出来。也就是说，不一定要别人真的动手， 只要「没有人在旁边守着就不安全」，也算实质性协助。

The first paragraph defines standby assistance: another person within arm's reach, ready to intervene physically to prevent injury. The contract gives examples: someone ready to catch the person if they fall getting in or out of a bath or shower, or ready to remove food from their throat if they choke while eating. So the helper doesn't have to actually step in; if it isn't safe without someone standing by, that also counts as substantial assistance.

下面是六项日常生活行为的定义，我逐项念：洗澡，用海绵擦洗，或者在浴缸、淋浴里清洗，包括进出浴缸或淋浴间； 自控，控制大小便，或者控制不了时能自己处理个人卫生，包括护理导尿管或结肠造口袋； 穿衣，穿脱所有衣物，以及必要的护具、扣件或假肢；进食，把食物送进身体，从盘子、杯子、桌子，或者通过喂食管、静脉注射； 如厕，往返厕所、上下马桶，并完成相关的个人卫生；移动，进出床、椅子或轮椅。

Below are the six activities, one by one. Bathing: washing by sponge bath or in a tub or shower, including getting in and out. Continence: controlling bowel and bladder, or managing hygiene when that isn't possible, including a catheter or colostomy bag. Dressing: putting on and taking off all clothing and any braces, fasteners or artificial limbs. Eating: getting food into the body from a plate, cup or table, or by feeding tube or intravenously. Toileting: getting to and from the toilet, on and off it, and the related hygiene. Transferring: moving into or out of a bed, chair or wheelchair.

为什么要念这么细？因为理赔的时候，医护人员就是按这几句话一项一项评估的。 客户问「我这样算不算」，答案在这里，最终以理赔审核为准。

Why read it in such detail? Because at claim, the health professional assesses item by item against exactly these sentences. When a client asks "does this count?", the answer is here, with the claim review having the final word.

慢性疾病（护理）案例分析：Nationwide 条款Case Analysis: Nationwide's Rider

Nationwide 长期护理附加险的领取条件原文：经持照医护人员认证为慢性疾病、已满足免责期、护理期间持续接受护理计划中的合格长期护理服务 / Nationwide LTC rider eligibility criteria: certified chronically ill by a licensed health care practitioner, elimination period satisfied, and receiving qualified long-term care services under a plan of care
合格长期护理服务的定义原文：符合 IRC §7702B(c)(1) 的诊断、预防、治疗、康复、缓解、维护和个人护理服务，按持照医护人员的护理计划提供 / Definition of qualified long-term care services under IRC §7702B(c)(1), provided under a plan of care prescribed by a licensed health care practitioner
  • 护理期间，必须按医生制定的护理计划，持续接受合格的长期护理服务During care, must keep receiving qualified long-term care services under the plan of care
  • 合格服务按税法 IRC §7702B(c)(1)：诊断、预防、治疗、康复、缓解病情、维护、个人护理Qualified under IRC §7702B(c)(1): diagnostic, preventive, therapeutic, rehabilitative, mitigating, maintenance and personal care

现在看 Nationwide 长期护理附加险的条款。左边是领取福利的条件，三条必须同时满足：第一，被保险人经持照医护人员认证， 或重新认证为慢性疾病状态；第二，免责期已经满足，免责期在附加险有效期间只需要满足一次； 第三，在护理期间，被保险人一直在接受护理计划里规定的「合格长期护理服务」，而且护理计划要交给保险公司。

Now Nationwide's long-term care rider. On the left are the conditions for benefits, all of which must be met. One, the insured has been certified or recertified as chronically ill by a licensed health care practitioner. Two, the elimination period has been satisfied; it only has to be satisfied once while the rider is in force. Three, during the period of care, the insured has been receiving qualified long-term care services specified in a plan of care submitted to the carrier.

右上是「合格长期护理服务」的定义：符合美国税法 IRC §7702B(c)(1) 的服务，包括必要的诊断、预防、治疗、 康复、缓解病情、维护性服务和个人护理服务，而且要按持照医护人员开出的护理计划来提供。

Top right is the definition of qualified long-term care services: services meeting IRC §7702B(c)(1), meaning necessary diagnostic, preventive, therapeutic, curative, treatment, mitigation, rehabilitative, maintenance and personal care services, provided under a plan of care prescribed by a licensed health care practitioner.

关键差异就在第三条。国家人寿的慢性疾病条款，看的是功能丧失本身：两项日常生活行为、连续 90 天、医护人员认证。 Nationwide 的长期护理附加险，在这之上还多一道：护理期间必须按护理计划持续接受合格服务，并且有记录可查。 这位客户没按医嘱治疗、没吃药、没做注射，记录也不完整，所以 Nationwide 拒赔；国家人寿这边条件满足，就赔了 $112,182。

The key difference is condition three. National Life's chronic rider looks at the loss of function itself: two activities of daily living, 90 consecutive days, certified by a professional. Nationwide's LTC rider adds another layer: during care, the insured must keep receiving qualified services under the plan of care, with records to show it. This client didn't follow treatment, didn't take the medication, skipped the injections and had incomplete records, so Nationwide declined; National Life's conditions were met, and it paid $112,182.

还有一点：Nationwide 那边的长期护理附加险是额外付费的，客户每个月多交了钱，最后没拿到；国家人寿的慢性疾病条款是免费附带的。 这是给客户讲单时很有说服力的一个对比。但要讲公道：两种产品本来就不一样，长期护理险有它的长处，后面第 34 到 37 页会讲。

One more point: Nationwide's LTC rider cost extra, so the client paid more every month and still received nothing; National Life's chronic rider came at no cost. It's a persuasive comparison when presenting to a client. But be fair: the two products are different by design, and long-term care coverage has its own strengths, covered on slides 34 to 37.

讲师提醒Presenter note

这个案例的教训不是「哪家公司好」，是条款里的那句话。对我们的意思很具体：客户一开始理赔， 就提醒他按医嘱治疗、留下每一次看诊和护理的记录。理赔不是填表填得好就能过，是病历要撑得住。

The lesson isn't which carrier is better; it's the contract language. For us it means something concrete: the moment a client starts a claim, tell them to follow treatment and keep a record of every visit and every bit of care. A claim isn't won on the form; it's won on the medical record.

阿兹海默症（老年痴呆）Alzheimer's DiseaseAlzheimer's Disease

  • 由医生诊断为阿兹海默症或路易体痴呆症Diagnosed by a physician with Alzheimer's disease or Lewy body dementia
    • 简易精神状态测验（MMSE）或同类测试，得分低于 30 分中的 20 分Mini-Mental State Exam (MMSE) or similar test: a score below 20 out of 30
    • 并且在以下至少两项认知功能测试中，被确认存在临床损伤：And clinical impairment confirmed in at least two of these cognitive tests:
      • 识别人物、地点或时间的能力（定向力）Orientation to person, place or time
      • 学习和记忆新信息的能力Learning and remembering new information
      • 注意力与计算能力（推理及处理复杂任务的能力）Attention and calculation (reasoning and complex tasks)

第三项：阿兹海默症，俗称老年痴呆，英文 Alzheimer's Disease。

The third: Alzheimer's disease.

先用一句话解释这个病：阿兹海默是大脑里堆积了异常的蛋白质，导致脑细胞慢慢死亡的退行性疾病。 早期表现是经常忘事；后期会完全不认识家人、不能独立生活，最后丧失语言和吞咽能力。 按阿兹海默症协会的统计，美国 65 岁以上的人里，大约每 9 个人就有 1 个患阿兹海默症。

One sentence on the disease: Alzheimer's is a degenerative disease in which abnormal proteins build up in the brain and brain cells gradually die. Early on, people forget things often; later they no longer recognize family, can't live independently, and eventually lose speech and the ability to swallow. By the Alzheimer's Association's figures, about one in nine Americans aged 65 and over has Alzheimer's.

国家人寿的阿兹海默条款怎么定义？第一，必须由医生诊断为阿兹海默症，或者路易体痴呆症，路易体痴呆是另一种类似的痴呆。 第二，做一个测验叫 MMSE，简易精神状态测验，或者同类的测试，满分 30 分，得分必须低于 20 分才算。

How does National Life's Alzheimer's rider define it? First, a physician must diagnose Alzheimer's disease or Lewy body dementia, a related form of dementia. Second, on the Mini-Mental State Exam or a similar test, scored out of 30, the result must be below 20.

第三，在下面三项认知功能测试里，至少两项被确认存在临床损伤：一是定向力，认不清人物、地点或时间； 二是学习和记忆新信息的能力，比如刚说的话马上就忘；三是注意力和计算能力，也就是推理、处理复杂任务的能力，比如简单的算术算不了。

Third, clinical impairment confirmed in at least two of three cognitive tests: orientation, meaning not knowing people, places or time; learning and remembering new information, such as forgetting what was just said; and attention and calculation, meaning reasoning and handling complex tasks, such as being unable to do simple arithmetic.

三个条件要同时满足：诊断、MMSE 低于 20 分、两项认知功能受损。下一页看哪些痴呆不在这个条款里，以及投保年龄的限制。

All three must be met together: the diagnosis, an MMSE below 20, and impairment in two cognitive areas. The next slide covers the forms of dementia that are excluded and the issue-age limit.

阿兹海默症（老年痴呆）：排除与限制Alzheimer's: Exclusions and Limits

  • 其他痴呆均不在此范围内，包括但不限于：Other forms of dementia are excluded, including but not limited to:
    • 酒精或有毒物质引起的脑损伤Brain damage from alcohol or toxic substances
    • 中风相关或血管性痴呆Stroke-related or vascular dementia
    • 空间视觉能力障碍Visuospatial impairment
    • 语言功能障碍Language impairment
最高投保年龄 60 岁Maximum issue age 60
最高理赔额度 $1,500,000Maximum benefit $1,500,000
等待期 30 天Waiting period 30 days

哪些痴呆不在阿兹海默条款里？条款写的是「其他形式的痴呆都不在范围内，包括但不限于」下面四种。

Which dementias does the Alzheimer's rider exclude? The contract says other forms of dementia are excluded, including but not limited to these four.

第一，酒精或有毒物质引起的脑损伤，也就是喝酒、吸毒造成的，不赔。第二，中风相关或血管性痴呆， 这一类如果符合条件，走的是重大疾病里「中风」那一项，或者走慢性疾病的认知障碍，不走阿兹海默条款。 第三，空间视觉能力障碍。第四，语言功能障碍，比如没有伴随整体认知障碍的单纯失语。

One, brain damage caused by alcohol or toxic substances, meaning drinking or drug use: not covered. Two, stroke-related or vascular dementia; if it qualifies, it goes through the stroke item under critical illness, or the cognitive impairment route under chronic illness, not through the Alzheimer's rider. Three, visuospatial impairment. Four, language impairment, such as aphasia without broader cognitive decline.

右边三个限制。最高投保年龄 60 岁，过了 60 岁买保单就拿不到这一项了，所以有这方面顾虑的客户，越早规划越好。 最高理赔额度 $150 万。等待期 30 天。

Three limits on the right. The maximum issue age is 60: buy a policy after 60 and this rider isn't available, so clients with this concern should plan early. The maximum benefit is $1.5 million. The waiting period is 30 days.

还有一个承保上的限制，第 22 页会讲：承保评级在 200% 或 Express Non-Tobacco 2 以上的，拿不到阿兹海默条款。

There's also an underwriting limit, covered on slide 22: a policy rated 200% or Express Non-Tobacco 2 or worse doesn't get the Alzheimer's rider.

讲师提醒Presenter note

「越早规划越好」可以讲，但不要变成「再不买就来不及了」的催促话术。

"Plan early" is fine to say, but don't turn it into "buy now before it's too late" pressure.

阿兹海默症 vs. 慢性疾病Alzheimer's vs. Chronic Illness

慢性疾病附加险Chronic illness rider

分期领取赔付金Paid in instalments

阿兹海默症附加险Alzheimer's rider

一次性领取赔付金Paid as a lump sum

  • 客户可根据自身需求选择用哪一项The client chooses which rider to claim under
  • 选择其中一项，不会取消另一项Choosing one doesn't cancel the other
  • 可以先选慢性疾病，之后再改为阿兹海默Start with chronic, then switch to Alzheimer's
  • 也可以先领一部分阿兹海默赔付，之后再选慢性疾病Or take part of the Alzheimer's benefit, then go to chronic
    • 前提是加速给付 ABR 额度尚未全额支付As long as the ABR amount hasn't been paid in full

客户经常问：阿兹海默和慢性疾病有什么区别？阿兹海默的人，往往也满足慢性疾病里「认知障碍」那一条，那我用哪一个？

Clients often ask: what's the difference between Alzheimer's and chronic illness? Someone with Alzheimer's often also meets the cognitive-impairment route of chronic illness, so which one do I use?

关键区别在拿钱的方式。慢性疾病是分期领：每月最多动用 2% 保额，一次管一年。阿兹海默是一次性领，一笔到账。 客户可以按自己的需要选用哪一项。

The key difference is how the money comes. Chronic illness pays in instalments: up to 2% of face a month, one year per claim. Alzheimer's pays a lump sum, all at once. The client picks whichever suits their needs.

而且两项不是二选一到底的。选了其中一项，不会取消另一项。可以先用慢性疾病分期领，之后改成阿兹海默一次性领； 也可以先领一部分阿兹海默，剩下的再用慢性疾病分期领。前提只有一个：生前福利的额度还没有全部付完。

And it isn't a one-time, either-or choice. Choosing one doesn't cancel the other. A client can start with the chronic instalments and later switch to the Alzheimer's lump sum, or take part of the Alzheimer's benefit first and then go to chronic instalments for the rest. The only condition: the accelerated benefit amount hasn't been paid out in full.

怎么帮客户想？一次要用一大笔钱，比如要改装房子、要搬进护理机构、要还清房贷，一次性的阿兹海默更合适； 要的是每个月稳定的护理开支，分期的慢性疾病更合适。不管选哪一项，都是打折动用身故金，用掉的部分身故时就少了。

How to help a client think it through: if they need a large sum at once, say to adapt the home, move into a care facility or pay off the mortgage, the Alzheimer's lump sum fits better; if they need steady monthly care costs covered, the chronic instalments fit better. Either way, it's the death benefit drawn early at a discount, and whatever is used is gone from the death benefit.

重大疾病（重疾）Critical IllnessCritical Illness

13 项13 conditions

  • 失明（Blindness）Blindness
  • 癌症（Cancer）Cancer
  • 肌萎缩性侧索硬化症（ALS）Amyotrophic lateral sclerosis (ALS)
  • 终末期肾衰竭（End Stage Renal Failure）End-stage renal failure
  • 心脏病发作（Heart Attack）Heart attack
  • 重大器官移植（Major Organ Transplant）Major organ transplant
  • 中风（Stroke）Stroke
  • 主动脉移植手术（Aorta Graft Surgery）Aorta graft surgery
  • 再生障碍性贫血（Aplastic Anemia）Aplastic anemia
  • 囊性纤维化（Cystic Fibrosis）Cystic fibrosis
  • 心脏瓣膜置换（Heart Valve Replacement）Heart valve replacement
  • 运动神经元疾病（Motor Neuron Disease）Motor neuron disease
  • 心脏骤停（Sudden Cardiac Arrest）Sudden cardiac arrest
等待期Waiting period30 天30 days
赔多少How much按对预期寿命的影响和治疗成功率By impact on life expectancy and treatment success
理赔金The money客户自由使用The client's to use freely
最高理赔额度Maximum benefit$1,000,000

第四项：重大疾病，英文 Critical Illness，业内叫重疾。国家人寿一共承保 13 项，我们一项一项过。 标了金色的三项，癌症、心脏病发作、中风，是最常见、理赔最多的三项。

The fourth: critical illness. National Life covers 13 conditions; we'll go through each. The three in gold, cancer, heart attack and stroke, are the most common and the most claimed.

左边七项。失明：双眼永久性视力丧失，矫正后视力低于 20/200，或者视野小于 20 度。癌症：必须是侵袭性癌症， 原位癌和早期的非黑色素瘤皮肤癌不赔，下一页看合同原文。肌萎缩性侧索硬化症，也就是渐冻症 ALS，运动神经元病变。 终末期肾衰竭：双肾基本不工作，要靠透析或者肾移植。心脏病发作：心肌梗死，心脏的血管堵塞导致心肌坏死。 重大器官移植：心、肝、肺、胰、骨髓等主要器官移植，列入等待名单就可以。中风：脑血管堵塞或破裂，留下永久性的神经功能损伤， 一过性的脑缺血 TIA 不赔。

The seven on the left. Blindness: permanent loss of sight in both eyes, corrected vision below 20/200 or a visual field under 20 degrees. Cancer: it must be invasive cancer; carcinoma in situ and early non-melanoma skin cancer are excluded, and the next slide shows the contract wording. ALS, the motor neuron disease. End-stage renal failure: both kidneys essentially stopped, needing dialysis or a transplant. Heart attack: myocardial infarction, a blocked artery causing heart muscle to die. Major organ transplant: heart, liver, lungs, pancreas, bone marrow and other major organs; being placed on the waiting list is enough. Stroke: a blocked or ruptured blood vessel in the brain leaving permanent neurological damage; a transient ischemic attack (TIA) doesn't count.

右边六项。主动脉移植手术：主动脉是从心脏出来、身体里最大的那根血管，这个手术是把一段换掉。 再生障碍性贫血：骨髓不造血，要输血或骨髓移植。囊性纤维化：先天的遗传病，肺里黏液堆积，条款要求 20 岁以前确诊。 心脏瓣膜置换：心脏四个瓣膜之一坏了要换掉。运动神经元疾病：ALS 是其中一种，还有其他类似的病。 心脏骤停：心脏突然停跳，被电击或心肺复苏救回来。

The six on the right. Aorta graft surgery: the aorta is the largest blood vessel, leaving the heart, and the surgery replaces a section of it. Aplastic anemia: the bone marrow stops producing blood cells, requiring transfusions or a marrow transplant. Cystic fibrosis: an inherited disease in which mucus builds up in the lungs; the rider requires diagnosis before age 20. Heart valve replacement: one of the heart's four valves fails and is replaced. Motor neuron disease: ALS is one; there are others like it. Sudden cardiac arrest: the heart stops suddenly and is restarted by defibrillation or CPR.

下面四条规则：等待期 30 天；赔多少，按这个病对预期寿命的影响和治疗成功率来决定，同一个癌症， 早一点的和晚期的拿到的完全不同，这就是第 29 页会看到的 Category 严重程度分级；理赔金客户自由使用；最高 $100 万。

Four rules at the bottom. A 30-day waiting period. The amount depends on the condition's impact on life expectancy and the treatment success rate: the same cancer pays very differently early versus late, which is the severity category you'll see on slide 29. The money is the client's to use freely. The maximum is $1 million.

讲师提醒Presenter note

每一项的完整定义（要满足什么、不算什么、要存活多少天）在全文第二节「条款原文的关键定义」表里。 失明在多个州不作为重疾，讲的时候带一句「以所在州的条款为准」。

The full definition of each condition (what must be met, what's excluded, how long the insured must survive) is in the "key definitions" table in section two of the article. Blindness isn't a qualifying condition in several states, so add "subject to your state's contract."

重大疾病 合同条款：国家人寿的癌症定义The Contract: National Life's Cancer Definition

国家人寿浸润性癌症定义原文，附手写中文批注：确诊后须存活 90 天；不赔原位癌、非转移非黑色素瘤皮肤癌、良性肿瘤、4 期以下甲状腺癌、早期前列腺癌、Rai 0 期慢性淋巴细胞白血病 / National Life's invasive cancer definition with handwritten Chinese notes: must survive 90 days after diagnosis; excludes carcinoma in situ, non-metastatic non-melanoma skin cancer, benign tumors, thyroid cancer below Stage 4, early prostate cancer and Rai Stage 0 CLL

接下来两页，是两家公司重疾条款的原文：国家人寿和 Corebridge。先看国家人寿的癌症定义， 手写字是中文批注，我念重点。

The next two slides show the critical illness wording of two carriers: National Life and Corebridge. First, National Life's cancer definition; the handwriting is Chinese annotation, and here are the key points.

什么算癌症？必须是侵袭性癌症 Invasive Cancer：存在一个或多个恶性肿瘤，特征是恶性细胞不受控制地生长和扩散， 并且侵入周围的正常组织。诊断要由病理报告确认；如果做不了病理，也接受有病历支持的临床诊断。 确诊之后，被保险人必须存活 90 天，才能领这一项。

What counts as cancer? It must be invasive cancer: one or more malignant tumors marked by uncontrolled growth and spread of malignant cells and invasion of surrounding normal tissue. The diagnosis must be confirmed by pathology; where that isn't possible, a clinical diagnosis backed by medical records is accepted. The insured must survive 90 days after the date of diagnosis to collect.

哪些不赔？第一，任何没有转移的非黑色素瘤皮肤癌；第二，癌前病变、良性肿瘤或息肉、不典型增生； 第三，非侵袭性的原位癌，包括膀胱的非侵袭性乳头状癌、乳腺导管原位癌 DCIS、原位黑色素瘤； 第四，4 期以下的甲状腺癌；第五，早期前列腺癌，分期 T2aN0M0 且 Gleason 评分 6 分或以下； 第六，早期慢性淋巴细胞白血病，Rai 0 期。

What's excluded? One, any non-metastatic non-melanoma skin cancer. Two, pre-malignant lesions, benign tumors or polyps, and dysplasias. Three, non-invasive cancer (carcinoma in situ), including non-invasive papillary bladder cancer, ductal carcinoma in situ of the breast, and melanoma in situ. Four, thyroid cancer below Stage 4. Five, early prostate cancer staged T2aN0M0 with a Gleason score of 6 or lower. Six, early chronic lymphocytic leukemia, Rai Stage 0.

为什么要念这么细？因为客户最常拿来问的就是癌症。「我查出来乳腺有个原位癌，能不能赔？」按这份条款，原位癌不在重疾范围里。 提前讲清楚，比理赔那天被拒强得多。

Why read it in such detail? Because cancer is what clients ask about most. "I was diagnosed with in-situ breast cancer; can I claim?" Under this contract, carcinoma in situ isn't covered as a critical illness. Saying so up front is far better than a denial on claim day.

重大疾病 合同条款：Corebridge 的癌症排除The Contract: Corebridge's Cancer Exclusions

Corebridge 浸润性癌症定义原文及中文对照：不包括白斑病、增生、类癌、红细胞增多症、一期霍奇金病、A 期前列腺癌、Duke's A 期结肠癌、乳腺导管内非浸润癌、0 或 1 期膀胱移行细胞癌、原位癌、除恶性黑色素瘤外的皮肤癌、T1N0M0 且小于 1 厘米的甲状腺乳头状癌、RAI 0 期慢性淋巴细胞白血病、其他癌前病变和良性肿瘤 / Corebridge invasive cancer definition with Chinese translation, listing its exclusions

这一页是 Corebridge 的癌症定义，左边英文原文，右边是中文对照。它对侵袭性癌症的定义和国家人寿差不多， 区别在排除清单，一共 14 条。

This is Corebridge's cancer definition, English on the left and a Chinese translation on the right. Its definition of invasive cancer is close to National Life's; the difference is the exclusion list, fourteen items long.

我挑和国家人寿不一样的念：一期霍奇金病；A 期前列腺癌；Duke's A 期结肠癌；0 期或 1 期的膀胱移行细胞癌； 类癌 Carcinoid；还有白斑、增生、红细胞增多症这类。这几种在 Corebridge 都不算重疾癌症。 也就是说，一些早期的结肠癌、膀胱癌、淋巴瘤，在 Corebridge 是排除的。

Here are the ones that differ from National Life: Stage 1 Hodgkin's disease; Stage A prostate cancer; Duke's stage A colon cancer; Stage 0 or 1 transitional cell carcinoma of the bladder; carcinoid tumors; and conditions such as leukoplakia, hyperplasia and polycythemia. None of these count as cancer for Corebridge's critical illness benefit. In other words, some early colon cancers, bladder cancers and lymphomas are excluded there.

但要讲公道：也有 Corebridge 比国家人寿宽的地方。甲状腺癌，Corebridge 只排除 T1N0M0、小于 1 厘米的乳头状癌； 国家人寿是 4 期以下的甲状腺癌都排除。皮肤癌，Corebridge 排除的是浸润深度不到 1 毫米、Clark 分级 2 级以下的， 黑色素瘤达到这个深度就赔。

But be fair: in places Corebridge is broader than National Life. On thyroid cancer, Corebridge excludes only papillary carcinoma staged T1N0M0 under 1 cm; National Life excludes all thyroid cancer below Stage 4. On skin cancer, Corebridge excludes melanoma shallower than 1 mm or below Clark level 2, so a melanoma at that depth qualifies.

所以这一页的结论不是「谁全面赢」，而是：同样叫「癌症」，每家公司排除的早期癌不一样。 客户有家族病史、特别担心某一种癌，就把这一种在几家的定义里逐条对一遍。

So the takeaway isn't that one carrier wins outright. It's that the same word, "cancer," excludes different early cancers at each carrier. If a client has a family history or a particular worry, check that one cancer line by line in each carrier's definition.

重大伤害（重伤）Critical InjuryCritical Injury

4 项4 conditions

  • 非医疗诱发昏迷（Non-medically Induced Coma）：连续 96 小时（4 天）Non-medically induced coma: 96 hours (4 days) in a row
  • 瘫痪（Paralysis）：偏瘫、截瘫、四肢瘫痪Paralysis: hemiplegia, paraplegia, quadriplegia
  • 严重烧伤（Severe Burns）：脸或身体超过 30% 面积Severe burns: over 30% of the face or body
  • 创伤性脑损伤（Traumatic Brain Injury）：脑组织受损，非自残Traumatic brain injury: brain tissue damaged, not self-inflicted
等待期Waiting period30 天30 days
赔多少How much按对预期寿命的影响和治疗成功率By impact on life expectancy and treatment success
理赔金The money客户自由使用The client's to use freely
最高理赔额度Maximum benefit$1,000,000

第五项：重大伤害，英文 Critical Injury，业内叫重伤。前面的重疾是「病」，这一项是「伤」，国家人寿一共 4 项。

The fifth: critical injury. Critical illness is about disease; this one is about injury. National Life covers four.

第一，非医疗诱发的昏迷：「非医疗」的意思是不是麻醉、不是医生为了治疗让你昏迷，而是脑外伤、中毒、车祸这些造成的， 必须连续 96 小时，也就是 4 天。条款还要求昏迷程度达到一定标准、需要生命维持，并留下永久性损伤；酒精或药物导致的不算。 第二，瘫痪：偏瘫是半身，截瘫是下半身，四肢瘫痪，三种都包括，要持续 90 天并且是永久性的。 第三，严重烧伤：脸部或身体超过 30% 的面积，三度烧伤。第四，创伤性脑损伤：外力造成脑组织受损，自残的不算，自杀未遂造成的也不赔。

One, non-medically induced coma. "Non-medically induced" means not from anesthesia or a doctor putting you under for treatment, but from a head injury, poisoning, a car accident and the like, lasting 96 hours, four days. The rider also requires a defined depth of coma, life support and a permanent deficit; a coma caused by alcohol or drugs doesn't count. Two, paralysis: hemiplegia (one side), paraplegia (lower body) and quadriplegia (all four limbs), lasting 90 days and permanent. Three, severe burns: third-degree burns over more than 30% of the face or body. Four, traumatic brain injury: brain tissue damaged by external force; self-inflicted injury, including a suicide attempt, is excluded.

规则和重疾一样：30 天等待期；赔多少按伤情对预期寿命的影响和治疗成功率决定；理赔金客户自由使用；最高 $100 万。

The rules match critical illness: a 30-day waiting period; the amount depends on the injury's impact on life expectancy and the treatment success rate; the money is the client's to use freely; the maximum is $1 million.

为什么这一项值得讲？因为在后面的同业对比表里，很多公司根本没有重大伤害这一类。对开车上下班、做体力活、 喜欢户外运动的客户，这一项很实在。但同样要讲清楚：骨折、扭伤这类普通的伤不在里面，下一页就是不赔的清单。

Why spend time on this one? Because in the comparison tables later, many carriers don't offer critical injury at all. For clients who commute by car, do physical work or love outdoor sports, it's a real benefit. But say this too: ordinary injuries such as fractures and sprains aren't included. The next slide is the list of what isn't covered.

客户常误以为可以赔的 Top 10（其实不赔）Top 10 Things Clients Think Are Covered (They Aren't)

  • ✕ 1. 手指骨折✕ 1. Broken finger
  • ✕ 2. 脚踝 / 脚趾骨折✕ 2. Broken ankle or toe
  • ✕ 3. 背痛✕ 3. Back pain
  • ✕ 4. 子宫切除术✕ 4. Hysterectomy
  • ✕ 5. 怀孕及产后恢复✕ 5. Pregnancy and postpartum
  • ✕ 6. 手肘骨折✕ 6. Broken elbow
  • ✕ 7. 关节 / 膝盖疼痛✕ 7. Joint or knee pain
  • ✕ 8. 疝气修复✕ 8. Hernia repair
  • ✕ 9. 胆囊切除✕ 9. Gall bladder removal
  • ✕ 10. 子宫肌瘤切除✕ 10. Fibroid removal

这些是医疗保险该管的事：生前福利只赔「重大 + 长期 + 救命」级别These belong to health insurance: living benefits are for major, long-term, life-threatening events

知道了哪些赔，下一个问题：哪些不赔？这十项，是国家人寿客服那边，客户最常打电话来要申请、结果都不符合的情况。

Now that we know what's covered, the next question: what isn't? These ten are the situations National Life's service team most often hears from clients wanting to file, none of which qualify.

我念一遍：手指骨折；脚踝或脚趾骨折；背痛；子宫切除术；怀孕及产后恢复，真的有人拿怀孕来申请； 手肘骨折；关节或膝盖疼痛；疝气修复；胆囊切除；子宫肌瘤切除。

Here they are: a broken finger; a broken ankle or toe; back pain; a hysterectomy; pregnancy and postpartum recovery, and yes, people do file for pregnancy; a broken elbow; joint or knee pain; hernia repair; gall bladder removal; fibroid removal.

这十项有一个共同点：都是医疗保险该管的事，属于普通的看病、做手术。生前福利只赔重大、长期、危及生命这个级别的情况。 请大家把这句话记牢，也讲给客户：「生前福利不是小病小痛的报销，是为重大、长期、危及生命的情况准备的救命钱。」

What the ten have in common: they're health insurance matters, ordinary treatment and surgery. Living benefits pay only for events that are major, long-term or life-threatening. Remember this line and give it to clients: "Living benefits aren't reimbursement for minor problems; they're money held for major, long-term, life-threatening events."

特别注意第 2 项，和前面那个慢性疾病案例对一下：脚趾骨折本身不赔。那位客户拿到钱，是因为受伤之后连续 90 天以上 失去了两项生活自理能力，符合的是慢性疾病的条件，不是「骨折」。如果客户问「我摔断了腿能不能赔」， 正确的回答是：骨折本身不赔；如果因此连续 90 天以上没办法自己洗澡、穿衣这类，那要看是否符合慢性疾病的条件。

Pay special attention to item 2 and compare it with the chronic claim earlier: a broken toe on its own isn't covered. That client was paid because, after the injury, he lost two activities of daily living for more than 90 consecutive days; he met the chronic illness condition, not "a fracture." If a client asks "would a broken leg pay?", the right answer is: the fracture itself doesn't; if it leaves you unable to bathe or dress yourself for more than 90 days, then we look at whether the chronic illness condition is met.

讲师提醒Presenter note

卖单的时候把这条边界讲清楚，理赔的时候客户就不会觉得被骗。预期管理好，客户反而更信任你。

Draw this line clearly at the sale, and the client won't feel misled at claim. Set expectations well and clients trust you more, not less.

已有的病拿不到对应 ABRExisting Conditions Lose the Matching ABR

曾经心脏病发作 / 癌症康复Prior heart attack or recovered from cancer→ 拿不到重大疾病 ABR（其他 ABR 仍可）→ No critical illness ABR (others still available)
有伤残（Disability）历史 / 慢性背痛History of disability or chronic back pain→ 拿不到慢性疾病 ABR→ No chronic illness ABR
次标准体 ≥ Table 4 / Express Standard 2Substandard ≥ Table 4 / Express Standard 2→ 只能拿末期疾病 ABR→ Terminal illness ABR only
评级 ≥ 200% / Express Non-Tobacco 2Rated ≥ 200% / Express Non-Tobacco 2→ 拿不到阿兹海默条款→ No Alzheimer's rider
多被保人的保单：任何一位被保人不合格Multi-insured policy: any one insured doesn't qualify→ 其他被保人也拿不到 ABR→ The other insureds lose the ABR too

客户必须如实回答 medical form 上所有问题：保单生效 2 年内的理赔会被复核，撒谎被发现 = 条款被撤销Clients must answer every medical question truthfully: claims in the first 2 years are reviewed, and a misstatement means the rider is rescinded

这一页讲「谁拿不到」。很多人以为生前福利是每张保单都一样带的，其实不是：承保的时候，按客户的健康状况， 有些项目就不给了。已经有的病，拿不到对应的那一项。我们一行一行看。

This slide is about who doesn't get it. Many people assume every policy carries the same living benefits. Not so: at underwriting, depending on the client's health, some benefits aren't offered. An existing condition loses the benefit that matches it. Line by line.

第一行，曾经心脏病发作、或者癌症康复的客户，拿不到重大疾病这一项，其他几项仍然可以有。 第二行，有伤残历史、或者慢性背痛的，拿不到慢性疾病这一项。第三行，承保评级是次标准体 Table 4 或以上、 或者 Express Standard 2 的，只能拿末期疾病这一项。第四行，评级在 200% 或以上、或者 Express Non-Tobacco 2 的， 拿不到阿兹海默条款。第五行，一张保单保好几个人的，任何一位被保人不合格，其他被保人也拿不到生前福利。 这一条按保守的理解来讲，做多被保人方案时逐一核对。

Row one: a client with a prior heart attack, or who has recovered from cancer, doesn't get critical illness; the others remain available. Row two: a history of disability or chronic back pain means no chronic illness benefit. Row three: rated substandard at Table 4 or worse, or Express Standard 2, means terminal illness only. Row four: rated 200% or worse, or Express Non-Tobacco 2, means no Alzheimer's rider. Row five: on a policy covering several people, if any one insured doesn't qualify, the others lose the living benefits too. Read that last one conservatively and check every insured on a multi-life case.

最下面这个警示一定要讲：客户必须如实回答体检和健康问卷上的所有问题。保单生效两年内，叫可争议期 contestability， 这期间提出的理赔会被复核。如果发现当初隐瞒了病史，整个条款会被撤销，英文叫 rescind，等于作废。 隐瞒换来的保单，恰恰在最需要它的那一天失效。

The warning at the bottom must be said: the client has to answer every medical question truthfully. The first two years are the contestability period, and claims in that window are reviewed. If a concealed history comes to light, the rider is rescinded, voided. A policy bought by omission fails on exactly the day it's needed.

合规提醒Compliance note

核保时帮客户如实申报，是保护客户，也是保护我们自己。千万不要为了把单子做下来，帮客户隐瞒病史，那是给将来埋雷。

Helping clients disclose fully at underwriting protects them and protects us. Never help a client hide a history to get a case placed; that plants a problem for later.

5 大项额度是合并封顶，不是独立The Five Caps Are Shared, Not Separate

客户常见误解The common mistake

「我有 $150 万末期疾病 + $150 万慢性疾病 + $150 万阿兹海默 + $100 万重大疾病 + $100 万重大伤害」"I have $1.5M terminal + $1.5M chronic + $1.5M Alzheimer's + $1M critical illness + $1M critical injury"

= $650 万可以拿？✕ 错！= $6.5M to collect? ✕ No!

实际是 Aggregate Cap：合并封顶 $150 万It's an aggregate cap: $1.5M combined

案例：$400 万保单Example: a $4M policy

第 1 步：先用重大疾病，理赔 $75 万，保额降到 $200 万Step 1: a critical illness claim pays $750,000; the face drops to $2M

第 2 步：后来末期疾病，最多再拿 $75 万（不是 $150 万）Step 2: later, terminal illness pays at most another $750,000 (not $1.5M)

五大项是同一份保额的不同提取方式：提一次，就少一截The five are different ways to draw on one face amount: each draw leaves less

这一页纠正一个客户非常普遍、也非常关键的误解：以为五大项的额度是分开的，可以叠加。 他们心里的算法是：「我有 $150 万末期疾病，加 $150 万慢性疾病，加 $150 万阿兹海默，加 $100 万重大疾病， 再加 $100 万重大伤害，一共能拿 $650 万？」答案是：错。

This slide corrects a very common and very important misunderstanding: that the five caps are separate and stack. The client's mental arithmetic goes: "$1.5 million terminal, plus $1.5 million chronic, plus $1.5 million Alzheimer's, plus $1 million critical illness, plus $1 million critical injury: $6.5 million in total?" The answer is no.

实际的规则叫 Aggregate Cap，合并封顶。所有生前福利，共用的是这一份保单的保额，而且共用一个总上限：五项加起来最多 $150 万。 看右边的例子：一张 $400 万的保单。第一步，客户先因为重大疾病理赔，拿到 $75 万；因为是打折提前付， 这 $75 万动用了 $200 万的保额，所以保额从 $400 万降到 $200 万。第二步，后来他又成为末期疾病， 这时候他最多再拿 $75 万，而不是另外一个独立的 $150 万：$150 万是几项合起来的总上限，已经用掉了 $75 万。

The actual rule is an aggregate cap. All the living benefits draw on this one policy's face amount and share one overall ceiling: $1.5 million across all five. Take the example on the right: a $4 million policy. Step one, the client claims critical illness and receives $750,000; because it's paid early at a discount, that $750,000 uses up $2 million of face, so the face drops from $4 million to $2 million. Step two, the client later becomes terminally ill and can now take at most another $750,000, not a separate $1.5 million: $1.5 million is the combined ceiling, and $750,000 of it has been used.

所以要同时看两样东西：一是剩下的保额，二是合并的总上限，哪个先碰到就停在哪。$100 万保额的保单， 碰到的通常是保额；保额很大的保单，碰到的通常是总上限。用一句话讲给客户： 「五大项是你这份保额的五种提取方式，提一次就少一截，不是五个独立的账户。」

So two things are in play: the remaining face and the combined ceiling, and whichever is reached first stops it. On a $1 million policy, the face is usually the limit; on a large policy, the ceiling usually is. For the client, in one line: "The five are five ways of drawing on your one face amount. Each draw leaves less; they aren't five separate accounts."

讲师提醒Presenter note

这一条必须在成交前讲。理赔那天才发现，客户会认为你骗了他，而且从他的角度看，他是对的。

This has to be said before the sale. Discovered on claim day, the client will believe you misled them, and from where they sit, they'd be right.

互动设计Interaction

自测：$100 万保额，客户先用重大疾病动用了 $40 万保额，后来又确诊末期疾病，最多还能动用多少保额？ （$60 万。五类合并封顶，不是再来 $100 万。实际到手还要打折。）

Quick check: on a $1 million policy, a client first uses $400,000 of face on critical illness, then is diagnosed as terminally ill. How much face is left to use? ($600,000. The five share one cap; it isn't another $1 million. And what arrives is still discounted.)

ABR 理赔税务表How ABR Claims Are Taxed

福利类型Benefit个人持有、个人收款Individually owned and paid公司持有、公司收款Business owned and paid
末期疾病Terminal illness通常符合 §101(g)，免税Usually qualifies under §101(g): tax-free通常不符合 §101(g)，需进一步计算应税金额Usually outside §101(g): taxable amount to be worked out
慢性疾病Chronic illness符合条件时免税，受 LTC 规则及 per diem 上限约束Tax-free when qualified, subject to LTC rules and the per diem limit通常不符合 §101(g)，需进一步计算应税金额Usually outside §101(g): taxable amount to be worked out
阿兹海默 / 认知障碍Alzheimer's / cognitive impairment按慢性疾病规则判断Follows the chronic illness rules按慢性疾病及 §101(g)(5) 判断Chronic illness rules and §101(g)(5)
重大疾病Critical illness取决于条款结构、付款原因和保费来源Depends on rider structure, reason for payment and who paid premiums取决于条款结构、收款人、税基和商业关系Depends on rider structure, payee, basis and business relationship
重大伤害Critical injury取决于 §104 / §105 及合同结构Depends on §104 / §105 and contract structure取决于收款人与合同性质，不能一概而论Depends on payee and contract; no single answer

慢性疾病超过 IRS per diem 的部分，要证明用于护理才免税：2026 年 $156,950 / 年 = $13,079 / 月 = $430 / 天Chronic payments above the IRS per diem are tax-free only with proof of care costs: 2026, $156,950 a year = $13,079 a month = $430 a day

这一页讲生前福利理赔的税。先说一句定位：这是制度性的介绍，不是税务建议，具体到每一位客户，要由他自己的会计师确认。

This slide covers tax on living benefit claims. First, the framing: this is an overview of the rules, not tax advice; each client's situation must be confirmed by their own accountant.

表分两栏：左边是个人持有、个人收款；右边是公司持有、公司收款。先看左边。末期疾病，通常符合税法 §101(g)， 也就是视同身故金，免税。慢性疾病，符合条件的时候免税，但受长期护理的规则和 IRS 每日限额 per diem 约束。 阿兹海默和认知障碍，按慢性疾病的规则来判断。重大疾病，要看条款怎么设计、因为什么付款、保费是谁付的。 重大伤害，要看税法 §104、§105 和合同的结构。客户一般会收到 1099-LTC 表，用于申报和追踪。

Two columns: individually owned and paid on the left, business owned and paid on the right. The left first. Terminal illness usually qualifies under IRC §101(g), treated like a death benefit, and is tax-free. Chronic illness is tax-free when it qualifies, but it's subject to the long-term care rules and the IRS per diem limit. Alzheimer's and cognitive impairment follow the chronic illness rules. Critical illness depends on how the rider is built, why the payment is made and who paid the premiums. Critical injury depends on IRC §104 and §105 and the contract's structure. The client generally receives a Form 1099-LTC for reporting.

右边，公司持有的保单，就复杂多了。末期和慢性通常不符合 §101(g) 的免税规则，需要进一步计算应税金额； 阿兹海默要按慢性疾病规则加上 §101(g)(5) 来判断，这一条讲的就是和生意相关的保单； 重疾、重伤要看收款人、税基、合同性质，不能一概而论。很多企业主会顺手把保单挂在公司名下， 结果把一笔本来免税的理赔变成了应税收入。持有人是谁，要在投保之前就和客户的会计师确认。

On the right, business-owned policies are far more complicated. Terminal and chronic usually fall outside §101(g) and the taxable amount has to be worked out; Alzheimer's is judged under the chronic rules plus §101(g)(5), the provision on business-related policies; critical illness and injury depend on the payee, the basis and the nature of the contract, with no single answer. Many business owners put the policy in the company's name for convenience and turn a tax-free benefit into taxable income. Settle who owns the policy with the client's accountant before it's issued.

最下面一条：慢性疾病每年领的钱，超过 IRS 每日限额的部分，要提交护理费用的证明才免税。 2026 年的限额是每天 $430，一年 $156,950，一个月约 $13,079。这个数每年按通胀调，用之前查 IRS 当年的公告。

The bottom line: chronic illness payments above the IRS per diem limit are tax-free only with proof of care costs. For 2026 the limit is $430 a day, $156,950 a year, about $13,079 a month. It's indexed every year, so check the IRS figure for the year before quoting it.

合规提醒Compliance note

我们不是税务顾问。可以讲「一般情况下」「通常」，不要讲「一定免税」。企业主想用公司付保费， 常见的做法是 Executive Bonus 这类结构，让员工本人做持有人；具体怎么做，请客户的会计师定。

We aren't tax advisers. Say "generally" and "usually," never "always tax-free." When a business owner wants the company to pay premiums, a common approach is an executive bonus arrangement with the employee as owner; the specifics are for the client's accountant.

Fertility Journey Rider 试管婴儿福利The Fertility Journey Rider

所有国家人寿保单自动免费携带Included automatically and free on every National Life policy

覆盖什么What it covers

  • 人工授精（Artificial Insemination）Artificial insemination
  • 辅助生殖技术（ART）Assisted reproductive technology (ART)
  • 试管婴儿（IVF / In Vitro）In vitro fertilization (IVF)
  • 输卵管腹腔镜手术Laparoscopic tubal surgery
  • 子宫镜检查与治疗Hysteroscopic diagnosis and treatment

拿多少 / 怎么拿How much / how it pays

  • 一次性的 accumulation value 信用A one-time accumulation value credit
  • = 3 倍最低 / 保证月保费= 3 × the minimum / guaranteed monthly premium
  • 自动加入现金价值Added to the cash value automatically
  • 2 年等待期2-year waiting period
  • 不影响 ABR 任何额度Doesn't touch any ABR amount

讲完五大项，还有一个很少有人讲、但对年轻家庭很实在的条款：Fertility Journey Rider，试管婴儿福利。 所有国家人寿的保单都自动带，免费，不用额外付钱。

After the five, one more rider that few people mention but that matters to young families: the Fertility Journey Rider. Every National Life policy carries it automatically, at no cost.

它覆盖五类生育治疗：人工授精；辅助生殖技术 ART；试管婴儿 IVF；输卵管的腹腔镜手术；子宫镜检查和治疗。

It covers five kinds of fertility treatment: artificial insemination; assisted reproductive technology; IVF; laparoscopic tubal surgery; and hysteroscopic diagnosis and treatment.

怎么给？不是报销治疗费，而是一次性往保单里加一笔 accumulation value 信用，金额是最低保费、 也就是保证月保费的 3 倍，自动加进现金价值。举个例子：保单的最低月保费是 $500，做了符合条件的治疗， 国家人寿往现金价值里加 $1,500。有 2 年等待期，保单生效两年以后的治疗才算。 它不占生前福利的任何额度，不在合并封顶里，也不减少保额。

How does it pay? Not by reimbursing treatment, but with a one-time accumulation value credit to the policy equal to three times the minimum, or guaranteed, monthly premium, added to the cash value automatically. For example, if the policy's minimum monthly premium is $500, a qualifying treatment adds $1,500 to the cash value. There's a two-year waiting period: only treatment after the policy has been in force two years counts. It doesn't use any living benefit amount, isn't part of the aggregate cap and doesn't reduce the face.

金额不大，但对正在计划要孩子的客户，是一个零成本的加分项，而且很多同行不知道、也不会讲。

The amount is modest, but for clients planning a family it's a zero-cost plus, and many agents don't know about it or mention it.

讲师提醒Presenter note

讲的时候说「补贴一部分」，不要说「试管婴儿保险公司帮你出钱」。信用是加进现金价值的，不是付给诊所的现金。

Say "a credit toward it," not "the insurer pays for your IVF." The credit goes into the cash value; it isn't cash paid to the clinic.

生前福利打折理赔：计算方式How the Discount Is Calculated

死亡赔付的现值PV of the death benefit

以被保险人的年龄为基础，按疾病对预期寿命的影响调整Based on the insured's age, adjusted for the illness's effect on life expectancy

− 剩余保费的现值− PV of future premiums

终身寿险：按最低保费、假设交到 100 岁；定期寿险：算到保单满期（通常 95 岁），平准期后按年度续保保费Permanent: minimum premium, assumed paid to 100. Term: to policy expiry (usually 95), annual renewable rates after the level period

− 手续费与未偿还贷款− Fee and loans

贷款按提前给付的比例扣Loans are deducted in proportion to the amount accelerated

= 生前福利金额= Living benefit

折现利率会调整：资料列终身 3.5%、定期 5%；第 29 页那笔 2025 年理赔用的是 5.80%The rate changes: the material lists 3.5% permanent and 5% term; the 2025 claim on slide 29 used 5.80%

客户的预期寿命和保单现金价值，是影响折现幅度最重要的两个因素Life expectancy and cash value matter most to the size of the discount

现在讲今天最关键的一件事：为什么那位巴士司机动用了 $26.4 万保额，只拿到 $112,182？这就是打折理赔。

Now the most important point of the day: why did the bus driver use $264,000 of face and receive only $112,182? That's the discount.

国家人寿不是把保额面值直接给你，而是把「未来某一天才会付的一笔身故金」，打个折，今天提前给你。 算法就是这四行：第一行，死亡赔付的现值。以被保险人的年龄为基础，再按这个病对预期寿命的影响来调整， 算出「这笔身故金如果在他预计过世的那一年付，折到今天值多少」。

National Life doesn't hand over the face amount. It takes a death benefit that would be paid at some future date, discounts it, and pays it today. The calculation is these four lines. Line one: the present value of the death benefit. Starting from the insured's age, adjusted for the illness's effect on life expectancy, it works out what the death benefit paid in the expected year of death is worth today.

第二行，减去剩余保费的现值。保单之后本来还要交的保费，也折成今天的钱扣掉。终身寿险按最低保费、假设一直交到 100 岁； 定期寿险算到保单满期，通常是 95 岁，平准期过了以后按每年续保的保费算。第三行，减去手续费和没还的保单贷款， 贷款按比例扣，比如有 $2,000 贷款、提前给付 30%，就扣 $600。剩下的，就是客户实际拿到的生前福利金额。

Line two: subtract the present value of future premiums. The premiums the policy would still have needed are also discounted to today and deducted. Permanent policies use the minimum premium assumed paid to age 100; term policies run to expiry, usually age 95, at annual renewable rates after the level period. Line three: subtract the administrative fee and any outstanding loan, deducted proportionally: with a $2,000 loan and 30% accelerated, $600 comes off. What's left is the living benefit the client receives.

折现用的利率：培训资料上列的是终身寿险 3.5%、定期寿险 5%，而且写明会随时调整。第 29 页那一笔 2025 年的真实理赔， 用的是 5.80%，挂钩的是保单的浮动贷款利率。所以讲的时候不要背一个固定的数字，要讲「利率是浮动的，利率越高，折得越多」。 同样的诊断，定期寿险的利率高，拿到的比例通常更低。

The discount rate: the training material lists 3.5% for permanent and 5% for term, noting it can change at any time. The real 2025 claim on slide 29 used 5.80%, tied to the policy's variable loan rate. So don't quote a fixed number; say "the rate floats, and the higher it is, the deeper the discount." For the same diagnosis, term policies use a higher rate and usually pay a smaller share.

最下面这句话请记住：影响折现幅度和到手金额，最重要的是两个因素，一是客户的预期寿命，二是保单的现金价值。下一页把这两条展开。

Remember the line at the bottom: the two biggest factors in the discount, and so in what arrives, are the client's life expectancy and the policy's cash value. The next slide unpacks both.

生前福利打折理赔：拿得多 vs 拿得少When It Pays More, When It Pays Less

赔付高（折现较低）Pays more (smaller discount)

  • 疾病或状况导致较快死亡The condition leads to death sooner
  • 年龄较大的被保险人An older insured
  • 终身型保单（Permanent），并且：A permanent policy that is:
    • 持续缴费稳定Funded steadily
    • 保单已生效多年In force for many years
    • 已高额供款（over-funded）Over-funded

赔付低（折现较高）Pays less (larger discount)

  • 疾病可被治愈或可长期存活The condition is curable or long-lived
  • 年龄较小的被保险人A younger insured
  • 定期寿险（Term）A term policy
  • 终身型保单，但是：A permanent policy that is:
    • 缴费不稳定Funded irregularly
    • 保单生效时间较短Recently issued
    • 现金值低（under-funded）Under-funded, low cash value

这一页用左右对比，把「什么情况下拿得多、什么情况下拿得少」讲清楚。

This slide sets side by side when living benefits pay more and when they pay less.

左边，赔付高，也就是折现比较少的情况。疾病会导致比较快的死亡，离身故近，要折现的年数就少； 被保险人年龄比较大，道理一样；保单是终身型的，而且一直稳定缴费、生效多年、甚至已经高额供款 over-funded， 现金价值厚，折扣就小。

On the left, paying more, meaning a smaller discount. The condition leads to death sooner, so there are fewer years to discount; an older insured, same reasoning; and a permanent policy that has been funded steadily, has been in force for years, or is over-funded, so the cash value is substantial and the discount smaller.

右边，赔付低，折现比较多的情况。疾病可以治好，或者还能活很久，离身故远，折现就大；被保险人年轻； 保单是定期寿险，折现利率高；或者虽然是终身型，但缴费不稳定、刚生效没几年、现金值低、供款不足 under-funded。

On the right, paying less, a larger discount. The condition is curable or the insured can live a long time, so death is far off and the discount large; a young insured; a term policy, with its higher discount rate; or a permanent policy that's been funded irregularly, was issued recently, or is under-funded with low cash value.

归纳成三条，设计保单的时候你真正能影响的只有一条：病情的严重程度，决定预期寿命，你影响不了； 折现利率，挂钩浮动贷款利率，你也影响不了；现金价值的高低，这一条你能影响。 所以「足额供款」除了关系将来的现金价值，还直接决定生前福利理赔那天的数字。

Boil it down to three factors, of which you can influence only one when designing a policy: severity, which drives life expectancy and which you can't influence; the discount rate, tied to the variable loan rate, which you can't influence either; and the level of cash value, which you can. So full funding isn't only about future cash value; it directly sets the number on the day a living benefit is claimed.

提炼成一句给客户的话：「保单养得越久、现金价值越厚、缴费越稳，真用到生前福利的那天，能拿到手的比例通常越高。」

In one line for the client: "The longer the policy has been kept up, the stronger the cash value and the steadier the funding, the larger the share you'll usually receive on the day you need a living benefit."

合规提醒Compliance note

这句话可以用来解释为什么要稳定供款，但不要变成「多交钱就能多赔」的承诺。能拿多少仍然要到理赔时才算得出来。

Use this to explain why steady funding matters, but don't turn it into a promise that paying more means a bigger claim. The amount still can't be known until the claim is calculated.

理赔金额计算：公司寄来的算法说明The Calculation, as the Carrier Sent It

国家人寿 2025 年 10 月 17 日的加速给付金额计算说明，共 7 步：可加速身故金 $500,000、按 5.80% 和重疾 Category 3 计算保费现值 $42,675.66 与身故金现值 $296,483.34、相减得 $253,808、乘以加速比例 100%、减 $250 手续费得 $253,558 / National Life's seven-step accelerated benefit calculation dated 10/17/2025: $500,000 accelerable, PV of premiums $42,675.66 and PV of death benefit $296,483.34 at 5.80% with Category 3 critical illness mortality, net $253,808, times 100% acceleration, less the $250 fee, giving $253,558
理赔计算说明原件 · 2025 年 10 月The carrier's calculation statement · October 2025

这一页是一份真实的理赔金额计算说明，是国家人寿在理赔时随文件寄来的。放它的目的，是让大家看到这笔钱在公司的系统里， 是怎么一步一步算出来的：背后有严谨的精算模型，不是随便给个数。

This is a real benefit calculation statement that National Life sent with a claim. It's here so you can see how the money is worked out step by step inside the carrier's system: there's a rigorous actuarial model behind it, not an arbitrary figure.

一共七步。第一步，算出可以加速的身故金：$500,000 乘以加速比例 100%。第二步，算出把保单维持到 100 岁需要的未来保费： 按 5.80% 的利率，这张单还要交 50 年、每年 $6,146.70。第三步，按 5.80% 和这位客户的死亡率，算出未来保费的现值，$42,675.66。 第四步，同样的方法，算出身故金的现值，$296,483.34。第五步，两个相减，取整得 $253,808。 第六步，乘以加速比例 100%，还是 $253,808。第七步，减掉 $250 的手续费，得到 $253,558。

Seven steps. One, the death benefit available to accelerate: $500,000 times the 100% acceleration percentage. Two, the future premiums needed to carry the policy to age 100: at 5.80%, fifty more annual premiums of $6,146.70. Three, the present value of those premiums at 5.80% with this client's mortality: $42,675.66. Four, the same method for the death benefit: $296,483.34. Five, the difference, rounded: $253,808. Six, times the 100% acceleration percentage: still $253,808. Seven, less the $250 administrative fee: $253,558.

注意第三、第四步里的那句话：死亡率按的是「重大疾病 Category 3、47 岁男性、Select Non-Tobacco 投保」。 Category 是病情严重程度的分级，同一个病，分级不同，算出来的现值就不同。

Note the phrase in steps three and four: mortality for a Category 3 critical illness, a male issued at 47, Select Non-Tobacco. The category is a severity grade; the same disease in a different category gives a different present value.

大家不需要会自己手算这张表，但要能看懂它的逻辑：从身故金出发，先折成现值，再扣掉未来保费的现值，乘以加速比例， 最后减掉手续费。下一页把这七步用大白话拆开。

You don't need to compute this yourself, but you do need to follow its logic: start from the death benefit, discount it to present value, subtract the present value of future premiums, multiply by the acceleration percentage, and take off the fee. The next slide breaks the seven steps down in plain language.

真实案例：$500K 保额，客户拿到 $253,558A Real Claim: $500K Face, $253,558 Received

47 岁男性 · 重大疾病 Category 3（重度）· Select Non-Tobacco · 2025-10-17Male, 47 · Critical illness Category 3 (severe) · Select Non-Tobacco · 2025-10-17

① 可加速身故金① Accelerable DB$500,000× 100%
② 身故金现值② PV of DB$296,4835.80% + Cat 3死亡率5.80% + Cat 3 mortality
③ 减未来保费现值③ Less PV of premiums$253,808已扣 $42,676$42,676 deducted
④ × 100% 加速④ × 100% accelerated$253,808选 50% 则减半Halves at 50%
⑤ 减 $250 手续费⑤ Less $250 fee$253,558客户实际到手Received
实际到手比例Share received50.7%$253,558 / $500,000
模型隐含的预期寿命Implied life expectancy≈ 9.3 年≈ 9.3 yrs$500K ÷ 1.058ⁿ = $296K → n ≈ 9.3
影响折扣的 3 件事3 things that move it① 病越重 → 拿越多① More severe → shorter life → more② 现金价值高 → 折得少② More cash value → smaller discount③ 利率上行 → 拿更少③ Rate tracks the variable loan rate; rates up → less

这一页把上一页那份计算说明用大白话拆开。客户是 47 岁男性，重大疾病 Category 3，也就是重度， 投保时是 Select Non-Tobacco，计算日 2025 年 10 月 17 日。保额 $500,000，现金价值只有 $5,487.46，折现利率 5.80%，选择 100% 加速。

This breaks the previous statement into plain language. The client is a 47-year-old man with a Category 3, severe, critical illness, issued Select Non-Tobacco, calculated on October 17, 2025. Face of $500,000, cash value of only $5,487.46, a 5.80% discount rate, accelerating 100%.

顺着五个格子走：$500,000 乘以 100%，可以加速的是 $500,000；按 5.80% 和重度的死亡率折现，身故金今天值 $296,483； 减掉未来保费的现值 $42,676，剩 $253,808；乘以加速比例 100%，还是 $253,808，如果客户只选 50%，这里就减半； 最后减 $250 手续费，客户实际到手 $253,558。

Follow the five boxes: $500,000 times 100% gives $500,000 to accelerate; discounted at 5.80% with severe-illness mortality, the death benefit is worth $296,483 today; less the $42,676 present value of premiums leaves $253,808; times the 100% acceleration it's still $253,808, and had the client chosen 50% it would halve here; less the $250 fee, the client receives $253,558.

下面三个洞见。第一，实际到手比例 50.7%，为什么这么低？因为这位客户的现金价值只有五千多，接近零，保单买了没多久。 一张长期稳定供款、现金价值厚的保单，同样的诊断，比例会高一些，但高多少，要到理赔时才算得出来。

Three insights below. First, 50.7% received. Why so low? This client's cash value was just over five thousand, close to zero, on a recently bought policy. A policy funded steadily for years with strong cash value would get a higher share for the same diagnosis, but how much higher can only be calculated at claim.

第二，可以反推出模型里的预期寿命。$500,000 除以 1.058 的 n 次方等于 $296,483，解出来 n 大约是 9.3 年。 也就是说，按这个简化的算法，模型大约认为这位 47 岁的客户还有九年多，56 岁前后。这个反推的用处， 是让你能向客户解释「为什么是五成而不是八成」：不是公司抠，是模型认为他还能活九年多，九年后的钱今天给，当然要折现。 这只是粗略反推，公司实际用的是逐年的死亡率，不是一个固定的年数。

Second, you can back out the life expectancy in the model. $500,000 divided by 1.058 to the power n equals $296,483, which gives n of about 9.3 years. In this simplified view, the model expects the 47-year-old to live another nine-plus years, to about 56. That lets you explain to a client why it's half and not 80%: the carrier isn't being stingy; the model expects nine more years, and money due in nine years, paid today, is discounted. It's a rough back-calculation; the carrier actually uses year-by-year mortality, not a single number of years.

第三，5.80% 这个利率是会变的，挂钩保单的浮动贷款利率。同样的案子，换一年算，数字就不一样；利率往上走，客户就拿得少。

Third, the 5.80% rate moves, tied to the policy's variable loan rate. The same case calculated in another year gives a different number; when rates rise, the client receives less.

合规提醒Compliance note

这是一个具体个案。不要拿 50.7% 去跟客户说「生病大概能拿一半」。正确的说法是：「能拿多少取决于病情、年龄、现金价值和当时的利率， 理赔时公司会给你一份这样的计算书。」

This is one specific case. Don't tell clients "an illness pays about half" on the strength of 50.7%. The right answer: "It depends on the condition, age, cash value and the rate at the time; at claim the carrier provides a calculation like this one."

互动设计Interaction

回到开场的问题，请刚才那一两位伙伴再回答一次：「客户问『生病能赔多少』，你怎么说？」

Back to the opening question: ask the same partners again, "A client asks how much an illness would pay. What do you say?"

生前福利 同业对比Living Benefits Across Carriers

National LifeLincolnPenn MutualPacific LifeMassMutualF&GAllianzPrudentialNorth AmericanCorebridgeNationwide
末期疾病Terminal illness
预期寿命（月）Life expectancy (months)241212121224126242412
最高加速Max acceleration身故金 100%，最高 $150 万100% of DB, to $1.5M50%，最高 $25 万50%, to $250K50%，最高 $25 万50%, to $250K75%，最高 $25 万75%, to $250K75%，最高 $25 万75%, to $250K100%，最高 $100 万100%, to $1M100%，最高 $100 万100%, to $1M身故金 100%100% of DB90%，最高 $100 万90%, to $1M100%，最高 $200 万100%, to $2M50%，最高 $25 万50%, to $250K
慢性疾病：折现型Chronic illness: discounted
触发条件Trigger慢性Chronic永久性慢性Permanent chronic永久性慢性Permanent chronic永久性慢性Permanent chronic—慢性Chronic慢性Chronic永久性（住护理院）Permanent (nursing home)慢性Chronic慢性Chronic永久性慢性Permanent chronic
慢性疾病：一元对一元（不折现）Chronic illness: dollar-for-dollar
触发条件Trigger慢性ChronicLTC 与慢性LTC & chronic✕LTC 与慢性LTC & chronic慢性Chronic✕✕慢性Chronic✕慢性ChronicLTC
每月给付Monthly options2%, 4%2%、4%（LTC）
2%（慢性）2%, 4% (LTC)
2% (chronic)		—2%, 4%2–10 年给付期2–10 yr periods——2%, 4%—2%、4%、按每日限额2%, 4%, per diem2%, 3%, 4%
给付方式Payment现金Cash报销（LTC）
现金（慢性）Reimbursement (LTC)
Cash (chronic)		—定额（LTC）
现金（慢性）Indemnity (LTC)
Cash (chronic)		定额Indemnity——定额Indemnity—现金Cash定额Indemnity
项数Number of triggers
重大疾病Critical illness138✕✕✕10✕✕5108
重大伤害Critical injury4✕✕✕✕✕✕✕✕✕✕
阿兹海默Alzheimer's2✕✕✕✕✕✕✕✕✕✕
终身收入福利 LIBRLifetime income rider有Yes✕✕✕✕✕✕✕✕有Yes✕

✕ = 没有这一项；— = 不适用。出处：国家人寿的同业对比资料，年份以原表为准✕ = not available; — = not applicable. Source: National Life's peer comparison; year as in the original

这一页是一张全行业的横向对比，把市面上主要的寿险公司放在一起比生前福利： Lincoln、Penn Mutual、Pacific Life、MassMutual、F&G、Allianz、Prudential、North American、Corebridge、Nationwide， 第一列是国家人寿。

This is an industry-wide comparison of living benefits across the major carriers: Lincoln, Penn Mutual, Pacific Life, MassMutual, F&G, Allianz, Prudential, North American, Corebridge and Nationwide, with National Life in the first column.

从上往下看。末期疾病：预期寿命门槛，国家人寿、F&G、North American、Corebridge 是 24 个月，大多数是 12 个月， Prudential 只有 6 个月；最高加速额度，国家人寿是身故金的 100%、最高 $150 万，Corebridge 最高 $200 万， Lincoln、Penn Mutual、Nationwide 是 50%、最高 $25 万。

Top to bottom. Terminal illness: the life-expectancy threshold is 24 months at National Life, F&G, North American and Corebridge, 12 months at most others, and only 6 at Prudential. Maximum acceleration: National Life allows 100% of the death benefit up to $1.5 million; Corebridge up to $2 million; Lincoln, Penn Mutual and Nationwide 50% up to $250,000.

慢性疾病分两种给付方式：折现型，就是我们前面讲的打折理赔；一元对一元型 Dollar-for-Dollar，按身故金的固定比例付、不打折。 国家人寿两种都有，一元对一元那种就是第 34 页要讲的高级护理条款 PCC，每月 2% 或 4%，付现金。 有几家的一元对一元是走长期护理 LTC 的路，用报销或定额给付，条件也不一样。

Chronic illness comes in two payout types: discounted, as we've covered, and dollar-for-dollar, paying a fixed share of the death benefit without a discount. National Life has both; its dollar-for-dollar version is the Premium Chronic Care rider on slide 34, at 2% or 4% a month, paid in cash. Several carriers' dollar-for-dollar benefits run through long-term care, by reimbursement or indemnity, with different conditions.

最下面四行是差距最大的地方。重大疾病的病种数量：国家人寿 13 项，F&G 和 Corebridge 10 项，Lincoln 和 Nationwide 8 项， North American 5 项，其余几家没有。重大伤害：只有国家人寿有，4 项。阿兹海默专项：只有国家人寿有，2 项。 13 加 4 加 2，一共 19 种触发条件，这就是原稿总结页上那个「19」。终身收入福利 LIBR：国家人寿和 Corebridge 有。

The bottom four rows show the widest gaps. Critical illness conditions: 13 at National Life, 10 at F&G and Corebridge, 8 at Lincoln and Nationwide, 5 at North American, none at the rest. Critical injury: National Life only, 4 conditions. Alzheimer's: National Life only, 2. Thirteen plus four plus two makes 19 triggers, the "19" on the original summary slide. The lifetime income benefit rider: National Life and Corebridge.

这张表不用记每一格，但看完要得到一个结论：在病种覆盖的广度上，国家人寿明显领先；在额度上，有的同业更高，比如 Corebridge 的 $200 万。 我们做经纪人的价值，就在于手里有这张表：客户拿别家的产品来问，可以一项一项比，而且好的、不好的都照实说。

You don't need to memorize every cell, but come away with the conclusion: in breadth of coverage National Life is clearly ahead; on caps, some carriers are higher, such as Corebridge at $2 million. Our value as brokers is having this table: when a client brings another carrier's product, compare it item by item, and say plainly where each is stronger and weaker.

讲师提醒Presenter note

这张表出自国家人寿自己的对比资料，同业的条款一直在改。拿来跟客户比的时候，说明资料年份，以对方公司当期的产品资料为准。

This table comes from National Life's own comparison, and competitors' riders keep changing. When you use it with a client, give the year and defer to the other carrier's current product material.

第一梯队对比Tier One Compared

National LifeF&GTransamericaAmerican NationalCorebridge
末期疾病Terminal24 个月，最高 $150 万24 mo, to $1.5M24 个月，最高 $100 万24 mo, to $1M12 个月，最高 $150 万12 mo, to $1.5M24 个月；0–64 岁最高 $200 万，65 岁起最高 $100 万24 mo; to $2M at 0–64, $1M from 6524 个月，最高 $200 万24 mo, to $2M
慢性疾病Chronic最高 $150 万To $1.5M最高 $100 万To $1M最高 $150 万To $1.5M最高 $200 万，65 岁起不适用To $2M; not from 65最高 $200 万To $2M
重大疾病Critical illness最高 $100 万To $1M最高 $100 万To $1M最高 $150 万To $1.5M最高 $200 万，65 岁起不适用To $2M; not from 65最高 $200 万To $2M
主动脉移植手术Aorta graft surgery✓动脉瘤Aneurysm首次冠脉搭桥First CABG动脉瘤Aneurysm冠脉搭桥CABG
再生障碍性贫血Aplastic anemia✓中枢神经系统肿瘤CNS tumor✓中枢神经系统肿瘤CNS tumor血癌Blood cancer
失明Blindness✓✕✓✓✕
侵袭性癌症Invasive cancer✓✓✓✓✓
囊性纤维化Cystic fibrosis✓✕首次冠脉球囊扩张First angioplasty重大多器官创伤Major multi-organ trauma✕
渐冻症 ALSALS✓✓中枢神经系统疾病CNS disease✓✕
终末期肾衰竭End-stage renal failure✓✓✓✓✕
心脏病发作Heart attack✓✓✓✓✓
心脏瓣膜置换Heart valve replacement✓✕✕任何器官的严重疾病Severe organ disease✕
重大器官移植Major organ transplant✓✓✓✓✓
运动神经元疾病Motor neuron disease✓✕✓严重中枢神经系统疾病Severe CNS disease✕
中风Stroke✓✓✓✓✓
心脏骤停Sudden cardiac arrest✓✕✕✕✕
艾滋病AIDS✕✕✓✓✕
重大伤害Critical injury最高 $100 万To $1M最高 $100 万To $1M最高 $150 万To $1.5M最高 $200 万，65 岁起不适用To $2M; not from 65最高 $200 万To $2M
昏迷Coma✓✕✕肢体丧失Loss of limb✓
瘫痪Paralysis✓✓✓✓✓
严重烧伤Severe burns✓✓✕✓✓
创伤性脑损伤Traumatic brain injury✓✕✕✕✕
阿兹海默Alzheimer's最高 $150 万To $1.5M无None无None无None无None
阿兹海默症Alzheimer's disease✓✕✕✕✕
路易体痴呆Lewy body dementia✓✕✕✕✕
合计Total19 项1910 项1013 项1316 项169 项9

我们把对手分成两个梯队，先看第一梯队：Corebridge（原来的 AIG 寿险）、F&G、Transamerica、American National。 这几家在生前福利上是有诚意、有竞争力的，是国家人寿真正需要正面比较的对手，要熟悉它们的强项和短板。

We split competitors into two tiers. Tier one first: Corebridge (formerly AIG's life business), F&G, Transamerica and American National. These carriers take living benefits seriously and compete on them; they're the ones National Life really has to be compared against, so know their strengths and weaknesses.

上面三行是额度。末期疾病：国家人寿 24 个月、最高 $150 万；F&G 24 个月、$100 万；Transamerica 12 个月、$150 万； American National 24 个月，0 到 64 岁最高 $200 万、65 岁及以上最高 $100 万；Corebridge 24 个月、$200 万。 慢性疾病和重大疾病，Corebridge 和 American National 的额度比国家人寿高，到 $200 万，但 American National 这两项 65 岁以上不适用。 这一点要照实讲：论额度，第一梯队里有比我们高的。

The top three rows are caps. Terminal: National Life 24 months, up to $1.5 million; F&G 24 months, $1 million; Transamerica 12 months, $1.5 million; American National 24 months, up to $2 million from 0 to 64 and $1 million at 65 and over; Corebridge 24 months, $2 million. On chronic and critical illness, Corebridge and American National have higher caps than National Life, at $2 million, though American National's don't apply from 65. Say it plainly: on caps, some tier-one carriers are higher.

中间是病种，一行一行对。打勾是有这一项；写了别的病名的，是那家公司用另一种病代替，比如 F&G 没有主动脉移植手术， 但有动脉瘤；打叉是没有。最下面一行是合计：国家人寿 19 项，F&G 10 项，Transamerica 13 项，American National 16 项，Corebridge 9 项。 差距主要在重大伤害和阿兹海默：阿兹海默这两项，第一梯队里只有国家人寿有；创伤性脑损伤也只有国家人寿有。 反过来，艾滋病这一项国家人寿没有，Transamerica 和 American National 有。

The middle is conditions, row by row. A check means covered; another disease name means that carrier covers a different condition in its place (F&G has no aorta graft surgery but covers aneurysm); a cross means not covered. The bottom row totals them: National Life 19, F&G 10, Transamerica 13, American National 16, Corebridge 9. The gap is mainly critical injury and Alzheimer's: in tier one only National Life covers the two Alzheimer's conditions, and only National Life covers traumatic brain injury. Conversely, National Life doesn't cover AIDS, while Transamerica and American National do.

所以面对第一梯队，我们的讲法是：额度不一定最高，但覆盖的情况最多，尤其是重伤和阿兹海默这两类，同业基本没有。 客户更在意哪一样，就照哪一样帮他选。

So against tier one, the message is: not always the highest caps, but the most conditions covered, especially critical injury and Alzheimer's, which peers largely lack. Whichever matters more to the client is what we choose by.

讲师提醒Presenter note

原稿 Corebridge 那一列合计写的是 10 项，但按表里的格子数是 9 项（重疾 6 项 + 重伤 3 项），这里按格子改成 9。 上一页总表里 Corebridge 重疾写 10 项、重伤没有，两张表的出处和年份不同，讲的时候不要混在一起比。

The original slide totals Corebridge at 10, but its cells add to 9 (6 critical illness + 3 critical injury), so it's shown as 9 here. The previous slide's industry table lists Corebridge with 10 critical illness conditions and no critical injury; the two tables come from different sources and years, so don't mix them when comparing.

第二梯队对比Tier Two Compared

National LifeNationwideNew York LifeAllianzPacific LifeMassMutual
末期疾病Terminal24 个月，最高 $150 万24 mo, to $1.5M12 个月，保额 50%，最高 $25 万12 mo, 50% of face, to $250K12 个月，最高 $50 万12 mo, to $500K12 个月，最高 $100 万12 mo, to $1M12 个月，保额 75%，最高 $25 万12 mo, 75% of face, to $250K12 个月，保额 75%，最高 $25 万12 mo, 75% of face, to $250K
慢性疾病Chronic最高 $150 万To $1.5M永久性，最高保额 20%Permanent; to 20% of face额外付费的长期护理险Paid LTC rider最高 $100 万To $1M永久性Permanent额外付费的长期护理险Paid LTC rider
重大疾病Critical illness最高 $100 万To $1M每次最高保额 10% 或 $25,000，最多 5 次Per claim 10% of face or $25K; max 5无None无None无None无None
主动脉移植手术Aorta graft surgery✓✕✕✕✕✕
再生障碍性贫血Aplastic anemia✓✕✕✕✕✕
失明Blindness✓✕✕✕✕✕
侵袭性癌症Invasive cancer✓✓✕✕✕✕
囊性纤维化Cystic fibrosis✓✕✕✕✕✕
渐冻症 ALSALS✓✕✕✕✕✕
终末期肾衰竭End-stage renal failure✓✓✕✕✕✕
心脏病发作Heart attack✓✓✕✕✕✕
心脏瓣膜置换Heart valve replacement✓✓✕✕✕✕
重大器官移植Major organ transplant✓✓✕✕✕✕
运动神经元疾病Motor neuron disease✓✕✕✕✕✕
中风Stroke✓✓✕✕✕✕
心脏骤停Sudden cardiac arrest✓✓✕✕✕✕
艾滋病AIDS✕✕✕✕✕✕
重大伤害Critical injury最高 $100 万To $1M每次最高保额 10% 或 $25,000，最多 5 次Per claim 10% of face or $25K; max 5无None无None无None无None
昏迷Coma✓✕✕✕✕✕
瘫痪Paralysis✓✓✕✕✕✕
严重烧伤Severe burns✓✕✕✕✕✕
创伤性脑损伤Traumatic brain injury✓✕✕✕✕✕
阿兹海默Alzheimer's最高 $150 万To $1.5M无None无None无None无None无None
阿兹海默症Alzheimer's disease✓✕✕✕✕✕
路易体痴呆Lewy body dementia✓✕✕✕✕✕
合计Total19 项198 项80 项00 项00 项00 项0

第二梯队：Nationwide、New York Life、Allianz、Pacific Life、MassMutual。这几家都是大公司、老牌子， 客户常常拿来问「为什么不买它们」。但在生前福利这一块，它们做得相对少。

Tier two: Nationwide, New York Life, Allianz, Pacific Life and MassMutual. Big, long-established names, and clients often ask "why not them?" But on living benefits, they offer comparatively little.

先看末期疾病：这五家都是 12 个月的门槛。额度上，Nationwide、Pacific Life、MassMutual 都是按保额的一定比例、 最高 $25 万；New York Life 最高 $50 万；Allianz 最高 $100 万。国家人寿是 24 个月、最高 $150 万。

Terminal illness first: all five use a 12-month threshold. On caps, Nationwide, Pacific Life and MassMutual pay a percentage of face up to $250,000; New York Life up to $500,000; Allianz up to $1 million. National Life: 24 months, up to $1.5 million.

慢性疾病：Nationwide 是永久性的、最高保额的 20%；Pacific Life 是永久性；Allianz 最高 $100 万； New York Life 和 MassMutual 是额外付费的长期护理险。注意「永久性」三个字：有些公司要求慢性状况是永久的、不会好转才赔， 这比国家人寿「连续 90 天」的门槛严得多。

Chronic illness: Nationwide requires a permanent condition, up to 20% of face; Pacific Life requires permanence; Allianz up to $1 million; New York Life and MassMutual offer it as long-term care at extra cost. Note the word "permanent": some carriers pay only if the chronic condition is permanent and won't improve, far stricter than National Life's 90 consecutive days.

重大疾病和重大伤害：只有 Nationwide 有，每次理赔最高保额的 10% 或 $25,000，最多 5 次。病种上，Nationwide 合计 8 项， 其他四家是 0 项；阿兹海默五家都没有。国家人寿是 19 项。

Critical illness and injury: only Nationwide, up to 10% of face or $25,000 per claim, at most 5 claims. Nationwide covers 8 conditions in total; the other four, none; and none of the five has an Alzheimer's benefit. National Life covers 19.

对客户的讲法：这些公司在别的方面各有长处，品牌大、历史久都是真的。但如果客户买寿险，很在意「活着的时候生了大病能不能用」， 那在这一块，第二梯队给得少，国家人寿给得多。用数据比，不用贬低别人。

For the client: these carriers each have strengths elsewhere, and their size and history are real. But if a client buying life insurance cares about using it while alive through a serious illness, tier two offers little here and National Life offers a lot. Compare with data; there's no need to run anyone down.

对手眼里的我们：Corebridge 的对比表How a Competitor Sees Us: Corebridge's Chart

Corebridge QoL SelectChoice II 提前给付条款对比表，与 National Life、Transamerica、F&G、North American、Nationwide、Ameritas、Columbus Life、Lincoln、John Hancock、Mutual of Omaha 比较：可用产品、保证最低给付、慢性 / 重疾 / 末期、承保等级、可选一元对一元慢性给付 / Corebridge QoL SelectChoice II accelerated benefit rider comparison against National Life and nine other carriers: products, guaranteed minimum payout, chronic, critical and terminal illness, underwriting classes, optional dollar-for-dollar chronic benefit
Corebridge 销售资料 · 对比对象为它的同业Corebridge sales material · comparing itself with peers

这一页换个角度：这是 Corebridge 自己做的对比表，看对手怎么描述我们，也看它的卖点在哪里。

A different angle on this slide: Corebridge's own comparison chart. It shows how a competitor describes us, and where its selling point lies.

它的核心卖点是第二行：Guaranteed Minimum Payout，保证最低给付。Corebridge 的 QoL 提前给付条款， 理赔时保证至少付身故金的一定比例，比例按投保年龄和保单年度定。表里其他公司这一格几乎都是 N/A，国家人寿也是。 这一点要照实承认：国家人寿的生前福利没有保证最低给付，打多少折，要到理赔时按当时的情况算。

Its central selling point is row two: a guaranteed minimum payout. Corebridge's QoL accelerated benefit riders guarantee a minimum share of the death benefit at claim, based on issue age and policy duration. Almost every other carrier shows N/A there, National Life included. Acknowledge it honestly: National Life's living benefits have no guaranteed minimum, and the discount is calculated at claim from the circumstances at that time.

再看国家人寿那一列：适用 IUL、定期、终身寿；慢性、重疾都有；末期疾病 24 个月；承保等级「到 Table D」， 和第 22 页对得上，评级再差就只剩末期；最后一行，可选的一元对一元慢性给付，写的是「有，配 Premium Chronic Care 附加条款，只限 IUL」， 这就是下一页的高级护理条款。

Now the National Life column: available on IUL, term and whole life; chronic and critical illness both covered; terminal at 24 months; underwriting classes "up to Table D," which matches slide 22, where worse ratings leave terminal only; and the last row, an optional dollar-for-dollar chronic benefit, "Yes, with the Premium Chronic Care rider (only on IUL)." That's the rider on the next slide.

为什么要放对手的资料？因为客户手上可能就拿着这一张。我们先看过，知道它说的哪些是对的、它的强项在哪， 讲起来才站得住：它有保证最低给付，我们有更多的病种、重伤、阿兹海默和不折现的 PCC。

Why show a competitor's material? Because the client may be holding this very chart. Having read it first, we know what's accurate and where its strength lies, and our case holds up: it has a guaranteed minimum; we have more conditions, critical injury, Alzheimer's and the undiscounted PCC.

高级护理条款 PCC（加州、纽约不可用）Premium Chronic Care (Not Available in CA/NY)

项目Item慢性疾病条款（免费）Chronic illness rider (free)高级护理条款 PCC（付费）Premium Chronic Care (paid)
每位被保险人最高额度Maximum per insured所有生前福利合计最高 $150 万$1.5M across all living benefits最高 $300 万Up to $3M
投保年龄Issue ages0–85 岁0–8518–75 岁18–75
赔付方式Payout理赔时按折现计算Discounted at claim按身故金的 2% 或 4% 每月给付，不折现2% or 4% of the death benefit a month, undiscounted
IRS 每日限额IRS per diem受约束Applies受约束Applies
等待期Waiting period30 天30 days无None

接下来讲一个进阶的条款：高级护理条款，英文 Premium Chronic Care，简称 PCC。它是国家人寿 LLD 这类 IUL 上可以加的付费附加条款， 加州和纽约州不能卖，标题里「NA CA/NY」就是这个意思，Not Available in CA/NY。可以把它理解成普通慢性疾病条款的升级版， 我们用一张表把两者的区别讲清楚。

Next, a more advanced rider: Premium Chronic Care, or PCC. It's a paid rider available on National Life IULs such as LLD, not sold in California or New York; that's what "NA CA/NY" in the original title means, not available in CA/NY. Think of it as an upgraded version of the regular chronic illness rider. One table shows the differences.

第一行，每位被保险人的最高额度：普通慢性条款和其他生前福利合计最高 $150 万；PCC 每位被保险人最高 $300 万，翻了一倍。 第二行，投保年龄：普通条款 0 到 85 岁，覆盖面更广；PCC 是 18 到 75 岁。

Row one, the maximum per insured: the regular chronic rider shares a $1.5 million ceiling with the other living benefits; PCC goes up to $3 million per insured, double. Row two, issue ages: the regular rider runs 0 to 85, a wider window; PCC is 18 to 75.

第三行最关键，赔付方式。普通条款理赔时要按折现计算，会打折；PCC 是直接按身故金的 2% 或 4% 每月给付，不折现。 2% 还是 4%，投保的时候选；选了 4% 以后可以降成 2%，不能反过来。这个差别非常大，下一页用数字看。

Row three is the key one, how it pays. The regular rider is discounted at claim; PCC pays 2% or 4% of the death benefit a month, undiscounted. The 2% or 4% is chosen at issue; 4% can later be reduced to 2%, but not the other way. That difference is large, and the next slide puts numbers on it.

第四行，两者都受 IRS 每日限额约束。第五行，等待期：普通条款 30 天，PCC 没有等待期。 触发条件两者一样，都是两项日常生活行为连续 90 天，或者严重认知障碍，每年都要重新认证。

Row four: both are subject to the IRS per diem limit. Row five, the waiting period: 30 days for the regular rider, none for PCC. The trigger is the same for both: two activities of daily living for 90 consecutive days, or severe cognitive impairment, with annual recertification.

总结一下：PCC 在额度、赔付方式、等待期这几个核心点上都更好，代价有两个，一是要额外付费，二是投保年龄窗口窄一些。 适合想要更高、更确定的护理保障的客户。

To sum up: PCC is better on the core points of cap, payout method and waiting period, at two costs: it's paid for, and the issue-age window is narrower. It suits clients who want higher, more certain care coverage.

讲师提醒Presenter note

原稿演讲备注把 PCC 说成 North American 的条款、「加州和纽约可用」，这是理解错了：PCC 是国家人寿的附加条款，加州、纽约不可用。 全文第二节有 PCC 的完整对照和一个算例。PCC 不能和退休金计划、Gap Protector 或 CMC 同用。

The original speaker notes describe PCC as a North American rider "available in California and New York." That's a misreading: PCC is a National Life rider, not available in CA or NY. Section two of the article has the full comparison and an example. PCC can't be combined with pension plans, Gap Protector or CMC.

高级护理条款 PCC：不折现，差多少PCC: What "Undiscounted" Is Worth

LLD 计划书摘要：40 岁女性、$500,000 保额；65 岁时 Premium Chronic Care 2% 每月 $10,000，提前给付条款的慢性疾病每月 $7,276，末期疾病一次性 $427,546，重疾、重伤最高 $392,707，阿兹海默 $370,094 / LLD illustration summary for a 40-year-old woman with $500,000 face: at 65, Premium Chronic Care at 2% pays $10,000 a month versus $7,276 a month under the chronic ABR, $427,546 terminal, up to $392,707 critical illness or injury, $370,094 Alzheimer's

$50 万 × 2% = $1 万 / 月$500K × 2% = $10K / mo

$50 万 × 4% = $2 万 / 月$500K × 4% = $20K / mo

计划书节选：Premium Chronic Care 45 岁 2% 每月 $10,000；折现后的慢性疾病月给付 55 岁 $5,468、65 岁 $7,276、75 岁 $7,901、85 岁 $8,458 / Illustration excerpt: Premium Chronic Care at 45, 2%, $10,000 a month; discounted chronic ABR monthly at 55 $5,468, 65 $7,276, 75 $7,901, 85 $8,458

超过 IRS 每日限额的部分可能要缴税，请客户问会计师Amounts above the IRS per diem may be taxable; the client should ask their accountant

这一页用数字看 PCC「不折现」到底差多少。截图是一份 LLD 的计划书：40 岁女性，标准非吸烟，保额 $500,000，月保费 $618.76。

This slide puts numbers on PCC's "undiscounted." The screenshots come from an LLD illustration: a 40-year-old woman, standard non-tobacco, $500,000 face, $618.76 a month.

先看右边的算式。保额 $50 万，按 2% 给付，每个月 $1 万；按 4% 给付，每个月 $2 万。这是直接按身故金算的，不打折。

The arithmetic on the right first. A $500,000 death benefit at 2% pays $10,000 a month; at 4%, $20,000 a month. That's straight off the death benefit, with no discount.

再看计划书里怎么对比。左边「If I Become Ill」那一栏，同样是 65 岁：PCC 按 2% 是每月 $10,000； 免费的慢性疾病条款折现以后，是每月 $7,276。右下的小表更清楚，折现的慢性疾病月给付随年龄变：55 岁 $5,468，65 岁 $7,276， 75 岁 $7,901，85 岁 $8,458，年纪越大折得越少，但都低于 PCC 的 $10,000。同一张单，65 岁时末期疾病一次性 $427,546， 重疾、重伤最高 $392,707，阿兹海默 $370,094，这些都是折现后的计划书数字，不是保证。

Now the illustration's comparison. In the "If I Become Ill" panel on the left, at the same age, 65: PCC at 2% pays $10,000 a month; the free chronic rider, after discounting, pays $7,276 a month. The small table on the right shows it more clearly: the discounted chronic monthly benefit changes with age, $5,468 at 55, $7,276 at 65, $7,901 at 75, $8,458 at 85. The older the insured, the smaller the discount, but all are below PCC's $10,000. On the same policy at 65, terminal illness shows $427,546 as a lump sum, critical illness or injury up to $392,707, Alzheimer's $370,094. These are discounted illustration figures, not guarantees.

最后一句免责一定要带上：4% 一个月 $2 万，一年就是 $24 万，超过了 2026 年 IRS 每日限额折成的一年 $156,950。 超过的部分如果拿不出护理费用的证明，可能要缴税。具体请客户问会计师。

Always add the caveat: 4% at $20,000 a month is $240,000 a year, above the 2026 IRS per diem of $156,950 a year. Without proof of care costs, the excess may be taxable. The client should ask their accountant.

合规提醒Compliance note

计划书里的数字都是在一组假设下的演示，不是承诺。讲 PCC 的好处，同时要讲它要额外付费，下面两页就看这笔费用在计划书的哪里。

Illustration figures are demonstrations under one set of assumptions, not promises. When you present PCC's advantages, also say it costs extra; the next two slides show where that cost appears in the illustration.

高级护理条款 PCC：费用在计划书哪里PCC: Where the Cost Shows Up

保费 − 保单费用 + 利息 = 保单现金价值Premiums − policy charges + interest = cash value

LLD 计划书 Policy Charges and Other Expenses 页：40 岁女性、$500,000 保额，第 1–5 年每年保费 $7,425；红框标出 Cost of Other Benefits 一列，第 1 年 $306 到第 14 年 $399 / LLD illustration Policy Charges and Other Expenses page: female 40, $500,000 face, $7,425 a year in years 1–5; the Cost of Other Benefits column boxed in red, from $306 in year 1 to $399 in year 14

这两页是同一份 LLD 计划书里的「Policy Charges and Other Expenses」，保单费用明细。先看最上面这条公式： 保费，减去保单费用，加上利息，等于保单的现金价值。每个月进来的钱是保费，出去的是各种费用，剩下的再记利息。

These two slides show the "Policy Charges and Other Expenses" page of the same LLD illustration. Start with the formula at the top: premiums, minus policy charges, plus interest, equals cash value. Premiums come in, charges go out, and what remains earns interest.

表的左边是保费：这张单每年交 $7,425，前 5 年合计 $37,125，计划交 10 年，一共 $74,250。中间一排是各项费用： 保费费用 Premium Expense Charge、保险成本 Cost of Insurance、其他福利成本 Cost of Other Benefits、保单费 Policy Fee、 费用收取 Expense Charge 等等。

On the left are premiums: $7,425 a year, $37,125 over the first five years, planned for ten years and $74,250 in total. The middle columns are the charges: premium expense charge, cost of insurance, cost of other benefits, policy fee, expense charge and so on.

红框框出来的是「Cost of Other Benefits」，其他福利的成本，也就是附加条款的费用。这张单加了好几个附加条款，PCC 是其中要付费的一项， 它的费用就在这一列里。第 1 年 $306，之后每年慢慢涨：第 2 年 $315，第 5 年 $340，第 10 年 $370，第 14 年 $399。 计划书没有把 PCC 单独拆出来，所以讲的时候说「附加条款的费用，PCC 在这一列」，不要说「PCC 一年就是 $306」。

The red box is Cost of Other Benefits, the charge for riders. This policy carries several riders, and PCC is one of the paid ones, so its cost sits in this column: $306 in year 1, rising gradually to $315 in year 2, $340 in year 5, $370 in year 10 and $399 in year 14. The illustration doesn't break PCC out separately, so say "the rider charges, which include PCC, are in this column," not "PCC costs $306 a year."

讲这一页的目的很简单：PCC 好，但不是免费的。它的费用每个月从现金价值里扣，会让现金价值长得慢一点。 客户要不要加，是拿这笔费用去换更高、不折现的护理给付，值不值得由客户自己判断。

The point of this slide is simple: PCC is good, but it isn't free. Its charge comes out of the cash value every month and slows its growth a little. Adding it means trading that cost for a higher, undiscounted care benefit, and whether that's worth it is the client's call.

高级护理条款 PCC：停交保费以后，费用还在扣PCC: Charges Continue After Premiums Stop

保费 − 保单费用 + 利息 = 保单现金价值Premiums − policy charges + interest = cash value

同一份计划书：70–74 岁已不交保费，Cost of Other Benefits 仍为每年 $453 到 $436；105–109 岁降到 $77、$62、$40、$6、$0 / The same illustration: at ages 70–74 no premium is paid, yet Cost of Other Benefits is still $453 to $436 a year; at 105–109 it falls to $77, $62, $40, $6 and $0

同一张表往后翻。红框框了两段：70 到 74 岁，和 105 到 109 岁。

The same table, further along. Two ranges are boxed: ages 70 to 74, and 105 to 109.

先看保费那一列：70 岁以后是 0，保费早就交完了，累计还是 $74,250。但是 Cost of Other Benefits 这一列没有停： 70 岁 $453，71 岁 $450，到 74 岁 $436，每年还在从现金价值里扣。保险成本这一列也在涨，70 岁 $3,054，74 岁 $4,281。 也就是说，不交保费了，费用照样从保单里出，这就是为什么现金价值要养得够厚。

Look at the premium column first: from 70 it's zero; premiums were finished long ago, still $74,250 cumulatively. But Cost of Other Benefits doesn't stop: $453 at 70, $450 at 71, $436 at 74, still coming out of the cash value each year. Cost of insurance is rising too, from $3,054 at 70 to $4,281 at 74. In other words, after premiums stop, the charges keep coming out of the policy, which is why the cash value has to be built up properly.

再看最后一段，105 到 109 岁：这一列降到 $77、$62、$40、$6，到 109 岁是 $0。附加条款的费用跟着保额的风险部分变， 越到后面越少。

Then the last range, 105 to 109: the column drops to $77, $62, $40, $6, and $0 at 109. Rider charges move with the policy's amount at risk and shrink toward the end.

这两页想让大家养成一个习惯：给客户讲任何一个附加条款，都翻到计划书的费用页，指给他看这笔钱在哪里、一年多少、扣到什么时候。 讲清楚成本，客户对好处才信得过。

These two slides are meant to build a habit: whenever you present a rider, turn to the charges page of the illustration and show the client where the cost is, how much a year and for how long. When the cost is clear, the client can trust the benefits.

2024–2025：四笔真实理赔2024–2025: Four Real Claims

情形Case保额Face理赔Paid比例Share
40 岁男性，猝死Male, 40, sudden death$1,000,000身故全额Full death benefit100%
37 岁女性，直肠癌 2 期Female, 37, stage 2 rectal cancer$500,000$250,00050.0%
62 岁女性，轻微中风Female, 62, minor stroke$300,000$86,00028.7%
50 岁男性，舌癌 3 期Male, 50, stage 3 tongue cancer$500,000$256,00051.2%

病越轻、预期寿命越长，折得越多The milder the condition and the longer the life expectancy, the deeper the discount

这一页是 2024 到 2025 年的四笔实际理赔，我们一笔一笔看，比例是我们按理赔金额除以保额算出来的。

These are four actual claims from 2024 and 2025, one at a time. The share column is our own calculation, the amount paid divided by the face.

第一笔，40 岁男性，猝死，保额 $100 万。这一笔不是生前福利，是身故理赔，家人拿到全额 $100 万。放在这里是提醒大家：寿险的本职是身故保障。

One: a 40-year-old man, sudden death, $1 million face. This isn't a living benefit; it's a death claim, and the family received the full $1 million. It's here as a reminder that life insurance's core job is the death benefit.

第二笔，37 岁女性，直肠癌 2 期，保额 $50 万，理赔 $25 万，大约五成。第四笔，50 岁男性，舌癌 3 期，保额 $50 万，理赔 $25.6 万，51.2%。 两笔癌症，都是拿到保额的五成左右，和第 29 页那个算例差不多。

Two: a 37-year-old woman, stage 2 rectal cancer, $500,000 face, paid $250,000, about half. Four: a 50-year-old man, stage 3 tongue cancer, $500,000 face, paid $256,000, 51.2%. Both cancer claims paid roughly half the face, close to the worked case on slide 30.

第三笔要讲慢：62 岁女性，轻微中风，保额 $30 万，理赔 $8.6 万，只有 28.7%，不到前两笔的六成。原因不是年龄，62 岁其实应该拿得更多， 而是病情不重、预期寿命长，所以折得狠。这一行把「病越重拿越多」这个反直觉的机制讲得很清楚， 也是一针必须提前给客户打的预防针：轻一点的病，能动用的钱可能比他想的少很多。

Slow down on three: a 62-year-old woman, a minor stroke, $300,000 face, paid $86,000, only 28.7%, barely six-tenths of the others. Not because of age (at 62 you'd expect more) but because the condition was mild and life expectancy long, so the discount was deep. This row shows the counterintuitive mechanism, "the more serious, the more it pays," and it's the expectation you must set in advance: a milder condition may release far less money than the client imagines.

合规提醒Compliance note

这四笔是个案，客户信息已略去。不要拿来当「得癌症能拿一半」的承诺；每一笔的金额都取决于当时的病情分级、现金价值和利率。

These are individual cases with client details removed. Don't present them as "cancer pays half"; each amount depended on the severity category, cash value and rate at the time.

病越重，拿得越多：更早的几笔理赔The More Serious, the More It Pays: Earlier Claims

情形Case保额Face理赔Paid比例Share
女性，宫颈癌（2017 年确诊）Female, cervical cancer (2017)$500,000$266,19953.2%
女性，乳腺癌（投保几个月后确诊）Female, breast cancer (months after issue)$500,000$420,00084%
50 岁女性，肺癌 4 期Female, 50, stage 4 lung cancer$1,000,000$820,00082%
重大疾病，2020 年Critical illness, 2020—$1,000,000单次封顶Per-claim cap

晚期、预期寿命短，折得少；重疾理赔单次最高 $100 万Late stage, short life expectancy: smaller discount. Critical illness pays at most $1M per claim

上一页是 2024 到 2025 年的四笔，这一页往前看几笔，来自团队培训里分享过的案例，客户信息都已略去。把两页放在一起，「病越重拿越多」就看得更清楚。

The last slide showed four claims from 2024 and 2025. This one looks further back, at cases shared in our team training, with client details removed. Put the two slides together and "the more serious, the more it pays" becomes much clearer.

第一笔，一位女性，在投保大约一年后的常规体检里被怀疑宫颈癌，2017 年 8 月确诊，10 月手术后马上申请重大疾病理赔， 保额 $50 万，理赔 $266,199，53.2%。她自己有很好的医疗保险，医药费都有人付；但她说，身患重病已经没办法每天长时间工作， 收入没了，房贷、生活费还在。这笔钱用途不限，让她可以安心养病。还有一个细节：她当初本来想买 $100 万，后来减到 $50 万。

One: a woman whose routine physical, about a year after the policy was issued, raised a suspicion of cervical cancer. Diagnosed in August 2017, she filed a critical illness claim right after surgery in October: a $500,000 face, $266,199 paid, 53.2%. She had excellent health insurance and her medical bills were covered, but, as she put it, she could no longer work long days; the income stopped while the mortgage and living costs didn't. The money came with no restrictions on use and let her focus on recovering. One more detail: she had first planned on $1 million and cut it to $500,000.

第二笔，一位女性投保 $50 万，几个月后确诊乳腺癌，理赔 $42 万，八成多。

Two: a woman with a $500,000 policy was diagnosed with breast cancer a few months after issue and received $420,000, over 80%.

第三笔要讲慢：50 岁女性，肺癌 4 期，保额 $100 万，理赔 $82 万，也是八成多。为什么这两笔比第一笔高这么多？因为是晚期，预期寿命短， 打折打得少。持照经纪人可以反推：拿到 $82 万，保额大概就是 $100 万；如果只买了 $50 万，最多也就四十多万。

Slow down on three: a woman of 50, stage 4 lung cancer, a $1 million face, $820,000 paid, also over 80%. Why are these two so much higher than the first? Late stage and short life expectancy mean a small discount. A licensed agent can work it backward: $820,000 paid implies roughly a $1 million face; with $500,000 of coverage the most she could have received was in the four hundred thousands.

最后一行，2020 年一张 $100 万整的支票。前面的支票都是有零有整的，这一张是整数，因为重大疾病理赔单次最高就是 $100 万。 保额更大的客户，比如 $300 万，不是另外 $200 万就作废了：只动用够封顶的那一部分保额，按晚期八成左右算，大约动用一百二三十万， 剩下的保额继续有效，五大项合并封顶的规则见第 23 页。

The last row is a check for exactly $1,000,000 from 2020. The other checks are odd amounts; this one is round because a critical illness claim pays at most $1 million at a time. A client with more coverage, say $3 million, doesn't lose the other $2 million: only enough face is accelerated to reach the cap, roughly $1.2 to $1.3 million at a late-stage share of about 80%, and the rest of the face stays in force. The aggregate cap across the five categories is on slide 23.

合规提醒Compliance note

这几笔是团队培训里的案例分享，客户与经纪人姓名都不写。不要说「得了癌症能拿八成」：比例取决于诊断分级、预期寿命、现金价值和当时的利率。

These are case studies shared in team training; client and agent names are left out. Don't say "cancer pays 80%": the share depends on the diagnosis, life expectancy, cash value and the rate at the time.

理赔流程The Claims Process

1提出理赔Open the claim
2填写初步理赔表格Complete the initial claim form
3填写医生信息表格Provide the physicians' details
4其他辅助信息（不一定需要）Supporting information, if requested
5确认理赔金额表格Confirm the benefit amount

最后一段，理赔流程。一共五步：第一步，提出理赔；第二步，填写初步理赔表格；第三步，填写医生信息表格； 第四步，其他辅助信息，这一步不一定需要；第五步，确认理赔金额。

The last part: the claims process. Five steps: open the claim; complete the initial claim form; provide the physicians' details; supporting information, which isn't always needed; and confirm the benefit amount.

接下来五页，每一步都配一份真实的文件，是第 28、29 页那位 47 岁客户的理赔，从 2025 年 7 月提出，到 10 月底确认金额、收到支票， 前后大约三个多月。大家看完就知道，一个客户在理赔过程中会收到哪些信、每封信要他做什么。

Each of the next five slides pairs a step with a real document from the claim of the 47-year-old on slides 28 and 29, from filing in July 2025 to confirming the amount and receiving the check in late October, a little over three months. By the end you'll know which letters a client receives during a claim and what each one asks of them.

先讲一个原则：理赔的事，经纪人要陪着客户走，但表格和病历是客户自己的，签名、授权都要客户本人来。我们的角色是提醒、解释、跟进。

One principle first: an agent walks alongside the client through a claim, but the forms and medical records are the client's, and signatures and authorizations must come from the client personally. Our role is to remind, explain and follow up.

讲师提醒Presenter note

全文第九节有「理赔前后要提醒客户的九件事」，比如付款时保单必须有效、定期险保费要继续交、需要美国执业医生等，讲完流程可以接着讲。

Section nine of the article lists nine things to tell clients around a claim, such as the policy having to be in force at payment, term premiums continuing, and needing a US-licensed physician. Cover them after the process.

第 1 步：提出理赔Step 1: Open the Claim

联系国家人寿Contact National Life

  • 电话 800-732-8939，按「1」英文Call 800-732-8939, press 1 for English
  • 邮件 claims@nationallife.comEmail claims@nationallife.com
  • 网上提交：nationallife.com/Contact-ClaimsOnline: nationallife.com/Contact-Claims

需要的信息见右图：被保险人、保单号、出生日期、发病日期、病情说明、条款类型、联系方式Information needed (right): insured, policy number, date of birth, onset date, description, rider type, contact details

国家人寿网上理赔表（中文翻译版）：被保险人姓名、保单编号、出生日期、发病日期、详细信息、条款类型下拉菜单（免除保费、残疾、失业、加速福利 - 慢性病 / 危重疾病 / 绝症 / 重伤、其他），以及申请人姓名、地址、电话、邮箱、与被保险人关系 / National Life online claim form (translated to Chinese): insured's name, policy number, date of birth, onset date, details, rider type menu (waiver of premium, disability, unemployment, accelerated benefit chronic / critical / terminal / injury, other), and the claimant's contact details

第一步，提出理赔。三种方式联系国家人寿：打电话 800-732-8939，按 1 转英文；发邮件到 claims@nationallife.com； 或者在国家人寿官网的 Contact Claims 页面网上提交。

Step one, open the claim. Three ways to reach National Life: call 800-732-8939 and press 1 for English; email claims@nationallife.com; or submit online through the Contact Claims page on nationallife.com.

右边是网上那张表，浏览器自动翻成了中文，所以有些词怪怪的，比如「骑手类型」其实是 Rider Type，条款类型。要填的信息： 被保险人姓名、保单编号、出生日期、病情或事件的发病日期、详细说明；条款类型从下拉菜单里选，有免除保费、残疾、失业、 加速福利的慢性病、危重疾病、绝症、重伤，还有其他；然后是申请人自己的姓名、地址、电话、邮箱、和被保险人的关系。

On the right is the online form, auto-translated by the browser, so some words read oddly; "骑手类型" is literally "rider type." The information needed: the insured's name, policy number, date of birth, the onset date of the illness or event, and a description; the rider type from a drop-down (waiver of premium, disability, unemployment, accelerated benefit for chronic, critical, terminal illness or critical injury, or other); then the claimant's own name, address, phone, email and relationship to the insured.

建议客户先打电话，电话里客服会告诉他要走哪一条、接下来寄什么表。打电话前把保单号、诊断日期、主治医生的联系方式准备好。

Suggest the client call first; the service team will say which route applies and which forms come next. Before calling, have the policy number, the diagnosis date and the treating physician's contact details ready.

讲师提醒Presenter note

原稿这一页的电话写成 800-723-8939，是笔误；国家人寿理赔信件上印的都是 800-732-8939，后面几页的原件可以对照。

The original slide gives 800-723-8939, a typo; every National Life claim letter shows 800-732-8939, as the documents on the following slides confirm.

第 2 步：填写初步理赔表格Step 2: The Initial Claim Form

国家人寿 2025 年 7 月 8 日的确认信：已收到提前给付理赔表、HIPAA 医疗授权书和政府身份证件复印件，已直接写信给医生调取病历；保单必须有效才能理赔，保费要继续交 / National Life letter of July 8, 2025: claim form, HIPAA authorization and government ID received; medical records requested directly from the physicians; the policy must be in force, so premiums should be paid

客户要交三样Three items from the client

  • 提前给付理赔表The accelerated benefit claim form
  • HIPAA 医疗授权书The HIPAA medical authorization
  • 政府签发的身份证件复印件A copy of government-issued ID

理赔期间保单必须有效：保费照交The policy must stay in force: keep paying premiums

第二步，填初步理赔表格。打完电话，国家人寿会寄来理赔表，客户填好、签好寄回。左边是客户寄回以后收到的确认信，日期是 2025 年 7 月 8 日。

Step two, the initial claim form. After the call, National Life sends the claim form for the client to complete, sign and return. On the left is the acknowledgment the client received once it was back, dated July 8, 2025.

信里说了三件事。第一，已经收到三样东西：提前给付条款的理赔表、理赔部的 HIPAA 医疗授权书、政府签发身份证件的复印件。 这三样就是这一步客户要交的。第二，公司已经直接写信给客户提供的医生，调取病历；病历一到，就会尽快审。 第三，请注意：要获得任何给付，保单必须有效；为了避免失效，保费要继续交。

The letter says three things. One, three items have been received: the accelerated benefit claim form, the claims department's HIPAA authorization, and a copy of government-issued ID; those are what the client must provide at this step. Two, the carrier has written directly to the physicians the client listed to request medical records, and will review promptly once they arrive. Three, note this: to be considered for any benefit, the policy must be in force, so premiums should keep being paid.

第三条最容易出事：客户生病了、手头紧，就停交保费，保单一失效，理赔就没了。这一步一定要提醒客户：理赔没结束之前，保费照交。

The third point is where things go wrong most often: an ill client, short on money, stops paying, the policy lapses, and the claim is gone. At this step, always remind the client: until the claim is settled, keep paying premiums.

讲师提醒Presenter note

截图里客户的姓名、保单号都已遮挡；原件底部印着的经纪人信息也已去掉。给伙伴看原件时同样要先遮挡。

The client's name and policy number are masked in the screenshot, and the agent details printed at the bottom have been removed. Mask originals the same way before showing them to partners.

第 3 步：填写医生信息表格Step 3: The Physicians' Details

国家人寿 2025 年 7 月 30 日来信：医疗总监需要更多信息，请提供主治医生的姓名、完整地址、电话、传真和就诊起止日期；第二页写明邮寄、电邮或传真回理赔部的方式 / National Life letter of July 30, 2025: the medical director needs more information; please list each treating provider's name, full address, phone, fax and treatment dates; page two gives the mail, email and fax return details

寄回：Claims Department, National Life Group, One National Life Drive, Montpelier, VT 05604 · 传真 802-229-7353 · claims@nationallife.comReturn to: Claims Department, National Life Group, One National Life Drive, Montpelier, VT 05604 · Fax 802-229-7353 · claims@nationallife.com

第三步，医生信息。这是三个礼拜后，2025 年 7 月 30 日的来信。

Step three, the physicians' details. This letter came three weeks later, on July 30, 2025.

信里说：公司的医疗总监需要更多的病历信息，来评估这位客户是否符合提前给付的条件。请确认给他治疗的医生， 这一位是前列腺切除手术，以及正在做放疗或化疗的医生。每一位医生要填：全名、完整的街道地址、城市州和邮编、电话、传真、就诊的起止日期。

It says the carrier's medical director needs additional medical information to assess eligibility for accelerated benefits. Please confirm the treating providers, in this case for the prostatectomy, and whoever is conducting radiation or chemotherapy. For each: full name, complete street address, city, state and ZIP, phone, fax, and the dates treated.

右边第二页写了寄回的方式：邮寄到佛蒙特州 Montpelier 的理赔部，或者电邮、传真，电邮要附 PDF。收到以后，公司会告诉客户理赔的进度。

Page two, on the right, gives the return options: mail to the Claims Department in Montpelier, Vermont, or email or fax, with email attachments as PDF. Once received, the carrier updates the client on the claim.

这一步卡住的，多半是客户记不清看过哪些医生、哪天看的。所以理赔一开始，就请客户把所有就诊的医生、医院、日期列一张清单， 后面每一步都用得上。

What usually holds this step up is the client not remembering which doctors they saw and when. So at the start of a claim, ask the client to list every doctor, hospital and visit date; every later step uses it.

第 4 步：其他辅助信息（不一定需要）Step 4: Supporting Information (If Needed)

国家人寿理赔进度信：已收到 City of Hope 医疗中心要求的特别授权书，用于调取病历；收集和审核可能需要数周，每 30 天更新一次；保费和贷款利息要继续交，保单必须有效 / National Life claim status letter: the special authorization required by City of Hope Medical Center to release records has been received; gathering and review can take several weeks, with an update every 30 days; premiums and loan interest should be paid, as the policy must be in force
  • 有的医院要用自己的授权书才放病历Some hospitals require their own authorization to release records
  • 收集和审核可能要几个礼拜，每 30 天更新一次进度Gathering and review can take weeks; updates every 30 days
  • 保费和贷款利息继续交Keep paying premiums and loan interest

第四步，其他辅助信息。这一步不一定每个案子都有，要看医院和病情。左边是一封理赔进度信。

Step four, supporting information. Not every claim has this step; it depends on the hospital and the condition. On the left is a claim status letter.

信里说：最近收到了 City of Hope 医疗中心要求的特别授权书，用来放出客户的病历。有些医院不认保险公司的通用授权， 一定要用自己医院的表格，这就是这一步多出来的那份文件。收集和审核理赔要求可能要好几个礼拜，公司每 30 天会更新一次进度。 然后又是那句话：保费和贷款利息要继续交，防止保单失效，保单必须有效才能理赔。这一次客户不需要再做什么。

It says the carrier recently received the special authorization City of Hope Medical Center requires to release the client's records. Some hospitals won't accept an insurer's general authorization and insist on their own form; that's the extra document at this step. Gathering and reviewing the claim requirements can take several weeks, with an update every thirty days. And again: premiums and loan interest should be paid to prevent a lapse, as the policy must be in force for any benefit. This time no further action is needed from the client.

讲给客户的重点是「耐心」和「别断保」。调病历是最花时间的环节，有的要半年以上。我们能做的，是每隔一段时间帮客户打电话问进度， 医院那边卡住了，提醒客户自己去催。

The message for the client is patience, and don't let the policy lapse. Getting records is the slowest part; some take six months or more. What we can do is call for status at intervals and, when a hospital is the bottleneck, remind the client to chase it themselves.

第 5 步：确认理赔金额Step 5: Confirming the Amount

国家人寿付款确认信：按客户 2025 年 10 月 20 日签署的选择表处理完毕，以一次性支票付给保单持有人 $253,546.00，为身故金的 100%；保单及附加条款随之终止，不再有任何价值或给付 / National Life payment confirmation: processed per the election form signed October 20, 2025; a lump-sum check of $253,546.00 paid to the policy owner, settling 100% of the death benefit; the policy and riders are now terminated with no further value or benefits
一次性支票，付给保单持有人Lump-sum check to the policy owner$253,546.00
  • 按签选择表那天的利率和保单价值计算Calculated at rates and values on the day the election is signed
  • 加速 100%：保单和附加条款随之终止100% accelerated: the policy and riders end

第五步，确认理赔金额。审核通过以后，公司会寄来一份选择表 Election Form 和计算书，就是第 28 页那份，客户选择加速多少、签字寄回。 左边是最后的付款确认信。

Step five, confirming the amount. Once the claim is approved, the carrier sends an election form with a calculation, the one on slide 28; the client chooses how much to accelerate, signs and returns it. On the left is the final payment confirmation.

信里说：按客户 2025 年 10 月 20 日签署的选择表，理赔处理完毕。已经以一次性支票付给保单持有人 $253,546.00，这是保单身故金 100% 的结算。 保单和所有附加条款从此终止，不再有任何价值、也不再有任何给付。提前给付的金额按签选择表那天的利率和保单价值来定。

It says the claim has been processed under the election form the client signed on October 20, 2025. A lump-sum check of $253,546.00 has been paid to the policy owner, settling 100% of the death benefit. The policy and all riders are now terminated, with no further value or benefits payable. The accelerated amount is determined using the rates and values in effect on the date the election is signed.

两点要讲。第一，支票金额 $253,546，比第 28 页计算书上的 $253,558 少了 $12。计算书的日期是 10 月 17 日，签字是 10 月 20 日， 信里写明按签字那天的利率和价值算，差额应该就来自这几天的差别，以公司的结算为准。

Two points. First, the check is $253,546, $12 less than the $253,558 on slide 28's calculation. The calculation was dated October 17 and the election signed on October 20; the letter says the rates and values on the signing date apply, so the difference most likely comes from those few days. The carrier's settlement governs.

第二，也是更重要的一点：这位客户选了加速 100%，拿了这笔钱，保单就结束了，以后家人不会再有身故金。 要不要全部加速、还是只加速一部分、留一部分保额给家人，签选择表之前一定要和客户、和家人一起想清楚。 选 50%，到手少一半，但保单还在。

Second, and more important: this client accelerated 100%, so once paid, the policy ended and the family will receive no death benefit later. Whether to accelerate everything or only part, keeping some face for the family, must be thought through with the client and family before the election is signed. At 50%, half as much arrives, but the policy stays in force.

从 7 月 8 日确认收到理赔表，到 10 月 20 日签字、收到支票，这一个案子大约三个半月。这就是一笔生前福利理赔从头到尾的样子。

From the July 8 acknowledgment to the October 20 signature and the check, this case took about three and a half months. That's a living benefit claim from start to finish.

讲师提醒Presenter note

钱是付给保单持有人的，不一定是被保险人，也不规定一定要用在治疗上。持有人和被保险人不是同一个人的保单，理赔前把这一点和客户讲清楚。

The money goes to the policy owner, who may not be the insured, and nothing requires it to be spent on treatment. Where owner and insured differ, make this clear to the client before the claim.

本文目录Contents
  1. 生前福利是什么What living benefits are
  2. 五类条款：触发条件与上限The five riders: triggers and caps
  3. 实际能拿到多少：打折理赔What actually arrives: the discount
  4. 五类额度是合并封顶The caps are aggregate
  5. 谁拿不到Who doesn't get it
  6. 以为能赔、其实不赔的十件事Ten things that aren't covered
  7. 理赔的税Tax on the claim
  8. 试管婴儿条款The fertility rider
  9. 理赔流程The claims process
  10. 背后的数据The data behind it
  11. 30 年演进史Thirty years of development
  12. 为什么很少有公司做得全Why so few carriers have the full set
这一页的定位变了What changed on this page

原来这一页是一篇面向客户的介绍。现在它是内部培训页， 因为新增的内容（承保排除、理赔打折的算法、哪些事不赔、理赔流程） 本来就是讲给经纪人听的，不是讲给客户听的。

This page used to be a client-facing explainer. It is now internal training, because what's been added (underwriting exclusions, how the discount is computed, what isn't covered, the claims process) is material for agents, not for clients.

前两节仍然是可以直接讲给客户的版本； 从第三节「实际能拿到多少」开始是内部机制， 对客户只讲结论：提前拿到的一定少于保额，具体多少要等理赔时才算得出来。

The first two sections are still the version you can give a client directly. From section three onward it's internal mechanics. To a client, say only the conclusion: an accelerated payment is always less than the face amount, and the actual figure can only be computed at claim.

一、生前福利到底是什么1. What living benefits actually are

生前福利（Living Benefits / ABR，Accelerated Benefit Riders）是附加在人寿保单上的一组条款， 允许被保险人在还活着的时候，因特定健康状况提前支取一部分身故理赔金。 它不是另外买的一份重疾险，而是把原本只在身故时才兑现的保额， 打折提前兑现一部分。

Living benefits (accelerated benefit riders) let the insured draw part of the death benefit while still alive, triggered by specific health events. They are not a separate critical illness policy; they bring forward money that would otherwise be paid at death, at a discount.

医疗 / 健康保险Health insurance生前福利 ABRLiving benefits
怎么给钱How it pays报销制，不理赔现金Reimbursement, not cash理赔现金Cash
给多少How much承担大部分医院相关费用，有自付额与自付上限Most of the hospital bill, subject to a deductible and an out-of-pocket maximum按保额提前打折兑现A discounted advance against the face amount
能拿去干嘛What it can be used for只能抵医疗账单Only the medical bill无限制：购房、购车、生活开支、医疗、教育都可以No restriction: a house, a car, living costs, medical, education

这张表就是整页最好用的一句开场：医疗保险付医院，生前福利付你。

That table is the best opening line on this page: health insurance pays the hospital; living benefits pay you.

生前福利不是长期护理险：这句话要这样讲Living benefits aren't long-term care insurance: say it this way

两者的区别见下表（加州要求向客户附上官方对比单张）。合规上同时规定：不能把慢性疾病 ABR 叫做 LTC、LTC 的替代品，或说它比 LTC 好， 要对比只能用公司批准的对比单张。

The difference is below (California requires the official comparison brochure to go to the client). Compliance rules add: never call the chronic ABR LTC, an alternative to LTC, or better than LTC; comparisons only via approved compliance flyers.

长期护理险（LTC）Long-term care insurance提前给付附约（ABR）Accelerated benefit rider
是什么What it is单独的健康险，不是寿险，没有身故金和现金值Standalone health coverage, not life insurance; no death benefit or cash value寿险保单上的附约，提前支取一部分身故金A rider on a life policy that advances part of the death benefit
怎么给钱How it pays多为报销合格护理费用，要收据Usually reimburses qualified care expenses, with receipts符合条件即支付，不限用途，不需要收据Pays when the event is met; any use; no receipts
不用会怎样If never used一般不退（不丧失价值选项要另外付钱）Generally lost (nonforfeiture costs extra)身故金照付给受益人The death benefit still goes to beneficiaries
官方声明Official statementABR 不是长期护理险，也不能替代它；不属于加州 LTC Partnership 计划；不是 Medicare 补充险An ABR isn't long-term care insurance and doesn't replace it; it isn't part of the California LTC Partnership; it isn't a Medicare supplement

它也不是医疗险、失能险或 Medicare 的替代品：医疗险付大部分看病费用；ABR 在特定事件发生时给一笔钱，补上医疗险不管的开销，保额用完就结束。

Nor does it replace health, disability or Medicare coverage: health insurance covers most medical costs; an ABR pays on specific events to offset what health insurance doesn't, and ends when the face is used up.

二、五类条款：触发条件与上限2. The five riders: triggers and caps

条款Rider 触发条件Trigger 额度上限Cap
末期疾病Terminal 医生诊断预期寿命在 24 个月以内
国家人寿是 24 个月；不少公司是 12 个月，比较时别默认一样A physician's diagnosis of 24 months or less
National Life uses 24 months; many carriers use 12, so don't assume they match		 $1,500,000
慢性疾病
护理Chronic		 连续至少 90 天无法独立完成 6 项日常生活行为中的 2 项（洗澡、自控、穿衣、吃饭、如厕、移动）；或认知障碍（需他人持续监督以防危及自身安全，短期或长期记忆受损、认不清人物地点时间、推理能力下降）At least 90 consecutive days unable to perform 2 of 6 activities of daily living (bathing, continence, dressing, eating, toileting, transferring) or cognitive impairment requiring continuous supervision for the insured's own safety $1,500,000
每月最多提取面额的 2%，每次理赔一年Up to 2% of face per month, one year per claim
阿兹海默Alzheimer's 医生诊断阿兹海默症或路易体痴呆；MMSE 或同类测试低于 20 / 30 分，且至少两项认知功能测试确认临床损伤（定向力、学习与记忆、注意力与计算）A diagnosis of Alzheimer's or Lewy body dementia, an MMSE-type score below 20 out of 30, and clinical impairment confirmed in at least two cognitive domains (orientation, learning and memory, attention and calculation) $1,500,000
最大投保年龄 60 岁Maximum issue age 60
重大疾病Critical illness 13 项：癌症、心脏病发作、中风、失明、渐冻症 ALS、重大器官移植、终末期肾衰竭、主动脉移植手术、再生障碍性贫血、囊性纤维化、心脏瓣膜置换、运动神经元疾病、心脏骤停13 conditions: cancer, heart attack, stroke, blindness, ALS, major organ transplant, end-stage renal failure, aorta graft surgery, aplastic anemia, cystic fibrosis, heart valve replacement, motor neuron disease, sudden cardiac arrest $1,000,000
重大伤害Critical injury 4 项：非医疗诱发昏迷（连续 96 小时）、瘫痪（偏瘫／截瘫／四肢瘫痪）、严重烧伤（脸部或体表超过 30%）、创伤性脑损伤（非自残）4 conditions: non-medically induced coma lasting 96 hours, paralysis (hemi-, para-, or quadriplegia), severe burns covering the face or over 30% of the body, and traumatic brain injury not self-inflicted $1,000,000

以 $100 万保额为例：末期疾病和阿兹海默的条款上限是 $150 万，重大疾病和重大伤害是 $100 万， 所以这张保单每一类最多都可以动用全部 $100 万保额；慢性疾病每月最多动用保额的 2%，即 $2 万保额，约 50 个月用完。 五类合并封顶（第四节），动用的保额还要打折（第三节）： 实际金额由公司按病情、年龄、剩余寿命计算，签单时给不出。

On a $1M policy, for example: the terminal and Alzheimer's riders are capped at $1.5M and critical illness and critical injury at $1M, so each category can use up to the full $1M of face. The chronic rider uses at most 2% of face a month, $20,000 of face, and runs out in about 50 months. All five share one cap (section 4), and the face used is discounted (section 3): the carrier computes the amount from condition, age and life expectancy, so it can't be quoted at sale.

两个 30 天 / 90 天不要搞混，这一页原来就写错过Two different clocks, and this page had them merged

等待期是 30 天（慢性、阿兹海默、重疾、重伤四项都是 30 天）； 90 天是慢性条款里「无法完成 2 项日常生活行为」需要持续的时长。 这是两个完全不同的钟。 这一页之前把它们合成了「等待期 90 天」，现在已改正。

The waiting period is 30 days for chronic, Alzheimer's, critical illness, and critical injury alike. The 90 days is how long the inability to perform two activities of daily living must persist under the chronic rider. They are two entirely different clocks. An earlier version of this page merged them into "a 90-day waiting period"; that's now corrected.

慢性 vs 阿兹海默：可以换，不用二选一到底Chronic versus Alzheimer's: you can switch

条款原文的关键定义Key definitions from the contract

以下来自 LSW 附约条款原文（20805CA / 20806CA / 8095CA）。客户问「我这个算不算」，答案在这里，最终以理赔审核为准。

From the LSW rider contract text (20805CA / 20806CA / 8095CA). When a client asks "does mine count?", the answer is here, though claims review decides.

项目Condition要满足Must meet不算Excluded
浸润性癌症Invasive cancer确诊后存活 90 天；接受有病历的临床诊断Survive 90 days after diagnosis; clinical diagnosis with records accepted未转移的非黑色素瘤皮肤癌；癌前病变、良性肿瘤、息肉；原位癌（含非浸润性乳头状膀胱癌、乳腺导管原位癌、原位黑色素瘤）；4 期以下甲状腺癌；早期前列腺癌（T2aN0M0 且 Gleason ≤ 6）；CLL Rai 0 期Non-metastatic non-melanoma skin cancer; pre-malignant, benign, polyps, dysplasia; carcinoma in situ (incl. non-invasive papillary bladder, DCIS, melanoma in situ); thyroid cancer below Stage 4; early prostate (T2aN0M0, Gleason ≤ 6); CLL Rai stage 0
心脏病发作Heart attack急性心梗诊断 + 至少一项：心电图改变、胸痛、影像、心肌标志物Acute MI diagnosis plus at least one of ECG changes, chest pain, imaging, cardiac markers心绞痛和其他急性冠脉综合征Angina and other acute coronary syndromes
中风Stroke神经功能缺损持续至少 30 天 + 永久缺损或影像证据Neurological deficit lasting 30+ days plus permanent deficit or scan evidenceTIA（24 小时内恢复）、外伤引起、不符合定义的腔隙性梗塞、影像上的无症状中风TIA (<24 hours), trauma-caused, lacunar strokes not meeting the definition, silent strokes on imaging
心脏骤停Sudden cardiac arrest需要复苏；之后植入 ICD/CRT-D、消融、手术或长期用药Required resuscitation, followed by ICD/CRT-D, ablation, surgery or long-term medication没有骤停就装起搏器/除颤器；酒精、药物或自残导致Pacemaker/defibrillator without an arrest; caused by alcohol, drugs or self-harm
终末期肾衰End-stage renal failure双肾衰竭，需透析或移植；存活 90 天Both kidneys, needing dialysis or transplant; survive 90 days
重大器官移植Major organ transplant心、双肺、肝、双肾、胰、骨髓；已列入等待名单即可Heart, both lungs, liver, both kidneys, pancreas, bone marrow; being on the waiting list qualifies
失明Blindness双眼 20/200 或视野小于 20 度20/200 or a field under 20 degrees in both eyes多个州不作为重疾（CT IL KS MD MA MN NJ NY OH PA UT VA WA）Not a qualifier in several states (CT IL KS MD MA MN NJ NY OH PA UT VA WA)
囊性纤维化Cystic fibrosis20 岁生日前确诊Diagnosed before age 20
昏迷Coma至少 96 小时，Glasgow ≤ 4，需要生命维持，留下永久缺损96+ hours, Glasgow ≤ 4, on life support, permanent deficit医疗诱导；酒精或药物导致Medically induced; alcohol or drugs
瘫痪Paralysis四肢瘫、截瘫、偏瘫持续 90 天且为永久Quadri-, para- or hemiplegia lasting 90 days and permanent
严重烧伤Severe burns三度烧伤占体表 30% 以上，或头面部 30% 以上；存活 30 天Third-degree burns over 30% of the body or 30% of face/head; survive 30 days
创伤性脑损伤Traumatic brain injury伤后 48 小时内 Glasgow ≤ 12 + CT 证据 + 永久缺损；存活 60 天Glasgow ≤ 12 within 48 hours, CT evidence, permanent deficit; survive 60 days轻度脑损伤、反复外伤、自伤Mild TBI, repetitive trauma, self-inflicted
慢性疾病Chronic illness6 项日常生活行为中 2 项需要实质协助（亲手协助或在一臂之内的看护）连续 90 天，或严重认知障碍需实质监督 90 天；由医生、注册护士或持牌社工在申请前 12 个月内认证，认证人不能是持有人、被保险人或其直系亲属Substantial assistance (hands-on or standby within arm's reach) with 2 of 6 ADLs for 90 days, or severe cognitive impairment needing substantial supervision for 90 days; certified within 12 months before election by a physician, RN or licensed social worker who isn't the owner, insured or immediate family自杀未遂或自伤、战争、暴乱、恐怖行为、犯重罪；生效后 30 天内Attempted suicide or self-injury, war, riot, terrorism, committing a felony; within 30 days of issue

其他重疾（ALS、运动神经元病、主动脉移植、再生障碍性贫血、心脏瓣膜置换）多数要求确诊后存活 30 天。存活期内可以先报案，期满后再付款，这样客户不会过早减少身故金。 申领时公司会报价，客户在 60 天内交回选择表；有受让人或不可撤销受益人要取得其同意；付款前被保险人身故，选择作废、照付身故金。加州慢性疾病每年上限为保额的 24% 与 $240,000 较低者。

Other critical illnesses (ALS, motor neuron disease, aorta graft, aplastic anemia, heart valve replacement) mostly require surviving 30 days. The claim can be filed during the survival period and paid after it, so the client doesn't cut the death benefit too early. The company quotes an amount and the election form comes back within 60 days; assignees and irrevocable beneficiaries must consent; if the insured dies before payment the election is cancelled and the death benefit paid. California's chronic annual cap is the lesser of 24% of coverage or $240,000.

Premium Chronic Care：付费、不打折的慢性疾病附约Premium Chronic Care: a paid, undiscounted chronic rider

2025 年 LLD 推出的新附约（加州、纽约不可用）。和免费的慢性疾病 ABR 用同样的触发条件，区别在钱：

New on LLD in 2025 (not available in California or New York). Same trigger as the free chronic ABR; the difference is the money:

慢性疾病 ABRChronic ABRPremium Chronic Care
费用Cost不收费None额外收费Extra charge
每人上限Per-insured cap$1.5M（与其他 ABR 合并）$1.5M (shared with other ABRs)$3M
投保年龄Issue ages0–8518–75
怎么付Payout每月最多 2%，打折Up to 2% a month, discounted投保时选每月 2% 或 4%，一元对一元不打折（4% 以后可降为 2%，不能反向）2% or 4% a month chosen at issue, dollar for dollar (4% can later drop to 2%, not the reverse)
等待期Waiting period30 天30 days无None
共同点Both受 IRS 每日上限约束；每年重新认证；不能和退休金计划、Gap Protector 或 CMC 同用Subject to the IRS per diem; annual recertification; not with pension plans, Gap Protector or CMC

一个假设例子：55 岁女性、标准非吸烟、保额 $294,700，57 岁时符合慢性条件：Premium Chronic Care 2% 每月约 $5,894，免费 ABR 约 $2,915。

A hypothetical: a 55-year-old standard non-tobacco woman with $294,700 of coverage qualifies at 57: Premium Chronic Care at 2% pays about $5,894 a month versus about $2,915 from the free ABR.

三、实际能拿到多少：打折理赔3. What actually arrives: the discount

这是整页最重要的一节，也是理赔那天唯一会被客户质问的一件事。 保险公司提前把钱付给你，所以要贴现， 你拿到的一定少于你动用的那部分保额。

This is the most important section on the page, and the only thing a client will ever argue about at claim. The carrier is paying early, so the amount is discounted, and what arrives is always less than the face amount consumed.

一个完整的真实算例One complete worked example

47 岁男性，$500,000 保额，重大疾病 Category 3（重度），Select Non-Tobacco， 保单现金值 $5,487.46，贴现率 5.80%，选择 100% 加速：

A 47-year-old male, $500,000 of face, critical illness at Category 3 (severe), Select Non-Tobacco, cash value of $5,487.46, a 5.80% discount rate, accelerating 100%:

可加速的死亡赔付Death benefit available to accelerate$500,000
按 5.80% ＋ Cat 3 死亡率折现Discounted at 5.80% plus the Cat 3 mortality assumption$296,483
减去未来保费的现值Less the present value of future premiums− $42,676　→　$253,808
× 加速比例 100%× 100% acceleration$253,808（选 50% 则减半）$253,808 (at 50% it halves)
减去 $250 手续费Less the $250 administrative fee$253,558
实际到手比例Percentage actually received50.7%

这里可以反推一下：从贴现率可以倒算出保险公司模型里的预期寿命。 $500,000 ÷ 1.058ⁿ = $296,483 → n ≈ 9.3 年， 也就是说 NLG 的模型认为这位 47 岁的客户大约在 56 岁前后过世。

You can work this backwards: the discount rate implies the carrier's assumed life expectancy. $500,000 ÷ 1.058ⁿ = $296,483 gives n ≈ 9.3 years: the model expects this 47-year-old to die around 56.

这个反推的用处是： 它让你能向客户解释「为什么是 50% 而不是 85%」。 不是公司抠，是因为模型认为他还能活九年多，九年的钱现在给，当然要折现。

Why it's useful: it lets you explain to a client why the answer is 50% rather than 85%. It isn't the carrier being stingy; the model expects another nine years, and nine years of money paid today is discounted accordingly.

四笔真实理赔，比例正好说明问题Four real claims, and what the ratios show

情形Case保额Face理赔Paid比例Ratio
40 岁男性，猝死Male, 40, sudden death$1,000,000身故全额Full death benefit100%
37 岁女性，直肠癌 2 期Female, 37, stage 2 rectal cancer$500,000$250,00050.0%
50 岁男性，舌癌 3 期Male, 50, stage 3 tongue cancer$500,000$256,00051.2%
62 岁女性，轻微中风Female, 62, minor stroke$300,000$86,00028.7%

2024–2025 年的四笔实际理赔。

Four actual claims from 2024–2025.

最后一行才是要讲慢的那一行：「轻微中风」只拿到 28.7%，不到前两笔的六成。 原因不是年龄（62 岁其实应该拿得更多），而是病情不重、预期寿命长，所以折得狠。 这一行把「病越重拿越多」这个反直觉的机制讲得很清楚， 而且它同时是一个必须提前给客户打的预防针。

The last row is the one to slow down on: the minor stroke paid 28.7%, barely six-tenths of the other two. Not because of age (at 62 you would expect more) but because the condition wasn't severe, so life expectancy stayed long and the discount was deep. That single row explains the counterintuitive mechanism clearly, and it's also the expectation you have to set before the claim, not after.

反过来看晚期的例子（幻灯片第 39 页，团队培训中分享的更早几笔，已匿名）：宫颈癌 $50 万保额理赔 $266,199（53.2%）； 乳腺癌 $50 万保额理赔 $42 万；50 岁女性肺癌 4 期，$100 万保额理赔 $82 万，都是八成多。 2020 年还有一张 $100 万整的重疾理赔支票，因为重疾单次理赔最高 $100 万；保额更大的客户只动用够封顶的那部分保额，其余保额继续有效。

Now the late-stage side (slide 39, earlier cases shared in team training, anonymized): cervical cancer on a $500,000 face paid $266,199 (53.2%); breast cancer on $500,000 paid $420,000, and a 50-year-old woman with stage 4 lung cancer and a $1 million face received $820,000, both over 80%. A 2020 critical illness check was for exactly $1 million, because a critical illness claim pays at most $1 million at a time; with a larger face, only enough is accelerated to reach the cap and the rest stays in force.

什么情况折得少，什么情况折得狠What makes the discount smaller or larger

赔付高（折现较低）

Pays more (smaller discount)

疾病导致较快死亡｜年龄较大的被保人｜终身型保单｜持续缴费稳定｜ 保单已生效多年｜已高额供款（over-funded）

A condition that shortens life sharply · an older insured · a permanent policy · premiums paid consistently · a policy in force for years · an over-funded contract

赔付低（折现较高）

Pays less (larger discount)

疾病可治愈或可长期存活｜年龄较小的被保人｜定期寿险｜缴费不稳定｜ 保单生效时间短｜现金值低（under-funded）

A treatable or survivable condition · a younger insured · term coverage · irregular premiums · a policy only recently issued · an under-funded contract with low cash value

归纳成三条，设计保单时你真正能影响的只有其中一条： ① 病情严重程度（决定预期寿命，你影响不了）、 ② 现金值高低（现金越多折扣越小，这一条你能影响）、 ③ 贴现率（挂钩浮动贷款利率，利率上行就拿得少，你也影响不了）。

Three factors, and only one of them is in your hands at design time: severity, which drives life expectancy and which you can't influence; cash value, where more means a smaller discount, and this one you can influence; and the discount rate, which tracks the variable loan rate, so a rising-rate environment pays less.

所以「足额供款」除了关系退休现金流，还直接决定生前福利理赔那天的数字。 这是把保单费用那一页和这一页连起来的那根线： 一张长期供款不足的保单，不只是现金值长得慢，是出事那天少拿一大笔。

So funding the policy properly isn't only about retirement cash flow; it directly sets the number on the day a living benefit is claimed. That's the thread connecting this page to Policy Costs: an under-funded policy doesn't just accumulate slowly, it pays materially less on the day it matters.

折现的几个关键参数The discount's key inputs

设计上的取舍：保额定得太大、保费交得太少，生前福利和日后收入都会变少；多交（接近上限）的保单，生前福利也更强。

The design trade-off: too much face for the premium means smaller living benefits and less future income; well-funded policies deliver stronger living benefits too.

四、五类额度是合并封顶，不是各算各的4. The caps are aggregate, not additive

客户最常见的误解，而且是我们讲错造成的： 「我有 $150 万 Terminal ＋ $150 万 Chronic ＋ $150 万 Alzheimer's ＋ $100 万 Critical Illness ＋ $100 万 Critical Injury，所以一共能拿 $650 万？」错。

The misunderstanding clients have most often, and one we create: "$1.5M terminal plus $1.5M chronic plus $1.5M Alzheimer's plus $1M critical illness plus $1M critical injury, so $6.5M in total?" No.

五大项是 Aggregate Cap（合并封顶），五项加起来最多 $150 万。举个例子： 一张 $400 万的保单，客户先申请重大疾病，理赔 $75 万；因为是打折提前付，这 $75 万动用了 $200 万保额，面额降到 $200 万； 后来变成末期疾病，最多再拿 $75 万，不是 $150 万：$150 万是几项合起来的总上限，已经用掉了 $75 万。 剩下的保额和合并的总上限，哪个先碰到就停在哪。

The five share one aggregate cap: $1.5M across all five. An example: on a $4M policy the client first claims critical illness and receives $750,000; paid early at a discount, that $750,000 uses $2M of face, dropping the face to $2M; later becoming terminally ill, they can take another $750,000 at most, not $1.5M: $1.5M is the combined ceiling and $750,000 of it is used. The remaining face and the combined ceiling both apply, and whichever is reached first stops it.

这一条必须在成交前讲。理赔那天才发现，客户会认为你骗了他， 而且从他的角度看，他是对的。

Say this before the sale. Discovered at claim, the client will believe you misled them, and from where they sit, they'd be right.

五、谁拿不到：承保阶段就定了5. Who doesn't get it: decided at underwriting

情况Situation结果Result
曾经心脏病发作 / 癌症康复A prior heart attack or cancer recovery拿不到 重大疾病 ABR（其他 ABR 仍可）No critical illness ABR; the others remain available
有伤残历史 / 慢性背痛A disability history or chronic back pain拿不到 慢性疾病 ABRNo chronic illness ABR
次标准体 ≥ Table 4 / Express Standard 2Substandard rated at Table 4 or above, or Express Standard 2只能拿末期疾病 ABRTerminal ABR only
评级 ≥ 200% / Express Non-Tobacco 2Rated at 200% or above, or Express Non-Tobacco 2拿不到 阿兹海默条款No Alzheimer's rider
多被保人保单里有一位不合格A multi-insured policy where one insured doesn't qualify其他被保人也拿不到 ABRNone of the insureds get the ABR

最后一行按保守的理解：任何一位被保人不合格，全体都拿不到 ABR。做多保人方案时逐一核对。

Read the last row strictly: if any insured doesn't qualify, none of them get the ABR. Check each insured when designing a multi-life case.

客户必须如实回答 medical form 上的所有问题。 保单生效两年内的理赔会被 contestability 复核， 撒谎被发现 = 条款被撤销（rescind）。 隐瞒换来的保单，恰恰在最需要它的那一天失效。

The client must answer every question on the medical form truthfully. A claim within the first two years goes through contestability review, and a misstatement discovered there means the rider is rescinded. A policy bought by omission fails on precisely the day it's needed.

六、客户常以为能赔、其实不赔的十件事6. Ten things clients assume are covered and aren't

这些是医疗保险该管的事。ABR 只赔「重大 ＋ 长期 ＋ 救命」级别。

These belong to health insurance. ABR pays only at the serious, long-term, life-threatening level.

1　手指骨折A broken finger6　手肘骨折A broken elbow
2　脚踝 / 脚趾骨折A broken ankle or toe7　关节 / 膝盖疼痛Joint or knee pain
3　背痛Back pain8　疝气修复Hernia repair
4　子宫切除术A hysterectomy9　胆囊切除Gall bladder removal
5　怀孕及产后恢复Pregnancy and postpartum recovery10　子宫肌瘤切除Fibroid removal

注意第 2 项和第 3 项。这一页早先的版本写过 「摔断腿长期卧床、换了膝关节都可能符合慢性条款」。 单纯的骨折和关节疼痛不赔。 慢性条款赔的不是「受了伤」，是连续 90 天以上失去两项生活自理能力。 一次骨折如果真的导致九十天无法自行洗澡和穿衣，那符合的是那个条件， 不是「骨折」本身。这两句话在客户听来差别很大。

Note items 2 and 3. An earlier version of this page said a broken leg or a knee replacement "could qualify" under the chronic rider. A fracture or joint pain on its own does not. The chronic rider doesn't pay for an injury; it pays for losing two activities of daily living for more than 90 consecutive days. If a fracture genuinely leaves someone unable to bathe and dress themselves for ninety days, it's that condition being met, not the fracture. To a client those two sentences sound very different.

慢性理赔为什么会被拒：一个对照案例Why a chronic claim gets denied

下面是一个同一位客户、两张保单、两种结果的案例。 （客户是北加州的一位巴士司机，姓名已略去；时间线见上面幻灯片第 9 页。这里要讲的是机制，不是某一家公司。）

Here is a case of one client, two policies, and two different outcomes. (The client is a bus driver in Northern California; the name is omitted, and the timeline is on slide 9 above. The point is the mechanism, not any particular company.)

赔了的那一张

The one that paid

$110 万保额，慢性疾病条款（免费附带）。 一年可动用面额 2% × 12 ＝ 24%，即 $26.4 万； 用这 $26.4 万的面额额度，实际提前拿到 $112,182， 剩余保额 $83.6 万。

$1.1M of face with the chronic rider included at no cost. A year's allowance is 2% × 12 = 24%, or $264,000 of face; that $264,000 of face produced an actual advance of $112,182, leaving $836,000 of coverage.

$112,182 ÷ $264,000 ≈ 42.5%，又是一次明显的折现。

$112,182 ÷ $264,000 ≈ 42.5%: the discount again.

被拒的那一张

The one that didn't

同一个人，Nationwide 的付费长期护理附加险。拒赔理由：

Same person, Nationwide's paid long-term care rider. The stated reasons:

没有依照医嘱持续治疗｜没有服药｜医生建议注射治疗但未执行｜ 缺乏完整的治疗记录可供追踪

Treatment wasn't continued as prescribed · medication wasn't taken · a recommended injection therapy wasn't carried out · there was no complete treatment record to follow

这个案例的教训不在「哪家公司好」，在条款里那句话： 在护理期间内，必须确实按照医生制定的护理计划，持续接受合格的长期护理服务。 「合格长期护理服务」有明确定义，见美国税法 IRC §7702B(c)(1)， 包括必要的诊断、预防、治疗、康复、缓解病情、维护性与个人护理服务。

The lesson isn't which carrier is better; it's the contract language: during the care period the insured must actually follow the physician's plan of care and continue receiving qualified long-term care services. "Qualified" is defined in IRC §7702B(c)(1), covering necessary diagnostic, preventive, therapeutic, rehabilitative, palliative, maintenance, and personal care services.

对我们的意思很具体：理赔不是填表填得好就能过，是病历要撑得住。 客户一开始申请慢性理赔，就要提醒他按医嘱做、并且留下记录。 这句话该在理赔开始的第一天说，不是被拒之后说。

What that means for us is concrete: a claim isn't won on the form, it's won on the medical record. The moment a client starts a chronic claim, tell them to follow the plan and keep the documentation, on day one, not after a denial.

七、理赔的税7. Tax on the claim

个人持有、个人收款Individually owned and paid公司持有、公司收款Business owned and paid
末期疾病Terminal通常符合 §101(g)，免税（会收到 1099-LTC）Usually qualifies under §101(g): tax-free (a 1099-LTC is issued)通常不符合 §101(g)，需进一步计算应税金额Usually outside §101(g): taxable amount to be worked out
慢性疾病Chronic符合条件时免税，受 LTC 规则及 per diem 上限约束Tax-free when qualified, subject to LTC rules and the per diem通常不符合 §101(g)，需进一步计算应税金额Usually outside §101(g): taxable amount to be worked out
阿兹海默 / 认知障碍Alzheimer's / cognitive impairment按慢性疾病规则判断Follows the chronic illness rules按慢性疾病规则及 §101(g)(5) 判断Chronic illness rules and §101(g)(5)
重大疾病Critical illness取决于条款结构、付款原因和保费来源Depends on rider structure, reason for payment and who paid premiums取决于条款结构、收款人、税基和商业关系Depends on rider structure, payee, basis and business relationship
重大伤害Critical injury取决于 §104 / §105 及合同结构Depends on §104 / §105 and contract structure取决于收款人与合同性质，不能一概而论Depends on payee and contract; no single answer

「公司持有」那一整列值得单独讲一次。 很多企业主客户会顺手把保单挂在公司名下（为了保费的税务处理）， 结果把一笔本来免税的理赔变成了应税收入。 持有人是谁，要在投保之前跟客户的会计师确认，不是理赔时才发现。

The business-owned column deserves its own conversation. Owners routinely put a policy in the company's name for the premium treatment, and in doing so turn a tax-free benefit into taxable income. Who owns the contract has to be settled with the client's accountant before the policy is issued, not discovered at claim.

慢性理赔超过 IRS per diem 上限的部分，必须提交护理费用证明才免税。 2026 年的上限是 $156,950 / 年 ＝ $13,079 / 月 ＝ $430 / 天。

Chronic payments above the IRS per diem limit are tax-free only with proof of care costs. The 2026 limit is $156,950 a year, or $13,079 a month, $430 a day.

per diem 每年按通胀调整，用之前查 IRS 当年公告。

The per diem is indexed annually; check the IRS figure for the year in question before quoting it.

八、试管婴儿条款：免费，而且很少有人讲8. The fertility rider: free, and rarely mentioned

所有 NLG 保单自动免费携带 Fertility Journey Rider。覆盖： 人工授精、辅助生殖技术 ART、试管婴儿 IVF、输卵管腹腔镜手术、子宫镜检查与治疗。

Every NLG policy carries the Fertility Journey Rider automatically, at no cost. It covers artificial insemination, assisted reproductive technology, IVF, laparoscopic tubal surgery, and hysteroscopic diagnosis and treatment.

对育龄客户，这是一个成本为零的加分项。 但要说准：它给的是现金值的一笔信用，不是报销 IVF 的费用， 三倍最低月保费通常不是一个大数字。讲成「保险公司帮你出试管婴儿的钱」就讲错了。

For clients of childbearing age it's a zero-cost extra. But state it precisely: it's a credit to cash value, not reimbursement of IVF costs, and three times the minimum monthly premium is usually not a large sum. "The insurer pays for your IVF" is wrong.

九、理赔流程9. The claims process

1提出理赔：电话 800-732-8939（按 1 转英文），或发邮件到 claims@nationallife.com；也可从 nationallife.com 的 Contact Claims 页面提交Open the claim: call 800-732-8939 (press 1 for English) or email claims@nationallife.com; the Contact Claims page on nationallife.com also works
2填写初步理赔表格Complete the initial claim form
3填写医生信息表格Complete the physician's statement
4其他辅助信息（不一定需要）Supporting documentation, if requested
5签回确认理赔金额表格Sign and return the benefit amount confirmation

有一个实际案例，从提出理赔到收到支票约七周， 而受伤到提出理赔隔了约三个月。后面那三个月正是慢性条款 90 天条件在走。 跟客户讲时间预期，这两段要分开讲：等 90 天是条款要求，不是公司拖延。

In one actual case, roughly seven weeks passed from filing to the cheque, with about three months between the injury and the filing, and those three months are the chronic rider's 90-day condition running. When setting a client's expectations, separate the two: the 90 days is the contract, not the carrier being slow.

另一个重疾案例（幻灯片第 41–45 页的五份原件）：2025 年 7 月 8 日确认收到理赔表，10 月 20 日签选择表， 前后约三个半月，中间要等医院放病历。客户选了加速 100%，支票 $253,546， 保单和附加条款随之终止，家人以后不会再有身故金。加速多少，要在签选择表之前和客户、家人一起想清楚； 金额按签字那天的利率和保单价值计算。

Another, a critical illness case (the five documents on slides 41–45): the claim form was acknowledged on July 8, 2025 and the election signed on October 20, about three and a half months including the wait for hospital records. The client chose to accelerate 100% and received $253,546, after which the policy and riders terminated and no death benefit remains for the family. Decide how much to accelerate with the client and family before the election is signed; the amount uses the rates and policy values on the signing date.

理赔前后要提醒客户的九件事Nine things to tell clients around a claim

十、背后的数据10. The data behind it

1 / 4+美国人的死亡由心脏病或中风造成（约 28%）of US deaths are from heart disease or stroke (about 28%)
约 ~40%美国人一生中会被诊断出癌症of Americans will be diagnosed with cancer in their lifetime
1 / 365 岁的美国人会活过 90 岁of 65-year-old Americans will live past 90
740 万7.4M65 岁以上美国人患有阿兹海默症Americans aged 65+ live with Alzheimer's

出处：CDC FastStats，2024 年死亡数据（心脏病 683,491 人、中风 166,852 人，全部死亡 3,072,666 人）； American Cancer Society，Lifetime Probability of Developing or Dying From Cancer（男性 39.9%、女性 39.0%；按 2018、2019、2021 年发病数据，2025 年 1 月更新）； 美国社会安全局（SSA）长寿估算；Alzheimer's Association，《2026 Alzheimer's Disease Facts and Figures》。 这些数字每年更新，引用前查最新一年。

Sources: CDC FastStats, 2024 deaths (heart disease 683,491, stroke 166,852, all causes 3,072,666); American Cancer Society, Lifetime Probability of Developing or Dying From Cancer (men 39.9%, women 39.0%; incidence data from 2018, 2019 and 2021, revised January 2025); Social Security Administration longevity estimates; Alzheimer's Association, 2026 Alzheimer's Disease Facts and Figures. The figures are updated yearly; check the latest edition before quoting.

结论很直接：对绝大多数人来说， 「生一场需要花钱的大病」的概率，远高于「在工作年龄突然身故」的概率。 一张只保身故的保单，恰好错过了概率最高的那个风险。

The conclusion is direct: for most people, a serious, expensive illness is far more likely than sudden death during working years. A policy that only pays at death misses the most probable risk.

十一、30 年演进史11. Thirty years of rider development

1991

首推末期疾病条款

First terminal illness rider

理赔门槛为 12 个月预期寿命。

With a 12-month life expectancy threshold.

1997

首推慢性疾病条款

Chronic illness introduced

同时把末期疾病的门槛放宽到 24 个月。

And the terminal threshold extended to 24 months.

2000

首张独立慢性疾病条款

First standalone chronic rider

等待期 5 年。

With a five-year waiting period.

2003

推出重大疾病条款

Critical illness rider

—

—

2007

慢性等待期缩短到 2 年

Chronic wait cut to two years

从 5 年降到 2 年。

Down from five.

2008

进入纽约州

Into New York

成为纽约州最早提供慢性疾病条款的公司之一。

Among the first carriers to offer a chronic rider in New York.

2013

末期与慢性额度提高

Higher caps

从 $100 万提高到 $150 万。

Terminal and chronic rose from $1M to $1.5M.

2015

重疾扩项，首推重大伤害

Critical illness expanded, critical injury added

—

—

2017

慢性等待期缩短到 30 天

Chronic wait cut to 30 days

从 2 年降到 30 天，这是幅度最大的一次。

From two years to 30 days, the largest single step.

2023

新增阿兹海默条款

Alzheimer's rider added

—

—

十二、为什么很少有公司做得全12. Why so few carriers offer the full set

筛选条件Filter数量Count
全美寿险公司总数Life insurers in the U.S.719
股份公司Stock companies532
互惠保险公司Mutual companies110
有末期与慢性生前福利的互惠公司Mutuals offering terminal and chronic31
再加上重大疾病条款…and critical illness9
再加上重大伤害、LIBR、阿尔茨海默与生育条款…and critical injury, LIBR, Alzheimer's and fertility1

公司总数与类型来源：ACLI《2025 Life Insurers Fact Book》。同业一直在追，讲这张表时说明年份。

Company counts and types: ACLI 2025 Life Insurers Fact Book. Competitors keep catching up, so say the year.

国家人寿兑现承诺的数字：2024 年 140 万客户、26.1 万张新保单、总给付 $29 亿，其中生前福利 $1.11 亿；2025 年生前福利给付 $1.28 亿。

National Life's promises kept: in 2024, 1.4 million customers, 261,000 new policies, $2.9 billion in total benefits including $111 million in living benefits; $128 million in living benefits in 2025.

相关Related 保单费用Policy Costs 相关Related Living Life DefenderLiving Life Defender

内部培训资料，仅供签约经纪人使用，不可转发给客户。 条款定义、额度上限与等待期以保单条款和承保公司当期资料为准； 文中理赔金额取自具体个案，贴现率、现金值与病情分级不同，结果会完全不同， 不构成任何理赔金额的承诺。 税务部分是制度性介绍，不构成税务或法律建议， 保单持有人结构与理赔的税务处理请由客户自己的持照会计师或税务师确认。

Internal training material for contracted agents; not for forwarding to clients. Rider definitions, caps, and waiting periods are governed by the policy contract and the carrier's current material. Claim amounts shown come from specific cases; a different discount rate, cash value, or severity category produces a completely different result, and nothing here is a promise of any claim amount. The tax section is an overview and is not tax or legal advice; ownership structure and the tax treatment of a claim must be confirmed by the client's own licensed CPA or enrolled agent.