Independent Producer Commission Schedule - Securian Dental

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$H:\ISPS\arpeggio reports\Directories\International ... - Securian Dental$

$H:\ISPS\arpeggio reports\Directories\International ... - Securian Dental$

Pool Rated Plans Independent Producer Commission Schedule Securian Life Insurance Company Pool rated plans include any Securian Dental Voluntary or Employer‐Paid products sold on a pool rated basis. All Pool rated groups covered by this Agreement are sold at rates pre‐established by Securian Life. Commissions are paid monthly. Commissions for first‐year sales and renewals are calculated on a per group basis, with each group assigned a start date. The commission for each group is a percentage of premiums paid to‐date, based on a tiered scale, with the scale re‐setting every 12 months at the anniversary of the start date. Commission Rate Premium Paid 10% of the first $ .01 ‐ $ 5,000.00 then, 7.5% of the next $ 5,000.01 ‐ $ 10,000.00 then, 5.5% of the next $ 10,000.01 ‐ $ 30,000.00 then, 3.5% of the next $ 30,000.01 ‐ $ 50,000.00 then, 2.5% of the next $ 50,000.01 ‐ + Individually Rated (Custom) Plans Group Size 100 + Risk & ASO Business You may request specific levels of compensation for individually rated opportunity. Commissions at the rate provided in the above schedule are subject to the terms and conditions of the Independent Producer Agreement. Commissions shall be paid to the Producer as long as Producer: (1) is continuously and actively engaged as a licensed producer; (2) is designated by the group named in the Master Dental Group Contract as the Producer with respect to such group; servicing the group in a manner satisfactory to Securian Life; and (3) the original Master Dental Group Contract for which the commissions are being paid has not been terminated. Securian Dental is underwritten by Securian Life Insurance Company and administered by DeCare Dental Health International, LLC In California, Securian Dental is underwritten by Securian Life Insurance Company, offered through DeCare Dental Insurance Services, LLC and administered by DDHI Administrators, LLC. Securian Agent Appointments •730 South Broadway • Gilbert, MN 55741 Toll‐free 1‐866‐201‐1818 Option 1 • Fax 877.631.8953 • Securian_Commission@SecurianDental.com www.SecurianDental.com Form: - SDCOMMSCHED REV 7-2011
HIPAA BUSINESS ASSOCIATE ADDENDUM This Addendum is entered into by and between Securian Life Insurance Company (“Covered Entity”) and _______________________________ and _______________________________ [Producer Name] [Agency Name] (“Business Associate”) and is incorporated into and is made part of the Dental Commission Agreement, (the “Agreement”) entered into by and between the parties. SECTION 1 – BUSINESS ASSOCIATE PROVISIONS 1.1 Introduction. Pursuant to the Agreement, Business Associate, on behalf of Covered Entity, performs or assists in the performance of functions and activities that may involve the use and disclosure of Protected Health Information as defined in the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), Parts 160 and 164 (“Privacy Regulations”). This Section 1 is intended to meet the requirements of the “business associate” provisions of Privacy Regulations and will govern the terms and conditions under which the Business Associate may use or disclose Protected Health Information. 1.2 Permitted Uses and Disclosures (a) Business Associate may use or disclose Protected Health Information to perform functions, activities, or services for, or on behalf of, Covered Entity pursuant to the Agreement and as permitted or required by this Addendum or the Privacy Regulations. (b) Business Associate may use or disclose Protected Health Information for the proper management and administration of its business or to carry out its legal responsibilities. (c) Business Associate may disclose Protected Health Information for the proper management and administration of its business, if i. the disclosures are required by law, or ii. Business Associate obtains reasonable assurances from the person to whom the information is disclosed that the information will be held confidentially and will be used or further disclosed only as required by law or for the purpose for which it was disclosed to such person, and the person will notify the Business Associate of any instances of which the person is aware in which the confidentiality of the information has been breached. (d) Business Associate may use Protected Health Information to provide Data Aggregation services to Covered Entity. 1.3 Limitations on Uses and Disclosures. With respect to Protected Health Information that Business Associate creates or receives on behalf of Covered Entity, Business Associate will not use or further disclose the Protected Health Information other than as permitted or required by this Addendum or as required by law. 1.4 Additional Obligations of Business Associate. Except as otherwise specified herein, the provisions of this Paragraph 1.4 apply only to Protected Health Information that Business Associate creates or receives on Covered Entity’s behalf. Securian Life Insurance Company_HIPAA (BAA)_Rev. 12/2010 1
Page 1 and 2: Securian Independent Producer Appoi
Page 3 and 4: (c) You will: (1) promote the sale
Page 5 and 6: eturns on terminated Policies; (3)
Page 7: IN WITNESS WHEREOF, you and, by the
Page 11 and 12: mutually agreed upon period of time
Page 13 and 14: 4.6 Indemnity. Business Associate w
Page 15 and 16: Any fee for providing such electron
Page 17 and 18: Independent Producer Data Sheet Sec
Page 19 and 20: Form W-9 Request for Taxpayer (Rev.
Page 21 and 22: Form W-9 (Rev. 11-2005) Page 3 Gene
Page 23 and 24: Assignment of Commissions Securian
Page 25: Commission Reports User Request For

Independent Producer Commission Schedule - Securian Dental

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