LESSON10
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Certificate Holder (Group Insured)
© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
• Reason for group’s existence
Labor Union Groups MultipleMultipleEmployer Groups SingleSingleEmployer Groups Association Groups
Employee Retirement Income Security Act (ERISA)
Group Insurance Policy Provisions
• Eligibility requirements
Actively-at-work provision Probationary period Eligibility period
Employee must be actively at work on the day the insurance coverage is to take effect Length of time (usually 1 to 6 months) that a new group member must wait to enroll Time (usually 31 days) during which a new group member may enroll for coverage
Noncontributory Plan
Usually, 75 percent participation of eligible employees required
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© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
• Activities of the group
EXAMPLE: RACE CAR DRIVERS
Most employer-employee groups are standard risks
© 1999 LOMA All Rights Reserved
Premium Amounts
• A group has 10 eligible employees • Under the group’s life insurance plan,
each employee receives $25,000 of coverage • Monthly premium rate for this coverage = $.35 per $1,000 of coverage
Contributory Plan Noncontributory Plan
Group members must contribute some or all of the premium
Group members are not required to contribute any part of the premium
Termination of a Group Insured’s Coverage
Typically occurs if the group insured • ceases to be an eligible group member • leaves the group • fails to pay a required premium
• Determination of benefit levels
BUSINESS
Group policyholder, not group insured, determines benefit levels provided to group members
RETURN TO MAIN MENU
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
• Participation levels
Contributory Plan
100 percent participation of eligible employees required
• Termination Provisions
Termination of the Group Insurance Policy
The insurer may terminate under certain conditions The group policyholder may terminate at any time
31
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© 1999 LOMA All Rights Reserved
Group Insurance Policy Provisions
• Incontestability provision
CONTESTABLE PERIOD
2000
1999
(Date of issue)
BUSINESS
Group Policyholder negotiates and purchases
Master Group Insurance Contract Group Insureds
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© 1999 LOMA All Rights Reserved
Types of Group Insurance Plans
Credit Union Groups
CREDIT UNION
Discretionary Groups
Must be approved by state insurance department
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© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
Monthly Premium Amount
$.35 x 250 total coverage units ($1,000 each)
RETURN TO MAIN MENU
$87.50
© 1999 LOMA All Rights Reserved
Federal Regulation of Group Plans
2001
Time during which the insurer may contest the validity of the master group insurance contract
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Insurance Policy Provisions
© 1999 LOMA All Rights Reserved
RETURN TO MAIN MENU
Certificates of Insurance
Certificate of Insurance
Held by
Describes the coverage provided by the group insurance contract and each group insured’s rights under the contract
Group Underwriting Considerations
• Flow of new members into the group
A group needs young, new members • To replace members who leave the group • To keep the group’s age distribution stable
• Size of the group
Generally, the larger the group, the more likely that the group will experience the predicted loss rate
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Insurance Premiums
• The insurer
• establishes group premium rates on a case-by-case basis • determines the cost of providing coverage • determines the cost of plan administration • recalculates a group’s rate every year
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Insurance Policy Provisions
• Grace period provision
CALENDAR 1
Time within which premium may be paid without penalty Renewal premium due date
BUSINESS
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
DebtorCreditor Groups
BANK
• Reason for group’s existence (continued)
Groups whose activities lead to Leabharlann Baidu higher-than-average loss rate among members are substandard or declined risks
© 1999 LOMA All Rights Reserved
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Lesson 10
• Principles of Group Insurance • Group Life Insurance
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© 1999 LOMA All Rights Reserved
Group Insurance Contracts
Provides coverage for
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
• Stability of the group
A group should remain relatively stable and not experience excessive changes in group membership
BUSINESS
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Premium Rates
Manual Rating Experience Rating Blended Rating
Insurer uses its own past experience to calculate the group’s premium rates
Insurer considers the group’s prior claim experience to calculate the group’s premium rates
RETURN TO MAIN MENU
Insurer uses both manual rating and experience rating to calculate the group’s premium rates
Certificate Holder (Group Insured)
© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
• Reason for group’s existence
Labor Union Groups MultipleMultipleEmployer Groups SingleSingleEmployer Groups Association Groups
Employee Retirement Income Security Act (ERISA)
Group Insurance Policy Provisions
• Eligibility requirements
Actively-at-work provision Probationary period Eligibility period
Employee must be actively at work on the day the insurance coverage is to take effect Length of time (usually 1 to 6 months) that a new group member must wait to enroll Time (usually 31 days) during which a new group member may enroll for coverage
Noncontributory Plan
Usually, 75 percent participation of eligible employees required
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
• Activities of the group
EXAMPLE: RACE CAR DRIVERS
Most employer-employee groups are standard risks
© 1999 LOMA All Rights Reserved
Premium Amounts
• A group has 10 eligible employees • Under the group’s life insurance plan,
each employee receives $25,000 of coverage • Monthly premium rate for this coverage = $.35 per $1,000 of coverage
Contributory Plan Noncontributory Plan
Group members must contribute some or all of the premium
Group members are not required to contribute any part of the premium
Termination of a Group Insured’s Coverage
Typically occurs if the group insured • ceases to be an eligible group member • leaves the group • fails to pay a required premium
• Determination of benefit levels
BUSINESS
Group policyholder, not group insured, determines benefit levels provided to group members
RETURN TO MAIN MENU
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
• Participation levels
Contributory Plan
100 percent participation of eligible employees required
• Termination Provisions
Termination of the Group Insurance Policy
The insurer may terminate under certain conditions The group policyholder may terminate at any time
31
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Insurance Policy Provisions
• Incontestability provision
CONTESTABLE PERIOD
2000
1999
(Date of issue)
BUSINESS
Group Policyholder negotiates and purchases
Master Group Insurance Contract Group Insureds
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Types of Group Insurance Plans
Credit Union Groups
CREDIT UNION
Discretionary Groups
Must be approved by state insurance department
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
Monthly Premium Amount
$.35 x 250 total coverage units ($1,000 each)
RETURN TO MAIN MENU
$87.50
© 1999 LOMA All Rights Reserved
Federal Regulation of Group Plans
2001
Time during which the insurer may contest the validity of the master group insurance contract
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Insurance Policy Provisions
© 1999 LOMA All Rights Reserved
RETURN TO MAIN MENU
Certificates of Insurance
Certificate of Insurance
Held by
Describes the coverage provided by the group insurance contract and each group insured’s rights under the contract
Group Underwriting Considerations
• Flow of new members into the group
A group needs young, new members • To replace members who leave the group • To keep the group’s age distribution stable
• Size of the group
Generally, the larger the group, the more likely that the group will experience the predicted loss rate
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Insurance Premiums
• The insurer
• establishes group premium rates on a case-by-case basis • determines the cost of providing coverage • determines the cost of plan administration • recalculates a group’s rate every year
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Insurance Policy Provisions
• Grace period provision
CALENDAR 1
Time within which premium may be paid without penalty Renewal premium due date
BUSINESS
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
DebtorCreditor Groups
BANK
• Reason for group’s existence (continued)
Groups whose activities lead to Leabharlann Baidu higher-than-average loss rate among members are substandard or declined risks
© 1999 LOMA All Rights Reserved
RETURN TO MAIN MENU
Lesson 10
• Principles of Group Insurance • Group Life Insurance
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Insurance Contracts
Provides coverage for
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Group Underwriting Considerations
• Stability of the group
A group should remain relatively stable and not experience excessive changes in group membership
BUSINESS
RETURN TO MAIN MENU
© 1999 LOMA All Rights Reserved
Premium Rates
Manual Rating Experience Rating Blended Rating
Insurer uses its own past experience to calculate the group’s premium rates
Insurer considers the group’s prior claim experience to calculate the group’s premium rates
RETURN TO MAIN MENU
Insurer uses both manual rating and experience rating to calculate the group’s premium rates