Group Insurance: Life and Disability Benefits

1. Group Insurance: Life and Disability Benefits

2. A. Characteristics of Group Insurance • Definition: an arrangement under which employer makes benefits payable to employees • Examples of benefits: medical, life, disability benefits

3. A. Group contract: the employer is the policyholder and employees are issued certificates • B. Group underwriting: minimize adverse selection reduce administrative costs

4. Factors used in group underwriting insurance incidental stability persistency determination of benefits premium payments administration

5. prior experience size composition industry geographic location

6. C. State Regulation • 1. McCarran-Ferguson Act • 2. Eligible groups individual employer trade associations labor union groups

7. 3. Contractual provisions uniformity among states common provisions

8. Federal Regulation 1. Age Discrimination in Employment Act • Prohibits discrimination against workers age >= 40 • Applies to employers with >= 20 employees • Group benefits, except for medical, can be reduced for older employees

9. 2. Civil Rights Act • Applies to employers with 15 or more • Requires pregnancy to be treated like any other condition • Pregnancy benefits excluded for dependents • Abortions can be excluded unless life threatening

10. 3.Americans with Disabilities Act • Applies to employers with 15 or more • Disabled persons cannot be denied employment • Disabled persons must be provided the same medical coverage as other employees • Allows certain coverage limitations

11. II. Group Life Insurance: Term Coverage • A. Most common form is yearly renewable group term • B. Rates increase with age

12. Contract Provisions • 1. Uniform • 2. Variations due to states rules, company practices and negotiations • 3. Benefit schedules: benefits depend on earnings and position • 4. Eligibility requirements

13. Covered classification • Full-time • Actively at work • Probationary periods • Insurability • Premium contributions • Beneficiary designations

14. Settlement options • Premiums • Claims • Grace period • Misstatement of age • Termination

15. Disabled employees • Conversion within 31 days • Accelerated benefits

16. Added Coverage • 1. Supplemental life insurance • 2. Accidental death and dismemberment insurance

17. Federal Taxation • Deductibility of premiums Employer contributions are tax deductible as a business expense Employee contributions are not tax deductible Favorable tax treatment for plans that qualify under section 79

18. Taxation of proceeds 1. free of income taxation 2. includible in gross estate if incidence of ownership exists at time of death Added coverage 1. Supplemental life insurance treated like additional group term

19. 2. ADD 3. Dependent life insurance: contributions not taxable to employees proceeds includible in dependent’s estate

20. B. LIFETIME COVERAGE • How to provide for postretirement coverage? • Current funding to continue term insurance

21. Group Universal Life Insurance • Reasons for Growth 1. Success in individual market 2. Taxation of death benefits in excess of $50,000 3. Employer desire to contain costs

22. Advantages to employer 1. Little direct cost 2. No ERISA requirements 3. Less pressure to provide postretirement coverage • Advantages to employees 1. Opportunity for postretirement coverage 2. Flexibility in designing coverage

23. General Nature 1. Flexible premium 2. Charge made each month to purchase term coverage 3. Cash value = premiums + interest - mortality and expense charges

24. Features of GULP 1. Death benefits: Option A or Option B 2. Mortality charges: guaranteed for 3 years and group experience rated after 3 years 3. Expense charges: % of premiums + monthly flat charge 4. Interest rate

25. 5. Premium adjustments: or 6. Loans and withdrawals are permitted 7. Dependent coverage is available 8. Accidental death and waiver of premium 9. Options at retirement or termination 10. Taxation

26. III. Group Disability Income Insurance • Purpose: to replace lost income as a result of sickness or accident. Significance: Risk of disability is greater than the risk of premature death Impact is more severe than death

27. Types of Plans • A. Short term • B. Long-term • C. Coordination between the two

28. A. Salary Continuation Plans • Uninsured • Eligibility: full time, satisfy a probationary period • Benefits: 100% of salary, duration: certain number of days

29. B. Disability Insurance • Eligibility: full time, actively at wok, probationary period 1. Short term plans 2. Long-term plans 3. Elimination period: a. short-term plans b. long-term plans

30. Definition of disability 1. Short-term plans 2. Long-term plans • Benefits 1. Short-term plans: flat amount or a % of salary

31. 2. Long-term plans: occupational and nono-ccupational disabilities, benefit amount a % of salary • Other contract provisions: 1. Claims 2. Payment of benefits 3. Rehabilitation

32. D. Federal Taxation • 1. Employer contributions tax deductible • 2. Employee contribution not tax deductible • 3. Employer contributions are not considered taxable income to employees • 4. Benefits: fully contributory: not taxable Noncontributory: taxable income

33. Group Long-Term Care Insurance • A. Reasons for coverage • Aging population • Increasing costs • Inadequate benefits under Medicare • Inability of families to provide care

34. B. Sources of long-term care • Personal savings • Public assistance • Life-care facilities • Riders in cash value policies • Individual LTC • Group policies

35. C. Effects of HIPAA • Favorable tax treatment to qualified long-term care insurance • Requirements for qualified policy • covers qualified long-term care services • expenses covered under Medicare are not paid • guaranteed renewable • no cash value • refunds of premiums and dividends must be applied to reduction in premiums

36. D. Group coverage • Eligibility requirements • Cost • Levels of care • Skilled nursing care • Intermediate • Custodial care • Home health care • Adult day care

37. Benefits • Inability to perform certain ADL • Cognitive impairment • Benefits limited to a specified $ amount • Benefits may be indexed to inflation • Duration 3 to 6 years • Exclusions • care outside U.S • Attempted suicide • Alcohol and drug treatment