group insurance: life and disability benefits. a. characteristics of group insurance u definition:...
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Group Insurance: Life and Disability Benefits
A. Characteristics of Group Insurance
Definition: an arrangement under which employer makes benefits payable to employees
Examples of benefits: medical, life, disability benefits
A. Group contract: the employer is the policyholder and employees are issued certificates
B. Group underwriting:
minimize adverse selection
reduce administrative costs
Factors used in group underwriting
insurance incidental
stability
persistency
determination of benefits
premium payments
administration
prior experience
size
composition
industry
geographic location
C. State Regulation
1. McCarran-Ferguson Act 2. Eligible groups
individual employer
trade associations
labor union groups
3. Contractual provisions
uniformity among states
common provisions
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
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
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
II. Group Life Insurance: Term Coverage
A. Most common form is yearly renewable group term
B. Rates increase with age
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
Covered classification Full-time Actively at work Probationary periods Insurability Premium contributions Beneficiary designations
Settlement options Premiums Claims Grace period Misstatement of age Termination
Disabled employees Conversion within 31 days Accelerated benefits
Added Coverage 1. Supplemental life insurance 2. Accidental death and dismemberment
insurance
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
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
2. ADD
3. Dependent life insurance: contributions not taxable to employees
proceeds includible in dependent’s estate
B. LIFETIME COVERAGE
How to provide for postretirement coverage?
Current funding to continue term insurance
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
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
General Nature
1. Flexible premium
2. Charge made each month to purchase term coverage
3. Cash value = premiums + interest - mortality and expense charges
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
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
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
Types of Plans A. Short term B. Long-term C. Coordination between the two
A. Salary Continuation Plans Uninsured Eligibility: full time, satisfy a probationary
period Benefits: 100% of salary, duration: certain
number of days
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
Definition of disability
1. Short-term plans
2. Long-term plans Benefits
1. Short-term plans: flat amount or a % of salary
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
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
Group Long-Term Care Insurance
A. Reasons for coverage– Aging population– Increasing costs– Inadequate benefits under Medicare– Inability of families to provide care
B. Sources of long-term care– Personal savings– Public assistance– Life-care facilities– Riders in cash value policies– Individual LTC– Group policies
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
D. Group coverage– Eligibility requirements– Cost– Levels of care
» Skilled nursing care» Intermediate » Custodial care» Home health care» Adult day care
– 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