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See Flexible Benefit Program.
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Used in major medical to describe the operation of deductibles and/or benefits limits. In other words, a deductible may apply once within a calendar period and the maximum benefit payable may be described in terms of a given sum within a particular calendar year.
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A federal government sponsored plan providing a death benefit and retirement/survivor/disability pensions. This is a contributory, earnings related supplementary plan.
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The insuring insurance company.
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Because each group is underwritten and rated on the basis of the people who make up the group, a rather complete census must be made. Most insurance companies have specific “census forms” with pertinent information concerning all employees to be enrolled in the group plan.
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A document delivered to an individual summarizing the benefits and principal provisions of the group contract under which the person is insured.
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A demand by an insured person for the benefits provided by the group contract.
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Refers to classes of coverage. Generally, life insurance and weekly indemnity are offered on a class basis, with larger benefits for highly paid workers and lesser benefits for other employees.
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Not all health or dental charges are necessarily reimbursed at 100%.
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As group life insurance limits grow, more individual life insurance factors come into play. One of these is the provision for common disaster, which stipulates that the insured is deemed to have survived the spouse beneficiary if the spouse beneficiary does not survive a specified time period.
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Refers to the practice of grouping all insured groups in a given area for experience purposes, thus basing the costs on the general experience and level of costs in the area. It is rarely used in group insurance and is generally associated with prepayment plans. Insurance carriers rate by individual case experience or, where small risks are involved, by pools that are not geographical in nature.
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When different rates are combined to arrive at an average, the result is termed a “composite rate”. A good example is the dependent rate which makes no distinction between workers who have one child or a dozen.
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A person or firm hired by an employer, usually on a fee basis, to design, install and/or service employee benefit plans.
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Group plans use “contributory” to designate situations in which the insured pays part of the premium. The alternative is “non-contributory”, meaning employer-pays-all.
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This refers to care in an extended-care facility, as opposed to care in a general hospital.
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Group life laws generally require that benefits lost on termination of employment be “converted” into individual life insurance, without evidence of good health.
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Where both a worker and spouse are covered by different plans, coordination language permits full recovery between the two carriers involved, but eliminates full reimbursement by either carrier.
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The weight given to your claims experience in determining your renewal rates.
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Creditor group life is a form of group life insurance used primarily to insure the unpaid balance of instalment purchases, such as mortgages, appliances or automobiles Variations might include accumulation plans such as mutual funds. Some carriers offer disability income creditor group insurance as well.
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A cutback is a reduction in the life insurance benefit. This device is used to keep life insurance rates from zooming out of sight, especially when there is substantial coverage on older and retired workers, recognizing that for most people aged 65 and 70, the critical life insurance needs no longer exists.
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