Group Term Life Insurance AD&D Disability Income Insurance Dental Insurance

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GAHU Group Insurance 101. Group Term Life Insurance AD&D Disability Income Insurance Dental Insurance Voluntary Disability, Life and Dental Presented by: Todd Boyd, MBA – Atlanta Sales Manager Venessa Collins- Dental Network Manager Assurant Employee Benefits May 24, 2006. - PowerPoint PPT Presentation

Transcript of Group Term Life Insurance AD&D Disability Income Insurance Dental Insurance

  • Group Term Life Insurance AD&D Disability Income Insurance Dental InsuranceVoluntary Disability, Life and DentalPresented by: Todd Boyd, MBA Atlanta Sales ManagerVenessa Collins- Dental Network ManagerAssurant Employee BenefitsMay 24, 2006 GAHU Group Insurance 101

  • The information provided in this presentation are examples of options available in the industry. Plan designs and options vary by carrier.


  • SchedulesTimes earnings plan 1x or 2x earnings most commonFlat Amount plan $10,000, $25,000, $50,000 most commonMaximums range from $150,000 - $ 500,000Can vary by classes of employee within groups, e.g. Officers and Managers receive 2x earnings to a max of $ 200,000, and all other employees receive a flat $25,000.

  • Non-medical maximum limitsNon-Contributory GroupsContributory GroupsGI amounts may vary for employees older than age 70

  • Participation RequirementsContributory (Partially Employee Paid) CoveragesUsually 75% or higher - many states require at least 75%Non-contributory (Employer Paid) Coverages100% participation required

  • BeneficiariesEmployee can name anyone as a beneficiary, other than the employerIf a beneficiary is not designated by employee, proceeds may be payable at the insurers option to surviving relatives, or to the executor or administrator of the deceaseds estate.

  • Limitations and ExclusionsLife Policies and AD & D policies may have separate sets of limitations and exclusionsCommon items not payable: Suicide - for contributory plansWarCommission of a felonyDeath resulting from intoxication or unprescribed drug use

  • Waiver of Premium Many carriers will waive the premium for the group term life insurance if an insured is disabled from any gainful occupation - some offer an own occupation definition as wellDuration of disability waiver can vary, from 1 or 3 years, to age 65.Can also be integrated with LTD coverage - waiver automatically approved if approved for LTD benefits (with same carrier)

  • Provides an additional benefit if the death results from an injury within a particular time frame - usually 180 days to 1 year. Benefit is normally the same as the life insurance benefit - allowing for a double payment if the death occurs from an injury Accidental Death & Dismemberment

  • AD & D Additional BenefitsAutomobile Accident rider (Seat Belt required)Higher Education benefitRepatriationTravel Assistance

  • Employee Paid Plan OptionsSupplemental Life (Optional Life)Employee is able to purchase amount over and above coverage provided by employerStand Alone Voluntary CoverageOptional coverage purchased by employeeEmployer provides opportunity to purchase and plan administration

  • Additional OptionsSurvivor Financial CounselingAccelerated Death BenefitConversionInterest bearing account for benefit proceedsWaiver of premium on AD & D


  • Probability of DisabilityA 30-year-old female has a 56.6% chance of becoming disabled before age 65 compared to only a 16.2% chance of dying.Guardian Life Study, quoted in Disability Income Insurance, Conning and Company Report, 2002

  • Probability of Disability1 in 7 people will become disabled for five years or more before they reach age 6511 in 88 people will use homeowners insurance11 in 47 people will use auto insurance118.7% of the working-age population (age 18-64) report a disability21Disability Management Source Book, 199922000 Bureau of Labor Statistics

  • Definitions of Disability OR Dual DefinitionOccupation TestEarnings TestAND/Maximum Capacity Definition

  • Definitions of Disability (cont.)Occupation TestMaterial DutiesOwn OccupationAny Gainful OccupationRegular Job DefinitionEarnings Test Flat amount, i.e. 7.5%Lesser of flat amount or CPI-W (10% or 3%)

  • Waiting PeriodTime period claimant must be disabled before they are eligible to receive benefitsOther names are: elimination period, qualifying periodCommon waiting periods are:1 month90 days180 days

  • Benefit SchedulesBenefit Rates (% of pre-disability earnings)50%60% (most common)66 2/3%70% (very rare)Benefit Maximums$ 6,000$ 5,000$ 10,000

  • Maximum Benefit DurationTo SSNRA (Social Security Normal Retirement Age)To Age 655 year 2 year

  • Pre-Existing Condition Limitation3/12 or 6/24prudent person languagetreatment-free period - 3/3/12 or 6/6/24

  • Indexing of Earnings Test7.5%Lesser of 10% or CPI-WLesser of 3% or CPI-WNo Indexing

  • Return-to-Work Earnings100% return-to-work offset (usually for 12 months)Indexed benefit - adjusted loss of salary ratio calculation 50% direct offset 70% indirect or All Sources offset

  • Offset with Social SecurityFull Family DirectFull Family Monthly Payment LimitPrimary Direct OnlyPrimary + 1/2 Dependent

  • Value OptionsCost of living adjustmentActivities of daily living benefitRetirement savings benefit or pension supplementMedical premium payment supplementCritical illness Employee Assistance Program

  • Cost Containment Features Managed rehabilitation programLimitations for certain diagnoses, ex. certain mental impairments, conditions with extremely subjective symptoms, etc.


  • Why offer Short Term Disability?Provide income for employees suffering short duration illnesses or injuries to recover and return to work with the policyholderCan increase employee satisfactionAssist in retaining valuable employees

  • Types of STD PlansSalary continuation (sick leave) plansSelf insured with advice to pay servicesFully insuredNon-occupational only, or integrated with workers comp

  • Benefit SchedulesBenefit rates50%60%66 2/3%Benefit maximums (weekly)$ 500$ 1000$ 1352 (similar to $ 6000 LTD monthly max)

  • Waiting Periods and Benefit DurationsWaiting periods1 day accident/7 day sickness1 d hospital, 7 d accident, 15 d sickness30 day accident/sicknessBenefit durations13 weeks26 weeksUsually matches LTD waiting period if group has both coverages

  • Group Dental Insurance GAHU Group Insurance 101

  • Working Americans are absent some 32 million days every year and children miss an estimated 52 million hours of school annually due to dental emergencies.Source: American Dental Association The Problem

  • Did you know...One of out every two people in the United States has some form of periodontal (gum) disease?1Growing evidence indicates that the presence of gum disease can be linked to coronary heart disease and strokes?2Oral cancer now accounts for 3% of all cancer deaths in the US - a number which exceeds that of melanoma and cervical cancer70.1 Billion dollars spent on dental services in 2002 (31.0B on Stroke and 61.2B Coronary Heart Disease)Source: 1 Web MD Health2 Mouth Body Connection, 20013American Heart Association. Heart Disease and Stroke Statistics2003 Update. Dallas, Tex.: American Heart Association; 2002.

  • Employees Want Dental Coverage !

  • Common Procedures,Plan Designs, and Options

  • Deductibles, MaximumsDeductible $0, $25, $50, $75Per Individual or Family max of 3 X $150Applies to all Type II and III ProceduresMay Waive or Combined on Type I Procedures

    Annual Maximums$750, $1000, $1500, $2000Some states may vary between in and out of networkOrtho is usually a lifetime max

  • Most Common Preventive Services100% Coinsurance Level100% Coverage encourages good dental healthOral Examinations Complete intraoral x-rays/Panoramic film4 Bitewing x-raysRoutine CleaningsFluoride Treatment Sealants

  • Most Common Basic Services80% Coinsurance LevelReturns tooth to natural functionEmergency oral examIntraoral Periapical x-raysAmalgam and composite restorationsPeriodontal including Periodontal maintenance EndodonticsSimple ExtractionsOral Surgery

  • Most Common Major Services50% Coinsurance LevelHigh Dollar Lower Utilized ProceduresCrowns, Inlays and OnlaysFull and partial denturesFixed bridgesDenture adjustmentsNon-surgical TMJ Stainless steel crownsGeneral anesthesia and IV sedationSpace maintainers

  • Dental Plan DifferentiatorsNon Surgical TMJ More than 15% of all Americans Suffer from chronic facial pain-ADAImplantsPlacements of Implants increased 49% in a 5 year period from 1995 to 2000-ADAPlan StabilityStable Dental plans should avg.. trend or less increases (especially Voluntary)

  • Endo/Perio/Oral Surgery must be in basic! 90% of all dental procedures rendered fall in Preventive or Basic Services.1 About 4% of submitted claims are Endo, Perio, Oral Surgery

    $1000 dollar maximum is not enough 5.8% of Employees met their maximum of $1000 in 200313.2% employees met their maximum of $15001 Increasing the Max increases the rate 3 to 7 %Dental Plan Myths

  • Whats in a PPO?National network

    Discounts on non-covered services

    Freedom to choose any provider

    At least 25% overall claims savings

    Can you Identify Active, Passive, and MAC Plans?

    No Charge Services

  • What is Prepaid Dental All About?No waiting periods

    No deductibles for routine services

    No referral required

    Each family member may choose a different plan dentist

    No claims to file

    Covers pre-existing conditions

  • InsuranceCompanyReimbursementClaim FormsCo-Insurance &Balance BillingInsuredPremiumsDental Insurance

  • PREPAID DENTAL PLANSPrepaid DentalCapitationClaim FormsCopaymentsSubscriberPremiumsPrepaid Dental Plans

  • What is prepaid Dental all about?Shared Risk partnership with