A&S: Group Plans Flashcards
Group Plan specifics
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Group plans: DIff types of groups
- employers
- trade associations
- creditrs (i.e mortgage life ins)
Group plans: Group Make up
insurers asses overall risk of GROUP by analyzing:
- Avg age
- older group = higher premium
- Gneder: women pay less for life ins but more for disability
- nature of biz: i.e contructions workers pay more
- comaprable businesses : looks at claims from other similar groups and uses data to assess this one
- turnover rate: past claims statistics
Group Plans pricing: Initial and renewal premiums for group plans (3 MEB)
3 main methods:
- Manual Method
- experience Method
- Blended Method
Group Plans (pricing): Manual method (pooled pricing)
- Prmeium for 1 group based on claims experience from another (similar) group
Group Plans (pricing) : CLAIMS EXPERIENCE METHOD
- usues groups claims experience from prior years to set renewal premiums
- rarely used
Group plans (Pricing): Blended Method
- combination of manual and claims experience method
- How much of each is blended depends on on the reliability of the claims statistics (i.e a small group stats not as reliable)
Group Plans: Refund accounting (for the group)
if claims lower than expected == refunds part of premium to employer
claims higher == factored in to next renewal date
Group Plans: Non Refund Accounting (For the Group)
if claims are lower, NO REFUND , ins co keeps all
claims higher == factored in to next renewal date
Group Plans: Contributory plans (for the individual)
member (employee) must contribute to the premium
Group Plans: Non contributory plans (For the individual)
member (employee) does NOT have to contribute to the premium (employee pays all)
all qualified employees REQUIRED to join
Group Plans: Administrative Services Only (ASO)
- lowers costs for VERY large companies (self insure)
- company pays ins claims for employee deaths/ claims themselves
- insurance co provides admin services only—>
Group Plans: Typical forms of coverage (DEEL)
- Disability Insurance
- Extended health care Benefits
- Employee Assistance programs (EAP)
- Life Insurance
Group Plans: Employee Assistance Programs (EAP)
- when employees have personal probelms impacting work
i. e depression, alcoholism, etc….
offers professional counselling
Group Plans: Pre existing conditions
contract will have clause such as :