A&S: Group Plans Flashcards

1
Q

Group Plan specifics

A

???

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2
Q

Group plans: DIff types of groups

A
  • employers
  • trade associations
  • creditrs (i.e mortgage life ins)
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3
Q

Group plans: Group Make up

A

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
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4
Q

Group Plans pricing: Initial and renewal premiums for group plans (3 MEB)

A

3 main methods:

  1. Manual Method
  2. experience Method
  3. Blended Method
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5
Q

Group Plans (pricing): Manual method (pooled pricing)

A
  • Prmeium for 1 group based on claims experience from another (similar) group
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6
Q

Group Plans (pricing) : CLAIMS EXPERIENCE METHOD

A
  • usues groups claims experience from prior years to set renewal premiums
  • rarely used
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7
Q

Group plans (Pricing): Blended Method

A
  • 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)
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8
Q

Group Plans: Refund accounting (for the group)

A

if claims lower than expected == refunds part of premium to employer

claims higher == factored in to next renewal date

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9
Q

Group Plans: Non Refund Accounting (For the Group)

A

if claims are lower, NO REFUND , ins co keeps all

claims higher == factored in to next renewal date

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10
Q

Group Plans: Contributory plans (for the individual)

A

member (employee) must contribute to the premium

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11
Q

Group Plans: Non contributory plans (For the individual)

A

member (employee) does NOT have to contribute to the premium (employee pays all)

all qualified employees REQUIRED to join

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12
Q

Group Plans: Administrative Services Only (ASO)

A
  • lowers costs for VERY large companies (self insure)
  • company pays ins claims for employee deaths/ claims themselves
  • insurance co provides admin services only—>
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13
Q

Group Plans: Typical forms of coverage (DEEL)

A
  • Disability Insurance
  • Extended health care Benefits
  • Employee Assistance programs (EAP)
  • Life Insurance
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14
Q

Group Plans: Employee Assistance Programs (EAP)

A
  • when employees have personal probelms impacting work
    i. e depression, alcoholism, etc….

offers professional counselling

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15
Q

Group Plans: Pre existing conditions

A

contract will have clause such as :

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16
Q

coordination of benefits (COB)/ COB clause

A
  • when have more than 1 ins co that can pay, clause determines which pays 1st and who pays 2nd
  • 1st paying ins co pays whatever insured entitled to
  • 2nd pays lesser of: what they woud have paid if they were only insurer
    vs
    the unpaid amount
17
Q

COB: how is 1st payer determined

A

ADULT: plan covered as member (empoyee) pays 1st

CHILD: plan of parent w earlier bday in year (not birth year/age), pays 1st.

18
Q

COB: Calculating benefit pmt

A

claim: $800

1st payer: $800-100 deductible= 700 x 80% co ins= $420

2nd payer: $800-100 deductible= 700 x 90% co ins= $630
or
unpaid amount: 800- $420 paid by 1st ins = $380