Chapter 11 Flashcards
a group insurance plan that insures a number of people such as a group of employees, under a single insurance contract, is called a
master group insurance contract
what term is typically used to represent the owner of a group insurance contract?
policyholder
- because the holder does not have the same ownership rights as a policyowner of individual insurance.
- rights are granted to insured group members
what is the term given to the individuals coered by a group insurance policy?
group insured. or grouped life insured (canada)
what do you call a person who is insured under a group health insurance policy in Canada
group person insured.
name some responsibilities of a group policy holder
- enrolling new group members
2. making premium payments
what kind of plan is it when a the insured group members are not required to pay any part of the insurance group premium?
noncontributory plan
what kind of plan is it when an insured group member must pay part or all of the premium for their coverage
contributory plan
- usually requires covered employees to pay their portions of the premium through payroll deductions
what 4 characteristics must by held by the group policyholder and the insurer to form a valid group insurance contract? [rules of contract law]
- mutually agree to the contracts terms
- both have contractual capacity
- exchange legally adequate consideration
- form the contract for lawful purposes.
how is the formation of the contract for lawful purposes structured differently for group over individual insurance?
- group insurance contract dos not induce wagering over a life (individual require that the insured is of insurable interrest to applicant)
- this is met for group because policyholder enters into the contract to provide a benefit to covered group members.
the group insureds are not parties to a master group insurance contract, therefor they do not recieve what (contract wise)
- they do not participate in the formation of contract
- dont receive opies of contract
- are provided with written descriptions of group plan
a certificate of insurance is the written description handed to members of the group plan. What does it describe?
- the coverage that the contract provides
2. the rights they have under the contract
what is a typical term given to an insured group member (referred to as…)
certificate holder.
Many group insurance policies impose requirements, such as classes (salary, occupation, length of employment) and eligibility provisions. Name (dont define) the two most common eligibility provisions?
- actively-at-work provision
2. probationary period
deifne the actively-at work provision
states, that to be covered, you must be an employee actively at work- rather than ill or on leave, when the coverage is to take effect.
define the probationary period
the length of time- before a new group member can become eligible to enroll in the group insurance plan.