Contract Provisions, Definitions, and Benefits

Question 1

Accelerated Life Benefit

(ALB)

Answer 1

A provision in a group life policy that allows pre-payment of a portion of an employee’s life benefit upon proof of a terminal illness in which the insured is expected to die within 12 months. AUL provisions allows for an employee to select 25%, 50%, or 75% of the death benefit.

Question 2

Accumulated Sick Leave

Answer 2

The number of sick leave days accrued by an employee at a given point in time. Usually used in conjunction with the elimination period of the policy.

Question 3

Actively at Work

Answer 3

Defines the requirement that an employee must be at work on their effective date of coverage and on the effective date of any change in coverage. OneAmerica considers an employee actively at work if they are out due to:
* Regularly schedule day off
* Holiday
* Vacation Day
* Jury Duty
* Funeral Leave
* Personal time off
If the employee is off for any of the above and physically able to work, they will be considered actively at work. The employee must have worked the day immediately prior to their absence to be considered actively at work.

Question 4

Air Bag Benefit

Answer 4

An optional Accidental Death Benefit will pay an additional benefit if the insured dies due to a non-occupational vehicle accident while wearing a properly installed airbag.

Question 5

Annual Base Salary

(ABS)

Answer 5

A definition of earnings that means the fixed amount of money paid to an employee by their employer in return for work performed. It does not include benefits, commissions, bonuses, tips, or any other means of compensation. This may also sometimes be called Basic Annual Earnings (BAE).

Question 6

Annual Enrollment

Answer 6

A scheduled period before each policy anniversary date, which allows employees to enroll for coverage under the policy.

Question 7

Any Occupation

Answer 7

Defined as being able to perform the duties or any other occupation for which a person is fitted.

Question 8

Benefit Amount

Answer 8

This is the amount an insured would receive if they were approved for a claim.

Question 9

Continuity of Coverage

Answer 9

A provision used in take-over cases when an employee is disabled but not eligible for Waiver of Premium. This covers employees who are not eligible for insurance because the employee is not actively at work.

Question 10

Contract

Answer 10

A legal agreement between the Employer (also known as the Policyholder or Group) and the insurance company which outlines what coverage will be extended to eligible employees and under what conditions. Can be one or all of the following: Application/Subscription Agreement, Certificate, or Policy.

Question 11

Conversion

Answer 11

A provision in the insurance policy that allows individuals who through termination are no longer eligible for coverage under the group policy, to convert to an individual plan of insurance without providing evidence of insurability.

Question 12

Date of Disability

Answer 12

The date a person becomes disabled and the elimination period begins.

Question 13

Dependent Child

Answer 13

A child born to the Employee, adopted by Employee, a stepchild living with Employee, whom the Employee has legal guardianship, or whom the Employee must provide insurance in accordance with court order.

Question 14

Dependent Spouse

Answer 14

Legal spouse, Domestic Partner, Common Law, or Civil Union (for New Jersey groups only).

Question 15

Effective Date

Answer 15

The date that a coverage is in-force or employee is covered under the group contract.

Question 16

Elimination Period

Answer 16

The time period which employee must be off work before wavier of premiums benefits are available.

Question 17

Employee

(EE)

Answer 17

A person employed by a company. For purposes of a group insurance contract, there must be an established employer/employee relationship in order for a person to be eligible for benefits.

Question 18

Employee Name

Answer 18

The name of the Insured under the group contract.

Question 19

Employer

(ER)

Answer 19

Also known as the Group or Policyholder. The insurance company has a contract with the employer, not with the employee. The employer offers insurance coverage to employees.

Question 20

Evidence of Insurability

(EOI)

Answer 20

When any employee must provide proof that they are insurable because they are a late enrollee or they are requested over the Guaranteed Issue Amount.

Question 21

Flat Amount

Answer 21

Means the benefit amount is not based on salary. It’s either a true flat amount (one for everyone) or an incremental amount.

Question 22

Full-Time Hours

Answer 22

The minimum number of hours an employee must work in a week in order to receive benefits. This is determined by each Policyholder for each coverage.

Question 23

Function of Salary

Answer 23

This is when a plan design is based on an employee’s salary.

Question 24

Guaranteed Increase in Benefit

(GIB)

Answer 24

This benefit allows an employee to increase their coverage on the Policyholder’s anniversary typically by either 10% of their current volume or $10K whichever is greater. This benefit is not allowed for anyone who has been declined for coverage or has had an Accelerated Life Benefit claim paid.

Question 25

Guaranteed Issue Amount

(GI)

Answer 25

The maximum amount of coverage available to an employee without having to supply Evidence of Insurability (EOI).

Question 26

Last Day Worked

Answer 26

The last day an employee was actively and physically at work. This is used in determining things such as when coverage terminates, and in determining eligibility for benefits such as claims, continuation, portability, and conversion.

Question 27

Late Enrollee

Answer 27

An employee who did not elect coverage during the initial enrollment period.

Question 28

Life Event Benefit

(LEB)

Answer 28

A change in your situation (e.g. marriage, child birth, etc.) that can make you eligible for a Special Enrollment Period, allowing you to enroll in insurance outside the yearly Open Enrollment Period.

Question 29

Modified Open Enrollment

(MOE)

Answer 29

A period of time each the year when all new employees will be effective or existing employees apply for coverage if they are late enrollees.

Question 30

New Employee

Answer 30

An employee hired on or after the Policyholder or coverage effective date.

Question 31

Own Occupation

Answer 31

Defined as being able to perform all the material duties of one’s own occupation on a full-time basis for selected number of years.

Question 32

Portability

Answer 32

A privilege that allows employees to take the coverage with them upon the termination of employment.

Question 33

Present Employee

Answer 33

An employee hired before the Policyholder or coverage effective date.

Question 34

Reduction Schedule

Answer 34

A schedule indicating when an employee’s coverage will reduce due to age and by how much.

Question 35

Regular Occupation

Answer 35

In this definition of disability, a person is considered disabled if they are unable to perform the “material and substantial duties” of their regular job, even if they can perform other jobs.

Question 36

Schedule of Benefits Page

Answer 36

This is a summary of benefits that appears after the table of contents of each certificate and policy. A policy contains all Schedule of benefits page for all classes for a particular coverage.

Question 37

Scheduled Enrollment Period

Answer 37

A period of time each year when employees can change their coverage or apply for coverage if they are late enrollees.

Question 38

Survivor Benefit

Answer 38

AUL will pay a lump sum benefit to the Eligible Survivor when proof acceptable to AUL is received that the Person died:
1. after Disability had continued for 180 or more consecutive days; and
2. while a Person was receiving a Monthly Benefit

Question 39

Volume

Answer 39

The amount which premium is based on also the amount of the life policy.

Question 40

Waiting Period

Answer 40

The period of time in which an employee must be working full-time before they become eligible for coverage.

Question 41

Waiver of Premium

(WOP)

Answer 41

When an employee is disabled or on medical leave, they can have their premium waived while they are not actively working as long as they fulfill certain criteria.