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Group Benefits
Group Health Insurance
Group Health Insurance is defined as coverage underwritten on members of a natural group, such as employees of a particular business, union, association, or employer group. In most cases each employee is entitled to benefits for hospital room and board, surgeon and physician fees, and miscellaneous medical expenses. Usually there is a deductible and a Coinsurance requirement each employee must pay. Characteristics of group health insurance include
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1. True Group Plan-one in which all employees must be accepted for coverage regardless of physical condition. (For example, coverage cannot be denied because of a pre-existing condition such as cancer.) Usually an employee must apply and pay the first premium within the first 30 days of employment or he or she forfeits the right to automatic coverage (a form of Guaranteed Insurability). Individuals are covered under a Master Contract each receiving a certificate denoting coverage.
2. Schedule of Benefits-describes what the insured and his or her covered dependent(s) is entitled to in the event of disease, illness, or injury. After the insured or the covered dependent has satisfied the Deductible (defined as the first portion of all of the eligible expenses that occur during a calendar year of coverage), the insurance company pays a given percentage (usually 80%) until a total sum (stop loss), usually $5000, is reached for the calendar year. After the total sum has been reached, the insurance company pays 100% of the total eligible expenses until the end of the calendar year subject to a maximum lifetime amount. See also Dependent.
3. Eligible Expenses-include hospital bills, surgery, doctor's services, private nursing, medicines, and X-rays. Payment allowed for these and other expenses are spelled out in the policy. For example, the hospital's daily charge for room and board is subject to a specified maximum.
4.Exclusions from Provisions of Medical Benefits-many exclusions occur in group health plans, including benefits under Workers Compensation; certain mouth conditions; convalescent or rest cures; expenses incurred by a member of a Health Maintenance Organization (HMO) or other prepaid medical plan; expenses associated with intentional self-inflicted injuries or attempt at suicide.
5. Coordination of benefits-when there are two or more group health insurance plans covering the insured, one plan becomes the Primary Plan and the other plan(s) becomes the Secondary Plan(s). The Primary Plan is required to pay benefits due the insured and/or covered dependents before any other plan pays benefits. When a claim is made, the primary plan must pay the claim without regard to the benefits provided under any other plan. The secondary plan pays the difference between the total claim amount and the amount that the primary plan has paid, up to total allowable expenses.
Group Life Insurance
Group life insurance is defined as life insurance available through an employer or association that covers participating employees and members under one master insurance policy. Most group life insurance policies are term insurance policies that terminate when the member or employee reaches a certain age or leaves the organization and do not accumulate any cash surrender value. You will find some common types of life insurance and definitions on this page that may be available to you as an employer. Please call, click or complete the attached form for a free quote
Term life insurance No-frills life insurance, with neither cash surrender value nor loan value (an amount that can be used as collateral for a loan). Term life insurance provides a pre-set amount of coverage if the policyholder dies during the period of time specified in the policy. Policyholders usually have the option to renew at the end of the term for the period of years specified in the policy. Unlike whole life insurance, premiums generally increase as the insured person gets older and the risk of death increases.
Universal life insurance A type of whole life insurance that offers some additional features and advantages. Like whole life insurance, universal life insurance accumulates cash value through investment of the premium payments. The unique feature of universal life insurance is that it has variable premiums, benefits and payment schedules, all of which are tied to market interest rates and the performance of the investment portfolio. Also, universal life policies normally provide you with more consumer information. For example, you are told how much of your policy payments goes for insurance company overhead expenses, reserves and policy proceed payments, and how much is retained and invested for your savings. This information isn't usually provided with whole life policies.
Variable life insurance A type of whole life insurance in which the amount of death benefits varies, depending on the performance of investments. The insurance company places some or all of the fixed premium payments into an investment account; some companies let the insured person decide how the money is invested. The policyholder bears the risk of investment losses, though there is a guaranteed minimum benefit payment. One benefit of variable insurance is that interest and dividend income from the investment account is not taxed until it is paid out to the policyholder.
Variable universal life insurance A type of whole life insurance that provides greater potential for financial gain--and brings greater risks. Like universal life insurance, variable universal life insurance offers flexible premiums, payment schedules and benefits. But variable universal life policies are riskier because the premiums are invested in stocks, rather than more predictable money market accounts and bonds. Also called universal variable life insurance.
Whole life insurance Life insurance that provides coverage for the entire life of the policyholder, who pays the same fixed premium throughout his or her life. The policy builds up cash reserves that may be paid out to the policyholder when he or she surrenders or partially surrenders the policy or uses the cash reserves to fund low-interest loans. The annual increase in the cash value of the policy is not taxed. If the policyholder surrenders the policy, a portion of the payment is not taxable. Also called straight life insurance or ordinary life insurance
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