Group Term Life Insurance

Transcription

1 Group Term Life Insurance For groups with 2-50 employees For the state of Virginia Plan Design Rate basis Rate guarantee 2-14 employees: Age banded rates (Each employee s premium is based on the group s rate table, using five-year age bands.) employees: Composite rates (Each employee s premium is based on the group rate, regardless of age.) Two years Guaranteed issue Life insurance coverage is guaranteed for amounts up to $30,000 for 2-9 employees, $50,000 for employees and $100,000 for employees. Coverage is not guaranteed for late enrollees and those enrolling in coverage that exceeds the guaranteed issue amount. Completed medical questionnaires are required for those enrollees. Benefit payments AD&D Benefits may be based on: Flat dollar benefit amount from $10,000 to $250,000 1, 1.5, 2, 2.5,or 3 times salary to a maximum of $250,000 Please note: Both flat benefit amounts and salary based benefits cannot be offered within the same class. Accidental death and dismemberment (AD&D) pays an additional benefit, equal to the life insurance amount, if an employee suffers a qualified loss within 365 consecutive days after an accident. A portion of the benefit is paid for the loss of sight or limb, certain digits, hearing, speech and paralysis. The full benefit is paid for multiple losses or death from the same accident. The benefit for all losses cannot exceed 100 percent of the principal sum. Benefit reduction schedule The life and AD&D benefit amount payable to beneficiaries is reduced by 35 percent for employees age and by 50 percent for employees age 70 and above. Dependent life Retirement Employers may select from one of the following options, or they may elect to offer multiple options under a class based plan. (Spouse and child coverage may not exceed 50 percent of the employee s benefit amount.) $10,000 spouse and $5,000 dependent child $5,000 spouse and $2,500 dependent child $2,500 spouse and $1,000 dependent child $2,000 spouse and $1,000 dependent child All amounts of dependent coverage are guaranteed issue. Dependent coverage is available for children age 15 days to 19 years. (Benefits are not payable for children from birth to 14 days old.) Dependent child coverage terminates at the end of the calendar year in which the child attains age 19. Coverage can be extended to the end of the calendar year in which the child attains age 24 if the child is a full-time student enrolled in a state-accredited college, university, trade or secondary school. Dependent spouse coverage terminates on the first premium due date following the spouse s 70th birthday. All benefits terminate at retirement. FOR SALES AND BROKER USE ONLY Life and disability products are underwritten by Anthem Life Insurance Company. Independent licensee of the Blue Cross and Blue Shield Association.

2 Coverage Features Resource Advisor Waiver of premium This program gives employees and their families free and confidential access to work/life support resources, including visits with a licensed mental health professional for a qualifying disability or loss of a loved one, legal/financial consultations for loss of a loved one, 24/7 telephone counseling and referral services, and Web site resources. If an employee under age 60 is totally disabled, life insurance premiums are waived after the first six months of a disability. Waiver of premium ends at age 65 or at retirement, whichever occurs first. Accelerated death benefit Employees diagnosed with a terminal illness with less than 12 months to live may request up to 75 percent of their life benefit, up to $125,000. The life insurance amount is then reduced by the living benefit amount. Employees should consult a tax advisor before requesting benefits. Continuation of coverage If an employee s coverage ends due to a layoff or leave of absence, employees can continue their life, AD&D and dependent coverage for up to three months by paying the premiums. If coverage ends due to a disability, employees can continue all coverage for up to six months by paying the premiums. Conversion Seat belt benefit Air bag benefit Education benefit Repatriation benefit Employees and dependents, if applicable, may have the right to convert their group term life coverage to an individual whole life policy if coverage is terminated. An additional benefit equal to the lesser of 10 percent of the AD&D benefit amount or $15,000 is paid if an employee dies in a motor vehicle accident while wearing a seat belt. An additional benefit equal to the lesser of 10 percent of the AD&D benefit amount or $10,000 is paid if an employee dies in a motor vehicle accident and the employee was: wearing a seat belt; and the driver or passenger in a vehicle equipped with an air bag and the air bag was deployed in the accident. If an employee dies in an accident, an additional benefit equal to the lesser of 11/4 % or $3,500 of the AD&D benefit amount is paid per academic term to each dependent child that is currently enrolled at an accredited post-secondary institution. A dependent child who is in the 12th grade at the time of the employee s death and enrolls at an accredited post-secondary institution within one year from the employee s death will also qualify for an education benefit. The maximum benefit amount is $20,000 and the maximum benefit period is four years from the date of the first payment. If an employee dies in an accident at least 75 miles from home, Anthem Life will reimburse for preparation and transportation expenses, up to $5,000. Eligibility

3 Employer eligibility Employee eligibility To qualify, the group must cover two to 50 eligible employees. Some industries may be ineligible. Other restrictions may apply. Employees must work at least 30 hours per week to be eligible for coverage. Employees must be actively at work for coverage to become effective. Classes Up to three classes of employees may be established, with no more than 2.5 times difference in benefit amounts between classes. Classes may be based on salary, occupation or other employment-related factors to determine various amounts of coverage under the policy. Participation Employer contribution All eligible employees must participate when coverage is non-contributory (entirely employer-paid), and 75 percent of eligible employees must participate when employee contribution is required. The minimum employer contribution for life insurance coverage (not including dependent coverage) is 25 percent for contributory plans and 100 percent for non-contributory plans. This product description is intended to be a brief outline of benefits available. It does not include all terms of coverage offered by Anthem Life. The entire terms are contained in the contract documents (the applicable certificate, policy and/or trust agreement). In the event of conflict between the contract documents and this product description, the contract documents will prevail. Products may vary and may not be available in all states. This information describes Anthem Life s standard programs. Exclusions and limitations are listed in the brochure for this product. Life and disability products are underwritten by Anthem Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks Blue Cross and Blue Shield Association. AL-2095 (10/07)

4 Group Short Term Disability For groups with 2-50 employees For the state of Virginia Plan Design Rate basis Rate guarantee Guaranteed issue Benefit payments Plan-design options Maximum benefit duration Definition of disability Benefit calculation 2-14 employees: Age banded rates (Each employee s premium is based on the group s rate table, using five-year age bands.) employees: Composite rates (Each employee s premium is based on the group rate, regardless of age.) Two years A $500 weekly benefit is guaranteed for groups with two to five employees. All amounts of coverage are guaranteed for groups with six to 50 employees. Coverage is not guaranteed for late enrollees and those enrolling in coverage that exceeds the guaranteed issue amount. Completed medical questionnaires are required for those enrollees. Benefits can be 60% or 67 % of the employee s weekly earnings, up to $1,350 per week, although a lower maximum may be set by underwriting. A flat benefit amount of either $200 or $250 per week is also available. The following options are available to determine when employees may start receiving benefits, including: The first day for a disability caused by an accident and the eighth day for a disability caused by an illness. The eighth day for a disability caused by an accident or illness. The 15th day for a disability caused by an accident or illness. Note: First-day hospital coverage is not available. Benefits may last for 13 or 26 weeks. Due to illness or injury, the employee is unable to perform all material and substantial duties of his or her regular occupation, is receiving regular care from a physician for the injury or illness, and has at least a 20 percent loss in predisability earnings. The weekly benefit is reduced by any deductible income the employee receives or is eligible to receive as a result of the disability, such as retirement benefits. Coverage Features Resource Advisor This program gives employees and their families free and confidential access to work/life support resources, including visits with a licensed mental health professional for a qualifying disability or loss of a loved one, legal/financial consultations for loss of a loved one, 24/7 telephone counseling and referral services, and Web site resources. Partial disabilities If the employee is disabled and is able to continue working, earning between 20 percent and 80 percent of pre-disability earnings, benefits are based on the percentage of income lost during the disability. Maternity benefits Coverage for pregnancy is the same as coverage for an illness. FOR SALES AND BROKER USE ONLY Life and disability products are underwritten by Anthem Life Insurance Company. Independent licensee of the Blue Cross and Blue Shield Association.

5 Continuation of coverage If an employee s coverage would otherwise end because a disability causes him or her to no longer meet the definition of an eligible employee, coverage may be continued for up to six months. All continued coverage is subject to payment of the required premium. Conditions and Limitations Work-related disabilities Risks not covered Retirement Work-related disabilities are not covered for employees and business owners who are eligible for coverage under workers compensation or occupational disease laws. Benefits are not payable if income is not lost due to the disability or if the disability or loss is the result of: an act of war, service in the armed forces, attempted suicide or intentional self-inflicted injury, participation in a riot, committing or attempting to commit a felony, under the influence of any drug, narcotic or intoxicant, a loss of professional license or certification, or a work-related injury or illness (if you are eligible for coverage under Worker s Compensation). All benefits terminate at retirement. Eligibility Employer eligibility Employee eligibility Classes Participation Employer contribution To qualify, the group must cover two to 50 eligible employees. Some industries may be ineligible, including but not limited to: private households, air transportation, police or fire protection, correctional institutions, forestry, hunting and tobacco. Other restrictions may apply. Employees must work at least 30 hours per week to be eligible for coverage. Employees must be actively at work for coverage to become effective. Up to three classes of employees may be established based on salary, occupation or other employment-related factors to determine various amounts of coverage under the policy. All eligible employees must participate when coverage is non-contributory (entirely employer-paid), and 75 percent of eligible employees must participate when employee contribution is required. The minimum employer contribution for short term disability coverage is 25 percent for contributory plans and 100 percent for non-contributory plans. This product description is intended to be a brief outline of benefits available. It does not include all terms of coverage offered by Anthem Life. The entire terms are contained in the contract documents (the applicable certificate, policy and/or trust agreement). In the event of conflict between the contract documents and this product description, the contract documents will prevail. Products may vary and may not be available in all states. This information describes Anthem Life s standard programs. Exclusions and limitations are listed in the brochure for this product. Life and disability products are underwritten by Anthem Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. AL-1051 (10/07)

6 Group Long Term Disability For groups with 2-50 employees For the state of Virginia Plan Design Rate basis Rate guarantee Guaranteed issue Benefit payments Elimination period 2-14 employees: Age banded rates (Each employee s premium is based on the group s rate table, using five-year age bands.) employees: Composite rates (Each employee s premium is based on the group rate, regardless of age.) Two years All amounts of coverage are guaranteed for groups with six to 50 employees. Coverage is not guaranteed for late enrollees, and they must complete and submit a medical questionnaire. For groups with two to five employees, medical questionnaires are required for all enrollees, unless Anthem Life is exactly matching a prior carrier s plan. (A copy of the prior carrier s certificate and the most recent billing statement are required.) For groups of 2-9 employees, 60% of salary, the employer may choose a maximum benefit of $3,000 or $6,000. For groups of employees, 50%, 60%, or 67% of salary, to a maximum of $10,000, although a lower maximum may be set by underwriting. A $10,000 maximum may be available only if the top five salaries qualify. For groups of 2-9 employees: Gold Plan Silver Plan Bronze Plan 90 or 180 days 90 or 180 days 180 days For groups of employees: 90, 180, or 365 days Maximum benefit duration For groups of 2-9 employees: Gold Plan Silver Plan Bronze Plan To age 65/RBD 5 years/rbd 2 years/rbd For groups of employees: the employer may choose between 2 years/rbd; 5 years/rbd; to age 65/RBD; and Social Security Normal Retirement Age (SSNRA). Reducing benefit duration (RBD) means that the benefit period reduces incrementally based on the employee s age at the time of disability. Definition of disability Two year own occupation To age 65 own occupation is available for groups with employees only as an executive carve out. For example, a two year own occupation means, due to illness or injury, the employee is unable to perform all material and substantial duties of his or her regular occupation through the elimination period and the next two years of disability and has at least a 20 percent loss in pre-disability earnings. For payments to continue beyond two years, the employee must be unable to perform any occupation for which he or she is suited and still have at least a 20 percent loss in pre-disability earnings. FOR SALES AND BROKER USE ONLY Life and disability products are underwritten by Anthem Life Insurance Company. Independent licensee of the Blue Cross and Blue Shield Association.

7 Benefit calculation The monthly benefit is reduced by any deductible income the employee receives or is eligible to receive as a result of the disability, such as workers compensation and/or retirement benefits. Benefits are reduced by the Social Security benefits received by the employee s entire family due to the disability. Coverage Features Resource Advisor Partial disabilities Recurrent disabilities Vocational rehabilitation Workplace modification Maternity benefits Survivor benefit Cost-of-living freeze Waiver of premium This program gives employees and their families free and confidential access to work/life support resources, including visits with a licensed mental health professional for a qualifying disability or loss of a loved one, legal/financial consultations for loss of a loved one, 24/7 telephone counseling and referral services, and Web site resources. During the first 12 months of a partial disability, employees are able to earn up to 100 percent of their pre-disability earnings. Their benefit is not reduced until the combination of their benefit amount and work earnings exceed their predisability earnings. After that period, monthly benefits are reduced by 50 percent of any income the employee earns while partially disabled. If an employee returns to work for less than six months and becomes disabled again due to the same cause, he or she will receive the monthly payments without satisfying a new elimination period. No benefits are payable for the period worked. We may provide services such as vocational testing and training, job modifications, and job placement to help an employee with a disability return to active employment. We may reimburse the employer for reasonable costs of workplace modifications to help an employee with a disability return to work. Coverage for pregnancy is the same as coverage for an illness. If an employee has a disability for at least 180 consecutive days and is receiving benefits at the time of death, a lump-sum payment equal to three times the monthly benefit will be paid to the employee s survivor. Once established, monthly benefits will not be further reduced due to cost-ofliving increases in other benefit sources. Long term disability premiums are waived while the employee has a disability and is receiving benefits. Continuation of coverage If an employee s coverage ends due to a layoff or leave of absence, coverage may be continued until the end the following month, subject to payment of the required premium. Social Security assistance If an employee is receiving benefits, we will assist them with applying for Social Security and, if necessary, offer guidance through the appeal process.

8 Conditions and Limitations Duration limits The standard benefit duration is 24 months for a disability caused by mental illness or substance abuse. Pre-existing conditions For groups of 2-9 employees: 12/6/24 For groups of employees, options are: 12/6/24 or 6/12/24 For example, 12/6/24 means an illness or injury is pre-existing if, during the 12 months before the employee's effective date, he or she received treatment for the illness or injury or if such symptoms were present that an ordinarily prudent person would seek treatment. A disability that begins within the first 24 months after the employee s effective date will not be covered if the disability results from a pre-existing condition, unless 6 consecutive months pass after the effective date without treatment. 6/12/24 means an illness or injury is pre-existing if, during the 6 months before the employee's effective date, he or she received treatment for the illness or injury or if such symptoms were present that an ordinarily prudent person would seek treatment. A disability that begins within the first 24 months after the employee s effective date will not be covered if the disability results from a pre-existing condition, unless 12 consecutive months pass after the effective date without treatment. Continuity of coverage No loss/no gain coverage is provided when replacing a prior carrier s plan. (A copy of the prior carrier's certificate is required.) Anthem Life will apply the total continuous time covered under both plans toward satisfying pre-existing condition limitation periods. If our plan s benefits are greater, the monthly payment and duration for qualified disabilities will be limited to what the prior plan provided. Risks not covered Retirement Benefits are not payable if income is not lost due to the disability or if the disability or loss is the result of: an act of war, service in the armed forces, attempted suicide or intentional self-inflicted injury, participation in a riot, committing or attempting to commit a felony, under the influence of any drug, narcotic or intoxicant, a loss of professional license or certification, or a workrelated injury or illness (if you are eligible for coverage under Worker s Compensation). All benefits terminate at retirement. Eligibility Employer eligibility In addition to covering a minimum of two eligible employees, a company must have been in business for at least one year and participate in Social Security. Eligibility is based on industry classification. Restricted industry groups must participate in workers compensation; standard industry groups that do not participate in workers compensation may be eligible, with increased premiums. Private households and groups where more than 60 percent of the employees are age 50 or older are not eligible. Groups where more than 50 percent of

9 employees are family members may not be eligible. Other restrictions may apply. Employee eligibility Classes Participation Employees must work at least 30 hours per week to be eligible for coverage. Employees must be actively at work for coverage to become effective. Up to three classes of employees may be established based on salary, occupation or other employment-related factors to determine various amounts of coverage under the policy. There must be a minimum of five people per class. All eligible employees must participate when coverage is non-contributory (entirely employer-paid), and 75 percent of eligible employees must participate when employee contribution is required. Employer contribution The minimum employer contribution for long term disability coverage is 50 percent for contributory plans and 100 percent for non-contributory plans. This product description is intended to be a brief outline of benefits available. It does not include all terms of coverage offered by Anthem Life. The entire terms are contained in the contract documents (the applicable certificate, policy and/or trust agreement). In the event of conflict between the contract documents and this product description, the contract documents will prevail. Products may vary and may not be available in all states. This information describes Anthem Life s standard programs. Exclusions and limitations are listed in the brochure for this product. Life and disability products are underwritten by Anthem Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. AL-3045 (10/07)