Forms Processing Training

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1 Life Insurance Forms Processing Training PEBB Outreach and Training February 2012 Agenda New Employee Eligibility and Enrollment Making Changes Underwriting Carrier Approval Claims Death Claim Accelerated Life Benefit Accidental Dismemberment Claim Premium Waiver Claim Transferring Life Insurance Portability Choice and Life Insurance Conversion 2 1

2 Eligibility and Enrollment Process Determining eligibility Eligibility for life insurance is the same as eligibility for medical and dental insurance Newly eligible employees: With internet access should be directed to the PEBB website (www.pebb.hca.wa.gov) for the Employee Enrollment Guide and the Life Insurance booklet Without internet access should be given the Employee Enrollment Guide Employee may also ask for the Life Insurance booklet 3 Employee should: Enrollment Process Complete the Life Insurance Enrollment/Change form no later than 60 days after their initial date of eligibility A form should be submitted to name a beneficiary, even if the employee is not requesting optional coverage Submit an Evidence of Insurability form to ReliaStar for approval of amounts greater than the guaranteed issue amounts 4 2

3 Employer should: Enrollment Process Review form for accuracy and completeness Complete section 1 of the form Determine if the application requires carrier approval If carrier approval is required Remind employee to submit an Evidence of Insurability form to ReliaStar Send a copy of the enrollment/change form to ReliaStar 5 Employer should: Enrollment Process Key the requested amounts in the PAY1 system Key guaranteed issue amounts first Once guaranteed issue amounts have moved to the current coverage column, key any additional amounts When you receive the carrier decision, key the approval, denial or closure Higher education institutions Key the guaranteed issue amounts in your payroll system When you receive the carrier decision, if approved key the approval 6 3

4 Life Insurance Benefit Group term life insurance policy Five parts to insurance Employee Basic Employee Supplemental Spouse* and Dependent Basic Spouse* Supplemental Accidental Death and Dismemberment (AD&D) *Spouse coverage includes state-registered domestic partners 7 Life Insurance Benefit Employee Basic employer-paid $25,000 term life $5,000 accidental death and dismemberment Employee Supplemental employee-paid Minimum $10,000 up to a maximum of $750,000 in $10,000 increments If less than age 60, up to $250,000 available without carrier approval (guaranteed issue) If age 60 or older, up to $100,000 available without carrier approval (guaranteed issue) 8 4

5 Life Insurance Benefit Spouse and Dependent Basic employee-paid $2,500 for spouse or state-registered domestic partner $2,500 per child for dependent children through the age of 25 Spouse Supplemental employee-paid Must be enrolled in Spouse Basic Cannot exceed one-half of Employee Supplemental amount Up to $50,000 without carrier approval Must be in $5,000 increments 9 Life Insurance Benefit Accidental Death and Dismemberment employee-paid Minimum of $25,000 up to a maximum of $250,000 May include dependents in the coverage Carrier approval is never required 10 5

6 Enrollment/Change Form 11 Evidence of Insurability For newly eligible employees: Evidence of Insurability form is required when the employee Requests more than $250,000 in Employee Supplemental if under the age of 60, or Requests more than $100, in Employee Supplemental l if age 60 or older Request more than $50,000 in Spouse Supplemental 12 6

7 Key Enrollment in PAY1 Demonstration 13 Changing Life Insurance Employees may make changes to their life insurance at any time during the year Depending on the change, carrier approval may be required Changes to coverage include: Enrolling after the first 60 days of eligibility Adding or removing a dependent Increasing or decreasing the amount of coverage Returning from leave and the employee did not self-pay their life insurance Transferring coverage to spouse/domestic partner s account when terminating employment 14 7

8 Changing Life Insurance Evidence of Insurability is required when: The employee requests: Supplemental life insurance for the first time after the initial 60 days of eligibility An increase to their supplemental coverage Employee is returning from leave and did not self-pay their life insurance while on leave Adding a spouse or domestic partner after 60 days of marriage or the registration of a partnership An employee is re-hired and coverage was converted when previous employment was terminated 15 Underwriting When an employee submits an Evidence of Insurability form to the carrier, the carrier: May make a decision based on the information on the EOI form, or May request additional information from the employee Once a decision is reached, the carrier will: Prepare a Final Action Notice (FAN) showing approval, denial, or closure A copy of the FAN is sent to the employee and the employer 16 8

9 Underwriting When an employee submits an Evidence of Insurability form to the carrier, the carrier: May make a decision based on the information on the EOI form, or May request additional information from the employee Once a decision is reached, the carrier will: Prepare a Final Action Notice (FAN) showing approval, denial, or closure A copy of the FAN is sent to the employee and the employer 17 Final Action Notice 18 9

10 Demonstration Key FAN in PAY1 19 Claims There are four types of claims that you may be required to submit to the carrier Death Claim employee or insured dependent Accelerated Benefit Claim insured must have a terminal condition and a life expectancy of no more than two years (24 months) Accidental Dismemberment Benefit Claim Insured suffers a covered loss as the result of an accidental injury Waiver of Premium insured s life insurance continues without payment of premium while the insured is totally disabled 20 10

11 Death Claim Form 21 Death Claim Give each beneficiary the following: Settlement Options brochure or Summary, based on amount of claim Submit to ING the : Completed Death Claim form Copies of all life insurance enrollment/change forms An original Certificate of Death Newspaper clippings, if available If applicable, copies of any Declaration of Tex Status and/or certified copies of letters of guardianship for a minor s estate See the Life Administration Manual 22 11

12 Accelerated Benefit Form 23 Accelerated Benefit Claim Give the insured the following forms and information Attending Physician s Statement of Terminal Illness Authorization for Release of Health-Related Information Privacy Notice Appropriate Disclosure Statement Submit to ING the: Completed Accelerated Benefit form Copies of all life insurance enrollment/change forms Copies of all signed letters related to life insurance See the Life Insurance Administration Manual 24 12

13 Accidental Dismemberment Form 25 Accidental Dismemberment Claim Give the insured the following forms and information Attending Physician s Statement of Dismemberment Authorization for Release of Health-Related Information Privacy Notice Submit to ING the: Completed Accidental Dismemberment Claim form Copies of all life insurance enrollment/change forms Copies of all signed letters related to life insurance Accident report or newspaper clippings See the Life Insurance Administration Manual 26 13

14 Premium Waiver Form 27 Premium Waiver Claim Give the insured the following forms and information Attending Physician s Statement of Disability Authorization for Release of Health-Related Information Privacy Notice Submit to ING the: Completed Waiver of Premium Disability Claim form Copies of all life insurance enrollment/change forms Copies of all signed letters related to life insurance See the Life Insurance Administration Manual 28 14

15 Claims Submit copies of all requested documentation (except the death certificate) t By mail to: ING Life Claims PO Box 1548 Minneapolis, MN By fax see Life Administration Manual By see Life Administration Manual Always mail the original death certificate 29 Terminating Employment Options Employee s terminating from service have three options to continue their life insurance: Transfer coverage to a spouse or domestic partner s PEBB account Apply for Portability Choice (carrier approval is required) Convert coverage to a whole life policy 30 15

16 Transfer of Coverage If employee terminating service and their spouse or domestic partner is also enrolled in PEBB benefits, the terminating employee may: Transfer some or all of employee and spouse supplemental to their spouse or partner s account Within plan maximums No later than 31 days after termination Terminating employee s Employee Supplemental transfers to spouse s Spouse Supplemental Terminating employee s Spouse Supplemental transfers to spouse s Employee Supplemental New amounts of coverage, after transfer, cannot exceed plan maximums 31 Transfer of Coverage Example of transfer: Type of Coverage Terminating Employee s Coverage Spouse/Domestic Partner s Coverage Employee Supplemental $192,000 $186,000 Spouse Supplemental $42,000 $25,000 Terminating employee has $42,000 in Spouse Supplemental which may be transferred to the spouse s Employee Supplemental coverage $42,000 + $186,000 = $228,000 Round down to the nearest $10,000 increment The new employee supplemental total for the spouse would be $220,

17 Type of Coverage Transfer of Coverage Terminating Employee s Coverage Spouse/Domestic Partner s Coverage Employee Supplemental $192,000 $186,000 Spouse Supplemental $42,000 $25,000 Terminating employee has $192,000 in Employee Supplemental which may be transferred to the spouse s Spouse Supplemental coverage The spouse has a new total of $220,000 Spouse Supplemental maximum can t exceed one-half of the Employee Supplemental or $110,000 in this example Only $85,000 of the $192,000 may be transferred to the spouse s account The terminating employee has the option to port or convert the remaining coverage 33 Portability Choice Employee may apply for Portability Life coverage for themselves or their dependents d Term Life policy Must apply no later than 31 days after termination or loss of eligibility for benefits Requires carrier approval Terminates when insured reaches the age of 70 Accidental Death and Dismemberment is not portable 34 17

18 Portability Choice Form 35 Conversion Employee may apply to convert their coverage for themselves or their dependents d Whole life policy Must apply no later than 31 days after termination or denial of Portability Choice application or 60 days after retirement Must have been insured for at least 5 years as an employee Carrier approval is not required for conversion 36 18

19 Life Conversion Information Form 37 Conclusion Questions and Comments 38 19

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