Rate Card General Agent Administrative Handbook

Transcription

1 February, MetLife Rate Card General Agent Administrative Handbook Rate Card Process For Indiana, Ohio and West Virginia 1

2 Table of Contents MetLife Contacts.3 Products & Plan Designs Underwriting Guidelines....9 Quote Request Information (excludes rate card business).12 Rate Card Implementation Process & Forms Commissions & Renewals...16 Rate Cards.provided electronically C&B Summaries provided electronically Employee Benefit Summaries provided electronically New Business Submission Forms.provided electronically 2

3 Welcome, To help you work with MetLife and deliver on your commitments to your agents and clients, we have created a customized Administrative Handbook for your General Agency. This handbook is designed to provide you with guidelines for underwriting, requests for proposals and sold case submissions. If you have any questions related to topics not found in this handbook, please refer to the contact list below. We appreciate your business and look forward to working with you. Account Executive Eric Lindblom 9200 South Hills Blvd Suite 130 Broadview Heights, OH (440) (office) (847) (cell) elindbloom@metlife.com General Agent Account Executive Kimberly Craven 5 Park Plaza Suite 1900 Irvine, CA (949) (office) (949) (cell) kcraven@metlife.com New Business Submission 5-49 Lives jmarpert@metlifeservice.com Request for Proposal 50+ Lives clevelandsbc@metlife.com cc: elindblom@metlife.com Customer Service Assistance ohio_service@metlifeservice.com Local Market Sales Team General Agency Sales Team Client Acquisition Associate Julie Marpert 312 Elm Street Cincinnati, OH (513) (office) (800) (fax) jmarpert@metlifeservice.com Affinity Consultant Nicole Tobin 200 Park Avenue New York, NY (212) (office) ntobin@metlife.com Submissions, RFPs & Customer Service Broker Commissions/BOR s broker_change@metlife.com Broker Service Center (888) Dental, Disability, Life Claims (800) ASK-4-MET ( ) 3

4 Products & Plan Designs Dental Plans for 5-49 Lives (Rates for these plan designs are available through the Rate Cards. Rates are contingent upon zip code. Please refer to the Rate Card for specific rates for a customer.) DENTAL PLAN DESIGNS Orthodontia must be determined by customer Plan Name Plan A Plan B Plan C Plan D Minimum Group Size Participation 5 enrolled lives 5 enrolled lives 5 enrolled lives 5 enrolled lives ER Sponsored - 75% of total eligible lives Voluntary - 50% of total eligible lives ER Sponsored - 75% of total eligible lives Voluntary - 50% of total eligible lives ER Sponsored - 75% of total eligible lives Voluntary - 50% of total eligible lives ER Sponsored - 75% of total eligible lives Voluntary - 50% of total eligible lives Plan Type Steerage PPO Steerage PPO Passive PPO Steerage PPO Out of Network Reimbursement Deductible MAC MAC 90 th R&C 90th R&C $50 Ind / $150 Family Deductible waived for Preventive $50 Ind / $150 Family Deductible waived for Preventive $50 Ind / $150 Family Deductible waived for Preventive $50 Ind / $150 Family Deductible waived for Preventive Annual Max $1,000 $750 $1,000 $1,500 $1,000 $1,500 Preventive Care 100% 80% 100% 100% 100% 100% 100% Basic Services 80% 60% 80% 90% 80% 90% 80% Major Services 50% 30% 50% 60% 50% 60% 50% Endodontics, Periodontics & Oral Surgery Orthodontia (Requires a minimum of 10 enrolled employees) Covered as Major Services Exception: Periodontal Maintenance in Basic Additional Cost Child only to age 19, no deductible, 50% to $1000 Covered as Major Services Exception: Periodontal Maintenance in Basic Additional Cost Child only to age 19, no deductible, 50% to $1000 Covered as Major Services Exception: Periodontal Maintenance in Basic Additional Cost Child only to age 19, no deductible, 50% to $1000 Covered as Basic Services Additional Cost Child only to age 19, no deductible, 50% to $1000 Dental Plans for 50+ Lives Rates are available through your local MetLife Account Executive by submitting a quote request. Please see Quote Request Information section for more information. 4

5 Vision Plans for 5-49 Lives (Rates for these plan designs are available through the Rate Cards. Rates are contingent upon contribution level. Please refer to the Rate Card for specific rates for a customer.) Participation Minimum Group Size Voluntary - the greater of 30% or 5 enrolled Non-Contributory - 100% with at least 5 enrolled 5 eligible lives, must be packaged with the dental In-Network Coverage Out-of-Network Coverage Eye Examination (one per frequency) Comprehensive exam of visual functions and prescription of corrective eyewear Covered after a $10 copay Covered up to $45 allowance Materials/Eyewear (Either glasses or contacts allowed per $25 copay Not applicable frequency) Standard Corrective Lenses Covered up to Single vision $30 allowance Lined bifocal Covered after eyewear copay $50 allowance Lined trifocal $65 allowance Lenticular $100 allowance Standard Lens Options Ultraviolet coating Covered in full Applied to the allowance for the Polycarbonate (child up to age 18) Covered in full applicable Polycarbonate (adult) $33 copay corrective lens Progressive $55 copay $50 allowance Scratch-resistant coating $17 copay Applied to the allowance for the Anti-reflective coating $43 copay applicable Photochromic $47 copay corrective lens Frame Allowance (20% off the additional amount when patients Covered up to choose a frame that exceeds the allowance at $130 allowance after eyewear Covered up to copay in-network private practice providers) $70 allowance Costco Contact Lenses Fitting and evaluation $70 allowance after eyewear copay Standard or Premium fit: Member receives 15% off; Copay will not exceed $60 Applied to the allowance for the contact lenses Elective lenses Covered up to $130 allowance Covered up to $105 allowance Necessary Covered after eyewear copay Covered up to $210 allowance Frequencies Available (Exams/Lenses/Frames/Contact Lenses) 12/12/12/12 or 12/12/24/12 5

6 Life Plans for 5-49 Lives (Rates for these plan designs are available through the Rate Cards. Rates are contingent upon SIC. Please refer to the Rate Card for specific rates for a customer.) BASIC LIFE AD&D PLAN DESIGNS Plan Name Plan A Plan B Plan C Plan Type Flat $15,000 Flat $25,000 Flat $50,000 Guarantee Issue Age Reduction Schedule Full Amount Full Amount Full Amount 35% at age 65, 50% at age 70 35% at age 65, 50% at age 70 35% at age 65, 50% at age 70 Eligibility Employee Only Employee Only Employee Only Participation 100% of total eligible 100% of total eligible 100% of total eligible Minimum Group Size Maximum Group Size Disability Provision Standalone 10 employees Sold w/dental 5 employees Standalone 10 employees Sold w/dental 5 employees Standalone 10 employees Sold w/dental 5 employees 49 eligible 49 eligible 49 eligible Waiver of Premium Disabled prior to age 60 Coverage continues to age 65 Waiver of Premium Disabled prior to age 60 Coverage continues to age 65 SUPPLEMENTAL LIFE AD&D PLAN DESIGN Waiver of Premium Disabled prior to age 60 Coverage continues to age 65 Plan Name Employee Spouse Child Plan Type Increments of $10,000 Increments of $5,000 Plan Maximum Lesser of 5x pay or $500,000 50% of the employee amount up to $100,000 Amounts of $1,000; $2,000; $4,000; $5,000; $10,000 50% of the employee amount up to $10,000 Guarantee Issue $50,000 $25,000 $10,000 Age Reduction Schedule Minimum Group Size None None None 10 eligible employees (Basic Life is required) 10 eligible employees (Basic Life is required) 10 eligible employees (Basic Life is required) Participation Greater of 25% or 5 enrolled Greater of 25% or 5 enrolled Greater of 25% or 5 enrolled Disability Provision Will Prep and Estate Resolution Service Waiver of Premium Disabled prior to age 60 Coverage continues to age 65 Waiver of Premium Disabled prior to age 60 Coverage continues to age 65 Waiver of Premium Disabled prior to age 60 Coverage continues to age 65 Included Included Included Life Plans for 50+ Lives Rates are available through your local MetLife Account Executive by submitting a quote request. Please see Quote Request Information section for more information. 6

7 STD Plans for 5-49 Lives (Rates for these plan designs are available on the Rate Card. Rates are contingent the contribution level and SIC. Please refer to the Rate Card for specific rates for a customer.) STD PLAN DESIGN Plan Name Plan A Plan B Contribution Level Participation Maximum Weekly Benefit Elimination Period Non-Contributory - 100% Employer Paid Voluntary 0 to 25% Employer Paid Non-Contributory - 100% of total eligible Voluntary - 25% of total eligible Non-Contributory - 60% or $1,000 Voluntary - $50 increments up to the lesser of 60% or $1,000 Accident - 7 days Sickness - 7 days Non-Contributory - 100% Employer Paid Voluntary 0 to 25% Employer Paid Non-Contributory - 100% of total eligible Voluntary - 25% of total eligible Non-Contributory - 60% or $1,000 Voluntary - $50 increments up to the lesser of 60% or $1,000 Accident - 7 days Sickness - 7 days Benefit Duration 12 weeks 25 weeks Pre-Existing Condition 3/12 3/12 Minimum Group Size Standalone - 10 enrolled Non-Contributory and Sold w/dental 5 enrolled Voluntary and Sold w/dental 5 enrolled & 10 eligible Standalone - 10 enrolled Non-Contributory and Sold w/dental 5 enrolled Voluntary and Sold w/dental 5 enrolled & 10 eligible Maximum Group Size 49 eligible 49 eligible STD Plans for 50+ Lives Rates are available through your local MetLife Account Executive by submitting a quote request. Please see Quote Request Information section for more information. 7

8 LTD Plans for 5-49 Lives (Rates for these plan designs are available through the Rate Cards. Rates are contingent upon SIC. Please refer to the Rate Card for specific rates for a customer.) Maximum Monthly Benefit 60% to $6,000 Own Occupation Period 24 Months Pre Existing Condition 3/12 Participation Minimum Group Size Maximum Group Size Benefit Duration 100% of the total eligible lives 5 enrolled lives, package with Dental required below 10 lives 49 eligible lives The later of Your Normal Retirement Age as defined by Social Security or the period shown below: Age on date of Disability Duration Less than 60 To age months months months months months months months months months 69 and over 12 months Elimination Period 90 Days or until the end of the STD Maximum Benefit Period 180 Days or until the end of the STD Maximum Benefit Period LTD Plans for 50+ Lives Rates are available through your local MetLife Account Executive by submitting a quote request. Please see Quote Request Information section for more information. 8

9 Underwriting Guidelines Applies to 5-49 Rate Cards ONLY Eligibility Full time active employee working at least 30 hours per week. Retirees, part time, temporary, seasonal, leased and independent contractors (1099) are not eligible. Documented proof of active, full time employment is required for all employees who are age 70 or older. No more than 2 virgin voluntary coverages are allowed. For groups with < 10 employees, no more than 75% of the group can be members of the same family (spouses, siblings, children, and parents). Please note, wage and tax statements will be required for non-california groups with more than 50% family members. DE 6 forms will be required for California groups that have greater than 50% family members. Dental Employer Contribution: o Employer Sponsored - Employer must contribute at least 50% of the employee premium. o Voluntary - Employer must contribute between 0% and 49% of the employees premium. Participation: o Employer Sponsored - Total participation must meet or exceed 75% of the group s total eligible lives. We will accept groups with 65% - 74% for a 6% load. Minimum of 5 enrolled lives. o Voluntary - Total participation must meet or exceed 50% of the group's total eligible lives. We will accept groups with 35% - 49% participation for a 6% load. Minimum of 5 enrolled lives. Orthodontia is only available to groups with prior Dental with Major coverage and 10+ enrolled lives. Employees on COBRA cannot exceed 15% of the enrolled lives. Coverage is not available to groups that fall into the following industries: o o 8070 o 8072 o o o Rates are guaranteed for 12 months. Out of State Coverage: o Dental plan rates are for Ohio, Indiana and West Virginia based companies. o Please contact MetLife when 10% or more of the employees do not reside in Ohio, Indiana and West Virginia. o Dental coverage is not available to groups with employees located in the extraterritorial states of Louisiana, Mississippi, Montana, & Texas. 9

10 Vision Must be packaged with Dental, standalone not available Participation: o Voluntary Minimum of 30% participation with at least 5 enrolled o Non Contributory Minimum of 100% participation with at least 5 enrolled Employees age 65 and over must be less than 20% of the group Coverage is not available to groups that fall into the following industries: o o o o o Rates are guaranteed for 12 months Basic Life Must be packaged with the Dental below 10 lives. Minimum of 5 enrolled lives. Coverage must be non-contributory with 100% participation. The Risk Assessment Summary is required. Benefits reduced by 35% at age 65; reduced to 50% of the original amount at age 70. Coverage is not available to groups that fall into the following industries: o o Pilots and elected officials are not eligible for coverage. Rates are guaranteed for 24 months. Supplemental Life Must be packaged with Basic Life. Only available to groups with 10 or more eligible lives. Total participation must meet or exceed 25% of the group s total eligible lives. Minimum of 5 enrolled lives. Statement of Health is required in the following circumstances: o New Hires If an employee has been hospitalized within 90 days of our effective date. (Hospitalized means admission for inpatient care in a hospital; receipt of care in a hospice facility; intermediate care facility, or long term care facility, or receipt of the following treatments wherever performed: chemotherapy, radiation therapy or dialysis.) o Transfer Groups When the enrollee is a late entrant or elects a higher benefit amount than the amount they had with the prior carrier. Coverage is not available to groups that fall into the following industries: o o Pilots and elected officials are not eligible for coverage. Will Prep and Estate Resolution Services are provided on all Supplemental Life quotes. Rates are guaranteed for 24 months. 10

11 STD Non-Contributory STD o Minimum group size is 5 eligible lives. o Must be packaged with Dental between 5-9 enrolled lives. o Coverage must be non-contributory with 100% participation. Voluntary STD o Minimum group size is 10 eligible lives. o Must be packaged with Dental between 5-9 enrolled lives. o Employer must contribute between 0% and 25% of the employee's premium. Groups or employees located in California, Hawaii, New Jersey, New York, or Rhode Island are not eligible. Pilots and elected officials are not eligible for coverage. The Risk Assessment Summary is required. Coverage is not available for groups with the following standard industry classifications (SIC): Long Term Disability Employees must participate in Social Security to be eligible for coverage Minimum of 5 enrolled lives. Package with dental required below 10. Coverage must be non-contributory with 100% participation. The Risk Assessment Summary is required. Coverage is not available to groups that fall into the following industries: , , , , , , 3292, , , , 4953, , , 5194, , , , Groups that fall into the following industries must be sent to MetLife for underwriting: , , Pilots and elected officials are not eligible for coverage. Rates are guaranteed for 24 months. 11

12 Quote Request Information Quote Requests for Groups with 50+ Lives: Send RFP s directly to clevelandsbc@metlife.com Indicate GA RUSH in subject line Include a CC to elindblom@metlife.com RFP s will be turned around within 3 days with target within 48 hours Information Needed to Quote Groups with 50+ Lives General Information o Name of Group o Location o SIC or Industry Description o Plan Designs o Employer and Employee Contribution Percentage For Each Plan o Current Participation o Current/Renewal Rates o Prior Carrier Booklets (not required for quote) Census Information o DOB or Age o Gender o Class (if necessary) o Salary (if necessary) o Occupation (required for Disability) o Zip Code (required for Dental) o Dependent Status (required for Dental) 12

13 Implementation THE FOLLOWING FORMS ARE APPLICABLE FOR RATE CARD BUSINESS ONLY. (Please consult with your MetLife Account Executive for implementation of 50+ lives.) Broker Appointment Producer Appointment Form Please contact your local Client Acquisition Associate (see page 3 for contact info) to confirm if your broker is appointed. If the broker is not appointed, please complete the broker appointment paperwork and to CLR_Institutional@metlife.com cc your assigned Client Acquisition Associate. Please note: Case Submissions with brokers not appointed will be pended until appointment is complete. Binder Check is waived for all Aspire Rate Card Cases New Group Submission Checklist Must be typed Provide eligibility, class descriptions, contributions, plan design elections and producer information. Please submit completed paperwork to your assigned Client Acquisition Associate (see page 3 for contact info) Employer Signature Required on Page 10 The below Request for Participation form and Risk Assessment form are embedded in New Group Submission Checklist New Group Submission Checklist 13

14 The Request for Participation Form Request For Participation Groups using Rate Cards are written under a Multiple Employer Trust. The employer must agree to participate in the Multiple Employer Trust. This form is embedded in the New Group Submission Checklist mentioned above. Employer Signature Required Risk Assessment Summary Risk Assessment Summary Necessary for LIFE, LTD and STD ONLY. Broker Signature Required AXA Assistance Service Agreement Travel Assistance Agreement Necessary for Supplemental Life ONLY.. Cost & Benefits Summary (C&B) Generated by the Excel Quoting Tool provided to the GAs. Provides the rates and plan design the employer selected. GA, Broker or Customer Signature Required Cost & Benefit Summary Census/Enrollment Forms Groups may submit a census or enrollment forms. Enrollment forms are required for Supplemental Life. Sample Census 14

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16 Commissions Agent commissions will be distributed directly from MetLife to the writing agent. The writing agent is eligible to participate in MetLife s Supplemental Broker Compensation Program and any lines of coverage written through the GA will count towards qualification in the program. GA commissions are payable directly to the GA. The GA is not eligible for the Supplemental Broker Compensation Program. Commissions are not vested for the GA or the writing agent. Renewals Renewals are auto-generated and sent 60 days prior to the renewal date. Renewal letters are sent to the agent and GA two weeks prior to the customer s copy. Renewals are still generated for cases in rate guarantees. Each group will renew on their policy anniversary date. The renewal action is determined by the experience of the Aspire Benefit Service Rate Card block of business. 16