Life. Calculating Life Premium. Billing for Life Products

Transcription

1 Group Administration Manual, Life Life Products Administration We are pleased to offer Group Life Insurance benefits in combination with your Group Health Benefits for ease of administration. This section of your Group Administration Manual outlines our billing process and administration forms and procedures which will allow for a more streamlined administrative process. Billing for Life Products Product Types Additional Product Types are used throughout the statement to describe the Life products selected: LBAS Basic Life Insurance Benefit ADD Basic Accidental Death and Dismemberment LDEP Dependent Life Insurance Benefit LSUP Optional Life Insurance Benefit ADDS Optional AD&D Insurance Benefit Contract Types Additional Contract Types are used throughout the statement to describe premium calculations for subscribers and their dependents: LSUB Life Insurance Benefit for Subscriber. LDEP Life Insurance Benefit for Dependents, (Spouse and/or Children, regardless of the number of children). LSPS Life Insurance Benefit for Spouse only. LCHD Life Insurance Benefit for Children only, regardless of the number of children. Calculating Life Premium Volume of Life Insurance Volume of Life Insurance is the amount of coverage, which is described in your Group Life Insurance policy. The Volume can be a flat amount of coverage for all subscribers or it can be based on the annual salary or job title of the subscriber. These volumes of insurance are shown throughout your billing for each subscriber and total volume is shown on the summary page of your billing. Life Insurance Rates Life Insurance Rates are detailed in your Group Life Insurance Policy. Contract Types for Life products (see chart) can be charged either as a composite rate (per $1,000 of coverage) or as a flat rate (regardless of Volume of Life Insurance). The rate appears next to the volume on the billing. Life Insurance Premium To calculate the Life premium for Contract Types billed a composite rate (per $1,000 of coverage), multiply the Subscriber s Volume times the Rate. As an example: Subscriber Volume of Insurance X Rate per $1,000 Premium Billed Example: $15,000 X $0.20/$1,000 = $3.00 To calculate the Life premium for Contract Types billed a flat rate, (such as Dependent Life) Insurance: Dependent Life Elected by Subscriber Flat Rate The premiums are first calculated for each subscriber in the Membership Detail section of your billing, the subscriber premiums then are totaled (by product) in the Product Summary section of your billing. = Premium Billed Example: YES $2.00 $2.00 Example: NO $

2 7.2 Anthem Blue Cross Reporting Membership Changes The Group Membership Maintenance Recap form should always be submitted with any changes affecting billing. Examples of Life changes may include: Terminating a subscriber due to termination of employment Volume of Insurance change due to change in subscriber annual salary, job title or age In addition, a Life Insurance Enrollment form must be completed, signed and dated by the subscriber, then forwarded to us along with the Group Membership Maintenance Recap form whenever a subscriber s Life insurance benefit changes for the following reasons: Enrolling a new subscriber Subscriber selects optional life product after initial enrollment Subscriber declines optional life product after electing it Adding Dependent Life coverage due to marriage or birth of child Deleting Dependent Life coverage due to divorce of spouse or age of child If a subscriber chooses to add a contributory Life product more than 31 days after their eligibility date, see Late Enrollment and Guarantee Issue. Type of Change: Group Membership Life Insurance Evidence of Group Membership Change Form Enrollment Form Insurability Form Maintenance Recap Form Adding a Life or Dependent Life Required Required coverage within 31 days from eligibility date Adding a Life or Dependent Life Required Required Required coverage after 31 days from eligibility date (contributory coverage) Terminating all Life coverage s due to termination of employment Required Terminating a Life or Dependent Life Required Required coverage by request of subscriber (contributory coverage) Salary change of subscriber affecting Life volume Job title of subscriber affecting Life volume Beneficiary Change Required Required Required

3 Group Administration Manual, Eligibility for Life Products The process of enrolling, changing and terminating subscribers has been outlined in the Eligibility section of this manual. While the overall process remains the same, forms have been changed or added to allow for combined Life and Health administration. Administration procedures for Life Insurance may differ from Health Insurance, and have been outlined in this section. New Enrollments Eligibility To meet eligibility requirements for Life Insurance, a subscriber must meet eligibility criteria as defined in your Group Life Insurance Policy, reach an eligibility effective date as designated by the group (probation period), and enroll by completing a Group Enrollment form. The enrollment and date of actual coverage for a subscriber and dependents is governed by the terms of the Group Life Insurance Policy. Enrolling New Subscribers New subscribers should be enrolled on the first billing date after they become eligible (within 31 days from their eligibility date). The original (white) Group Enrollment form must be completed in ink, signed and dated by the subscriber, then forwarded as follows: White Canary Goldenrod Pink Anthem Blue Cross Membership Anthem Blue Cross Marketing Employer Employee Since Anthem Blue Cross Life and Health Insurance Company does not retain beneficiary information, you as the group administrator, are responsible for maintaining and submitting both the original enrollment form along with any change of beneficiary forms in the event of a claim. Late Enrollment If the subscriber pays a portion of the Life Insurance premium (contributory coverage), and their Anthem Blue Cross Life and Health Insurance Company Enrollment form has NOT been completed, signed, dated and submitted to us within 31 days from their eligibility date, then the subscriber must also complete, sign and date the Evidence of Insurability form. This applies not only to Basic Life coverage, but also to a subscriber electing Supplemental Life or Dependent Life after the initial 31-day enrollment period. Submit the original Evidence of Insurability form to us with the Anthem Blue Cross Life and Health Insurance Company Enrollment form. The subscriber and dependents are LATE ENROLLEES and will be subject to review and approval by Anthem Blue Cross Life and Health Insurance Company. If approved, late enrollees become effective on the first day of the month following approval by the Medical Underwriting Department. This process will not be waived during a medical open enrollment. If the subscriber does not pay a portion of the Life Insurance premium (non contributory coverage), an Evidence of Insurability form is NOT required. The subscriber will be effective as of the date originally eligible for coverage. Guarantee Issue Amount Under some Life plans, subscribers may be eligible for Life Insurance in excess of a Guarantee Issue amount. In these cases, the subscriber must complete, sign and date the Evidence of Insurability form. Submit the original form to us with the Anthem Blue Cross Life and Health Insurance Company Enrollment form. The subscriber will be subject to review and approval by Anthem Blue Cross Life and Health Insurance Company. If approved, coverage in excess of the Guarantee Issue amount will become effective on the first day of the month following approval by the Medical Underwriting Department.

4 7.4 Anthem Blue Cross ID Cards While subscribers receive ID cards reflecting their medical products selected, Life insurance benefits will not appear on the cards. Subscribers should refer to their Certificate Booklet for details on their Life insurance benefits, and to their enrollment form (and change of beneficiary forms) for beneficiary information. Membership Terminations Processing Terminations Subscriber terminations due to termination of employment requires the Group Membership - Maintenance Recap form to be completed. Terminations by request of subscriber (contributory coverage only), require additionally that the Life Insurance Enrollment form be completed by the subscriber by completing sections 1-Personal Information, 2-Coverage Election, and 4-Declination of Coverage. For terminations due to death, please see the Claims section. COBRA COBRA does NOT apply to Life Insurance. Conversion of Group Life Insurance The Request for Group Life Conversion Information form must be completed by the employer and provided to each subscriber upon termination of employment. Within 31 days from the termination date, the subscriber must complete and mail the form to the address on the form. BENEFIT: When an active employee loses group life coverage due to employment termination or if their benefit amount is reduced due to age or change in class, the amount of coverage lost can be converted to another form of life insurance. Whole life insurance is the only form of life insurance available on life conversions, except where otherwise specified by state law. COVERAGES: The group term life, optional life or dependent life coverage can be converted. AD&D coverage does not offer conversion. DEADLINE: The subscriber MUST complete a Request for Group Life Conversion Information form within 31 days of the termination or reduction of their group coverage to be eligible. HEALTH EVIDENCE: Since this is guaranteed if applied for within 31 days, Evidence of good health is NOT required. The Evidence of Insurability form does not need to be completed. Claims Life Insurance, Accidental Death and Dependent Life Insurance Claims In the event of a death of a subscriber, please refer to the Beneficiary Claim form in this section. Living Benefit The Living Benefit can be included with Basic Life and Optional Life benefits. It is not available for AD&D or Dependent Life coverage s. This provision offers a percentage of the Life benefit when an active subscriber becomes terminally ill 1. The most common maximum percentage is 50 percent, and life expectancy must be 12 months or less. Employees can opt for less than the maximum, but only one payment will be made during the insured s lifetime. Unlike some Life carriers, we do NOT charge an administration fee for this provision. We also do not discount the present-day value. The following are the Living Benefit claim forms: 1) Claim for Personal Living Benefit 2) Living Benefit Attending Physician s Statement 1 Refer to contract wording for specific definition.

5 Group Administration Manual, Waiver of Premium Claim Many Life Insurance policies offer a Waiver of Premium benefit in the event of total disability of an eligible subscriber under age 60. Should a subscriber remain totally and continuously disabled for a nine month period, the Life Insurance premium will be waived. Life Insurance coverage will remain in force until the subscriber is deemed no longer disabled or until they become of retirement age or part of a company sponsored retirement plan. It is neither available for AD&D nor Dependent Life coverage. The Claim for Waiver of Premium - Group Life Insurance and Group Waiver of Premium Attending Physician s Statement must be completed and submitted to Anthem Blue Cross Life and Health Insurance Company between the ninth and the 12th months of the onset of disability. Please refer to the claim form supplied in this manual for detailed instructions.

6 7.6 Anthem Blue Cross EAP Product Description Employee Assistance Programs (EAPs) have been proven to be of great value to employers. Anthem EAP services can help reduce employee absenteeism and benefit expenses while boosting job productivity and healthy lifestyles.* Anthem EAP puts convenient and confidential resources within reach to help your employees and their household members deal with: Relationship, marital and family issues Child care and elder care needs Alcohol and drug abuse Loss or grief Depression and anxiety Financial and legal concerns Stress Benefits Depending on the plan you purchase, Basic, Enhanced or OnCall, the following benefits are included (unless otherwise noted, the benefits apply to all plans): Toll-free, 24/7 telephone consultation and referral services 1 Employees and family members in their household can talk directly with an Anthem EAP counselor. For toll-free access, employees and their family members should call the EAP number on their health plan ID card. Employees will also receive a welcome letter with the toll-free phone number. Face-to-face counseling visits per employee and household member per issue (Basic and Enhanced plans only) Employees and family members in their household receive face-to-face counseling visits with licensed/certified therapists in our network at no cost to them. Employees will receive a welcome letter with information about the plan, including the number of visits. Legal and financial referral 2,3 For life events requiring legal services, employees and their household members have access to a free, 30-minute office or telephone consultation on most personal legal matters such as divorce and preparing a will just to name a few. Ongoing services are provided at a 25 percent discount off the professional s normal fees. They will also have telephonic access to financial counselors for advice on virtually any personal financial matter, including credit counseling, debt and budget assistance, and tax, retirement and college planning. The consultations are generally limited to between 30 minutes and 60 minutes per issue. Local referrals are available at a 25 percent discounted rate for more complex financial planning issues. Unlimited child and elder care referral 4 Through free telephonic consultation, counselors can advise employees and family members in their household on issues such as a parent who needs partial or full-time care or a child who needs special care. You can also get referrals to elder care or child care facilities and community resources through the Anthem EAP webiste or the toll-free telephone number. Website resources All Anthem EAP plans offer access to our online employee resources that cover such topics as aging and elder care, parenting and child care, emotional well-being, substance abuse and recovery, and health and fitness. Supervisor/manager and human resources telephone consultation (Enhanced plan only) Anthem EAP provides unlimited telephone consultation on a case-by-case basis to supervisors and managers dealing with one or more troubled employees or workplace situations, including management referrals to the EAP. Supervisors and managers will receive a welcome kit with the toll-free number they can call for immediate consultations. Workplace trauma response (Enhanced plan only)

7 Group Administration Manual, Introductory employee orientation - Webcast (Basic and Enhanced plans only) Supervisor/manager training (Enhanced plan only) 5 Educational and wellness workshops (Enhanced plan only) 6 Health/benefit fair (Enhanced plan only) 7 Case assistance for management referrals, return to work, etc. (Enhanced plan only) Substance abuse policy consultation and recommendations (Enhanced plan only) Critical Incident Stress Debriefing (CISD) services (Enhanced plan only) Introductory promotional program materials Ongoing promotional program materials Claims Face-to-face counseling visits provided by the EAP are of no charge to employees and their household members. Providers in our network file claims and the claims are paid by Anthem EAP. Eligibility and Enrollment There is no enrollment for the Anthem EAP. Unless otherwise specified by the employer, participation in the EAP is open to all employees and their eligible household members. Employees and their household members are only required to provide the name of the employee s employer as evidence of eligibility. Forms for Employer Services Appropriate release of information forms are provided for management consultation and case management/ management referrals as they occur. Confidentiality is a key component and quality standard of our EAP. Anthem EAP is HIPAA compliant and adheres to applicable state and federal laws, as well as professional licensure standards pertaining to confidentiality and privilege. All information between the EAP counselor and the employee or eligible family member is held confidential unless: the individual authorizes release of information with a signature; the individual represents, in the EAP counselor s opinion, a physical danger to self or others; child, elder or dependent adult abuse/neglect is suspected; or a court or a legally valid order for records is issued. Employees must sign and date a detailed authorization to release confidential information when they are formally referred for case management services Anthem EAP maintains secure administrative systems for clinical tracking, EAP claims payment, provider network management, customer billing, reporting and quality assurance. We do not track individual use of our website. Contact For detailed information about Anthem EAP, please call your designated account manager. 1 Referral services apply only to Basic and Enhanced plans. 2 Legal and financial services are available only online for the OnCall plan. 3 Matters involving disputes or actions between members and their employer or other work-related issues, malpractice issues or issues involving Anthem Blue Cross or its parent company or affiliated companies are specifically excluded from this plan. Also excluded are matters that, in the opinion of the attorney, lack merit. Court costs, filing fees, fines and costs incurred beyond this initial 30-minute consultation are the responsibility of the member. 4 Child and elder care services are available only online for the Basic and OnCall plans. 5 Supervisor/manager training is available on a fee for-service basis for the Basic plan. 6 Workshops are available on a fee-for-service basis for the Basic plan. 7 Health/benefit fairs are available on a fee-for-service basis for the Basic plan. * Craven, Carrie, Horizon Behavioral (2005, July 15). Behavioral Health in the Workplace: The Business Case for Opening Pandora s Box. Presented at the Disability Management Employer Coalition (DMEC) 10th Annual National Disability and Absence Management Conference. Orlando, FL. Cost Effectiveness (2006). Concern: EAP. Retrieved June 15, 2006 from

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