Forms Processing Training

(1)

Life Insurance

Forms Processing Training

PEBB Outreach and Training February 2012

Forms Processing Training

• New Employee Eligibility and Enrollment M ki Ch

Agenda

• Making Changes

• Underwriting – Carrier Approval • Claims

• Death Claim

• Accelerated Life Benefit A id t l Di b t Cl i • Accidental Dismemberment Claim • Premium Waiver Claim

• Transferring Life Insurance

(2)

• Determining eligibility

Eligibility and Enrollment Process

• 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

(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 Insurabilityform 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

or closure

• Higher education institutions

• Key the guaranteed issue amounts in your payroll system • When you receive the carrier decision, if approved key

(4)

• Group term life insurance policy

Life Insurance Benefit

• 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

• Employee Basic

– employer-paid

Life Insurance Benefit

• $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)

(5)

• Spouse and Dependent Basic

– employee-paid

Life Insurance Benefit

• $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

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• Accidental Death and Dismemberment

– employee-paid

Life Insurance Benefit

• Minimum of $25,000 up to a maximum of $250,000

• May include dependents in the coverage

(6)

Enrollment/Change Form

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• For newly eligible employees:

Evidence of Insurability

• Evidence of Insurability

form is required when the

employee

• Requests more than $250,000 in Employee Supplemental if under the age of 60, or

R t th $100 000 i E l S l t l if

• Requests more than $100,000 in Employee Supplemental if age 60 or older

(7)

• Demonstration

Key Enrollment in PAY1

13

• Employees may make changes to their life insurance at any time during the year

Changing Life Insurance

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 • Increasing or decreasing the amount of coverage

• Returning from leave and the employee did not self-pay their life insurance

(8)

• Evidence of Insurability is required when:

Changing Life Insurance

• 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

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• When an employee submits an

Evidence of Insurability

form

Underwriting

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

(9)

• When an employee submits an

Evidence of Insurability

form

Underwriting

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

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(10)

• Demonstration

Key FAN in PAY1

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• There are four types of claims that you may be

Claims

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

(11)

Death Claim Form

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• Give each beneficiary the following:

Death Claim

• 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

(12)

Accelerated Benefit Form

23

• Give the insured the following forms and information

Accelerated Benefit Claim

• 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

(13)

Accidental Dismemberment Form

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• Give the insured the following forms and information

Accidental Dismemberment Claim

• 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

(14)

Premium Waiver Form

27

• Give the insured the following forms and information

Premium Waiver Claim

• Attending Physician’s Statement of Disability

• Authorization for Release of Health-Related Information • Privacy Notice

• Submit to ING the:

(15)

• Submit copies of all requested documentation (except

th d th

tifi t )

Claims

the death certificate)

• By mail to:

• ING Life Claims PO Box 1548

Minneapolis, MN 55440

• By fax –see Life Administration Manual • By fax see Life Administration Manual • By Email –see Life Administration Manual • Always mail the original death certificate

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• Employee’s terminating from service have three

i

h i lif i

Terminating Employment Options

options to continue their life insurance:

• Transfer coverage to a spouse or domestic partner’s PEBB account

(16)

• If employee terminating service and their spouse or domestic partner is also enrolled in PEBB benefits, the terminating

Transfer of Coverage

p , g

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 • 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 • Example of transfer:

Transfer of Coverage

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

(17)

Transfer of Coverage

Type of Coverage Terminating Employee’s Coverage Spouse/Domestic Partner’s Coverage Coverage 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

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• 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

• Employee may apply for Portability Life coverage for

th

l

th i d

d t

Portability Choice

themselves or their dependents

• Term Life policy

• Must apply no later than 31 days after termination or loss of eligibility for benefits

• Requires carrier approval

(18)

Portability Choice Form

35

• Employee may apply to convert their coverage for

th

l

th i d

d t

Conversion

themselves or their dependents

• 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

(19)

Life Conversion Information Form

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