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B. Group Life Insurance

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Key Takeaways
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Educational Objective
  • II.G.1. Be able to differentiate between the basic characteristics of group and individual policies concerning: a. An individual insurance policy vs. group master contract vs. individual certificate of insurance. b. Medical examinations and eligibility. c. Contributory and noncontributory plans. d. Employer responsibilities: i. Selection of coverage. ii. Nondiscrimination within a class of employees. iii. Recordkeeping. iv. Enrollment.

Individual life insurance is written on a single life, with the rate and coverage based on the underwriting of that one person. Group life insurance, by contrast, is issued to a sponsoring organization and covers the lives of more than one individual member of that group. Group insurance is most commonly written for employer-employee groups, though other kinds of groups are eligible for coverage as well. It is usually written as annually renewable term insurance. Two features distinguish group insurance from individual insurance:

  • Evidence of insurability is usually not required, unless an applicant enrolls outside the normal enrollment period; and
  • Participants (insureds) under the plan do not receive a policy, because they do not own or control the policy.

Instead, each insured participant under a group plan is issued a certificate of insurance, evidencing that they have coverage. The actual policy, called the master policy/contract, is issued to the sponsor of the group, which is often an employer. The group sponsor is the policyholder and is the party that exercises control over the policy.

Know This

Group insurance is written as annually renewable term insurance. In group insurance, the master contract belongs to the employer, and certificates of insurance go to the individual insureds.

Group underwriting differs from individual underwriting, and is based on the characteristics and makeup of the group rather than the health of any one person. Characteristics of concern to a group underwriter include:

  • Purpose or nature of the group — the group must be created for a purpose other than obtaining group insurance
  • Size of the group — a larger group produces more accurate projections of future loss experience, based on the Law of Large Numbers
  • Turnover of the group — a group should show steady turnover, with younger, lower-risk members entering and older, higher-risk members leaving
  • Financial strength of the group — because group insurance is costly to administer, the underwriter must consider whether the group can afford the premiums and renew the coverage

The cost of group coverage is also based on the average age of the group and the ratio of men to women within it. To reduce adverse selection, the insurer requires a minimum number of participants, depending on whether the employer or the employees pay the premium.

1. Policies and Certificates of Insurance

An insurer issues only one policy for a group life plan — the master policy, issued to the sponsor of the group (often an employer). Each individual plan participant instead receives a Certificate of Insurance, which outlines the contract provisions and benefits available to that person. The certificate of insurance must list:

  • The policy number
  • The name, address, and other contact information for the insurer
  • The name of the insured (the employer or sponsor of the group)
  • The amount of insurance provided, and to whom the benefit is payable
  • Any principal exclusions that appear in the contract

A certificate is considered individualized if it contains either the name of the covered employee, or some other means of identifying to that employee that it is their individual certificate.

2. Enrollment

Application, or enrollment, is the term for any steps required of a named insured to apply for a certificate under a group life policy — for example, completing an enrollment form or submitting to a medical examination if the insurer requires one.

3. Medical Examinations and Eligibility

Group life plans may be sponsored by employers, debtor groups, labor unions, credit unions, associations, and other organizations formed for a reason other than purchasing insurance. Insurers may set a required minimum number of persons to be insured under a group plan; in California, a group policy must cover at least 10 eligible group members.

Group life insurance is underwritten on a group basis rather than an individual basis. Each participant completes a short application clearly identifying the insured and the insured's beneficiary. Generally, if the group is large enough, no medical questions are asked, since the plan is issued based on the nature of the group and the group's past claims experience.

4. Contributory vs. Noncontributory

The employer or other group sponsor may pay the entire premium, or may share the premium with the employees. When the employer pays the full premium, the plan is a noncontributory plan, and the insurer will require that 100% of eligible employees be included. When premiums are shared between employer and employees, the plan is a contributory plan, and the insurer will require that 75% of eligible employees be included.

5. Selection of Coverage

In some employee benefit plans, the employer contributes a fixed amount toward the plan for each employee, and the employee then selects from a menu of benefits the option that best suits their needs — which may include a retirement annuity, health insurance, or life insurance, sometimes with a choice of providers.

6. Nondiscrimination

To reduce adverse selection within a group, all employees must be eligible for coverage under a single-employer group policy. An employer may subdivide employees into classes (for example, salaried versus hourly employees); however, within any one class, discrimination in benefits is prohibited — all members of the group are entitled to the same set of benefits. Coverage may be excluded only if an employee elects, in writing, not to participate.

7. Recordkeeping

Insurers issuing group life policies in California must keep records of all transactions (original or copies) for a minimum of 5 years following the delivery of a policy or contract. These records must include:

  • The original policy application
  • Records showing the premiums received by the insurer
  • Records showing the amount of commissions paid, and to whom
  • Any correspondence, written solicitations, or proposals sent by the insurer to a prospect, applicant, or insured, or received by the insurer
  • A copy of the outline of coverage or disclosure statement
  • Any other pertinent records

8. Characteristics of Group Life Insurance

Educational Objective
  • II.G.2. Know the following characteristics of group life insurance: a. Eligible groups. b. Coverage for dependents of insureds. c. Types of life policies and premiums. d. Incontestability. e. Exclusions of war, military, and aviation risk. f. Misstatement of age. g. Conversion privilege. h. Grace period coverage. i. Blanket life insurance. j. Domestic partnership.

Eligible Groups and Insureds

Group life plans may be sponsored by employers, debtor groups, labor unions, credit unions, associations, and other organizations formed for a reason other than purchasing insurance. Insurers may establish a required minimum number of persons to be insured under a group plan.

Single Employers

When a policy is issued to an employer, the employer or a trustee becomes the policyholder, insuring employees for the benefit of persons other than the employer. A policy on which no part of the premium is paid by insured employees must insure all eligible employees, except those who reject coverage in writing.

Labor Unions

A policy issued to a labor union, or a similar organization, to insure members for the benefit of persons other than the union itself, is subject to the following requirements:

  • The members eligible for insurance must be all the members of the union or organization, or all of any class or classes of members
  • Premiums must be paid from union funds, from funds contributed by insured members specifically for their insurance, or from both — and if no part of the premium is derived from member contributions, all eligible members must be insured, except those who reject coverage in writing
  • An insurer may exclude or limit coverage for any person whose evidence of individual insurability is not satisfactory to the insurer

Associations

An association group (such as an alumni or professional association) may buy group insurance for its members. The group must have at least 100 members, be organized for a reason other than buying insurance, have been active for at least two years, have a constitution and by-laws, and hold at least annual meetings. These groups include, but are not limited to, trade associations, professional associations, college alumni associations, veteran associations, customers of large retail chains, and savings-account depositors. Association group plans may be either contributory or noncontributory.

Credit Unions

A group life policy may be issued to a credit union, or to a trustee or agent designated by two or more credit unions, to insure the lives of credit union members for the benefit of persons other than the policyholder, subject to the following:

  • All members of the credit union must be eligible for coverage
  • The premium must be paid by the policyholder from the credit union's funds and must insure all eligible members
  • An insurer may exclude or limit coverage for any member whose evidence of individual insurability is not satisfactory to the insurer

Debtor Groups

A policy issued to a creditor or its parent holding company, or to a trustee, trustees, or agent designated by two or more creditors (who are deemed to be the policyholder), is subject to the following:

  • The debtors eligible for insurance must all be debtors of the creditor
  • The premium must be paid from the creditor's funds, from charges collected from the insured debtors, or from both
  • An insurer may exclude any debtor whose evidence of individual insurability is not satisfactory to the insurer
  • The amount of insurance on the life of any debtor may never exceed the greater of the scheduled or actual amount of unpaid indebtedness to the creditor

Dependents of Insured Employees

Under group insurance policies, coverage may be extended to insure dependents of the insured, in amounts consistent with a plan that precludes individual selection. Coverage on a dependent cannot exceed 100% of the insurance on the life of the insured employee, and premiums for dependent coverage may be paid by the employer, the employee, or both jointly.

The term dependents includes the insured's spouse and all children from birth until 26 years of age, or children older than 26 who are both incapable of self-sustaining employment because of an intellectual disability or physical handicap, and who are mainly dependent on the insured employee for support and maintenance. A disabled child must first be insured within 31 days of reaching the limiting age, and proof of the incapacity and dependency may be required once a year after the first 2 years past the limiting age.

Domestic Partnership

An insurer in California is required to provide the registered domestic partner of an employee, insured, or policyholder the same coverage that would be provided to a spouse, and must inform employers and guaranteed associations of this coverage. A policy of group health insurance may require verification of the domestic partnership status through a copy of a valid Declaration of Domestic Partnership, and may require notification upon the partnership's termination — but only if the insurer also requests marital-status verification and dissolution notification from employees whose spouses are covered.

Types of Policies

Under the California Insurance Code, any life insurer may issue life, disability, term, and endowment insurance on a group plan, at premium rates lower than the usual rates for such insurance. Insurance written under a franchise agreement or on a wholesale basis may be written at rates more or less than the usual rates.

Blanket Life Insurance

A blanket life policy covers a group of people exposed to the same hazard. It differs from traditional group insurance in that it doesn't name individual insureds and doesn't issue certificates of insurance. Coverage under a blanket policy is temporary, lasting only as long as the group is exposed to the hazards specified in the policy — typical examples include an airline covering passengers while in flight, or a school covering students and teachers during school hours.

The California Insurance Code permits insurers to offer blanket insurance to:

  • Newspapers, magazines, or other similar publications, to insure those who deliver publications or collect payments, those who supervise deliveries or collections, wholesalers, or others in the distribution, sales, or marketing process
  • Religious, charitable, recreational, educational, athletic, or civic organizations
  • Employers who pay the benefits of a voluntary plan of unemployment compensation disability insurance
  • Employers who provide benefits to any group of workers, dependents, or guests, limited to specified hazards incident to the activities or operations of the policyholder
  • An entertainment production company that provides benefits to any group of participants, volunteers, audience members, or contestants

Blanket life insurance may be issued for a term not exceeding one year, at premium rates less than the usual rates, and may be renewed. When the insured pays the policy premiums, the insured may request a copy of the policy in the form of a certificate. A person may elect not to be covered under a blanket plan by submitting a written request to the insurer; if more than 10% of eligible persons elect not to participate, the contract cannot be put into effect, or if already in effect, cannot be renewed.

Conversion Privilege

Another characteristic of group insurance is the conversion privilege. If an employee terminates membership in the insured group, that employee has the right to convert to an individual policy without proving insurability, at a standard rate based on the individual's attained age. The group life policy may convert to any form of insurance issued by the insurer — usually whole life — except term insurance. The face amount will equal the group term face amount, but the premium will be higher. The employee usually has 31 days after terminating from the group to exercise the conversion option, during which time the employee remains covered under the original group policy.

If the insured dies during the conversion period, a death benefit equal to the maximum amount of individual insurance that would have been issued must be paid by the group policy, whether or not an application for an individual policy was ever completed. If the master contract itself is terminated, every individual who has been on the plan for at least 5 years is allowed to convert to individual permanent insurance of the same coverage.

Know This

When converting from group life to individual life insurance, evidence of insurability is not required.

If an employee is not given notice by the employer or the insurer of the right to convert within 15 days of termination of employment, the Insurance Code requires that the employee be given an additional 25 days following the notice to apply for a conversion policy. In no event, however, will an employee have more than 60 days following the end of any conversion period to elect to convert and pay the first premium for individual coverage, and there is no coverage after the initial 31-day conversion period until a new premium is paid.

A spouse or child who was covered under the group policy as a dependent has the same privilege to convert to an individual plan, also without evidence of insurability. All of the conversion provisions described above apply equally to a dependent's conversion.

Incontestability

The incontestability clause states that an insurer cannot contest statements made on the application once the policy has been in effect for a given length of time — 2 years in California. In other words, the insurer may not rescind the contract on the basis of an error or misrepresentation by the policyowner or insured once the policy has been in force for 2 years.

Misstatement of Age

The policy must contain a provision for the equitable adjustment of the premium, or the amount of insurance payable, in the event of a misstatement of an employee's age.

War, Military, or Aviation Risk

Insurers may reduce or exclude liability for losses arising from war, military or naval service, and aviation.


Key Takeaways
  • Group life insurance is written as annually renewable term coverage on a master policy held by the group sponsor; each insured participant instead receives a certificate of insurance
  • A California group policy must cover at least 10 eligible members; large groups generally require no medical questions
  • Noncontributory plans (employer pays 100%) require 100% employee participation; contributory plans (shared premium) require 75% participation
  • Coverage may not discriminate within an employee class; insurers must retain group life records for at least 5 years
  • Eligible group types include single employers, labor unions, associations (100+ members, active 2+ years), credit unions, and debtor groups, each with their own funding and eligibility rules
  • Dependent coverage cannot exceed 100% of the insured employee's coverage; dependents include a spouse, domestic partner, and children up to age 26 (or beyond, if disabled)
  • Blanket life insurance covers a group exposed to a common hazard without naming individual insureds or issuing certificates; it runs for no more than one year
  • The conversion privilege lets a terminated employee (or covered dependent) convert to individual permanent (non-term) insurance without evidence of insurability, usually within 31 days, with added notice periods of up to 60 days total
  • California's incontestability period for group life is 2 years; policies must also address misstatement of age and may exclude or limit war, military, and aviation risk