Show:
Life Coverage
Group Life Insurance
EOI & Life Coverage
Life Claim Process
Life Claim Docs
100

Is EE Basic Life Coverage Contributory or Non-Contributory?

Non-Contributory –Employer Paid

100

Does Term Life Insurance have a cash value?

No

100

Is EOI required for Child Life coverage?

No

100

What happens if a claim is denied?

  • Claim Examiner Denies Claim and sends Correspondence
  • If a claim is denied the Next of Kin/Beneficiaries have the right to appeal
100

What must be requested if the Beneficiary is a Trust?

Trust Documents

200

Which group(s) do we currently manage Beneficiary information for?

Smith + Nephew 

200

Do our group contracts provide term life or whole life coverage for active EEs and their dependents?

Term Life

200

Is EOI required for EE Supplemental Life?

Yes, for New Hires over the GI and for all late applicants

200

What happens if a claim is incomplete?

  • If claim is incomplete Claim Examiner will request additional information from Employer, Family, Beneficiary or Funeral Home (FH) and pend claim until required documents are received.
200

What must be requested if the Beneficiary is an Estate?

Estate Documents

300

Define life insurance.

Life insurance pays the designated amounts to the beneficiaries on file upon the death of the insured.

300

Name 4 types of Life Insurance.

EE Basic, EE Supplemental, Dependent, ADD

300

Is EOI required for Dependent Spouse/Domestic Partner Life?

Yes, for New Hires over the GI and for all late applicants

300

What happens if a claim is approved?

  • Claim Examiner approves and pays claim and sends Correspondence
  • Claim Payments are in Lump Sum check format and mailed USPS
  • Checks can be overnighted FedEx in extreme circumstances, exception requires manager approval
300

What additional document must be requested if the marital status on the DC is Divorce and why?

A copy of the divorce decree to see if the ex-spouse is entitled to a portion of the benefits.

400

Define and explain SIB.

Pays a percentage of the Employees salary as of last day worked (LDW) monthly to the beneficiaries upon the death of the insured. Eligible beneficiaries are the spouse/domestic partner and/or children under the maximum age. This is in addition to any Life and AD+D coverage.

400

Who is eligible for Life coverage?

  • Depends on the contract, generally:
  • Full Time Active Employees (Not out on leave of STD, LTD or FMLA past policy provided period of time i.e. 12 months)
  • Part Time Employees who work the required number of hours per week
  • Retirees under the plan limiting (max) age
  • Dependents of Eligible Employees (Spouse/Domestic Partner and/or Children under limiting [max]age generally 26)
400

What is the Contestability Period?

Claim be may denied for EOI Fraud or Suicide Exclusion within two years of the effective date.

400

What 5 items must an Examiner confirm on a Death Certificate?

  • Name, SSN and DOB matches Claim Form
  • Marital Status (i.e. Single, Married, Widow, Divorced)
  • Residence State
  • Date of Death (DOD)
  • Cause (i.e. Heart Attack) and Manner of Death (Natural, Accidental, Suicide, Homicide, etc.)
400

For what Manners of Death may additional documentation be required?

If cause is homicide, suicide or accidental or there is AD+D coverage additional documents may be required (i.e. Autopsy results, police report, etc.)

500

Name the 5 types of enrollment. 

New Hire, Open, Modified, Annual, Ongoing

500

When is coverage effective?

Depends on the contract/policy, employees must be actively working at the time they enroll for coverage to become effective. There may be a waiting period depending on the coverage type and policy/contract

500

When must an Examiner check for EOI and why?

EOI must be checked if DOD is within two years of the effective date, to ensure EOI was approved, to ensure no fraud and the EOI approval was valid.

500

What documents are required for a Complete ("clean") claim?

  • Completed Claim form signed by Employer/Plan Sponsor/Policy Holder
  • Copy of certified Final Death Certificate (DC)
  • Beneficiary Designation or certification of Next of Kin
  • Documentation of enrollment/premiums for Contributory Coverage
  • Additional required documentation if applicable
500

Does the family/beneficiary need to submit an official claim form to claim the life benefits?

No. ER submits claim form.