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MA-Life-Insurance-Producer-Exam : General-Provisions : 2 : : Group Life Insurance

Group life insurance products and conversion rights

Group Life Insurance

Group life insurance provides coverage for multiple people under a single master policy. It's commonly offered by employers as an employee benefit and has distinct features compared to individual life insurance.

Definition

Single master policy covering a group:
- Master policy: Issued to group policyholder (employer, association, creditor)
- Individual certificates: Each covered person receives certificate of insurance
- Group underwriting: Minimal or no individual medical underwriting
- Lower cost: Generally less expensive than individual policies

Key Parties

Policyholder (Master Policyholder):
- Owns the master policy: Employer, association, union, creditor
- Pays premiums: Often pays all or part
- Administers plan: Handles enrollment, changes, claims

Insured/Certificate Holder:
- Covered individual: Employee, member, borrower
- Receives certificate: Proof of coverage document
- May pay portion: Through payroll deduction

Beneficiary:
- Receives death benefit: Person(s) designated by insured
- Insured chooses: Not the employer

Certificate of Insurance

Not a policy:
- Summary of coverage: Shows amount, effective date, beneficiary
- Evidence of coverage: Proof individual is insured
- References master policy: Full terms in master policy
- Not a contract: Master policy is the contract

Contains:
- Coverage amount
- Effective date
- Beneficiary designation
- Conversion rights
- Claims procedures

Group Term Life Insurance

Most common type:

Characteristics

  • Annually renewable: Coverage renewed each year
  • No cash value: Pure death benefit protection
  • Level or increasing premium: Premium may increase with age
  • Coverage ends: When leave group (with conversion rights)

Coverage Amounts

Flat amount:

All employees: $50,000
Simple, easy to administer

Multiple of salary:

Coverage: 1×, 2×, or 3× annual salary
Employee earning $60,000: $120,000 coverage (2× salary)
Higher earners get more coverage

Position schedule:

Executives: $500,000
Managers: $250,000
Supervisors: $100,000
Employees: $50,000

Tax Treatment

$50,000 Exclusion (IRC § 79):
- First $50,000: No taxable income to employee
- Over $50,000: Imputed income based on IRS Table I
- Employer deducts: All premiums as business expense

Example:

Employee coverage: $150,000
Employee age: 50
Table I rate (age 50-54): $0.23 per $1,000 per month

Taxable coverage: $150,000 - $50,000 = $100,000
Monthly cost: ($100,000 ÷ $1,000) × $0.23 = $23
Annual imputed income: $23 × 12 = $276

Employee reports: $276 as additional taxable income

Group Paid-Up Life Insurance

Permanent insurance:
- Accumulates: Builds paid-up insurance each year
- Cash value: Some cash value accumulation
- Combination: Often combined with term for full benefit

Group Universal Life (GUL)

Permanent coverage option:
- Portable: Can take with you when leave
- Flexible: Adjust coverage and premiums
- Employee pays: Typically employee-paid (after-tax)
- Supplemental: Addition to basic group term

Simplified or No Medical Underwriting

Group underwriting:
- Participation requirements: Minimum percentage must enroll
- Employer pays large portion: Ensures broad participation
- Pre-existing conditions: Usually covered immediately
- No individual evidence: Most don't require medical exams

Requirements for Group Coverage

Characteristics needed:
1. Group formed for purpose other than insurance: Employment, association membership
2. Minimum size: Typically 10+ employees (varies by state)
3. Flow of persons: People join and leave group
4. Automatic determination: Amounts determined by formula, not individual selection
5. Minimum participation: Usually 75% if contributory

Contributory vs. Non-Contributory

Non-Contributory:
- Employer pays 100%: All premiums paid by employer
- 100% participation: All eligible employees covered
- No evidence required: Guaranteed issue
- More attractive: Better employee benefit

Contributory:
- Employees pay part: Share premium cost through payroll deduction
- Minimum participation: Typically 75% must enroll
- May require evidence: If don't enroll during eligibility period
- More common: Shares cost burden

Example:

Non-contributory:
Employer pays: 100% of premium
Participation: 100% (all employees covered)
Evidence of insurability: None required

Contributory:
Employer pays: 60% of premium
Employee pays: 40% (payroll deduction)
Participation requirement: 75%
Evidence if late enrollment: May be required

Eligibility Requirements

Typical requirements:
- Full-time employment: Minimum hours (e.g., 30 hours/week)
- Waiting period: 30-90 days before eligible
- Active at work: Must be actively working
- Employee class: May limit to certain classes

Enrollment Periods

Initial eligibility period:
- 31 days: From eligibility date
- No evidence: Guaranteed issue during this window
- Late enrollment: May require medical underwriting

Open enrollment:
- Annual: Once per year
- Increase coverage: Elect additional or different amounts
- Evidence may be required: For increases

Actively-at-Work Provision

Must be working on effective date:
- Not sick or disabled: Must be at work
- If absent: Coverage delayed until return to work
- Protects insurer: Prevents adverse selection

Example:

Employee eligible: January 1
Out sick: January 1-15
Returns to work: January 16

Coverage effective: January 16 (when actively at work)
Not: January 1

When Coverage Ends

Coverage terminates when:
- Employment ends: Quit, fired, laid off
- Retirement: Unless retiree coverage offered
- Eligibility lost: Drop below minimum hours
- Master policy ends: Group plan terminated

Conversion Privilege

Right to convert to individual policy:

Requirements

  • Time limit: Typically 31 days from termination
  • No evidence of insurability: Guaranteed issue
  • Individual policy: Convert to permanent individual policy
  • Premium at attained age: Based on current age
  • Same insurer: Usually must use same insurance company

What Can Convert To

  • Whole life: Most common option
  • Universal life: If available
  • Any permanent plan: Offered by insurer (not term)
  • Cannot convert to: Term insurance

Coverage Amount

  • Up to group amount: Cannot exceed group coverage amount
  • May reduce: Can take less than group amount
  • No increase: Cannot increase above group coverage

Example:

Group coverage: $200,000
Employee terminates: June 1
Conversion period: 31 days (through July 1)

Within 31 days:
- Can convert up to $200,000
- No medical exam required
- Premium based on age 45 (current age)
- Whole life policy

Estimated premium:
Age 45, $200,000 whole life: ~$4,000/year
(Much higher than group term, but guaranteed issue)

Death During Conversion Period

Coverage continues:
- 31-day extension: If die within 31 days
- Death benefit paid: Even if didn't convert
- Group amount: Pays group coverage amount
- Protects employee: Grace period for conversion

Spouse and Children

Optional coverage:
- Spouse life insurance: Coverage on employee's spouse
- Child coverage: All children under one rider
- Lower amounts: Typically $10,000-50,000
- Employee-paid: Usually contributory

Child coverage typical terms:

Birth to 6 months: $1,000-2,000
Age 6 months to 19 (or 26 if student): $10,000
All children: One premium covers all
Conversion: Children can convert at age 21/25

Purpose

Pay off debt if borrower dies:
- Lender is beneficiary: Bank, finance company, credit union
- Decreasing coverage: Matches declining loan balance
- Short-term: Term of loan (1-10 years typically)

Types

Credit life (death benefit):
- Pays loan balance: If borrower dies
- Protects lender: Ensures loan repaid
- Protects borrower's estate: Debt doesn't burden heirs

Credit disability:
- Pays loan payments: If borrower becomes disabled
- Monthly benefit: Covers monthly payment
- Limited duration: 12-24 months typically

Characteristics

Group basis:
- Group policy: Lender is master policyholder
- Certificates: Each borrower gets certificate
- Simplified underwriting: Often guaranteed issue
- Decreasing term: Coverage decreases with loan balance

Example:

Car loan: $30,000
Term: 5 years
Monthly payment: $550

Credit life coverage:
Initial: $30,000
Year 1: $24,000 (remaining balance)
Year 2: $18,000
Year 3: $12,000
Year 4: $6,000
Year 5: $0 (loan paid off)

If borrower dies year 2:
Benefit paid: $18,000 (to lender)
Loan: Paid in full
Estate: No debt

Regulation

Heavily regulated:
- Premium limits: Maximum rates set by state
- Voluntary: Must be optional, not required
- Disclosure: Terms must be clearly disclosed
- Refunds: Pro-rata refund if loan paid early
- Cannot require: Lender cannot require as loan condition (must be voluntary)

Hybrid individual/group:
- Individual policies: Separate policy for each person
- Group enrollment: Sold through employer or association
- Simplified underwriting: Less stringent than true individual
- Employee-paid: Payroll deduction
- Portable: Can keep if leave group

Feature Group Life Individual Life Underwriting Simplified/group Full individual medical Portability Limited (conversion) Fully portable Cost Lower Higher Coverage amount Limited Unlimited (based on needs) Cash value Usually none (term) Available (permanent) Ownership No ownership rights Own the policy Premiums May increase Level (whole life) Customization Limited options Fully customizable Beneficiary Insured chooses Owner chooses When terminates Leave employment Can keep for life

  • Group life = one master policy: Covers multiple people under single contract
  • Certificate of insurance: Evidence of coverage, not the policy itself
  • Master policy holder: Employer, association, or creditor owns policy
  • $50,000 exclusion: First $50,000 of employer-provided group term not taxable
  • Table I: IRS table for imputed income on coverage over $50,000
  • Conversion privilege: 31 days to convert to individual policy without evidence
  • No evidence required: Guaranteed issue during conversion period
  • Attained age premium: Conversion premium based on current age
  • Convert to permanent: Must convert to whole life or universal life (not term)
  • Death during conversion: Coverage continues if die within 31 days
  • Contributory = 75% participation: Minimum participation requirement
  • Non-contributory = 100% participation: All eligible employees covered
  • Actively-at-work: Must be working on effective date
  • Group underwriting: Based on group characteristics, not individuals
  • Credit life insurance: Pays loan balance if borrower dies
  • Decreasing term: Credit life decreases as loan balance decreases
  • Lender is beneficiary: On credit life insurance
  • Cannot require credit life: Must be voluntary

Group life insurance products and conversion rights

Group Life Insurance

Group life insurance provides coverage for multiple people under a single master policy. It's commonly offered by employers as an employee benefit and has distinct features compared to individual life insurance.

Definition

Single master policy covering a group:
- Master policy: Issued to group policyholder (employer, association, creditor)
- Individual certificates: Each covered person receives certificate of insurance
- Group underwriting: Minimal or no individual medical underwriting
- Lower cost: Generally less expensive than individual policies

Key Parties

Policyholder (Master Policyholder):
- Owns the master policy: Employer, association, union, creditor
- Pays premiums: Often pays all or part
- Administers plan: Handles enrollment, changes, claims

Insured/Certificate Holder:
- Covered individual: Employee, member, borrower
- Receives certificate: Proof of coverage document
- May pay portion: Through payroll deduction

Beneficiary:
- Receives death benefit: Person(s) designated by insured
- Insured chooses: Not the employer

Certificate of Insurance

Not a policy:
- Summary of coverage: Shows amount, effective date, beneficiary
- Evidence of coverage: Proof individual is insured
- References master policy: Full terms in master policy
- Not a contract: Master policy is the contract

Contains:
- Coverage amount
- Effective date
- Beneficiary designation
- Conversion rights
- Claims procedures

Group Term Life Insurance

Most common type:

Characteristics

  • Annually renewable: Coverage renewed each year
  • No cash value: Pure death benefit protection
  • Level or increasing premium: Premium may increase with age
  • Coverage ends: When leave group (with conversion rights)

Coverage Amounts

Flat amount:

All employees: $50,000
Simple, easy to administer

Multiple of salary:

Coverage: 1×, 2×, or 3× annual salary
Employee earning $60,000: $120,000 coverage (2× salary)
Higher earners get more coverage

Position schedule:

Executives: $500,000
Managers: $250,000
Supervisors: $100,000
Employees: $50,000

Tax Treatment

$50,000 Exclusion (IRC § 79):
- First $50,000: No taxable income to employee
- Over $50,000: Imputed income based on IRS Table I
- Employer deducts: All premiums as business expense

Example:

Employee coverage: $150,000
Employee age: 50
Table I rate (age 50-54): $0.23 per $1,000 per month

Taxable coverage: $150,000 - $50,000 = $100,000
Monthly cost: ($100,000 ÷ $1,000) × $0.23 = $23
Annual imputed income: $23 × 12 = $276

Employee reports: $276 as additional taxable income

Group Paid-Up Life Insurance

Permanent insurance:
- Accumulates: Builds paid-up insurance each year
- Cash value: Some cash value accumulation
- Combination: Often combined with term for full benefit

Group Universal Life (GUL)

Permanent coverage option:
- Portable: Can take with you when leave
- Flexible: Adjust coverage and premiums
- Employee pays: Typically employee-paid (after-tax)
- Supplemental: Addition to basic group term

Simplified or No Medical Underwriting

Group underwriting:
- Participation requirements: Minimum percentage must enroll
- Employer pays large portion: Ensures broad participation
- Pre-existing conditions: Usually covered immediately
- No individual evidence: Most don't require medical exams

Requirements for Group Coverage

Characteristics needed:
1. Group formed for purpose other than insurance: Employment, association membership
2. Minimum size: Typically 10+ employees (varies by state)
3. Flow of persons: People join and leave group
4. Automatic determination: Amounts determined by formula, not individual selection
5. Minimum participation: Usually 75% if contributory

Contributory vs. Non-Contributory

Non-Contributory:
- Employer pays 100%: All premiums paid by employer
- 100% participation: All eligible employees covered
- No evidence required: Guaranteed issue
- More attractive: Better employee benefit

Contributory:
- Employees pay part: Share premium cost through payroll deduction
- Minimum participation: Typically 75% must enroll
- May require evidence: If don't enroll during eligibility period
- More common: Shares cost burden

Example:

Non-contributory:
Employer pays: 100% of premium
Participation: 100% (all employees covered)
Evidence of insurability: None required

Contributory:
Employer pays: 60% of premium
Employee pays: 40% (payroll deduction)
Participation requirement: 75%
Evidence if late enrollment: May be required

Eligibility Requirements

Typical requirements:
- Full-time employment: Minimum hours (e.g., 30 hours/week)
- Waiting period: 30-90 days before eligible
- Active at work: Must be actively working
- Employee class: May limit to certain classes

Enrollment Periods

Initial eligibility period:
- 31 days: From eligibility date
- No evidence: Guaranteed issue during this window
- Late enrollment: May require medical underwriting

Open enrollment:
- Annual: Once per year
- Increase coverage: Elect additional or different amounts
- Evidence may be required: For increases

Actively-at-Work Provision

Must be working on effective date:
- Not sick or disabled: Must be at work
- If absent: Coverage delayed until return to work
- Protects insurer: Prevents adverse selection

Example:

Employee eligible: January 1
Out sick: January 1-15
Returns to work: January 16

Coverage effective: January 16 (when actively at work)
Not: January 1

When Coverage Ends

Coverage terminates when:
- Employment ends: Quit, fired, laid off
- Retirement: Unless retiree coverage offered
- Eligibility lost: Drop below minimum hours
- Master policy ends: Group plan terminated

Conversion Privilege

Right to convert to individual policy:

Requirements

  • Time limit: Typically 31 days from termination
  • No evidence of insurability: Guaranteed issue
  • Individual policy: Convert to permanent individual policy
  • Premium at attained age: Based on current age
  • Same insurer: Usually must use same insurance company

What Can Convert To

  • Whole life: Most common option
  • Universal life: If available
  • Any permanent plan: Offered by insurer (not term)
  • Cannot convert to: Term insurance

Coverage Amount

  • Up to group amount: Cannot exceed group coverage amount
  • May reduce: Can take less than group amount
  • No increase: Cannot increase above group coverage

Example:

Group coverage: $200,000
Employee terminates: June 1
Conversion period: 31 days (through July 1)

Within 31 days:
- Can convert up to $200,000
- No medical exam required
- Premium based on age 45 (current age)
- Whole life policy

Estimated premium:
Age 45, $200,000 whole life: ~$4,000/year
(Much higher than group term, but guaranteed issue)

Death During Conversion Period

Coverage continues:
- 31-day extension: If die within 31 days
- Death benefit paid: Even if didn't convert
- Group amount: Pays group coverage amount
- Protects employee: Grace period for conversion

Spouse and Children

Optional coverage:
- Spouse life insurance: Coverage on employee's spouse
- Child coverage: All children under one rider
- Lower amounts: Typically $10,000-50,000
- Employee-paid: Usually contributory

Child coverage typical terms:

Birth to 6 months: $1,000-2,000
Age 6 months to 19 (or 26 if student): $10,000
All children: One premium covers all
Conversion: Children can convert at age 21/25

Purpose

Pay off debt if borrower dies:
- Lender is beneficiary: Bank, finance company, credit union
- Decreasing coverage: Matches declining loan balance
- Short-term: Term of loan (1-10 years typically)

Types

Credit life (death benefit):
- Pays loan balance: If borrower dies
- Protects lender: Ensures loan repaid
- Protects borrower's estate: Debt doesn't burden heirs

Credit disability:
- Pays loan payments: If borrower becomes disabled
- Monthly benefit: Covers monthly payment
- Limited duration: 12-24 months typically

Characteristics

Group basis:
- Group policy: Lender is master policyholder
- Certificates: Each borrower gets certificate
- Simplified underwriting: Often guaranteed issue
- Decreasing term: Coverage decreases with loan balance

Example:

Car loan: $30,000
Term: 5 years
Monthly payment: $550

Credit life coverage:
Initial: $30,000
Year 1: $24,000 (remaining balance)
Year 2: $18,000
Year 3: $12,000
Year 4: $6,000
Year 5: $0 (loan paid off)

If borrower dies year 2:
Benefit paid: $18,000 (to lender)
Loan: Paid in full
Estate: No debt

Regulation

Heavily regulated:
- Premium limits: Maximum rates set by state
- Voluntary: Must be optional, not required
- Disclosure: Terms must be clearly disclosed
- Refunds: Pro-rata refund if loan paid early
- Cannot require: Lender cannot require as loan condition (must be voluntary)

Hybrid individual/group:
- Individual policies: Separate policy for each person
- Group enrollment: Sold through employer or association
- Simplified underwriting: Less stringent than true individual
- Employee-paid: Payroll deduction
- Portable: Can keep if leave group

Feature Group Life Individual Life Underwriting Simplified/group Full individual medical Portability Limited (conversion) Fully portable Cost Lower Higher Coverage amount Limited Unlimited (based on needs) Cash value Usually none (term) Available (permanent) Ownership No ownership rights Own the policy Premiums May increase Level (whole life) Customization Limited options Fully customizable Beneficiary Insured chooses Owner chooses When terminates Leave employment Can keep for life

  • Group life = one master policy: Covers multiple people under single contract
  • Certificate of insurance: Evidence of coverage, not the policy itself
  • Master policy holder: Employer, association, or creditor owns policy
  • $50,000 exclusion: First $50,000 of employer-provided group term not taxable
  • Table I: IRS table for imputed income on coverage over $50,000
  • Conversion privilege: 31 days to convert to individual policy without evidence
  • No evidence required: Guaranteed issue during conversion period
  • Attained age premium: Conversion premium based on current age
  • Convert to permanent: Must convert to whole life or universal life (not term)
  • Death during conversion: Coverage continues if die within 31 days
  • Contributory = 75% participation: Minimum participation requirement
  • Non-contributory = 100% participation: All eligible employees covered
  • Actively-at-work: Must be working on effective date
  • Group underwriting: Based on group characteristics, not individuals
  • Credit life insurance: Pays loan balance if borrower dies
  • Decreasing term: Credit life decreases as loan balance decreases
  • Lender is beneficiary: On credit life insurance
  • Cannot require credit life: Must be voluntary
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