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Not all DI plans are equal
- 1. Not All DisabilityPlans Are Created Equal The Unique Value of Assurant Employee Benefits Disability Products and services marketed by Assurant Employee Benefits are underwritten by Union Security Insurance Company. In New York, products and services are marketed by Assurant Employee Benefits and underwritten by Union Security Life Insurance Company of New York, which is licensed in New York and has its principal place of business in Syracuse, New York.
- 2. This presentation providesa general overview focusing on Assurant Employee Benefits’ most common true group disability plan. Assurant Employee Benefits offers other disability plan options. See specific plans for coverage details including limitations, exclusions and restrictions.
- 3. Making Sense ofInsurance Jargon We want to help you understand how to navigate the various definitions and terms often associated with disability contracts. We believe doing so will assist you in helping your clients make informed decisions.
- 4. The Heart ofDisability Insurance The Definition of Disability ONE material duty vs. all material duties Occupation Test OR Earnings Test vs. both tests
- 5. A Common Definitionof Disability in the General Marketplace “ You are disabled when… You are limited from performing the material and substantial duties of your regular occupation … AND… You have a 20% or more loss in your indexed monthly earnings…”
- 6. Our Most CommonTrue Group Definition of Disability “ Disability or disabled means that...an injury, sickness, or pregnancy prevents you from performing… at least ONE of the material duties of your regular occupation … OR … from earning more than 80% of your indexed monthly pay…”
- 7. Other Advantages ofOur Contract Our contract offers disability benefits in easy to understand language. Loosely defined vocational rehab benefits Specific vocational rehab benefits Prudent person language Treatment-free period The proportionate loss formula 70% Indirect RTW earnings offset Offer CPI-W Offers 7.5% Earnings Threshold Indexing Average Competitors in the Marketplace Assurant Employee Benefits
- 8. Outstanding Claims OperationThree Disability Benefit Centers Disability Claims Professional Designation (DCP SM ) Proprietary Claims Management System Guided by our Claims Philosophy – “ Do the right thing at the right time”
- 9. Our Customers Deserveto Have Legitimate Claims Paid Promptly During 2006, our Benefit Centers: Managed 22,500 new disability claims 1 Paid over $252 million in benefits 1 Approved 92% of the disability claims that were submitted 1 We provide claimants written benefit status within 10 days of receipt of claim! 1 Union Security Insurance Company and Union Security Life Insurance Company of New York internal data, January 1 through December 31, 2006. Based on STD and LTD fully-insured claims
- 10. Partnering with ourClaimants Since its inception, our Vocational Services team has accepted over 10,000 disability claimants into its rehabilitation program. 1 37% of our claimants who filed LTD claims during 2006 had returned to work as of 8-3-07. 1 Among those that are eligible, 90.5% of our LTD claimants that have been disabled for more than 36 months have been awarded Social Security disability benefits. 1 1 Union Security Insurance Company and Union Security Life Insurance Company of New York internal data.
- 11. Additional Benefit OptionsCost of Living Allowance (COLA) Activities of Daily Living (ADL) Benefit Employee Assistance Program Medical Premium Payment Supplement Retirement Savings Benefit Business Income Benefit (BIB) EASY TO ADD ON!
- 12. Trusted Advisor Disability plans can be confusing for anyone, but they serve a very essential purpose. Helping your clients understand the underlying value of a disability plan will allow them to make a wise benefit choice for their employees and do so with confidence. Your clients will appreciate you for it.
- 13. Disability products andservices marketed by Assurant Employee Benefits are underwritten by Union Security Insurance Company. In New York, products and services are marketed by Assurant Employee Benefits and underwritten by Union Security Life Insurance Company of New York, which is licensed in New York and has its principal place of business in Syracuse, NY. Plans contain limitations and exclusions. Benefits provided and premium amounts depend on the plan selected. Some plan benefits may not be available in all states. We have the right to cancel policies with advance written notice. This policy provides disability income insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Insurance Department. GP-90/PF99
Editor's Notes
- #5 If you don’t qualify for benefits, no other provision matters. The definitions of other carriers are varied. The material duties, all the material duties etc… How do other carriers adjudicate claims through contracts that include this vague language? How do they decide how limited a claimant must be to qualify for benefits? How can the policyholder be assured that different claims personnel will come to the same conclusion on two different, but similar, claims? Our straightforward contract language supports a more efficient and consistent claims process. Our most common true group disability plan offers income protection from loss of duties or income. This additional protection may be the difference between qualifying for benefits or a denied claim. This is particularly pertinent for employees that receive commissions or derive their income from serving a clientele. Our OR definition provides additional opportunity to qualify for benefits. We offer other definitions of disability. F-21, our cost containment plan, offers an AND definition consistent with many other carriers. Our Voluntary product offers an Occupation Test without the Earnings Test.
- #6 The claimant must be limited from multiple duties of their occupation before qualifying for benefits. A claimant must suffer an occupation and earnings loss before qualifying for benefits.
- #7 A claimant may qualify for benefits if limited from one material duty. The claimant receives protection from two tests of disability. They qualify for benefits if they have a loss of duty OR an earnings loss.
- #8 The Consumer Price Index (CPI-W) has been in the 2% to 3% range for the past several years. Our generous indexing offers the claimant a greater opportunity to continue qualifying for benefits while working. Our offset method is generally advantageous to higher income earners. We have a collateral piece, KC4517 - “A greater benefit when returning to work in a limited capacity”, that illustrates the value of this benefit. (This is located on the Sales Literature Index.) Similarly to the definition of disability, the treatment-free period in our pre-ex provision offers an additional opportunity to qualify for benefits that is often not included in competitor plans. Prudent person language may provide the carrier with discretion to deny benefits even if the claimant never sought treatment during the pre-ex period. Our Managed Disability Solutions (MDS) is a combination of the Managed Rehabilitation Benefit and the Quality of Care Benefit. The Managed Rehabilitation Benefit provides uncommon benefits such as Family Care Expense Credit that includes all dependents of the claimant, not just children, as is standard in many contracts. We will also reimburse an employer a portion of an employee’s first month’s pay when he/she returns to work while disabled. Through the Quality of Care Benefit we can take an active role in partnering with the claimant’s physician and may also pay for medical expenses if doing so will likely result in a claimant’s recovery and successful return to active employment.
- #9 Our three benefit centers in Kansas City, Indianapolis, and Minneapolis provide additional capacity and diversification allowing us to manage work flow and ensure that benefits are administered efficiently. Our claims analysts receive ongoing instruction and must demonstrate claims knowledge and aptitude to satisfy the requirements of DCP. Our experienced and knowledgeable staff provide a resource to our claimants. Our claims management system allows our multi-disciplinary claims management team, including analysts, nurses, forensic accountant, certified rehabilitation counselors, etc… to work collaboratively toward providing support and benefits to our claimants.
- #11 Through benefits that include worksite accommodations, vocational training, educational expense assistance and a generous family care expense credit, our Vocational Rehabilitation Services staff has helped many of our claimants regain quality of life that they may not have had an opportunity to do otherwise. Our RTW specialists actively work with our claimant and the policyholder to promote a successful continuation of the relationship between employee and employer. SSDB can be difficult to initially qualify for and can easily take 18 months or more if an appeal is necessary. We work with our claimants by continuing to pay disability benefits during the SSDB application process. Also, through our partnership with Advantage 2000, we take care of many of the administrative requirements and even provide arbitration representation if necessary at no cost to our claimant. For the general population; in 2005, 61.9% of all SSDB applicants were denied.
- #12 COLA - This benefit enables a disabled person's monthly LTD net benefit to increase in the same manner a Social Security disability benefit increase. Employers can select a percentage increase of 3%, 4%, 5%, or 6% and they also select a maximum duration of 5 years, 10 years or unlimited. ADL - Benefit is payable if the claimant is unable to perform two or more activities of daily living (i.e., bathing, dressing, toileting, transferring, continence and eating) without assistance from another person for at least 30 consecutive days; or suffers a cognitive loss for at least 30 consecutive days. Two options are available paying 80% or 100% of the claimant’s pre-disability income. EAP – Different levels of counseling services are available to help employees deal with problems and regain/maintain productivity in the workplace. MPPS – Pays the claimant's monthly contribution for his or her own medical premiums up to a selected maximum amount. The policyholder has five options with respect to the monthly maximum: $100, $200, $300, $400 or $500. RSB - Provides funding to a retirement savings account on behalf of the claimant. Benefit % (of pre-disability pay) - 1%, 2%, 3%, 4% or 5% to a maximum of $10,000. BIB - The intent of this rider is to provide the policyholder with some economic protection in the event one of their revenue generating employee becomes disabled. Therefore, this benefit is paid directly to the policyholder. The benefit payable can be up to the claimant’s schedule amount if they have no earnings while disabled.