Group Insurance PDF
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GROUP INSURANCE FOURTH EDITION WILLIAM F. BLUHM PRINCIPAL EDITOR ASSOCIATE EDITORS ROBERT B. CUMMING ALAN D. FORD JERRY E. LUSK PETER L. PERKINS Group Insurance Fourth Edition Principal Editor William F. Bluhm Associate Editors Robert B. Cumming Alan D. Ford Jerry E. Lusk Peter L. Perkins This text is a comprehensive treatment of all aspects of group insurance in the United States and Canada, both life and health, with emphasis on the actuarial aspects of this important field of insurance. Since its original publication in 1992, Group Insurance has become the re- source of choice for experts as well as beginners. The Society of Actuaries has adopted portions of each prior edition for use in its examination program, making it required reading for those who wish to become Fellows of the Society of Actu- aries. The Fourth Edition has been exten- sively revised, containing some entirely new chapters and some that have been substantially rewritten. Many of the changes were made to realign the text with changes in the Society of Actuaries education syllabus. As well, changes in the group marketplace have been reflect- ed, and the scope of material has been increased in some areas, such as in the descriptions of new coverages. In addi- tion, a new section addressing actuarial practice has been added. (■continued on back flap) Digitized by the Internet Archive in 2017 with funding from Kahle/Austin Foundation https://archive.org/details/isbn_9781566984485 GROUP INSURANCE FOURTH EDITION PRINCIPAL EDITOR ASSOCIATE EDITORS ROBERT B. GUMMING ALAN D. FORD JERRY E. LUSK PETER L. PERKINS ACTEX PUBLICATIONS WINSTED, CONNECTICUT Copyright © 2003 All rights reserved. No portion of this book may be reproduced in any form or by any means without the prior written permission of the copyright owner. Request for permission should be addressed to: AC'TEX Publications, Inc. P.O. Box 974 Winsted, CT 06098 Manufactured in the United States of America 10 9 8 7 6 5 4 3 2 Cover Design by MJB Library of Congress Cataloging-in-Publication data Group Insurance / William F. Bluhm, principal editor, p. cm. Includes bibliographical references. ISBN: 1-56698-448-3 1. Insurance, Group - United States. 2. Insurance, Group - Law and legislation - United States. I. Bluhm, William F., 1952- HG8058. G748 1992 368.3’00973 - dc20 92-31337 ISBN: 1-56698-448-3 The first edition of Group Insurance began in a conceptual stage around 1987, as an outgrowth of my involvement in the Society of Actuaries’ Education and Examination Committee. The second and third editions were ‘nudges’ in the direction of the changing landscape of group insurance and actuarial practice. This latest edition might better be called a full-fledged ‘shove.’ I encourage readers to contact me with comments and suggestions on the content and direction - particularly actuarial students, and particularly while the material is fresh in your minds. There are many people who have contributed to each of the four editions in different ways. This includes some technical support, but mostly moral support. I will not try to list all of them here - the list would be overly long, I would end up always wanting to add more, and, of greater concern to me, would miss someone whom I don’t want to hurt. However, to each of you who has given encouragement and support, I give you my sincere and heartfelt thanks. There are, however, a few people who stand out far and away above the rest. The first is my dear friend Dick London. Dick founded Actex, and nourished it unselfishly to its impressive position today. Along the way, he got excited about this book, championed it in a way no one else has, and, most of all, respected my desire to maintain creative control over it. Dick is one of those few friends I have found through my life that I know I can count on, who has rejoiced in my journey, and who values the friendship as much as I do. m Preface IV I also want to acknowledge the contribution of Marilyn Baleshiski at Actex, who has returned to this project as its formatting editor after an absence of one edition. Thanks, Marilyn. I thank Christine, Samantha, and Joey, my family, for their love and understanding. You are the most precious part of my life. Finally, I would like to dedicate this book to Debbie Demay, who last year sadly left those of us who loved her. She was a rock of ad- ministrative support, helping me through multiple editions, with multiple headaches, always doing so as a professional and a lady. Debbie, you are still in, and will stay in, our hearts and memories. Minneapolis, Minnesota William F. Bluhm, FSA, MAAA March 2003 Principal Editor Table of Contents Preface iii ◄SECTION ONE ► INTRODUCTION Chapter 1 The Group Insurance Marketplace 3 %ara L. Clarke Chapter 2 Overview of Sales and Marketing rWitfiam JA. (RaaS 19 Chapter 3 Health Care Policy and Group Insurance Jeffrey Cj. JAtfen 35 ◄SECTION TWO> GROUP COVERAGES, BENEFITS, AND PLAN PROVISIONS Chapter 4 Group Life Insurance Benefits JUicfiaeCj. Tfiompson Tra n ^ Cassa n cfra 59 v Table of Contents VI Chapter 5 Group Disability Income Benefits (Michaef(D. Lacfance 83 Chapter 6 Medical Benefits in the United States CDarreCf(D. TJnapp 95 Chapter 7 Medical Benefits in Canada (Bruno Cjagnon 119 Chapter 8 Dental Benefits in the United States JferscheC (Reich 145 Chapter 9 Prescription Drug Benefits JAuctrey JfaCvorson 167 Chapter 10 Group Long-Term Care Insurance (MaCcoCm Cheung 183 Chapter 11 Miscellaneous Benefits iCiCCiam J. Thompson 209 Chapter 12 Government Old-Age, Survivors, and Disability Plans in the United States (Bruce D. SchoSeC 221 Chapter 13 Government Health Care Plans in the United States John Vj. (BauerCein 227 ◄SECTION THRI:I> OVERVIEW OF LEGAL AND REGULATORY ENVIRONMENT Chapter 14 Principles of Health Insurance Regulation Jufia (PhiCips Leigh Tt. VCachenheim 247 Chapter 15 Regulation in the United States (EdwardL. (Potanha %eith (M. A ndrews 259 Chapter 16 Regulation in Canada (David(B. (Martin (NicoCa (parf{er-Smith 325
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