Lincoln Financial Group employer administration guide

Do not reproduce. This document is meant for educational purposes only. The descriptions herein are a summary and intended for informational purposes. This document does not include all terms, conditions and exclusions of the policies described.

Partnering to help you lead.

Lincoln Financial Group makes it easy for you. Easy to empower and educate your employees. Easy to make decisions--and move forward--confidently. Our knowledge and the breadth of our portfolio allows us to meet your needs today and adapt as they change for tomorrow. We're driven to provide you competitive benefits through flexibility, constant innovation and timely insights. We never waver in our commitment to find the answers that are right for you.

Important Notice

This guide explains general principles in your Lincoln Financial Group certificate of insurance or group policy. Any information regarding a particular person's eligibility, benefit level, or right to continuation or conversion is obtained from the certificate of insurance. If a conflict exists between this manual and the certificate of insurance or group policy, the certificate of insurance or group policy takes precedence. Lincoln Financial Group reserves the right to change or discontinue the procedures outlined herein at any time. Regarding sample forms used or described in this manual: Insurance forms are frequently revised. Please contact your Lincoln Financial Group benefits representative to be certain you are using the most current form available. This guide includes products offered by Lincoln Financial Group that may not be applicable to your organization. Your payment of premiums will be interpreted as acceptance and acknowledgment of your responsibility under this Administration Guide.

Do not reproduce. This document is meant for educational purposes only. The descriptions herein are a summary and intended for informational purposes. This document does not include all terms, conditions and exclusions of the policies described.

Table of Contents

Annual vs. Open Enrollment .............................................5 Enrollment Options.............................................................5 Paper Enrollment Process .................................................6 Note for Self-Billed Groups ...............................................7 Notes for List-Billed Groups..............................................7 Employee Eligibility.............................................................8 Late Entrants........................................................................9 Non-contributory coverage (employer paid):...............9 Contributory coverage (employee paid):.......................9 Family Status Change / Qualifying Event........................9 Enrolling a Rehired Employee........................................ 10 Canceling Coverage.......................................................... 10 Guaranteed Issue ............................................................. 10 Evidence of Insurability Requirements........................ 11 Evidence of Insurability Process.................................... 11 Evidence of Insurability Underwriting Requirements .............................................................................................. 11 Notification of Underwriting Decisions ....................... 12 Evidence of Insurability Status Reports....................... 12 Electronic Submission of Administrative Changes and Adjustments ...................................................................... 12

Billing for Life/Disability/Dental/Vision Products ...... 13 Billing for Worksite Accident and Critical Illness Products ............................................................................. 14 Payroll File Billing for Accident and Critical Illness Products ............................................................................. 14 Payroll File Billing Instructions....................................... 14 Premium Remittance Process........................................ 15 Billing and Premium Remittance for Life/Disability/Dental/Vision Products......................... 15

Billing and Premium Remittance for Worksite Accident and Critical Illness Products...........................16 Billing and Premium Remittance for Universal Life Product................................................................................16 Reinstatement Process....................................................16 Adjustments to List Bill....................................................17 New Employees Due to Mergers and Acquisitions....18 Responsibilities of Self-Billed Groups ...........................18 Instructions for Completing Statement of Premium Due.......................................................................................18 Example of Statement of Premium Due.......................19 Calculating an Insured's Age for Premium Purposes.20 Establishing Initial Payroll Deductions..........................20 Calculating Premiums.......................................................20 Life........................................................................................20 Dependent Life..................................................................20 Short-Term Disability (STD).............................................21 Long-Term Disability (LTD)..............................................21

Conversion of Group Life Insurance..............................23 Requirements for Conversion Notification to the Insured ................................................................................23 Privilege of Late Notification of the Conversion.........24 Requesting a Quote..........................................................24 Submitting an Application...............................................24 Death During the Conversion Period............................25 Conversion of Long-Term Disability (LTD) Insurance.25 Requesting a Quote..........................................................26 Submitting an Application...............................................26 Portability ...........................................................................26 Continuation ......................................................................28

Life Claims...........................................................................29 How do I contact Lincoln?...............................................29

2

How do I start a Life Claim?............................................ 29 Express Life Claims Service............................................. 29 What is the basic claim information needed to start a claim review? .................................................................... 29 Turn-Around Times for Claims....................................... 30 What happens if the basic information is not provided? ........................................................................... 30 What other information may be required to complete the claim review? ............................................................. 30 Payment Options.............................................................. 31 Accidental Death & Dismemberment (AD&D)........... 31 Beneficiary Designation.................................................. 31 What If ............................................................................... 31 Funeral Home Assignment............................................. 32 Accelerated Death Benefit............................................. 32 Extension of Death Benefit (Life Waiver of Premium) .............................................................................................. 32 Premium Adjustments for Waiver of Premium......... 33 Taxability............................................................................ 33 Accident / Critical Illness Claims.................................... 34 Filing an Accident or Critical Illness Claim................... 34 Payment of Benefits......................................................... 34 Appealing a Denied Claim............................................... 34 Short-Term Disability (STD) Claims............................... 35 Filing a Claim for Short-Term Disability....................... 35 Payment of Benefits......................................................... 35 Updated Salary Not Reflected in Benefit Checks....... 36 Reporting Part-Time Earnings for an Employee Who Is Receiving Disability Benefits .......................................... 36 Lincoln Financial Group's LINKS Process ..................... 36 How the LINKS Process Works....................................... 36 Return-to-Work Notification.......................................... 36 Preexisting Condition Clause ......................................... 36 Social Security Assistance............................................... 37 Appealing a Denied Claim............................................... 37

New Jersey / New York Disability Claims Information ..............................................................................................38 New York DBL Claim Features........................................38 New Jersey TDB Claim Features.....................................39 Long-Term Disability (LTD) Claims.................................39 Filing a Claim for Long-Term Disability (LTD)..............39 Payment of Benefits.........................................................39 Calculating LTD Benefits..................................................40 Preexisting Condition Clause..........................................40 Integration of Other Income...........................................40 Accumulation of the Elimination Period......................41 Recurrent Disability..........................................................41 Partial Disability Provision...............................................41 Work-Related Disabilities................................................42 Court-Ordered Garnishment of Benefits.....................42 Death of an Employee Who Was Receiving Disability Benefits ...............................................................................42 Updated Salary Not Reflected in Benefit Checks.......43 Reporting Part-Time Earnings for an Employee Who Is Receiving Disability Benefits...........................................43 Waiver of Premium for Disability...................................43 Premium Adjustments for Waiver of Premium..........43 LTD Life Waiver Links Process ........................................43 Return to Work Assistance..............................................43 Appealing a Denied Claim...............................................44 Tax Information Pertaining to Disability Benefits.......44 Dental Insurance...............................................................49 Filing a Claim......................................................................49 Preauthorization for Dental Work.................................49 Dental ID Cards..................................................................49 Prior Insurance Credit......................................................49 Accessing Dental Health Information...........................49 Locating a Participating Dentist (Dental PPO).............50 COBRA .................................................................................51 Vision Insurance ................................................................52

3

Locating a Provider.......................................................... 52 Vision ID Card.................................................................... 52 Filing Out-of-Network Claims......................................... 52

Benefit Administration Overview.................................. 53 Super Users and Delegates ............................................ 53 What do super users do, and what information can they access? ...................................................................... 53 Who can be a super user?.............................................. 53 Can brokers be named as super users?....................... 53 Who can be a delegate? ................................................. 53 Why do super users and some delegates have access to salary information?..................................................... 54 If several people from within a client's organization require online access, would they all use the same sign-on? .............................................................................. 54 System Access for Super Users and Delegates .......... 55 How is the super user selected and given access to the company's Lincoln benefit information? ............. 55 How does the super user choose delegates?............. 55 Once a super user chooses delegates online, how do the delegates complete their registrations? .............. 55 What is the maximum time for which a super user can appoint a delegate?......................................................... 55 Does a super user's access have an expiration date? .............................................................................................. 55 What if a company's super user leaves the position or the company? What happens to the delegates the super user has chosen?................................................... 55 When a super user leaves, how can a company avoid disruption and ensure that its benefits can be administered? ................................................................... 56

4

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download