Group insurance handbook

목차 (Table of Contents)

• CONTENTS
• CHAPTER LIST OF ILLUSTRATIONS = xxvii
• PARTⅠ : EMPLOYEE BENEFIT PLANS
• 1. COMPONENTS OF EMPLOYEE BENEFIT PLANS / by C. Arthur Williams, Jr. = 3
• DEFINITION OF EMPLOYEE BENEFIT PLANS. IMPORTANCE AND RECENT GROWTH. ECONOMIC SECURITY AFFORDED BY EMPLOYEE BENEFIT PLANS : Plans Providing Death Benefits. Plans Providing Benefits in Case of Poor Health. Plans Providing Benefits in Case of Unemployment.
• Plans Providing Benefits. PARTIES INVOLVED IN ECONOMIC SECURITY PROGRAMS.
• 2. RATIONALE OF EMPLOYEE BENEFIT PLANS / by Wendell Milliman = 18
• OBJECTIVES OF EMPLOYEE BENEFIT PLANS : Basic Purpose. Ancillary Purposes. REASONS FOR GROWTH OF EMPLOYEE BENEFIT PLANS : Advantages of Employee Benefit Plan Mechanisms. Employee Benefit Plans. Governmental Influences. Influence of Other Interests. Influence of Social and Economic Factors. REQUIREMENTS OF SOUND EMPLOYEE BENEFIT PLANS : Acceptable Cost. Acceptable Benefits . Communication. Payment of Benefits. Periodic Review.
• PARTⅡ : GROUP COVERAGES : THEIR NATURE, DEVELOPMENT AND SIGNIFICANCE
• 3. FUNDAMENTAL CHARACTERISTICS OF THE GROUP TECHNIQUE / by Davis W. Gregg = 31
• BROAD CHARACTERISTICS OF GROUP INSURANCE. BASIC FEATURES : Eligible Groups. Size Specifications. Benefit Schedules. Financing. GROUP SELECTION : Theory of Group Selection. Departures from Group Selection Theory. SIGNIFICANCE OF THE BASIC CHARACTERISTICS.
• 4. DEVELOPMENT AND SIGNIFICANCE OF GROUP LIFE INSURANCE / by C. Manton Eddy = 45
• DEVELOPMENT OF GROUP LIFE INSURANCE IN THE UNITED STATES : Early Development. Later Milestones. GROWTH OF GROUP LIFE INSURANCE. DEVELOPMENT OF GROUP LIFE INSURANCE IN OTHER COUNTRIES. DEVELOPMENT OF GROUP LIFE INSURANCE IN CANADA. SIGNIFICANCE OF GROUP LIFE INSURANCE.
• 5. DEVELOPMENT AND SIGNIFICANCE OF GROUP HEALTH INSURANCE / by J. F. Follmann Jr = 57
• EARLY DEVELOPMENT OF GROUP HEALTH INSURANCE : Development in Other Nations. Development in the United States. GROWTH OF GROUP HEALTH INSURANCE : Number of Insuring Organizations. Number of Persons Covered. Premium Volume. Benefits Paid. FACTORS INFLUENCING THE GROWTH OF GROUP HEALTH INSURANCE : Factors outside the Insurance
• CHAPTER Field. Factors within the Health Insurance Field. SIGNIFICANCE OF GROUP HEALTH INSURANCE.
• 6. LEGAL ENVIRONMENT OF GROUP INSURANCE / by Arthur M. Browning = 85
• LEGAL DEFINITION OF GROUP LIFE INSURANCE AND RELATED PROVISIONS : 1917 Model Bill. The Group Association. South-Eastern Underwriters Association Case. 1946 Model Bill. Subsequent Revisions to the Model Bill. LEGAL DEFINITION OF GROUP HEALTH INSURANCE. MAXIMUM AMOUNTS OF GROUP LIFE INSURANCE. FEDERAL INCOME TAXATION OF GROUP LIFE INSURANCE. UNION AND UNION-MANAGEMENT WELFARE : NAIC Code Ethical Practices. State and Federal Disclosure Laws. POSSIBLE FUTURE DEVELOPMENT.
• PART III : GROUP LIFE COVERAGES
• 7. GROUP TERM LIFE INSURANCE / by William G. Williams = 103
• SCOPE OF GROUP TERM LIFE INSURANCE. EMPLOYER-EMPLOYEE GROUP TERM LIFE INSURANCE : Type of Benefits Provided. Effectiveness of Yearly Renewable Term Plan. Advantages of Group Term Life Insurance. Limitations of Group Term Life Insurance. Terminal Funding with Group Term Life Insurance. CREDITOR GROUP LIFE INSURANCE : Creditor Group Life Insurance versus Conventional Group Term Life Insurance. Eligible Creditors, Loans and Purchases. Creditor Modifications of conventional Term Plan.
• 8. FORMS OF GROUP PERMANENT LIFE INSURANCE / by William W. Keffer = 128
• GROUP TERM LIFE INSURANCE FOR RETIRED EMPLOYEES : Extent of Use of Group Term Life Insurance. Problems under Group Term Life Insurance. ALTERNATIVES TO GROUP TERM LIFE INSURANCE : Level Premium Group Permanent Forms. Group Paid-up Life Insurance. Deposit Funds. FEDERAL TAXATION OF GROUP TERM AND GROUP PERMANENT LIFE INSURANCE : Taxation of Group Term Life Insurance. Taxation of Group Permanent Life Insurance. Federal Income and Estate Taxation of Death proceeds. Tax Status of Deposit Fund Arrangements.
• LEVEL PREMIUM GROUP PERMANENT INSURANCE : Optional Permanent Insurance, with Employee Contributions. Employer Contributions for Nonvested Benefits. Differences in Policy Provisions from Group Term Life Insurance. GROUP PAID-UP LIFE INSURANCE : Basic Features. Deferred Paid-up Variation. Underwriting and Administration of Group Paid-up Plan. Advantages and Limitations of Group Paid-up Plan.
• 9. ACCIDENTAL DEATH AND DISMEMBERMENT, DEPENDENTS AND FEDERAL EMPLOYEES GROUP LIFE INSURANCE / by Carl R. Ashman = 151
• ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE : Nature of Accidental Death and Dismemberment Coverage. Benefit Structure and Amounts. Limitations and Exclusions. Treatment of Retired Employees. Recent Developments. DEPENDENTS GROUP LIFE INSURANCE : Nature of Dependents Group Life Insurance. Benefit Amounts. Termination of Coverage. Continuance of Coverage in the Event of Employee's Death or Disability. Critique. FEDERAL EMPLOYEES GROUP LIFE INSURANCE : Background. Eligibility and Enrollment. Benefit Structure and Amounts. Cost. Insurers. Conversions. Critique.
• 10. UNDERWRITING GROUP LIFE INSURANCE / by J. C. Archibald = 165
• UNDERWRITING THE GROUP POLICYHOLDER : Occupational Hazards. Other Hazards. Administrative Facilities of Policyholder. Employer Cooperation. Transfer Business. DESIGN OF OPERATIONAL FEATURES OR THE GROUP LIFE PLAN : Eligibility. Actively-at-Work Requirement. Late Entrants. Termination of Coverage. DESIGN OF BENEFITS : Types of Benefit Schedules. Maximum Benefit Amounts. Retired Lives. Superimposed Coverage. RENEWAL UNDERWRITING OF GROUP LIFE INSURANCE UNDERWRITING OF GROUP LIFE INSURANCE. REINSURACE OF GROUP LIFE INSURANCE : Reinsuring the Catastrophe Hazard. Reinsuring the Individual Life. Reinsurance by Spreading the Risk among Group Insurers.
• 11. MANUAL RATE MAKING IN GROUP LIFE INSURANCE / by Morton D. Miller = 182
• DISTINCTIVE CHARACTERISTICS OF GROUP INSURANCE PRICING. BASIC GOALS OF RATE MAKING. NET PREMIUMS FOR TERM COVERAGE : Characteristics of Group Mortality. Sources of Group Mortality Data. Development of the 1960 CSG Table. Net Premium Calculation. GROSS PREMIUMS FOR TERM COVERAGE : Loading. Nonstandard Industries. Other than Annual Premiums. Application of Gross Premiums. MANUAL RATE MAKING FOR SPECIAL FORMS OF GROUP LIFE INSURANCE : Group Paid-up Life Insurance. Level Premium Group Permanent. Dependents Group Life Insurance. Group Accidental Death and Dismemberment. Creditor Group Life Insurance. RATE REGULATION IN GROUP LIFE INSURANCE : Initial Rates. Employer and Employee Contributions. Creditor Group Life Insurance Rates.
• 12. EXPERIENCE RATING IN GROUP LIFE INSURANCE / by Paul H. jackson = 213
• NATURE OF EXPERIENCE RATING : Mortality. Expenses. Risk Charges. Interest BASIC REASONS FOR THE USE OF EXPERIENCE RATING : Conservatism of Manual Rates. Broad Rating Classes. Competition with Self-insurance. Competition among Insurance Companies and Brokers. STATISTICAL CONSIDERATIONS IN EXPERIENCE RATING : Probable Loss Ratio. Large Groups. Smaller Groups. Treatment of Catastrophic Losses. Large Amounts on Individual Employees. Experience Rating Deficits. Other Considerations. FACTORS USEDIN EXPERIENCE RATING : Incurred Claims. Expense Charges. Claim Fluctuation Reserves. Package Plans. Discounts.
• PART Ⅳ : GROUP HEALTH COVERAGES
• 13. TYPES OF HEALTH RISK BEARERS : INSURANCE COMPANIES / by William N. Seery = 229
• TYPES INSURANCE COMPAINES WRITING GROUP HEALTH COVERAGE : Life Insurance Companies. Casualty Insurance Companies. Monoline Companies. All-Lines Group of Companies. NATURE OF INSURANCE COMPANY GROUP HEALTH COVERAGE : Indemnity Approach. Experience Rating. National Coverage. Premium Taxes. Combination Coverage. Profit Factor. COMPETITION AMONG GROUP HEALTH INSURANCE COMPANIES. REGULATION OF GROUP HEALTH INSURANCE : Rationale of Regulation. Nature of Regulation of Group Health Insurance. Critique of Group Health Insurance Regulation. THE PERFORMANCE OF GROUP HEALTH INSURANCE FUNCTIONS WITHIN AN INSURANCE COMPANY.
• 14. TYPES OF HEALTH RISK BEARERS : BLUE CROSS AND BLUE SHIELD PLANS / by Thomas B. Fitzpatrick = 244
• OBJECTIVES OF THE PLANS : Blue Cross Shield. BLUE CROSS OPERATIONS : Principles and Operational Aspects of Blue Cross. Marketing Considerations regrarding Blue Cross. National and Interplan Aspects of Blue Cross . National and Interplan Aspects of Blue Cross. BLUE SHIELD OPERATIONS : Principles and Operational Aspects of Blue Shield. Marketing Considerations regarding Blue Sheield. National and Interplan Aspects of Blue Shield.
• 15. TYPES OF HEALTH RISK BEARERS : GROUP PRACTICE PREPAYMENT PLANS / by Avram Yedidia = 272
• NATURE OF MEDICAL GROUP PRACTICE. GROUP PRACTICE PREPAYMENT : Nature of Group Practice Prepayment. Types and Extent of Group Practice Pre payment Plans. The American Medical Association's Attitude toward Group Practice Prepayment Plans. CHOICE OF PLANS : Government Employee Programs. Collective Bargaining Agreements. NATURE AND ORGANIZATION OF SEVERAL GROUP PRACTICE PREPAYMENT PLANS : Kaiser Foundation Health Plan. Health Insurance Plan of Greater New York. Ross-Loos Medical Group. Community Health Association, Detroit, Michigan (CHA), Group Health Cooperative of Puget Sound, Seattle, Washington. Group Health Association, Inc of Washington, D.C. (CHA). CHARACTERISTICS OF THE SIX GROUP PRACTICE PREPAYMENT PLANS : Common Features. Significant Variations among the Plans, ADVANTAGES AND DISADVANTAGES OF GROUP PRACTOICE PREPAYMENT PLANS : Advantages to Consumers. Disadvantages to Consumers. Advantages to Physicians. Disadvantages to Physicians. ROLE OF GROUP PRACTICE PREPAYMENT PLANS.
• 16. GROUP HOSPITAL BENEFITS / by Gordon N. Farquhar = 295
• NATURE OF GROUP HOSPITAL COVERAGE. CONDITIONS AND GENERAL PROVISIONS. BASIC COMPONENTS OF HOSPITAL EXPENSE BENEFITS : Room and Board Special Hospital Services and Supplies. Maternity Benefits. AMOUNTS NAD DURATION OF BENEFITS : Room and Board. Hospital Services and Supplies. Maternity Benefits. Deductible Provision. ELIGIBILITY FOR GROUP HOSPITAL INSURANCE : Dependents' Coverage. Retired Employees. HOSPITAL ADMISSION PLANS. BENEFITS FOR MENTAL ILLNESS. NURSING HOME CARE. RECENT DEVELOPMENTS : Intensive Care. Progressive Care.
• 17. GROUP SURGICAL AND MEDICAL BENEFITS / by William A. Halvorson = 313
• NATURE AND SCOPE OF SURGICAL CARE AND PHYSICIANS ; VISITS : Nature and Extent of Surgery. Nature and Extent of Physicians' Visits. EXTENT OF COVERAGE. TYPES OF ORGANIZATIONS OFFERING PREPAYMENT : Insurance Companies' Approach Blue Shield Approach. Group Practice Prepayment Approach. of Foundations for Medical Care. SURGICAL BENEFITS : Nature of Benefit Schedules. Development of Surgical Schedules. Nonsched-uled Surgical Benefits. Service Benefits. MEDICAL BENEFITS : In-Hospital Medical Benefits. Home and Office Physician Visits Benefits. Diagnostic Xray and Laboratory Benefits. Supplemental Accident Benefits. Follio and Specified disease Benefits. Common Exclusions.
• 18. GROUP MAJOR MEDICAL BENEFITS / by O. D. Dickerson = 336
• GENERAL NATURE AND EXTENT OF MAJOR MEDICAL COVERAGE. MAJOR MEDICAL BENEFIT PROVISIONS : Covered Expenses. Exclusions. Upper Limits. Percentage Participation Provisions. Deductible Provisions. Benefit Provisions An Example. Reinstatement of Benefits. COMPREHENSIVE MEDICAL EXPENSE PLANS : Insurance Company Comprehensive Plans. Blue Cross and Blue Shield Extended Benefits. Independent Plans.
• 19. UNDERWRITING GROUP MEDICAL EXPENSE COVERAGE / by Donald D. Cody = 354
• BASIS OF GROUP UNDERWRITING : Group Underwriting Objectives. Group Underwriting Standards. Statutory Group Underwriting Requirements. UNDERWRITING PROBLEMS IN GROUP MEDICAL EXPENSE COVERAGE : Medical Care Costs. Benefit Abuses and Overinsurance. Uninsurable Group. Questionable Groups Requiting Higher Premium Rates. UNDERWRITING OF REGULAR EMPLOYER-EMPLOYEE GROUPS : Basic Underwriting Procedure. Initial Underwriting. Renewal Underwriting. UNDERWRITING OF TRUSTEE GROUPS FORMEDUNDER TAFT-HARTLEY ACT. UNDERWRITING GROUPS WHERE UNION IS POLICYHOLDER. UNDERWRITING TRADE ASSOCIATION GROUPS. UNDERWRITING PUBLIC EMPLOYEE GROUPS. UNDERWRITING SMALL GROUPS OF THREE TO TWENTY-FOUR LIVES. REINSURANCE OF GROUP MEDICAL EXPENSE COVERAGES : Automatic Quota Share Treaties. Facultative Quota Share Agreements.
• 20. GROUP DISABILITY INCOME BENEFITS / by J. Henry Smith = 373
• DEVELOPMENT OF GROUP DISABILITY INCOME COVERAGE. ELIGIBILITY FOR COVERAGE : Eligibility for Short-Term Coverage. Eligibility for Long-Term Coverage. CONTINGENCIES COVERED : Covered under Long-Term Disability Income Benefit Amounts. Long-Term Disability Income Benefit Amounts. TERMINATION OF COVERAGE. STATE STATUTORY DISABILITY BENEFIT PLANS : Form of Compulsory Disability Coverage during Unemployment. Impact on Group Insurance Plans.
• 21. UNDERWRITING GROUP DISABILITY INCOME COVERAGE / by Brooks Chandler = 392
• GENERAL CONSIDERATIONS IN UNDERWRITING GROUP DISABILITY INCOME COVERAGE. UNDERWRITING PROCEDURE AND SOURCES OF INFORMATION. UNDERWRITING SINGLE EMPLOYER GROUPS OF TWENTY-FIVE OR MORE LIVES FOR SHORT-TERM DISABILITY INCOME COVERAGE : Initial Underwriting of Short-Term Disability Income Plans. UNDERWRITING SINGLE EMPLOYER GROUPS OF TWENTY-FIVE OR MORE LIVES FOR LONG-TERM DISABILITY INCOME COVERAGE : Acceptability and Plan Design. UNDERWRITING OF OTHER GROUPS : Single Employer Groups under Twenty-five Lives. Trusteed Welfare Fund Groups Formed under the Taft-Hartley Law. Voluntary Employer Association Groups. Associations of Individuals. State Statutory Disability income Plans. REINSURANCE OF GROUP DISABILITY INCOME COVERAGE.
• 22. MANUAL AND EXPERIENCE RATING FOR GROUP HEALTH COVERAGES / by Edward A. Green = 408
• BASIC PRINCIPLES FOR PREMIUM DETERMINATION : Adequacy. Competitive Level. Equity. Coordination with Operations. Simplicity. GREATER INTRICACY OF MEDICAL EXTENSE COVERAGES : Variety of Patterns. Influences of Claim Costs. Alternate Coverage. MANUAL RATING : Sources of Data. Use of Data. RISK AND EXPENSE CHARACTERISTICS : Personal Characteristics. Environment. Secular Trend. Statistical Deviation and Credibility. Size and Administrative Pattern. EXPERINENCE RATING : Claim Charges and Credibility. Expense Charges. Risk Margin.
• 23. COST CONTROL THROUGH COOPERATION WITH PURVEYORS OF MEDICAL CARE / by L. M. Branson = 436
• THE NEED FOR COST CONTROL : Nature and Extent of the Health Risk. Insurance Benefits Arising form Disabilities. PURPOSE OF INSURANCE IN COST CONTROL. ORIGIN OF COST PROBLEMS. COOPERATION AS A SOLUTION : Cooperation of the Medical Profession. Hospital Cooperation. Cooperation by Insurance Companies.
• 24. COST CONTROL THROUGH CONTRACTUAL PROVISIONS / by Daniel W. Pettengill = 455
• NATURE OF THE COST CONTROL PROBLEM. ELIGIBILITY PROVISION : Employees. Dependents. PROVISIONS RELATING TO PRE-EXISTING CONDITIONS. PROVISIONS EXTENDING COVERAGE AFTER CESSATION OF ACTIVE WORK : Disability Absences. Layoffs and Strikes. Retirement. Other Terminations of Employment. Termination of the Group Contract. PROVISIONS RELATING TO OVER-INSURANCE : Disability Income Benefits. Medical Expense Benefits. BENEFIT PROVISIONS APPLICABLE TO MANY GROUP HEALTH COVERAGES : Percentage Participation. Deductibles. Scheduled Versus Unscheduled Benefits. MISCELLANEOUS BENEFIT PROVISIONS APPLICABLE TO SPECIFIC COVERAGES : Disability Income Benefits. Hospital Benefits. Surgical Benefits. Physician's Fee Benefit. Comprehensive and Major Medical Expense Benefits. Dental Benefits.
• PART Ⅴ : COMMON ASPECTS OF GROUP INSURANCE COVERAGES
• 25. MASTER CONTRACTS AND CERTIFICATES / by John M. Hill, Ⅱ = 477
• STANDARDIZATION OF GROUP CONTRACT PROVISIONS. POWER OF POLICYHOLDER TO PURCHASE GROUP INSURANCE. MULTI-STATE GROUP COVERAGES : Situs of Group Contract. Extra-territorial Legal Requirements. Law Governing Rights and Obligations under Group Contracts. NATURE OF THE GROUP CONTRACT : Policyholder Contractual Provisions. Certificate Holder Contractual Provisions. General Claim Provisions. CREDITOR GROUP INSURANCE CONTRACTS : Regulation of Group Contract. Policy Provisions.
• 26. GROUP INSURANCE MARKETING / by Kenneth C. Foster = 506
• NATURE OF THE GROUP MARKET : Differences between Mass and Individual Insurance Marketing Similarities between Mass and Individual Insurance marketing. Growth of the Group Insurance Market. Segments of the Group Insurance Market. Market Penetration. THE HOME OFFICE ORGANIZATION : General Considerations. Marketing Functions. THE FIELD ORGANIZATION : The Group Office. The Group Representative. Agency Representatives. Brokers, Consultants and Administrators. THE SALES PROCESS : Prospecting. Preparing the Proposal. Presenting the Proposal. Post-Sales Activity. ENTERING THE GROUP MARKET : Motives. Considerations. TRENDS AND PROBLEMS : Increasing Costs. Combined Coverages. Changes in Insurance Company Services. Claim Control Activities. New Products. Governmental Plans. Self-insured Plans. Problems of Marketing of Marketing Creditor Group Insurance.
• 27. COMPENSATION SYSTEMS USED IN MARKETING GROUP INSURANCE / by Che Lin = 526
• NATURE OF GROUP INSURANCE COMPENSATION : Compensation Defined. Conditions for the Payment of Commissions. Types of Commission Schedules. Rationale of Group Insurance Commission Levels. COMMISSIONS FOR REGULAR GROUPS : Group Term Life and Group Health Insurance Commissions. Group Permanent Insurance Commissions. COMMISSIONS FOR SMALL GROUPS. COMPENSATION OF GROUP REPRESENTATIVES.
• 28. INSTALLATION AND GENERAL ADMINSTRATION OF GROUP PLANS / by A. B. Halverson = 541
• INSTALLATION : Solicitation of Eligible Employees. Explanation of Policyholder Adminstration. CONSERVATION. GENERAL ADMINISTRATION : Records of Insurance. Issuance of Certificates. Billings. Commissions and Other Credits. Policy Records. Statistical Analyses. Correspondence.
• 29. CLAIMS HANDLING IN GROUP INSURANCE / by La Rue S. Wagenseller = 556
• NATURE OF THE CLAIM HANDLING FUNCTION : Objectives of Claims Administration. Performance of the Claims Function. FILING A CLAIM : REQUIREMENTS OF INSURANCE COMPANIES. CLAIMS HANDLING FOR SPECIFIC GROUP INSURANCE LINES : Group Life Insurance. Group Accidental Death and Dismemberment Insurance. Group Short-Term Disability Income Insurance. Group Long-Term Disability Income Insurance. Group Hospitalization Insurance. Group Surgical Insurance. Other Medical Expense Coverages of Limited Scope. Group Major Medical Coverage. CLAIMS PROCESSING ASPECTS PECULIAR TO BLUE CROSS AND BLUE SHIELD PLANS.
• 30. GROUP INSURANCE RESERVES / by Milton F. Chauner = 575
• NATURE OF RESERVES : Nature of Premium Reserves in Individual Insurance Contracts. Nature of Group Insurance Reserves. TYPES OF GROUP INSURANCE RESERVES : Premium Reserves. Claim Reserves. Contingency Reserves. Special Reserves. RESERVES FROM THE POLICYHOLDER'S STANDPOINT.
• PART Ⅳ : EXTENSIONS OF THE GROUP CONCEPT
• 31. LIBERALIZATION OF BENEFIT AMOUNTS / by Robert N. Stabler = 587
• GROUP LIFE INSURANCE BENEFIT AMOUNTS : Growth of Group Life Insurance Benefit Amounts. Methods of Controlling Adverse Selection. Statutory Limits on Group Life Insurance Benefit Amounts. Proposals to Limit Group Life Insurance Benefit Amounts. Arguments regarding Statutory Limits on Group Life Insurance Amounts. GROUP HEALTH INSURANCE BENEFIT AMOUNTS : Growth of Group Health Insurance Benefit Amounts. Liberalizations of Benefit Amounts in Specific Group Health Coverages. Attitudes toward Limitations on Group Health Insurance Benefit Amounts.
• 32. ELIGIBILITY OF ASSOCIATIONS / by Clarence H. Tookey and Robert C. Tookey = 603
• TRADE ASSOCIATIONS. ASSOCIATIONS OF INSURANCE : Union Groups. Associations of Public Employees. Professional Associations. Miscellaneous Associations. REGULATION OF ASSOCIATION GROUP INSURANCE : Group Life Insurance. Group Health Insurance.
• 33. TAFT-HARTLEY WELFARE FUNDS / by Lawrence M. Cathles, jr = 618
• INSURANCE : Nature of Welfare Founds. Influence of the Taft-Hartley Act. THE TRUSTEES AND THEIR RESPONSIBILITY. ESTABLISHING THE BENEFIT PROGRAM : Eligibility. Administration. Reserve. Benefits. LEGAL AND TAX ASPECTS : Provisions of State Laws. Taxation. EXPERIENCE RATING. APPROPRIATE USE OF FUND TECHNIQUE. PRESENT AND FUTURE POTENTIAL.
• 34. WHOLESALE AND FRANCHISE INSURANCE / by James W. Rose and Carroll J. McBride = 633
• WHOLESALE LIFE INSURANCE : Employer-Employee Plans. Association Plans. Legal Restrictions on Wholesale Insurance. FRANCHISE HEALTH INSURANCE : Regulation of Franchise Insurance. Employer-Employee Plans. Association plans. Reserves in Franchise Insurance Plans. Tax Aspects of Franchise Insurance. Significance of Franchise Insurance.
• 35. EXTENSIONS OF CREDITOR GROUP COVERAGES / by Stanley W. Gingery = 667
• NATURE AND EXTENT OF CREDITOR GROUP INSURANCE : Basic Characteristics. Origin of Creditor Insurance. Development of Creditor Insurance on a Group Basic. Extent of Creditor Group Insurance Coverages. Legal Requirements. Underwriting. NEW AREAS FOR CREDITOR GROUP COVERAGES : Revolving Credit. Mobile Home and Shell Home Financing. Education Loans. Corporation and Partnership Indebtedness. Commercial Loans. Leases. Residential Mortgages. Land Development Financing. Installment Purchases of Mutual Fund Shares.
• 36. CONTINUATION OF MEDICAL EXPENSE COVERAGE FOR RETIRED INDIVIDUALS / by Raymond G. McCullough = 682
• HEALTH INSURANCE NEEDS OF PENSIONERS : Aging Nature of the American Population. Health of the Aged. Methods of Insuring Medical Expenses of the Aged. CONVERSION OF GROUP HEALTH COVERAGES TO INDIVIDUAL POLICIES : Eligibility for Conversion. Cost of Converted Policies Blue Cross and Blue Shield Conversions. Converted Policies Issued by Insurance Companies. CONTINUANCE OF EMPLOYEES UNDER GROUP HEALTH COVERAGES : Rationale for Group Continuance. Group Continuance under Insurance Company Plans. Plan Design.
• Cost of Pensioners' Insurance. Group Continuance under Blue Cross and Blue Shield Plans. Financing Arrangements for Continuation of Group Coverages.
• 37. STATE-65 AND OTHER MEDICAL EXPENSE PLANS FOR PERSONS AGE 65 AND OVER / by George E. Light = 700
• GROUP COVERAGE ISSUED BY INDIVIDUAL INSURING ORGANIZATIONS FOR THE ELDERLY : Group Coverage of Associations of Retired Persons. Group Converage of a Firm's Retired Employees. Mass Enrollment. STATE-65 PLANS : Development of State-65 Plans. Authorizing Legislation. Provisions in the Articles of Association. Administration and Management. Benefit Structures and Premiums. Enrollment. The Future of State-65 Plans.
• 38. DENTAL EXPENSE COVERAGE / by Herbert C. Lassiter = 717
• RATIONALE OF DENTAL EXPENSE COVERAGE. APPROACHES FOR PROVIDING DENTAL EXPENSE COVERAGE : Insurance Companies' Dental Expense Coverage Dental Service Corporations. Group Practice and Clinic Prepayment Dental Plans. GENERAL PROBLEMS IN ISSUING DENTAL EXPENSE COVERAGE : Marketing Problems. Underwriting Problems. Cost Control Problems.
• 39. GROUP PROPERTY AND LIABILITY INSURANCE / by James J. Chastain = 732
• DEFINITION AND PRINCIPAL CHARACTERISTICS : Group Rating. Uniform Coverage. Group Underwriting. Special Methods of Distribution of Cost among Group Members. Exclusive Agent Distribution. Combinations of Group Features. DIFFERENCES BETWEEN GROUP PROPERTY AND LIABILITY INSURANCE AND GROUP LIFE AND HEALTH INSURANCE : Differing Social Enviroment. Differing Sales Efforts Required. Differing Degrees of Market Saturation. Differing Amounts of Post-Sales Service Required. Differing Regulatory Status. Differing Federal Income Tax Treatment. NEEDS FOR GROUP PROPERTY AND LIABILITY INSURANCE : Coverage Needs. Cost Needs. Underwriting and service Needs. REGULATION OF GROUP PROPERTY AND LIABILITY INSURANCE : Insuring through a Nonadmitted Alien Insurer. Insuring through a cialized Package Policies to Groups. Soliciting Only Group Members. Insuring in Traditional Group Plans.
• PART Ⅶ : SELF-INSURANCE
• 40. MOTIVATIONS FOR SELF-INSURANCE / by Robert C. Goshay = 751
• NATURE OF SELF-INSURANCE : The Semantic Problem. Definition of Self-Insurance. EXTENT OF SELF-INSURANCE : Definitions and Statistical Measures. Indicative Measures. MOTIVATIONS AND DETERRENTS : The Concept of Optrative Expense. SIGNIFICANCE OF SELF-INSURANCE : The Employer-Firm. The State Governments. The Employee. The Insurer.
• 41. METHODS OF SELF-INSURANCE GROUP COVERAGES / by James C. Higgins = 767
• COMPLETELY SELF-INSURANCE BENEFITS : Training of Personnel for Claims Handling. Development and Communication of Plan Provisions. Settlement of Claims. Administration of the Plan. MINIMUM PREMIUM PLANS. METHODS OF MEETING PAYMENTS UNDER SELF-INSURED PLANS : Pay-as-You Go. Establishment of Trust under Internal Revenue Code Section 501 (c) (9). Establishment of Trust under Internal Revenue Code Section 401(a). Establishment of Bookkeeping Reserve. Stop-Loss Coverage.
• APPENDIXES
• 1. NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS MODEL BILL : GROUP LIFE INSURANCE DEFINITION AND GROUP LIFE INSURANCE STANDARD PROVISIONS AS OF DECEMBER, 1956 = 781
• 2. MODEL GROUP ACCIDENT AND SICKNESS INSURANCE BILL AS RECOMMENDED BY THE HEALTH INSURANCE ASSOCIATION OF AMERICA = 788
• 3. NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS CODE OF ETHICAL PRACTICES WITH RESPECT TO THE INSURING OR THE BENEFITS OF UNION OR UNION-MANAGEMENT WELFARE AND PENSION FUNDS = 790
• 4. FEDERAL EMPLOYEES GROUP LIFE INSURANCE ACT OF 1954 = 197
• 5. CONVENTION BLANK (ADOPTED BY THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS) = 806
• 6. APPLICATION FOR EMPLOYEE INSURANCE = 813
• 7. COMPARATIVE ANALYSIS OF STATE DISABILITY BENEFITS LAWS = 814
• 8. DISABILITY INCOME EXPERIENCE DURING 1959 STEEL STRIKE = 818
• 9. MODEL GROUP ANTI-DUPLICATION PROVISION = 819
• 10. SPECIMEN GROUP INSURANCE AGREEMENT AND DECLARATION OF TRUST = 824
• 11. SPECIMEN GROUP INSURANCE MASTER CONTRACT = 835
• 12. SPECIMEN GROUP INSURANCE CERTIFICATE = 880
• 13. DEPARTMENT OF LABOR FORM D-1 (DESCRIPTION OF EMPLOYEE WELFARE OR PENSION BENEFIT PLAN) = 894
• 14. DEPARTMENT OF LABOR FORM D-2 (ANNUAL REPORT FOR EMPLOYEE WELFARE OR PENSION BENEFIT PLAN) = 897
• 15. DEPARTMENT OF LABOR FORM D-3 (INFORMATION ON EMPLOYEE WELFARE OR PENSION PLAN COVERING LESS THAN 100 PARTICIPANTS) = 904
• 16. ATTENDING PHYSICIAN'S STATEMENT (HEALTH INSURANCE COUNCIL FORM GD-1) = 906
• 17. ATTENDING PHYSICIAN'S SUPPLEMENTARY STATEMENT (HEALTH INSURANCE COUNCIL FORM GDS-1) = 907
• 18. SURGEON'S STATEMENT (HEALTH INSURANCE COUNCIL FORM GS-1) = 908
• 19. HOSPITAL INSURANCE FORM (HEALTH INSURANCE COUNCIL FORM HAP-4) = 909
• 20. STANDARDIZED DUPLICATE COVERAGE INQUIRY FORM = 910
• 21. REPORT OF THE JOINT COMMITTEE ON REEXAMINATION OF GROUP VENTION AND THE BOARD OF DIRECTORS OF THE LIFE INSURANCE ASSOCIATION OF AMERICA = 912
• 22. EXCERPTS FROM THE TAFT-HARTLEY ACT = 924
• 23. RECIPROCAL ELIGIBILITY AGREEMENTS = 925
• 24. NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS REVISED RECOMMENDED BILL OF DECEMBER, 1960 TO PROVIDE FOR THE REGULATION OF CREDIT LIFE INSURANCE AND CREDIT ACCIDENT AND HEALTH INSURANCE = 928
• 25. STATES WHICH HAVE CREDITOR INSURANCE CONTROLS = 934
• 26. HEALTH INSURANCE ASSOCIATION OF AMERICA DEFINITION, FRANCHISE ACCIDENT AND SICKNESS INSURANCE, MARCH, 1965 = 936
• 27. NEW YORK INSURANCE DEPARTMENT FRANCHISE INSURANCE STANDARDS = 938
• INDEXES
• INDEX OF NAMES = 945
• INDEX OF SUBJECTS = 949