JOB AID
EGTL Takeover Process - Operations
DISCLAIMER: The information contained in this document is the property of Allstate Insurance Company. This document is for use by Allstate employees only. Any duplication or modification of its content is strictly prohibited. Always confirm you have the most current version of this document by visiting the authenticated content repository that supports your area. PURPOSE: Explains the process and workflows for handling EGTL takeovers
EGTL Takeover Basics EGTL takeover happens when EGTL is sold to an account with an existing group life plan that is to be discontinued when Allstate Benefits issues EGTL coverage. The following general rules apply: • Target groups have 25+ full-time, active eligible W2 employees legally working and residing in the United States • Allstate Benefits contracts do not cover contract (1099) employees • EGTL is approved for employers covering their W2 employees. EGTL is not approved for associations, unions or other membership organizations Grandfathering When we take over a plan that was insured by another carrier, we are often asked to waive Evidence of Insurability (EOI) for employees or spouses who had volumes outside our Guarantee Issue limitations under the prior contract. This is called “grandfathering.”
Grandfathering is an Underwriting function. Underwriting reviews the current enrollment to see if anyone falls outside the Guarantee Issue (GI) limits described in the proposal. All requests for grandfathering must be submitted to the GENELCO Underwriting team for consideration and follow the requirements below: • Submit a copy of the proposal as well as a copy of the current enrollment under the prior carrier • Include the required data elements as outlined in Step 1 of this job aid • Enrollment should be submitted as an Excel spreadsheet or, for groups with fewer than 100 enrolled employees, the underwriter can work from a PDF of a recent bill
Allstate Benefits may accept some, but not all, grandfathering situations, so negotiation should happen during the proposal process. Potential obstacles for grandfathering include, but are not limited to: • Employees insured for an amount greater than the GI limit offered in the AB proposal • Employees insured for amount greater than three times their annual earnings • Spouse benefits that exceed 50% of the employee benefit • Spouse benefits that exceed the maximum amount stated in the AB proposal
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JOB AID
EGTL Takeover Process - Operations
EGTL Enrollment Specifics • Passive Enrollment/Rollover In a Passive Enrollment, employees are enrolled under the Allstate Benefits contract with the same volume they had under the prior contract. This method works if all coverages are under the GI limit or if grandfathering is approved by Underwriting o Passive Rollover is often used when AB takes over an employer-paid plan where the current benefits are the same that AB is offering o Passive Rollover is possible with a voluntary plan only if AB takes over the contract prior to the group’s open enrollment date o Passive Enrollments cannot be used with groups sitused in Florida, Kentucky, Louisiana, Missouri, Montana, North Carolina, New Hampshire or Virginia due to state requirements • Active Enrollment In an Active Enrollment, all employees, currently enrolled or not, make an active coverage choice o If grandfathering is approved by Underwriting, employees with prior carrier coverage will be grandfathered for Guaranteed Issue up to the limit set by Underwriting • Mix (Passive/Active) In a Mixed Enrollment, employees are given the option of choosing new coverage or rolling over existing coverage levels to the new group policy
EGTL Process Flow
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JOB AID
EGTL Takeover Process - Operations
Sales Team 1. The sales team submits a quote request via AIM All required documentation must be uploaded to the Documents tab of the Opportunity Verify the return email address in AIM is where the quote should be delivered The enrollment engagement level must be established and communicated with the Underwriting request Determine if the request is for New or Takeover Business: • If the request is for voluntary Life and the employer does not currently have voluntary Life, the request is considered New Business • If the employer has a voluntary Life plan, the request is considered a Takeover • Voluntary Life and employer-paid Life are treated as different products when determining if the request is for New or Takeover business, even though both are Group Term Life products. If you are requesting a voluntary Life plan and the employer currently has no voluntary Life plan, the request is considered as New Business, although the employer may have an employer-paid Life plan Include the following information in your quote request: For New Business 1. The corporate name and address of the employer to be quoted 2. The agent’s name as you want it to appear on the proposal 3. The commission percentage to be included 4. A description of the benefits to be provided 5. The requested effective date of coverage 6. The date the proposal is due back to the requestor 7. A census of the eligible group, including: - Gender - Date of Birth or Age - Volume of insurance - If benefits vary between classes, census must show each employee’s class For Takeover Business • Takeover groups with fewer than 500 eligible employees 1. Provide the same information required for new business (above) 2. Provide a copy of the current contract and/or certificate • Takeover groups with 500 to 1,000 eligible employees 1. Provide the same information required for new business (above) 2. Provide a copy of the current contract and/or certificate 3. Provide experience for the last 3-5 years (not required, but yields better rates) • Takeover groups with 1,000+ eligible employees 1. Provide the same information required for new business (above) 2. Provide a copy of the current contract and/or certificate 3. Provide experience for the last 3-5 years (required for groups larger than 1,000 eligible lives)
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JOB AID
EGTL Takeover Process - Operations
For Takeover Business with Grandfathering 1. Provide the same information required for takeover business (above) 2. Provide an electronic version of the current carrier’s bill that includes: - Itemized deductions for each employee currently enrolled in group voluntary term Life coverage - First and last name of employee - Gender of employee - Coverage amounts for each employee and dependent(s) Experience Experience information is helpful to Underwriting on groups of 500+ employees, but is required for groups of 1,000+ employees. Experience includes: • Three to five years of paid premiums. Show separate premiums for: o Employer-paid Life o Voluntary Life o AD&D Premium reports provided by incumbent carriers are typically broken out this way • Three to Five years of paid claims. Show separate claims experience for: o Employer-paid Life o Voluntary Life o AD&D • Provide current rates for: o Employer-paid Life o Employer-paid AD&D o Voluntary Life o Voluntary AD&D If the rates have changed in the past three years, Underwriting requires the effective date of the rate change as well as the prior rate information • Include a Disabled Lives Census showing all employees currently insured under the group Life plan that are not actively at work. Include: o Name o Gender o Date of Birth o Volume of insurance o Diagnosis or reason for not being actively at work
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JOB AID
EGTL Takeover Process - Operations
Underwriting 2. Underwriting completes the quote/proposal and returns it to the original submitter • The Quote/Proposal needs to include the takeover maximum if grandfathering is approved • Rate appeals are submitted in AIM and require a two-day turnaround
Turnaround Times for Underwriting Proposals • Groups with 25 – 499 eligible lives: ... 2 business days after receipt of all necessary information • Groups with 500 – 999 eligible lives: . 2 - 3 business days after receipt of all necessary information • Groups with 1,000+ eligible lives: ...... 3 - 5 business days after receipt of all necessary information
Sales Team 3. Requester reviews and provides the proposal to the sales lead (if sales lead is not the requester) NOTE: If the client is a National Account, the National Account team adds the proposal to the Proposal package, which includes a cover letter from the sales lead as well as the proposals for any other products requested
Turnaround Times for National Accounts Implementation Teams • Standard proposal: ...... 2 business days after all necessary information received • Custom proposal: ...... 5 business days after all necessary information received • Standard RFP: ...... 3 - 5 business days after all necessary information received • Non-Standard RFP: ...... 5 - 7 business days after all necessary information received • Complex RFP: ...... 7 - 10 business days after all necessary information received NOTE: Turnaround times for National Accounts team are based on the date requests are received and include time for Underwriting to deliver the proposal (Step 1, above)
4. Sales lead presents the proposal to the client 5. When the client accepts the proposal, the sales team sends the initial Sold Case notification via AIM to the Home Office and includes: • The completed and signed customer agreement/master application (ABJ4040) o The signed customer agreement must have EGTL selected and include the addendum o The customer agreement must be loaded to the Documents tab of the Opportunity • A copy of the sold proposal NOTE: For national accounts, the initial Sold Case notification is emailed to AB- [email protected] • Signed commission agreement 6. The Sold Case workflow is initiated in AIM and includes the following steps: • Assigning the account manager • Holding an internal call with the sales lead and the broker • Holding the kickoff call with the client • Reviewing the customer agreement (ABJ4040) and verifying products sold • Distributing the project plan and timelines
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EGTL Takeover Process - Operations
7. The sales team updates the Summary tab of the Opportunity in AIM and checks the takeover field (if applicable) 8. The sales team indicates whether the account is approved as a takeover and if the prior carrier’s face amount is to be grandfathered a. Please provide an electronic version (.XLS or CSV) of the current carrier’s bill, to include: ii. Itemized deductions for each employee currently enrolled in group voluntary term life coverage iii. First and last name of employee iv. Gender of employee v. Coverage amounts for each employee and dependent(s) vi. Covered person’s SSN NOTE: The information noting that the account is approved as a takeover must be listed on the Sold Case Attributes tab of the Opportunity under Group New Business in AIM. If grandfathering is approved, note that detail in the Special Requests section
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JOB AID
EGTL Takeover Process - Operations
Enrollment Technology Services (ETS) 9. Enrollment Technology Services receives notification from AIM of the new account with the EGTL product and: Reviews the customer agreement (ABJ4040) as well as the proposal and any addendums Determines enrollment options: • Paper • Electronic via ESR (ETS is involved with this option) • EnrollMyWay (version 3.0, available late 2018) Determines Evidence of Insurability (EOI) options • Paper • Electronic EOI collection via ESR • Future Option: EOI online when enrolling with partners who build an online EOI connection
10. Based on the following “key dimensions,” ETS determines the requirements for building/ reviewing an EGTL enrollment site, what file types to use and what data is required in the files: Product funding (ER-paid and/or EE-paid) Billing type (Self-Admin or AB-Billed) Beneficiary management (ER-managed or AB-managed) EOI Collection Method (ESR or Paper) a. Initial voluntary enrollment • Enrollment method (paper or electronic via ESR) • Engagement level (passive or active) • Takeover above GI for coverage up to level with prior carrier (Y/N) • EOI collection method (paper or electronic via ESR) b. Ongoing perpetual enrollment (Y/N) • Enrollment method (paper or electronic via ESR) • EOI collection method (paper or electronic via ESR) Engagement level (passive, active or mixed) Spouse Age Calculation (Based on EE age or Spouse age) Dependent coverage options and limits Employer-paid coverage record submission (if AB billed) a. Initial - file or paper listing for manual keying b. Ongoing perpetual - file or paper listing for manual keying
11. Using the information from Step 10 above, ETS determines whether an Implementation Package (IP) is needed, if a data file is required and, if so, what type of data file should be used
12. If an IP is sent, ETS works with the enrollment partner to implement the EGTL product
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EGTL Takeover Process - Operations
13. After the enrollment partner has completed the IP programming: a. The QA review begins • If the review does not pass, documentation is provided to the enrollment partner for corrective action • After the enrollment partner corrects the QA issues, the QA re-review begins • When the QA review is complete and passed, AIM is updated b. The Actuarial review begins • If the review does not pass, documentation is provided to the enrollment partner for corrective action • After the enrollment partner corrects the Actuarial issues, the Actuarial re-review begins • When the Actuarial review is complete and passed, AIM is updated 14. After both reviews are passed, enrollment can begin: a. Passive Rollover Enrollments Information from the current list of individuals enrolled in the in-force plan is used to determine current insured amounts and prevent any loss in coverage when participants transfer to EGTL • These individuals can be enrolled via census if enrolling for existing benefits with no change in coverage levels on a guaranteed-issue basis b. New Hires When the new plan is in place and set up in the enrollment system, any newly hired employee can enroll for benefits c. New Enrollees/Open Enrollment/Re-enrollment • If an Open Enrollment is granted by Group Underwriting and the new EGTL plan is in place, new enrollees can enroll for benefits in the enrollment system. These individuals will be eligible for GI up to the EGTL plan GI limits. EOI will be required for amounts in excess of the GI limits • If an Open Enrollment is granted by Group Underwriting and the new EGTL plan is in place, those who had coverage under the prior carrier’s plan not exceeding the EGTL GI limits may apply for additional coverage up to the EGTL plan’s GI limits without EOI. If they want to increase to an amount in excess of the EGTL GI limit, EOI will be required • If an Open Enrollment is granted by Group Underwriting and the new EGTL plan is in place, those who had coverage under the prior carrier’s plan that does exceed the EGTL GI limits will require EOI for any additional coverage. Also, if the amount of coverage under the prior carrier’s plan exceeds the takeover limit approved by Group Underwriting, EOI is required to maintain that coverage level under the new EGTL plan • New hires are eligible to enroll up to the EGTL GI limits without EOI through the re- enrollment period after their hire date. EOI will be required if they request an amount greater than the EGTL GI maximum • If the account elected the GI Buy-Up Option, during re-enrollment, those who have coverage not exceeding the GI limits on the new AB EGTL plan can buy coverage up to the EGTL GI limit without EOI. Any amounts over the EGTL GI limit requires EOI
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JOB AID
EGTL Takeover Process - Operations
15. ETS reviews and tests the enrollment data
16. ETS updates AIM with participation numbers
17. ETS contacts Group New Business to set up the GI tool and Genelco NOTE: GI tool information will be sent from EnrollMyWay when the product is set up Group New Business 18. Group New Business is notified via AIM of a new account with EGTL and reviews the following: Customer agreement (ABJ4040), proposal and any addendums Signed Commission Agreement Prior carrier’s bill (stored in AIM documents after Underwriting Quote Request process) Participation numbers input in AIM by the ETS team from the enrollment file 19. The Group is released by Group New Business and the Group’s details are loaded into Genelco in preparation for enrollment (the ETS team is included on the email notification of the release) 20. Genelco is loaded with GI amounts (minimum and maximum amounts), rates, and age reduction schedule from the proposal 21. The GI table in Case Management is updated for the Group with details from the proposal including the takeover maximum amounts for accounts approved for takeover Enrollment Technology Services (ETS) 22. The ETS team processes the enrollment file according to the following parameters: a. Voluntary employee-paid takeovers must use the MTR file layout to include the prior carrier record type 62 b. If enrollment file is MTR, the file will be processed through Benefit Pipeline (BP) Application validation and Group auto-underwriting evaluation takes place Enrollment form images are created and, when released, will go to AWD Benefit Pipeline (BP) evaluates takeover face amounts against voluntary enrollment face amounts (if prior carrier record type 62 was provided) If enrollment data is clean (no errors), then the data is released and BP creates a SEDI file, which is processed through the master SEDI file If enrollment data is not clean (has errors), data is reviewed to determine if ETS can correct the errors or if the data needs to be corrected by the enrollment partner. After correction, the data is re-processed Group New Business 23. Group New Business completes the setup and releases the Group to First Bill NOTE: Group New Business updates Genelco manually if any benefits differ (if the GI table in Case Management is loaded accurately, correct volumes will be passed to Genelco via SEDI file)
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JOB AID
EGTL Takeover Process - Operations
Group Premium Accounting 24. Group Premium Accounting is notified via AIM of a new account with the EGTL product and: Reviews the customer agreement (ABJ4040), proposal and any addendums Reviews commission agreements Determines if eligibility was loaded via enrollment forms or electronically and obtains the information for review For a takeover, reviews the takeover spreadsheet or information with Underwriting’s approval Reviews rates in Genelco and compares to the Plan ID sheet from Group New Business NOTE: Sold rates and proposed rates must match o Validates if the rates are Uni-Smoker, Smoker / Non-Smoker o Validates if the spouse’s premium is based on the employee’s age or the spouse’s age NOTE: Current default is based on the spouse’s age
25. GPA confirms the billing setup with the client Billing frequency - monthly, 28-day bill, 10thly, etc. Billing method - paper invoice, EasyBill Online, Self-bill, or Self-Administration Self-bill: • Initial file is loaded to the admin system • Updates are sent in to maintain eligibility on a regular basis • Payment is remitted with detailed backup that supports the payment with each employee’s name, ID and premium amount • Payment is reconciled by AB and discrepancies sent back to the group for comments Self-Administration: • Initial file is loaded to the admin system • Quarterly and Annual updates are sent to AB to update the admin system • Employer is responsible for maintaining all signed documents such as enrollment, change and beneficiary forms (except for EOI, which must be submitted to AB) • In the event of a claim, the employer confirms all necessary information • Employer remits payment with a worksheet that calculates the premium due, includes a summary of the number of employees for each rate, volume, rate and premium amount • If there is a large variance between the premium remitted and the expected premium, AB will contact the group for an explanation of the difference or may require a new census to support the increase or decrease Payroll align date - first payroll end date after the Group effective date NOTE: If the Group is a national account, GPA contacts the National Accounts team to confirm billing setup
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EGTL Takeover Process - Operations
26. GPA produces a sample invoice to compare benefit amounts to the enrollment forms or to the premiums on the spreadsheet and confirms the following: GI amounts processed correctly Employee benefit amount does not exceed the plan maximum for employee Spouse benefit amount does not exceed the lesser of 50% of the employee benefit or the plan maximum for spouse NOTE: Benefit amounts may be subject to grandfathering during a takeover. Takeover amounts are reviewed in conjunction with the items above NOTE: The comparison is completed against either the enrollment forms or the premium provided on the spreadsheet. 27. GPA prepares a discrepancy letter if a benefit is requested by an employee or spouse who is ineligible for the coverage or benefit amount 28. If case setup or eligibility errors are identified, GPA sends the case back to Group New Business for correction 29. After correction, the invoice is produced and sent to the employer, based on their preferred billing method a. When the account remits payment, it is applied to the invoice b. For new accounts, if payment is not received within three weeks of invoice date, GPA calls the client to ensure the employer has the necessary information to remit the payment c. For existing accounts, if payment is not received within 45 days from the coverage begin date, GPA mails a delinquent letter (and copies the agent) announcing a two-week extension for payment If payments are not received by the extended date that was specified in the delinquent notice, GPA sends the client a termination letter and copies the agent NOTE: Mail the letter with a return receipt to confirm the employer receives the notice
Got AIM feedback, or questions about this job aid? Send an email to [email protected].
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