Module 1: Introduction to Group Insurance
This module covers the concept of risk and the four basic approaches to managing it. It describes what insurance is, why it’s needed and defines a group insurance arrangement. It concludes with a description of the types of groups that are insurable.
Module 2: Introduction to Insurance
Module 2 describes the traditional parties involved in a group insurance arrangement and defines the general categories of group insurance products that are available. It then describes the types of benefits provided under each product category and explains the insurer’s role in the provision of group insurance products.
Module 3: Group Insurance Arrangements
This module begins by explaining the nature of a group insurance contract. It continues by defining underwriting, what the insurer’s role is in underwriting, their guidelines and the spread of risk. It also covers the five fundamental principles of group insurance reflected in the underwriting of single-employer groups.
Module 4: Group Insurance Arrangements (continued)
This module continues the principles learned in the previous module. It defines what a premium is and covers the standard provision in a group insurance policy. It identifies the purposes and practices under standard provisions and defines some of the more common policy provisions.
Module 5: Introduction to Group Benefits Programs
Module 5 begins by explaining the difference between insured and non-insured benefits and identifies examples of typical non-insured benefits. It continues by defining the plan sponsor’s role, their decision-making factors and what affects their program management role and responsibilities.
Module 6: Benefits Program Design
This module focuses on the key activities involved in benefits plan design. It details the financing considerations and the key factors that impact plan design. It concludes by explaining the relevance of the benefits need lifecycle.
Module 7: Group Benefits Program Design
This module defines the two broad approaches to benefits program design. It then describes a flexible approach to plan design along with the various types of flexible benefits programs.
Module 8: Group Benefits Programs Administration
The key activities involved in plan administration are the focus of this module. It then describes the roles and responsibilities in self-administration, insurer administration and third-party administration. Some key requirements/issues that are related to enrollment and eligibility administration are outlined.
Module 9: Group Benefits Programs Administration (continued)
This module continues the previous discussion on administration. Key requirements/issues related to claims, premium, recordkeeping and communication administration are covered.
Module 10: Funding Group Benefits – Pooled Methods
Module 10 covers two basic areas – funding and pooling. The traditional funding methods and the continuum of risk represented by the primary funding methods are discussed. The focus is then shifted to understanding the significance of risk pooling and the fully pooled funding method. Finally, the difference between a fully pooled and prospectively rated renewal approach are discussed.
Module 11: Funding Group Benefits – Experience-Rated Methods
Continuing with the theme of funding, this module will define what an experience-rated funding method is. The theory of risk and the element of pooling as they apply to experience-rated funding are introduced. The considerations that influence a plan sponsor’s decision to pool part of the risk and the difference between a fully experience-rated arrangement and an experience-rated arrangement with pooling conclude this module.
Module 12: Funding Group Benefits – Self-Insured Methods
This module begins by describing the self-insured funding method and the two risk acceptance approaches that are available It defines Administrative Service Only (ASO) arrangements, what services are available and the plan sponsor’s and insurer’s roles under this type of agreement.
Module 13: Pricing Group Insurance Plans
Module 13 describes the difference between funding and underwriting and covers the basic costs an insurer must consider when pricing group insurance. It then describes the basic mechanics of setting rates and focuses on the differences among mortality, morbidity and utilization rates. In addition the types and significance of various reserve requirements in a group insurance plan are discussed.
Module 14: Pricing Group Insurance Plans (continued)
This module continues the discussion on the pricing process as it relates to the individual. Non-evidence and overall maximums are differentiated and the types of expenses and charges included in an insurer’s retention are described. The impact of cost trend factors on premiums/pricing and the factors that insurers examine in the renewal rating process conclude this module.
Module 15: Ethical Decision Making
Understanding the importance of business ethics is contained in the final module. The characteristics of ethical problems and the sources that can serve as guides in decision making are covered next. Finally, examples of ethical decisions regarding group benefits matters are discussed.