Group Health Expense

Product

Your group health expense benefit reimburses health expenses that are incurred by the insured person which are not covered by government programs. A group health expense policy is typically issued to the plan sponsor which can be your employer, union or other association.

Assuris Protection

If the life insurance company holding your group health expense policy fails, Assuris will ensure that the coverage under your group health expense policy will continue until the earlier of:

  • The next renewal date for your group contract, or
  • Six months from the date of failure of the life insurance company.

Assuris guarantees that you will retain 85% of your health expense benefit. For policies that have a health expense benefit of $60,000 or less, you will retain the full amount of your benefit.

It is anticipated that the plan sponsor or the liquidator will transfer the group health expense policy at the renewal date or within six months to another member company.

Example 1

Health Expense

$50,000
Original Benefit Amount

In calculating your Assuris protection, you will retain up to $60,000 or 85% of your health expense benefit, whichever is higher.

Since the amount is less than $60,000, your health expense benefit is fully protected.

$50,000
Adjusted Benefit

Example 2

Health Expense

$100,000
Original Benefit Amount

In calculating your Assuris protection, you will retain up to $60,000 or 85% of your health expense benefit, whichever is higher.

Since the amount is more than $60,000, the 85% protection is applied to your health expense benefit.

$85,000
($100,000 × 85%)
Adjusted Benefit

The liquidator, appointed to manage the failed company, will seek to sell the assets and transfer the liabilities with the aim to get the best value to for policyholders. This will determine the recovery percentage.

Your benefits will be adjusted to the greater of the Assuris protection or the recovery percentage achieved by the liquidator.

For example, if your health expense is greater than $60,000 and the liquidator recovers 90% of the assets, your policy will be adjusted to 90% instead of Assuris’ guarantee of 85%.

Original Benefit Amount

Health Expense $100,000

Recovery

Liquidator Recovery:
$90,000
($100,000 × 90%)

Assuris Protection:
$85,000
($100,000 × 85%)

Explanation

Since the liquidator’s recovery is more than Assuris’ protection, you will retain $90,000.

Questions and Answers

1. What if you have separate group benefits with the same insurance company through different plan sponsors?

Assuris provides separate protection for each group plan sponsor.

2. What happens if you have a group policy and an individual policy with the same company?

Assuris provides separate protection for group policies and individual policies. If you are a member of a group insurance policy and you also have an individual policy with the same life insurance company, Assuris’ protection applies to each policy separately.