How to Implement an Insurance Program

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Insurance programs are subject to policies and procedures that have been established over several years by the governing body of our Union, the National Executive Council (NEC) and are contained in the document “Criteria and Guidelines for the Establishment of Insurance Programs.”

These policies protect the Federation and its membership by ensuring compliance with all state and federal insurance laws and regulations and guarantee that only quality insurance products are presented to AFGE members. Insurance companies and their representatives who are seeking authorization from AFGE to contact the membership must do so by application to the NEC’s Insurance Committee.

To begin the process, a National Vice President submits his or her request to the Chair of the NEC’s Insurance Committee, at least two months (60 days) before the next Committee meeting. The request should include the nature of the insurance program and the reason for the request. A statement should accompany the letter that the insurance program’s carrier or broker agrees to abide by AFGE’s criteria and fund the costs of the benefits and the ERISA reviews.

The guidelines contain several key provisions, two of which deserve special emphasis. The first one is found on page four and requires the insurance company to agree that the collection and administration of premiums will be the sole responsibility of the insurance company and that no reliance will be placed on any AFGE Local, Council, District or any AFGE entity to accomplish such purpose.

Another important provision is found on page two. It states that the insurance carrier must agree to pay any and all costs incurred in the evaluation of the proposed plan. Two evaluations are required. One is by an insurance consultant and the second is performed by an ERISA attorney. The evaluations will determine if the insurance carrier, insurance plans, the plans’ documents and the written agreement conform to NEC polices.

A sponsor of the insurance program(s) may contact AFGE’s insurance consultant to obtain a list of the required documents they will need to complete their evaluation. The consultant will bill the insurance company or sponsor directly for the costs incurred. The name of the consultant is available upon request.

Download a sample of the written agreement between the insurance company and AFGE. If the sample agreement is modified, an explanation and/or a justification for doing so are required.

Finally, AFGE requires that a retainer (payable to AFGE), in the amount of $1,500 per insurance program, be submitted along with the plan(s) promotional literature, enrollment/administrative forms, SPD and the policy.

The retainer will cover the costs associated with the review by an ERISA attorney. If the cost of the review is less than the retainer, the difference will be returned to the issuer of the draft.

Once reviews are complete, a written report summarizing the review is submitted to the AFGE Insurance Committee and to the AFGE General Counsel, via the National Benefits Coordinator. The Insurance Committee will determine if the insurance program meets AFGE’s criteria and guidelines.  If the Committee agrees that it does, it is presented to the full NEC with the Committee’s recommendation to grant authorization District-wide.

Any questions regarding the process may be directed to Mark Williams, the National Benefits Coordinator at 202-639-6483 or [email protected].

Toll-free Benefits Line:
(888) 844-2343

Programs are subject to change.

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