LIMRA Data Exchange Standards Community Support Forum

What is the standard expectation for the value to be sent in the BenefitAmount/ElectedBenefitAmount fields for plans that are subject to reduced payouts due to age attained by the insured? Should the full, pre-reduced amount always be provided, or should the calculated reduced amount always be provided? 

EG: John Doe is 68, but the plan offering reduces the benefit to 65% for members over the age of 65. John elects $100,000. Should the BenefitAmount/ElectedBenefitAmount fields show $100,000 or $65,000?
#LDEx-BEM

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Jacquelynn Payne | HCM Carrier Liaison | She/Her
Paycom
7501 W. Memorial Road | Oklahoma City, OK 73142
800.580.4505 ext. 13836
Jacquelynn.payne@paycomonline.com
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After looking at BenefitAmount in the xsd (schema), this description is attached to that value. "Value of approved coverage based on the defined plan rules for the enrolling person." Which leads me to believe in this scenario the amount would be $65,000 as that is the "approved coverage based on the defined plan rules". 

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Michael Grudgings
Business Architect
LIMRA
Des Moines IA
860 298 3850
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I concur with Michael G's interpretation: the benefit amount should change to $65,000, as of the effective date of the age reduction.

But technically, that answer is incomplete. As you point out, we do have an ElectedCoverage/ElectedBenefitAmount element in Coverage. That element was originally intended to communicate an elected amount subject to underwriting that's different than the currently approved benefit amount. What you're suggesting would be a novel use of ElectedBenefitAmount -- seemingly a way to retain the original, unreduced benefit amount, but I would recommend against using it in this way.

Consider this example:

• Employee applies for $150,000 benefit and is issued $100,000 on a guaranteed issue basis.
• The Carrier ultimately rejects the $50,000 increase, leaving the employee with a $100,000 BenefitAmount.
• Then an age reduction kicks in at age 65 to reduce the benefit further to $65,000.

In this situation, we would not be able to rely on ElectedBenefitAmount to carry the BenefitAmount before age reduction.

Perhaps we should consider the addition of a situational OriginalBenefitAmount field to carry the original, unreduced BenefitAmount.

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Lyle Griffin
President
Selerix Systems, Inc.
MCKINNEY TX
2145025573
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So after discussing this with the team it's supposed to work like this:

• BenefitEarningsAmount is not annualized ALL the time see additional description blurb from the 1.3 schema ("If additional compensation is included need to confirm the time period used to calculate.")
• If BenefitEarningsAmount is NOT annualized
• BenefitModeQuantity is required to explain what value BenefitEarningsAmount reflects
• Also, if you want BenefitEarningsAmount to always be annualized you can request that it is delivered in that format from the sender
• At which point BenefitModeQuantity is no longer required but could be set to annual if the benefit is based on a yearly amount, or 12 if based on a monthly amount, or 52 if based on a weekly amount

 

It's built this way to allow flexibility.

"Perhaps we should consider the addition of a situational OriginalBenefitAmount field to carry the original, unreduced BenefitAmount." 
We can continue to discuss the option of a "OriginalBenefitAmount" with committee members in future iterations of the LDEx Standard. 

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Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com
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Original Message:
Sent: 04-06-2022 18:18
From: Lyle Griffin
Subject: Benefit Amounts for Age Reduced Members

I concur with Michael G's interpretation: the benefit amount should change to $65,000, as of the effective date of the age reduction.

But technically, that answer is incomplete. As you point out, we do have an ElectedCoverage/ElectedBenefitAmount element in Coverage. That element was originally intended to communicate an elected amount subject to underwriting that's different than the currently approved benefit amount. What you're suggesting would be a novel use of ElectedBenefitAmount -- seemingly a way to retain the original, unreduced benefit amount, but I would recommend against using it in this way.

Consider this example:

• Employee applies for $150,000 benefit and is issued $100,000 on a guaranteed issue basis.
• The Carrier ultimately rejects the $50,000 increase, leaving the employee with a $100,000 BenefitAmount.
• Then an age reduction kicks in at age 65 to reduce the benefit further to $65,000.

In this situation, we would not be able to rely on ElectedBenefitAmount to carry the BenefitAmount before age reduction.

Perhaps we should consider the addition of a situational OriginalBenefitAmount field to carry the original, unreduced BenefitAmount.

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Lyle Griffin
President
Selerix Systems, Inc.
MCKINNEY TX
2145025573
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