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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Original Message:
Sent: 03-31-2022 10:08
From: Jacquelynn Payne
Subject: Benefit Amounts for Age Reduced Members
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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