1.) Mandatory Group plan:
A mandatory plan covers:
- all eligible employees; or
- all eligible employees and their spouses (on an all in or none basis), without any required proof of good health.
A specific predetermined dollar amount limit is based upon the size of each group. Issue ages are from 18 to age 69 inclusive and benefits expire at age 70.
- A spouse can have an amount up to the employee’s benefit or $50,000, whichever is less. NEM limits are based on employees only.
| Group Size | Guaranteed Issue Basis NEM Limits*** |
Overall Max Limits** |
Pre-Existing Conditions |
Required % * Members |
|---|---|---|---|---|
| 2 to 4 | $10,000 | $100,000 | 24/24 | 100% |
| 5 to 9 | $10K to $25K | $100,000 | 24/24 | 100% |
| 10 to 49 | $10,000 to $50,000 | $175,000 | 12/12 | 100% |
| 50 to 299 | $10,000 to $100,000 | $200,000 | N / A | 95% |
| 300 to 499 | $10,000 to $150,000 | $250,000 | N / A | 95% |
| 500 to 999 | $10,000 to $200,000 | $250,000 | N / A | 90% |
| 1,000 & + | $10,000 to $250,000 | $250,000 | N / A | 90% |
% * Members = Participation percentage of eligible employees/members for mandatory plan. Minimum PAD monthly is $50. Plans less than $50 monthly must pay annually.
NEM Limits = Non Evidence Medical Limits
***Any amount in increments of $5,000, between the minimum and maximum NEM Limits. **Overall Max Limits = Subject to Medical Evidence
Note: Individual selection by employee will not be allowed. One benefit amount must be selected by “class” of employees and there cannot be more than a “2 times” benefit difference by class.
“Class” is defined either by title or occupational description. A different plan option by class is permitted.