If you request a plan design change, you will receive new certificates, or the necessary pages to update those certificates you have distributed and those you have in supply. We will provide instructions with any new forms.  

The list bill is the most commonly selected bill type. The list bill shows each employee and the amount of premium due for each applicable coverage. Any additions, terminations and changes that occur between billing periods will be reflected on your next invoice after the changes have been made; therefore, please pay premium as billed.

Link to sample of list bill.

If You Have Selected The Self-Administered Billing Option

With the self-administered bill option, you are responsible for tracking and reporting additions, terminations and changes that occur between billing periods. The self-administered bill reports premium due for the total number of insured lives for each coverage. You then make the appropriate adjustments in your totals for the month and mail the revised billing statement and premium to MetLife.

Link to sample of self-administered bill.

Example Of How To Calculate AD&D Premium

Accidental Death and Dismemberment, if any:

Rate per $1,000 of benefits

AD&D Example: Benefit Amount ($25,000) ÷ $1,000 x Rate (.03) = AD&D Premium Due ($.75)

The rates shown are for example purposes only. Contact 1-800-ASK-4-MET (1-800-275-4638) for questions concerning your rates.

How to Read Your Billing Statement

To help you better understand MetLife's billing procedures, sample bill formats are included along with an item-by-item explanation of information it contains. Please contact Customer Service at 1-800-ASK-4-MET (1-800-275-4638) if you have questions about an item or any aspect of our billing process.

MetLife reserves the right to audit your records periodically to ensure the accuracy of premium calculations.

Please note: There is a $25.00 fee for all premium checks returned due to insufficient funds.

Electronic Funds Transfer

• Authorization for Electronic Fund Transfer Form

Electronic Funds Transfer (EFT) provides a new payment option for list billed customers to remit premium electronically from your bank to ours, without the resources and costs associated with requesting and issuing a manual check each month.

You will continue to receive a List Billing statement. The last page will state “Amount To Be Drafted” instead of balance due. The premium will be drafted from your authorized bank account on each bill due date.

To implement the EFT payment option, complete the Authorization for Electronic Fund Transfer Form and attach a copy of a voided business check.

Remit the EFT form and voided check to:

MetLife
Small Market
P.O. Box 14593
Lexington, KY 40512-4593

Or Fax to:

Attn: MetLife-Small Market
Subject: EFT Authorization Form
Fax: 1-888-505-7446

• Notify MetLife in writing. Notification should be sent to MetLife at least 60 days before your specified termination date. The policy will end on the later of the date stated in the notice; or the date MetLife receives the notice.
• Pay all unpaid premiums for the time your policy was in force. If MetLife receives a notice of termination request, all outstanding premiums must be paid in full before your request can be processed.

Please submit all request for termination to:

Fax 1-888-505-7446
Small Market Administration
PO Box 14593
Lexington, KY 40512-4593

• Enrollment Form (All Products)
• Statement of Health

• 100% of all eligible Employees must be enrolled.
• Eligible Employees cannot waive non-contributory coverage.

Contributory Coverage means the employee pays all or a portion of the cost of the coverage.

• Employees are not required to enroll for the coverage.
  

Enrollment of New Employees for Contributory Coverages.

Once new employees have met the requirements for coverage, they have 31 days to enroll in your group plan. Employees who do not enroll within this 31-day period are considered late enrollees. Late enrollees may apply for coverage at any time, subject to certain restrictions. Please refer to the Late Enrollments section of this manual for more details. Any employee who chooses to waive coverage must complete the waiving coverage section and sign the Enrollment Form.

For all benefits, except dental, employees must complete a Statement of Health Form for coverage amounts in excess of the non-medical maximum that can be found in the Schedule of Benefits in your Certificate of Insurance.

Enrollment of New Employees for Non-Contributory Coverages

Once new employees have met the requirements for coverage, they have 31 days to enroll in your group plan. All employees are to be covered on the date they are eligible. There are no late enrollments for non-contributory benefits. Enrollments processed after the billing period has ended for the eligibility date will be back-billed on the first available billing after the enrollment has been received and processed.

The completed Enrollment Form should be sent to MetLife. Keep a copy of the Enrollment Form in your files as evidence that the new employee was given the opportunity to enroll. All requested information is necessary to promptly and accurately enroll your employees.

For all benefits, except dental, employees must complete a Statement of Health Form for coverage amounts in excess of the non-medical maximum that can be found in the Schedule of Benefits in your Certificate of Insurance.

Checking Enrollment Applications

For List Billed Cases: Incomplete or missing information on the Enrollment Form may delay coverage for your employees. Please check to see that all required forms are completed before submitting them to MetLife. Keep a copy of the Enrollment Form for your files.

For Self-Administered Cases: Please check that all required forms are completed and signed. Keep these Enrollment Forms in your files. MetLife will use the information to determine eligibility for benefits at the time of claim.

Domestic Partnership

• Domestic Partnership Declaration Form

Domestic Partner means each of two people, one of whom is insured under the Policy, who represent themselves publicly as each other's domestic partner and have satisfied certain conditions set-forth in the Certificate of Insurance. Review your Certificate of Insurance to verify if your plan provides Domestic Partnership benefits. A Domestic Partner can become a qualified dependent for Dental, Life and AD&D if the requirements listed in the Certificate of Insurance are met.

The insured and the declared domestic partner are required to fill out the appropriate Domestic Partnership Form. Retain the form in your files.

For more specific information concerning the Domestic Partnership option, please refer to your group Certificate of Insurance.

For more information, contact Customer Service at 1-800-ASK-4-MET (1-800-275-4638).

Enrolling Rehired Employees

Any rehired employee should be enrolled as if he or she were a new employee regardless of whether or not this person was previously covered under your group plan. The only exception is if the employee is rehired within six (6) months of the date on which coverage terminated because employment ended.

Any rehired employee returning from the armed services does not have to meet the requirements for coverage of your group plan. Please note on the Enrollment Application that the employee is returning from the armed services and the date he or she returned to full-time employment.

Any rehired employee with coverage under the Portability option will remain covered under Portability until the next renewal date. At the next renewal date, coverage will terminate under Portability and the employee should be re-enrolled under the group Life plan. An employee may not be covered under the Portability Option and the employer's Life plan.

Effective Dates For Absent Employees And Dependents

Individual effective dates for an employee who becomes eligible for benefits after the initial effective date of the employer's plan may be delayed if the employee is not at work due to injury or sickness on the date that benefits would be effective.

At initial enrollment, eligible employees who are not at work due to injury or sickness on the day benefits would normally become effective, will have benefits delayed until they return to work. Refer to your prior carrier's Certificate of Insurance for the extension of benefits section.

Eligible dependents who are hospital confined, or confined at home under the care of a physician, on the day benefits would normally become effective will have benefits delayed until the day they are no longer confined.

• Enrollment Form (All Products)
• Statement of Health Form

Late Employee Enrollments For Contributory Coverage

Employees who do not complete and submit Enrollment Forms during their enrollment period, and employees requesting amounts over the non-medical maximum (found in your Certificate of Insurance) must submit Statement of Health Forms in addition to Enrollment Forms. Coverage is subject to approval by MetLife. Effective dates for approved enrollments are determined by MetLife. Please see your Certificate of Insurance for more details.

If employee and/or dependent coverage was terminated at the employee's request, and the employee wants to re-enroll for coverage, a Statement of Health Form will be required in addition to the Enrollment Form.

Late Dependent Enrollments For Customers With Dependent Coverage

Dependents not added during their enrollment period are subject to the same late enrollment procedures as employees. A Statement of Health Form must be completed and submitted for each late enrolling dependent. Please see your Certificate of Insurance for more details.

Late Enrollments For Non-Contributory Coverage

All employees are to be covered on the date they are eligible. There are no late enrollments for non-contributory benefits.

How to Submit Statement of Health Forms

Employers should treat all information in the Statement of Health Form as confidential. Information should not be discussed with, or disclosed to, others unless such discussion or disclosure is necessary to administer the MetLife coverage.

Review the employee's statement section of the form to ensure that all required questions have been answered and complete the employer section of the form. The original copy should be sent to MetLife. You should keep a copy for your records, and the employee should retain a copy for his/her records.

The authorization to furnish medical information is incorporated into the employee's statement. If necessary, it allows MetLife to request a medical examination and/or additional information from the employee's or dependent's attending physician for the purpose of underwriting the coverages involved. The signature of the employee who is applying for coverage and the dependent (if over the age of 18 and the information on the statement pertains to that dependent) is always required.

Mail Statement of Health Forms to:

MetLife Statement of Health
P.O. Box 14069
Lexington, KY 40512-4069

Once the completed Statement of Health is received and reviewed by MetLife, the employer will receive notification of approval or declination. If a status has not been received within three weeks of submitting the Statement of Health, contact Customer Service at 1-800-ASK-4-MET (1-800-275-4638). Please do not have the employee call.

The Statement of Health Form may require employees to disclose sensitive medical information about themselves and/or their dependents. This information is used exclusively for determination of insurability. It is not to be used or made available for any other purpose whatsoever.

• Change Request Form

Examples of Changes in Employee Status

Examples of changes that require notification include:

• Employee has a change in earnings or occupation that affects benefit amounts.
• Employee cancellation of a contributory coverage.
• Employee changes benefit class.
• Employee changes name.
• Employee deletes a dependent or all dependent coverages.
• Employee divorce or legal separation.
• Death of dependent.
• Death of employee.
• Dependent marries or reaches the limiting age as determined by individual's State requirements (see Certificate of Insurance for details).
• Employee adds a new dependent to existing dependent coverage including marriage, becoming a parent or legal guardian.

MetLife must be notified of any change in employee classification or salary to ensure benefits are properly paid at time of claim. You may indicate the changes on a written list. The listing must include the group name and number, employee's name, effective date of the change and the employee’s Social Security number.

The Change Request Form may be used for all other changes.

Death of an Employee

In the case of death of an employee, all of the deceased employee's dependent(s) coverages must be cancelled.

Complete a Change Request Form reflecting the date of death as the coverage termination date and submit to MetLife.

Employee Terminations

Examples of employee coverage terminations that require notification include:

• Employee has been terminated.
• Employee no longer meets the definition of an eligible employee under the plan.
• Employee stops making contributions

Notify MetLife by completing a Change Request Form.

Dependent Terminations For Customers With Dependent Coverage

Examples of dependent terminations: coverage terminates whenever the first of the following occur.

• The employee's coverage terminates.
• A dependent no longer meets the definition of an eligible dependent under the plan.
• An employee stops making contributions for the dependent coverage if the plan is contributory.

An employee's coverage may be continued even though he or she may not be actively at work under the following conditions:

• During a temporary layoff; or
• During an authorized leave of absence.

Continuing coverage in these situations is an option used only when the reasonable expectation exists that the employee will return to work.

To continue coverage, the same contribution must be paid as if the employee was at work. The termination date for any employee continuing coverage under these conditions is the date employment actually terminates. Please indicate the employee's name and the date employment terminated on a Change Request Form.

For more information on the requirements and time periods for this type of coverage to continue, please refer to your Certificate of Insurance.

Layoff Or Leave Of Absence For Customers With Dependent Coverage

If the employee's coverage is being continued because of a layoff or leave of absence, the employee's dependent coverage may also be continued. To continue coverage for dependents under these conditions, the same contribution must be paid as if the employee was at work.

If the employee's coverage terminates, the employee's dependent coverage will also terminate. For more information, please refer to the Certificate of Insurance.

Temporary Layoffs Or Leaves Of Absence

For an employee who has been laid off or who has taken a leave of absence, certain coverages such as Life/AD&D and Dental may be continued as determined by the rules and practices of the employer, however, continuance cannot be longer than 2 months. In the event the leave qualifies under the Family & Medical Leave Act of 1993 (FMLA), the period cannot be longer than 12 weeks following the date the leave of absence began.

Continuation of STD/LTD coverages for such an employee, however, is determined solely by MetLife and not by the employer. Refer to your Certificate of Insurance for any applicable rules.

If the employee does not return to work, submit a Change Request Form noting the date benefits terminate. Refer to your Certificate of Insurance for further information.

Beneficiary Designations

The beneficiary is the person or persons that the employee designates to receive the proceeds of life insurance benefits. The beneficiary maybe a relative or another person is usually an immediate relative (wife, husband, son, daughter, parents, or fiancée). Under certain circumstances such as; if the beneficiary is a minor child, MetLife recommends the employee may wish to consult an attorney. At initial enrollment, the full name and relationship of the beneficiary should be entered on the Enrollment Form. To make changes to a beneficiary designation, the employee should complete the Beneficiary Designation Form.

Examples of beneficiary designations are as follows:

• John F. Doe, husband
• John A. Doe and Mary L. Doe; parents, equally or to the survivor
• Walter John & James Doe, sons, equally to the survivors or survivor
• Jane B. Doe, wife, if living, otherwise Walter Doe, son

First National Bank of Dallas, Texas as Trustee under agreement dated March 1, 1970 (A trustee may only be designated as the beneficiary if there is a written trust agreement. Without a written trust agreement the trust may not be enforceable.)

Changing the Beneficiary

The employee should complete the Beneficiary Designation Form when changing the originally designated beneficiary. The original Beneficiary Designation Form should remain on file with the employer until a claim is filed.

Most policies are renewed annually. Renewal underwriting and pricing typically occur before your group’s anniversary.

About four months before this date, MetLife will contact you to verify the accuracy of the insured data shown on your premium statement according to your records. We ask that you verify this information 90 days prior to your renewal date. If we have not received it, we will follow up with you.

Having a current history of covered insureds facilitates accurate pricing of your coverage.

Census Requirements For Self-Administered Bill Type Option

For cases using the Self-Administered bill options, MetLife does not maintain employee level data. At the time of renewal, you must provide MetLife with a detailed census of all insureds each year 90 days prior to your renewal date. In addition, provide the percentage of premium contributed by the employer for each line of coverage.

The census must include:

• name and/or Social Security Number;
• date of birth;
• gender;
• occupation (for LTD or STD);
• salary (for LTD, STD or Life);
• class information (eligibility according to the schedule of benefits);
• dependent coverage (indicate participants and whether spouse or child) for all insureds;
• number of hours worked per week (for hourly employees);
• amount of coverage (by line of coverage); and
• total number of employees eligible.

• participants;
• amount of coverage;
• amount or percentage contributed by employer; and
• total number of employees eligible.

Providing updated census information helps us audit your records for accuracy.

Renewal Action Letter

MetLife sends a renewal action letter prior to your group’s anniversary. The letter states the status of your plan and any renewal changes.

When Your Group Falls Below Participation Requirements

Your group plan may terminate if the participation falls below the required participation percentage noted in your insurance policy.

Policy Changes

Changes can be made to your policy or certificate only by MetLife. To request a change to your group policy or certificate, contact your group insurance representative or your local MetLife sales office. Be sure your request includes the proposed change, effective date and an authorized signature on company letterhead. Once the policy and certificate forms are filed with and approved by regulators, changes often cannot be accommodated.

MetLife approves a change, you will receive an acknowledgment letter and, if needed, replacement policy and/or certificate forms.

Examples Of Policy Changes

Examples of policy modifications include changes in:

• Affiliates
• Class
• Employer contribution percentage
• Change of policy situs state
• Waiting period
• Elimination period
• Benefit level

• Accidental Dismemberment Statement of Claim Form
• Beneficiary Designation Form

Filing A Life Claim

Requirements For Submitting An Accidental Death Claim when A Covered Employee Dies

The beneficiary(ies) complete(s) the Life Insurance Claim Form and returns it to the employer with one certified copy of the death certificate.

The employer completes the Employer's Statement portion of the claim form and attaches a copy of the employee's enrollment form and copies of any beneficiary change forms in the employer's files.

The following information should also be provided:

• Copy of the police report
• Copy of the coroner's report
• Newspaper clippings describing the accident
• Eyewitness accounts
• Copy of the investigative report if the accident happened at work.

In instances where the employer has retained the employee's Life Enrollment Form on file, the enrollment form must be submitted at time of claim.

Submit to:

Requirements For Filing Accidental Dismemberment Claims

The attending physician completes the Physician's Statement of the Accidental Dismemberment Benefits Form; the insured completes the Employee's Statement and returns it to the employer. The employer completes the Employer's Statement and sends the completed claim form to the following address:

Getting Claim Assistance

MetLife is available to answer questions regarding group claim procedures. The employee or beneficiary may contact MetLife at 1-800-ASK-4-MET or (1-800-275-4638).

For New Mexico Residents only:

New Mexico Notice of Confidential Abuse Practices
This form permits victims of domestic violence to participate in a location confidentially program as provided under the New Mexico Domestic Abuse Insurance Protection Act.

• New Mexico Domestic Abuse

For Customers With Travel Assistance^SM & Identity Theft Solutions

Available with Supplemental or Buy-Up AD&D coverage only: AXA Assistance USA, Inc. will provide travel assistance services to MetLife participants who are enrolled in MetLife's Supplemental AD&D or Buy-Up AD&D. In the event of an accident or illness while traveling domestically (more than 100 miles from home) or internationally, eligible employees and their eligible dependents will have access to AXA’s global network of alarm centers, doctors, hospitals and clinics. Participants are just a phone call away from vital emergency services.

The Travel Assistance Brochures with ID Cards are available for employees to carry with them when they travel.

When an employee needs to utilize AXA’s service, he/she should call the phone number listed on the ID Card. Each ID card has a preprinted ID number that the employee or other insured will need to provide to the AXA Assistance Coordinator.

To order additional Travel Assistance ID Cards, call the MetLife customer service number: 1-800-ASK-4-MET (1-800-275-4638).

Identity Theft Solutions

Identity Theft: While the eligible participants are at home or away, they can take advantage of this valuable benefit packaged with Travel Assistance. The participant will be provided with educational tools and resources to help prevent an identity theft occurrence. If the eligible participant becomes a victim, they will receive personal assistance 24 hours a day, 365 days a year, to help alleviate their stress.
MetLife now offers Identity Theft Solutions, an additional benefit packaged with Travel Assistance. This feature is available through a relationship with AXA Assistance, and provides:

Education and Protection including:

• Assistance in obtaining complimentary credit reports used to detect fraudulent activity.
• Educational materials such as; the identity theft risk & prevention tool kit and resolution guide.
• Help placing “fraud alerts” with credit bureaus, if necessary.
• Follow up to confirm receipt of educational materials and offer additional assistance.

Personal Guidance – Case managers are available 24 hours a day, 365 days a year, providing assistance with:

• Taking inventory of lost/stolen items and directing the member to the appropriate contacts for resolution.
• Filing and obtaining police and credit reports.
• Contacting credit or fraud departments, government agencies and local law enforcement.
• Filing complaints with the Federal Trade Commission.

Eligible Employees and their eligible Dependents who require medical, pre-travel, financial and/or any of the services that AXA provides due to an accident or illness while traveling, should use the following telephone numbers:

AXA Assistance Customer Service Phone Number
1-800-454-3679 (Within US)
1-312-935-3783 (Outside US call collect)

ERISA is an important federal law that governs most benefit plans established and maintained by employers. It imposes among other things certain participant reporting requirements on an employer. As a service to employers, MetLife can include an "ERISA Information" statement with the certificates of insurance issued to a group. This statement, combined with a certificate of insurance, is intended to assist you in meeting ERISA’s requirement to provide a summary plan description (SPD) to participants describing the insurance benefits provided by MetLife under the ERISA plan. If you want the ERISA Information for your plan sent to you, please send a written request to us . Your request must include your MetLife group number, the name, address, and phone number of the plan administrator of your plan, the employer identification number (which may be your Federal Tax Identification Number), and the beginning and end date of your Plan's fiscal year.

What Is ERISA?

ERISA is a federal law that governs most employer established welfare benefit plans (government and church plans are excluded as well as some employee pay all plans). It is the employer's responsibility to provide certain information to plan participants and the Department of Labor and comply with other requirements.

What types of employer groups are governed by ERISA?

This law generally applies to any employee welfare benefit plan that is established or maintained by:

• Any employer engaged in commerce or in any industry affecting commerce, or
• Any employee organization(s) representing employees engaged in commerce that provide certain benefits to their employees, participants, dependents, or beneficiaries.

Welfare benefit plans may include plans that provide the following types of benefits:

• medical, dental, disability income, or life benefits
• unemployment, vacation or severance benefits
• other types of employer sponsored benefits.

Is there a minimum number of employees below which ERISA does not apply?

No. ERISA governs all welfare benefit plans that have one or more employees, unless they are church or government groups.

What does ERISA require employers to do?

Generally, ERISA requires all employers (or plan administrators as an employer may contract with) to provide participants and beneficiaries with a summary plan description (SPD) describing in understandable terms their rights, benefits and responsibilities under the plan. Employers are also required to furnish participants with a summary of any material changes to the plan or changes to the information contained in the summary plan descriptions. These documents must be furnished to the Department of Labor on request.

Employers with 100 or more participants must file a Form 5500 annually. Employers with fewer than 100 participants must file Form 5500-C at least every third year and Form 5500-R in the two intervening years.

Where can I obtain additional information about ERISA?

You should contact your legal and tax counsel to advise you about your obligations as an employer under this law. You may also contact The Department of Labor or visit their web site at www.dol.gov for more information.

ERISA Plan Number

Welfare Benefit Plans must start with 501.

• Guaranty Association Notices