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Health Ins Underwrit
TN Accident & Health (Health Insurance Underwriting)
| Term | Definition |
|---|---|
| Underwriting | A process of selecting and classifying insurable risks. It involves evaluating the risk factors that individual applicants present. Determines whether a policy will be issued (at what premium level) or denied. |
| Agent Report | Part of the application. It provides the agent's personal opinions and observations about the applicant. It includes any firsthand knowledge they may have about the applicant's health & financial condition. |
| Attending Physician Statement (APS) | Based on the information in the application or in the agent's report, the underwriter may have questions about the applicant's medical history or a specific medical condition. In this case, the underwriter can request an APS to be completed by their doc. |
| MIB Group, Inc, | A cooperative data exchange formed by North American insurance life and health insurance companies. Collects medical information, provided by member companies, on applicants for life, health, disability, LTC insurance. |
| Credit Report | Underwriting a health insurance policy requires assessing not only the applicant's health and medical history, but also their.... |
| Fair Credit Reporting Act (FCRA) | If an insurer orders a consumer or credit report on an applicant, the applicant must be informed as required by the... |
| 16,000 per violation | How much can a business be fined if the continue to call someone on the Do Not Call Registry? |
| Impairment Rider | Limits or excludes coverage for a specific condition identified during the underwriting process. |
| 1.) Morbidity Charge (cost of insurance) 2.) Interest 3.) Expense Load | Health insurance premiums are based on 3 factors... |
| Morbidity Charge (cost of insurance) | Covers the anticipated claims from the policy. It represents the risk presented by the insured and can vary widely per individual. |
| Interest | Earned on invested premiums serves as a credit that reduces the net premium rate. |
| Expense Load | Covers the insurer's expenses (and the company's profit goal) It covers the costs of selling, issuing, and administering the policy and its claims. The load represents about 35 to 40% of an individual health policy premium. |
| Any Occupation & Own Occupation | When it comes to defining disability, DI policies are broadly divided into what 2 types? |
| Any Occupation | A person is totally disabled only if he or she is unable to perform ANY occupation for which he or she is reasonably suited by education or experience. (Normally applies to insureds in blue-collar jobs) |
| Own Occupation | An insured qualifies for total disability benefits if unable to perform the material duties of his or her OWN occupation. (Generally reserved for those in professional or managerial occupations) |
| To qualify for social security benefits a worker must.... | suffer a total disability that prevents him or her from engaging in any gainful employment and that is expected to last a year or more (and ultimately result in the workers death) |
| Buy-Up Option | Policies for the professional market that allows the insured to increase policy coverage in the future without having to provide evidence of insurability. |
| YES | Is underwriting group insurance different from underwriting individual insurance? |
| Adverse Selection | People who need insurance the most are the ones most likely to apply for it. |
| Group Insurance Contracts | Issued on either an Experience-rated or community-rated basis. |
| Experience Rating | focuses on the individual group, its makeup and most important, its past claims EXPERIENCE |
| Community Rating | assesses the COMMUNITY or region in which the group operates |
Created by:
Tiphanie_Dyme
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