Accident and Health Insurance Basics

Individual health insurance policies are underwritten to cover the applicant, their spouse and family. Many of the factors considered in life insurance underwriting apply. However, unlike life insurance where there can be only one death claim per insured multiple claims per issued is the rule rather than the exception.

Individual health insurance policies are underwritten to cover the applicant, their spouse and family. Many of the factors considered in life insurance underwriting apply. However, unlike life insurance where there can be only one death claim per insured multiple claims per issued is the rule rather than the exception.

Insurable interest is proven by love and affection, economic or financial loss. In life and health insurance, it is required at the time of policy issuance.

Insurable interest is proven by love and affection, economic or financial loss. In life and health insurance, it is required at the time of policy issuance.

The sales interview and the policy delivery are the most common occasions for errors and omissions situations to occur.

The sales interview and the policy delivery are the most common occasions for errors and omissions situations to occur.

Upon application: Provide the SBC to a group health plan sponsor upon application, as soon as practicable following receipt of the application, but in no event later than 7 business days following receipt of the application.

Upon application: Provide the SBC to a group health plan sponsor upon application, as soon as practicable following receipt of the application, but in no event later than 7 business days following receipt of the application.

A critical illness policy covers multiple illnesses, such as heart attack, stroke, renal failure, and pays a lump-sum benefit to the insured upon diagnosis (and survival) of any of the illnesses covered by the policy.

A critical illness policy covers multiple illnesses, such as heart attack, stroke, renal failure, and pays a lump-sum benefit to the insured upon diagnosis (and survival) of any of the illnesses covered by the policy.

A dread disease, or limited risk, policy provides a variety of benefits for a specific disease such as cancer policy or heart disease policy. Benefits are usually paid as a scheduled, fixed dollar mount.

A dread disease, or limited risk, policy provides a variety of benefits for a specific disease such as cancer policy or heart disease policy. Benefits are usually paid as a scheduled, fixed dollar mount.

A hospital indemnity policy provides a specific amount on a daily, weekly, or monthly basis while the insured is confined to a hospital. Payment under this type of policy is unrelated to the medical expense incurred, but based only on the number of days confined in a hospital.

A hospital indemnity policy provides a specific amount on a daily, weekly, or monthly basis while the insured is confined to a hospital. Payment under this type of policy is unrelated to the medical expense incurred, but based only on the number of days confined in a hospital.

A medical expense contract covers many of the expenses one incurs from an accident or sickness, such as a physician or hospital expense. Expenses may be paid directly to the insured, and the insured would be responsible for paying the medical expenses. This type of benefit payment is called reimbursement.

A medical expense contract covers many of the expenses one incurs from an accident or sickness, such as a physician or hospital expense. Expenses may be paid directly to the insured, and the insured would be responsible for paying the medical expenses. This type of benefit payment is called reimbursement.

Accident only policies are limited policies that provide coverage for death, dismemberment, disability or hospital and medical care resulting from an accident. Because it is a limited medical expense policy, it will only pay for losses resulting from accidents and not sickness.

Accident only policies are limited policies that provide coverage for death, dismemberment, disability or hospital and medical care resulting from an accident. Because it is a limited medical expense policy, it will only pay for losses resulting from accidents and not sickness.

Accidental bodily injury is an unforeseen and unintended injury that resulted from an accident rather than a sickness.

Accidental bodily injury is an unforeseen and unintended injury that resulted from an accident rather than a sickness.

Any group health plan or a health insurance issuer offering group or individual health insurance coverage is required to provide a written summary of benefits and coverage for each benefit package without charge to insureds and policyowners as follows.

Any group health plan or a health insurance issuer offering group or individual health insurance coverage is required to provide a written summary of benefits and coverage for each benefit package without charge to insureds and policyowners as follows.

Field underwriting minimizes the problem of adverse selection.

Field underwriting minimizes the problem of adverse selection.

Group health insurance underwriting varies in important particulars from that of individual health insurance. The underwriter's attitude toward group risks can be less restrictive than with individual policies, because the group policies are subject to annual re-evaluation on the anniversary date. Remedial measures may be taken if the initial evaluation proved to be incorrect.

Group health insurance underwriting varies in important particulars from that of individual health insurance. The underwriter's attitude toward group risks can be less restrictive than with individual policies, because the group policies are subject to annual re-evaluation on the anniversary date. Remedial measures may be taken if the initial evaluation proved to be incorrect.

If an issuer decides to discontinue a particular product, the issuer must provide notice in writing to each plan sponsor or insured of the discontinuation at least 90 calendar days before the date it will be discontinued.

If an issuer decides to discontinue a particular product, the issuer must provide notice in writing to each plan sponsor or insured of the discontinuation at least 90 calendar days before the date it will be discontinued

If the policy is issued, a copy of this application is stapled in the back of the policy and it becomes part of the entire contract.

If the policy is issued, a copy of this application is stapled in the back of the policy and it becomes part of the entire contract.

In AD&D policies, death will pay out the principal sum while loss of sight or accidental dismemberment will pay out the capital sum.

In AD&D policies, death will pay out the principal sum while loss of sight or accidental dismemberment will pay out the capital sum.

In many cases, the initial premium is not paid until the policy is delivered. Most insurance companies require that when the agent collects the premium, he or she must obtain a statement signed by the insured testifying to his/her continued good health.

In many cases, the initial premium is not paid until the policy is delivered. Most insurance companies require that when the agent collects the premium, he or she must obtain a statement signed by the insured testifying to his/her continued good health.

Limited health insurance policies only cover specific accidents or diseases. A comprehensive plan would cover all sickness or accidents that are not specifically excluded.

Limited health insurance policies only cover specific accidents or diseases. A comprehensive plan would cover all sickness or accidents that are not specifically excluded.

Loss of income caused by accident and/or sickness causing an insured the inability to work and earn income is covered under disability income policies or coverages.

Loss of income caused by accident and/or sickness causing an insured the inability to work and earn income is covered under disability income policies or coverages.

Required Notice to Insured To make sure that the insured is aware that the policy's benefits are limited, the insurance company must, by law, plainly state the limited policy notice on the first page of the policy. "THIS IS A LIMITED POLICY"

Required Notice to Insured To make sure that the insured is aware that the policy's benefits are limited, the insurance company must, by law, plainly state the limited policy notice on the first page of the policy. "THIS IS A LIMITED POLICY"

Sickness is defined as an illness that first manifests itself while the policy is in force. The majority of health insurance claims result from sickness rather than accidental injury.

Sickness is defined as an illness that first manifests itself while the policy is in force. The majority of health insurance claims result from sickness rather than accidental injury.

The Life and Disability Insurance Guaranty Funds assets will be maintained in 3 separate accounts 1. The disability insurance accounts 2. The life insurance account 3. The annuity account It is an unfair trade practice to make any statement that an insurer's policies are guaranteed by the existence of the Insurance Guaranty Association.

The Life and Disability Insurance Guaranty Funds assets will be maintained in 3 separate accounts 1. The disability insurance accounts 2. The life insurance account 3. The annuity account It is an unfair trade practice to make any statement that an insurer's policies are guaranteed by the existence of the Insurance Guaranty Association.

The agent must make sure that the current policy is not cancelled before the new policy is issued.

The agent must make sure that the current policy is not cancelled before the new policy is issued.

The issuer provides notice in writing to the applicable state authority and to each plan sponsor or individual of the discontinuation at least 180 calendar days before the date the coverage will be discontinued.

The issuer provides notice in writing to the applicable state authority and to each plan sponsor or individual of the discontinuation at least 180 calendar days before the date the coverage will be discontinued.

The three most important underwriting factors considered in accepting or classifying health insurance applicants are 1. Physical condition of the applicant and other insureds 2. Moral and morale hazards 3. Occupation

The three most important underwriting factors considered in accepting or classifying health insurance applicants are 1. Physical condition of the applicant and other insureds 2. Moral and morale hazards 3. Occupation

There are two major causes of loss (perils) under a health insurance policy. Policies may cover both sickness and accident or accident only.

There are two major causes of loss (perils) under a health insurance policy. Policies may cover both sickness and accident or accident only.

There are two separate types of insurance included in the generic term health insurance. One type provides coverage for expenses related to health care, and the second is designed to provide payments for loss of income.

There are two separate types of insurance included in the generic term health insurance. One type provides coverage for expenses related to health care, and the second is designed to provide payments for loss of income.