chapter 9 heath insurance basics

explain the medical exams in lab tests in the underwriting process

medical exams and lab tests may be requested by Insurance based on the type of or amount of the proposed insurance, age of the applicant, or help of the applicant. Raleigh medical exam is always conducted by a qualified professional person oh, that person does not have to be a doctor. They can also be done by registered nurse or paramedic. Insurance companies pay for medical exams or lab tests that they request

what is error and omission?

mistakes can be made an interest producers can obtain insurance covers that protect them from the disputes and liabilities that may arise in the conduct of this business and that's why this type of coverage is known as are in a mission, it covers injuries and damages that occurred due to Professional Services a producer renders are failed to render. It is centrally malpractice insurance for agents

is there a placement of one of the insurance policies with another illegal?

no it is not however the circumstances under which the replacement occurs may be deemed illegal if it involves misrepresentation by the producer no policy should be replaced unless the replacement benefits the policyholder alone

individual accident and health insurance policy cannot be issued or delivered in South Carolina unless what is delivered with it?

outline of coverage

what is a major consideration in pre-existing conditions ?

in the event of a suggested replacement of a health policy, the client must be clearly advised not to surrender the existing policy until the new contract is issue and can be reviewed side by side with the present policy to review which is best for the applicant

health insurance how are benefits paid?

in the form of reimbursement, such as major medical, where the insured fluids some of the expense. Policies must clearly Define how these payments are calculated. Also, there are valued contracts such as disability income which will pay a predetermined flat dollar amount was the insured goes on claim

visual policies are usually under written accept medical insurance & there for one of the main conditions which affects ...

individual policies is the circumstances under which an insurer May terminate coverage, called reliability

most health insurance provides _______ for expense arising from Medical Care, although some types like disability income Insurance, are Indemnity policy wich pay set amount unrelated to actual expenses

reimbursement

what are the two bases health insurance may be written on?

reimbursement basis or valued basis

explain workers compensation in exclusions

injuries and illnesses are covered by law under the workers comp policy. A major medical plan May pay for some added benefits not covered by the comp policy, a benefits would not be duplicated

name some health risks

injuries, illnesses, and conditions that require Medical Care and treatment.

explain criminal activity during exclusions

is intentional as such, not covered

explain reimbursement contract

it bases the amount of benefit on the laws that is actually incurred. For instance , a policy that pays 80% of the cover loss is a reimbursement contract medical expense policies are reimbursement contracts, which held the insured offset the cost of a hospital confinement or treatment of an illness at home

what is a conditional receipt?

it holds the insurer to the policies term I'm affected from the date of the medical exam if required for the signed application whichever is later, on the condition that the applicant is found to be insurable. If the applicant is uninsurable, the insurer is not liable for any coverage and it Returns the premium to the applicant

what is a pre-existing condition?

it is a health condition that existed before an insurance policy was issued and, as such is not covered for some. Of time. It is normally defined as a sickness or physical condition for which • medical advice or treatment was recommended by or received from a physician • symptoms existed that would cause a careful person to seek diagnosis, care, or treatment

who is the group plan sponsor? what is each member in the group but issued?

it is the contract owner(employer) each participating member in the group has issued a Certificate of Insurance that specifies the term of their coverage.

explain catastrophic events in exclusions

losses from a declared war, or from nuclear event, are too big to measure and cover and so are excluded

explain the Peril sickness, what is the percentage of claims covered

say this to the range for the flu to a life-threatening heart condition. And health insurance, it is important that the illness is something which was unknown to the insured at the time of the policy commenced. The symptoms are diagnosis happened after the coverage was a force. Certain policies will deny coverage for a pre-existing condition which was not disclosed at the time with the application. By far, sickness is the major portion of health insurance, covering 90% of claims

what can ruin a person's life?

the financial impact of disability and sickness. And unlike the risk of death a person my face these wrist many times during his or her life. Health insurance provides financial protection against these risks.

pre-existing conditions exclusions have long been a standard part of most_____ oh, and they are still common with disability income in long-term care insurance policies. However, passage of the____ brighten effective into the use of pre-existing condition exclusion in _____.

health insurance policies/ patient protection and Affordable Care Act/ medical expense insurance policies.

explain the investigative consumer report in the underwriting process

Consumer Report provides information on a person's personal history and lifestyle. This also provides information on his or her financial conditions these reports can be required in underwriting a policy. A national investigative agency hired by the insurance company typically provides these reports

explain Hospital Indemnity insurance ( Hospital income)

Hospital Indemnity insurance helps provide extra cash to cover personal expenses not covered by insurance during hospitalization (example travel expenses to and from Medical Care.) benefits are paid in the form of periodic payments directly to the policy owner, not a medical care provider, if the insured becomes hospitalized. This is a separate, optional coverage which is not part of the insurance major medical plan. Benefits are based only on the number of days of inpatient hospitalization, not actual expenses incurred

explain HIV testing in the underwriting process

Insurance are permitted to test for the presence of human immunodeficiency virus or HIV, state laws in nearly every state regulate the manner in which ensures may use the information obtained with the HIV test. The state law section of this course will explain your State's requirements if they are covered on your state insurance license exam. I'll applicants take physical in which an HIV test will be performed Must sign a consent form this form indicates that HIV / AIDS will be tested for, and that in case of unusual results, the applicant must designate a person self, doctor, or third-party who receive the test results

what are the requirements for individual and group plans?

States still mainly control the provision of the individual health plans. But the federal government has now become involved in group health insurance. It has imposed several new requirements on the group plans to protect workers and their dependents as a result, the provision of individual group plans to vary, even if they cover the same risk. Ensures are free to impose restrictions and exclusions on individual policies then they are with group policies. But states are starting to restrict the freedom, for instance, by mandating that policies contain certain provisions.

why is it so important for health insurance? what are both businesses and individuals to see looking at ?

a large increase in health cost over the last few decades today, both businesses and individuals are seriously looking at how to offer critical health coverage at an affordable price

explain the difference between a limited plan and a comprehensive plan

a limited playing, such as Hospital income insurance for prescription drug coverage, pays only for the exact risk noted in the policy. A comprehensive plan, such as Blue Cross or HMO plan, covers whatever illnesses or accidents May befall the insured

what is one of the oldest types of limited risk policy? what does this do? how is this also available?

accidental death and dismemberment insurance, a type of health insurance that in some respects resembles life insurance ad&d pays a lump sum of money in the event of the insured's accidental death or dismemberment ad&d insurance is available as an individual policy, through a group insurance policy, or as a writer to some other form of insurance. Ad&d Riders are commonly added to life insurance policy or two health insurance policy either medical expense or disability income for a small additional premium

depending on the type of policy there are two perils that may or may not be covered equally what are those two perils?

accidental injury and illness

explain accidental injury peril

an accident, just as the name implies is something that just happened to the insured without his or her intention, a person fell from a ladder while cleaning leaves from a gutter, or was injured in a car crash. There is no intent in The Accidental bodily injury. On the other hand, and attempted suicide but be a result of purposeful Act of a person and this was no accident

what do individual policies cover vs group ?

an individual policy owner or at most, a family. Group Insurance, on the other hand covers a group of people and their families potentially hundreds if not thousands of people under a single contract

explain the application in the underwriting process

application is the basic source of underwriting information and therefore must be as Accurate as possible

explain attending physician statement in the underwriting process

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. And this case, the underwriter can request an APS to be completed by the applicants doctor

group insurers cannot Define a pre-existing condition more restrictively than a condition for which symptoms existed before the effective date of _____ that would cause an ordinarily prudent person to seek diagnosis, care, or treatment, or for which medical advice or _____ was recommended by or received from a physician in South Carolina, an insurer that uses an application to obtain the ______< of a proposed insured can only consider conditions that existed within one year before the effective date of _____, or conditions for which medical advice or treatment was recommended or received within ______before the effective date of coverage two significant challenges and replacing a health policy are first, the insured maybe many years older that when he brought the policy, so rates would be ______. Also, policies such as disability income are not identical so there is a risk that coverage in the new contract maybe less generous than the ______ for a condition the insured develops

coverage/ treatment/ health history/ date of coverage / 5 years/ higher for the age / old contract

explain credit disability insurance who is the creditor? Who was the borrower?

credit disability insurance covers the risk of a loan customer becoming disabled( and unable to pay off the loan) and pays a monthly benefit equal to the loan payment amount. The policy is written so that its benefit. Matches the remaining loan., but the benefit amount match to the loan balance at the time of disability. Benefits are payable as long as the insured remains disabled. A new car owner would buy this covers to make monthly payments in case of disability until he or she could go back to work and begin covering the car payments again. The premiums are included in the monthly car payments. The Creditor is the applicant, owner, and beneficiary. The borrower is the insured and the pear

explain custodial care during exclusions

for a person eating home health aides to live independently would not be covered. An individual needs long-term care insurance to cover help with that tivities of daily life.

as with life insurance, there is no requirement that policies be delivered in person, but most companies do require this. Producers are encouraged to ____ newly issued policies to their customers and are expected to review the policy with the customer to ensure that its term and conditions match those_____. if the policy is rated ( issued at a higher than standard premium rate) or denied, the producer must coordinate with underwriting to explain to the applicant the reason for the insurance decision. If factors emerge during underwriting which were not discussed with the agent during the acacian these are_____ to the applicant. Where's the the applicants formation, the agent can see these restrictions and explaining to the applicant. Personally delivering the policy to the insured Foster's the_____ and can help the producers sell it if at the sale. policies might legally be mailed to the insured, the mailing delivery process is called____ ( remember that the policy can be returned for a full refund during the free look period ) if the initial premium was not pay with the application, it must be cleared it with a positive Livery. In that case, the producers also required to collect a signed _____ from the applicant stay in that no change to his or her health has occurred since the application was first signed. the statement of good health because part of the application, giving is sure the right to ____ if it learns during the contestability period do life and health insurance share any common underwriting the applicant misrepresented the truth when signing this form

deliver / the client applied for/ coordinate / confidential and will be revealed/ producer client relationship/ constructive receipt / statement of continued good health/ void the contract

under the requirements of several federal and state laws such as GLB &HIPAA laws produced are not allowed to do what? however, these regulations do allow disclosure under specific circumstances what are those?

disclose personal, privileged information collected during the application process • there is a signed authorization dated within the last 12 months. This is commonly referred to as a HIPAA authorization • failing this there are other situations disclosure is permitted ○ the information is provided to a law enforcement agency or Insurance regulatory Authority Under sub opens ○ the information is provided to another insurer or self-insured plan for the purpose of coordination of benefits ○ the information is being provided to an insurer for the purpose of reporting claims information ○ the information has been provided to someone who has it beneficial interest in the policy such as a lienholder or assignee

what is critical illness Insurance commonly known as? explain critical illness insurance

dread disease insurance. critical illness insurance is an umbrella term for a group of policies that each covers a specific type of disease or illness. By far, cancer policies are most common, providing a schedule or benefits for the illness only. However, a person in a motorcycle accident would receive no benefits from the cancer policy. While some critical illness policies cover only one dread disease, other cover two or more.

explain that valued contracts

pay a stipulated sum as set forth in the contract, without regard for actual expenses. Disability income and Hospital Indemnity are both such policies as are some LTC contracts, in which an agreed sum is paid once the insured goes on claim. Accidental death and dismemberment insurance policies are also valued contracts, as our life insurance policies these contracts are often also called indemnity need contracts

explain pre-existing conditions , will a group Insurance exclude pre-existing conditions if so what happens?

pre-existing conditions are those for which medical advice or treatment was received a recommended up to 12 months before the effective date of coverage so a group Insurance May exclude pre-existing conditions, it must cover them no later than 12 months after the effective date of coverage. Disability income policies can exclude coverage for Disabilities that begin with in the first two years following the effective date of coverage of the disabilities result from a pre-existing condition

the full benefit payable for accidental death is known as what? it is the largest benefit that could be paid from the policy and it goes to who? hats with life insurance, the principal some can be what?

principal sum named beneficiary any amount the applicant wishes to apply for( within the insurers issue limits) there is just one principal sum listed in the policy

what are the producer responsibilities in individual health insurance?

producers play a central role in the health insurance cell process. But the insurance company in the applicant rely on the producers product knowledge, honesty, and ethical standards in the sale and purchase of health insurance. The insurer relies on the producer to collect all necessary underwriting information and provide the applicant with required disclosure documents. The Advocate relies on the producer to recommend products best suited to the applicants needs and interest

send Health coverages are available through the federal and state government. these were established for what purpose? why was Medicare originally established? what is Medigap?

social purposes to benefit people who may otherwise not be able to get medical coverage. Medicare was established originally to provide coverage for people who retire and did not have access to health coverage through the private Market because of high risk of the Aging group. to compliment the Medicare program, ensures created Medigap which can be purchased at the individuals expense to cover expenses that Medicare has insured pay out of pocket, or which are not covered by Medicare. I'll send Medicaid and children health insurance plans for Creative people who were not able to afford health coverage

explain social insurance during exclusions

such as Medicaid and Medicare benefits would not be duplicated, nor would benefits provided under the Veterans Administration

in order to protect the buyer from misunderstanding what one of the limited policies cover South Carolina insurance law requires what?

that in bold print on the first page of the policy is to statement " THIS IS A LIMTED POLICY " followed by definition of what this particular playing will

two monitor replacement activity states require that producers do what?

that the producer determines if the policy being applied for will replace an existing health insurance policy a note the answer on the application.

the state regulates the content and delivery of health insurance advertisements to ensure what? what is each insurer supposed to do? whose responsibility are the advertisements? how would an ad be misleading?

that they are accurate and truthful. Health insurers are to adhere to certain standards when marketing these individual health insurance policies in South Carolina. Each insurer is to maintain control over the form and content of its advertisements as well as the manner in which the advertisements are placed before the public. I'll advertisements, regardless of who created or presented them, are the responsibilities of the insurer whose policies are the subject of the ads. advertisements are to be complete and clear enough to avoid the chance that they might mislead or deceive. An ad is misleading if it fails to include any information necessary to prevent it from is leading the reader or viewer

explain the MIB group in the underwriting process

the MIB group is a Cooperative data Exchange Fort Bragg North America Insurance life and health insurance companies. Its purpose is to facilitate underwriting and reduce adverse selection by identifying applicants who might have previously applied for a policy. The MIB collects medical information provided by member companies, on applicants For Life, Health, disability, critical illness, and long-term care insurance. Individual information of is reported as numeric codes. which become accessible to member companies as they underwrite new applications and assess claims on those individuals. Member companies are not permitted to report their underwriting decision, just the information obtained during the underwriting process

explain the agents (producers) report and the underwriting process

the agent's report is usually a part of the application. It provides the agent's personal opinions and observations about the applicant. It includes any first-hand knowledge he or she may have about the applicants health and financial condition. This is not become part of the contract

explain application proceduresd

the application is the primary document used by Insurance Underwriters to access the applicants risk. It must be completed in its entirety and signed by the applicant in the agent. If the insured is someone other than the applicant, then the proposed insurer must also sign the application. No change it may be made on the application by the producer, changing the only be made by the applicant who must also initial changes

the benefit payable in the event of accidental dismemberment is called what? a South Carolina laws requires a minimum death benefit of what?

the capitals sum typically a percentage of the principal sum, the capital of sum varies ( within a single policy) depending on the type of dismemberment. for example the capital sum payable upon the loss of a foot or hand maybe 50% of the principal some while the capitals sum for losing a leg or an arm maybe two-thirds of the principal sum South Carolina law requires a minimum death benefit of $1,000 for an accidental death and $500 for an individual dismemberment

explain field underwriting what is the application called for the information is recorded on?

the producer is expected to guide the applicant for the application process and ensure that all application questions are fully answered. As an agent of the insurer, the producer is also expected to serve a field underwriting role. Besides making sure the application is properly completed, the producer is expected to explain his or her relationship with the applicant, how the producer met the applicant, and the purpose for the coverage. This information is recorded on a section of the application called the agent's report. The agent, who is the eyes and ears of the insurer who is a field underwriter.

why don't people buy individual health insurance policies today as much as they did in the past?

the reason is largely because most people obtain health insurance protection through a group insurance plan. A group plan is most commonly offered through employers or associations

most applications for individual health insurance are submitted with what things? when the applicant submits an initial premium with his or her application the producer must give the applicant what?

the required first premium. I completed application in a premium payment constitute an offer from the applicant. The insurer accept the offer by issuing the contract as applied for a policy receipt. The receipt indicates the insurer's liability and its responsibilities during the underwriting. Before the policy is actually issued. This usually in the form of a conditional receipt

life insurance insures against one risk, what is that risk?

the risk of death

both Group insurance and individual insurance have one thing in common , what is that?

they both involve a single contract

what is a common denominator of all limited risks policies?

they cover limited perils. While most life insurance and health insurance policies cover loss from many perils, with limited exclusions, a limited risk policy is based on a limited number of perils

explain limitations in health insurance

they must be clearly defined in the policies . levana policies like Hospital expenses most clearly bear the required notice, and any restrictions or exclusions must be stated clearly and exclusion for hazardous activities such a scuba diving would need to be attached to the contract at the time of the issued with a waiver signed by the insurer

explain prescription drug coverage

they usually provided as a part of a healthcare plan, prescription drug coverage is a separate entity added on to the basic plan at added cost. It often is provided by a different company than the insurer which issues the medical plan. Insurance pay copay, or flat dollar, for prescription regardless of the actual cost of the drug. For example generic drugs may have a $10 copay to encourage they're used when possible, and then a list of other approved brand name drugs called a formulary at a higher co-pay such as $40. Coverage may be excluded for drugs not listed to the formulary

what are policy exclusions?

those conditions that are not covered. That is, they are situations in which benefits are not payable because the underlined puerile is excluded from coverage.

what is the purpose of all insurances & health insurance?

to provide financial protection against the Financial Risk posed by certain hazards and perils. in health insurance the common perils against which one is insured are accidental injury and illness

explain it like the cosmetic surgery during exclusions

what means surgery that was not medically necessary. A person wanting a tummy tuck for appearance's sake would not be covered. However, breast reconstruction following a mastectomy would be covered as a part of needed procedure. as would breast reductions for a woman experiencing pain and discomfort who would be in Better Health following the surgery. Correction of a birth defect such as a cleft palate would be covered as well

what is the person of ad&d insurance? give an example

while more dads are the result of illness and accidental injury, accidental losses can be especially significant because they occur so suddenly. Ad&d insurance face benefits only if the loss is accidental. Ad&d policies are pure accident policies that pay benefits only in the event of accidental losses. Illness-related losses even sudden ones like heart attacks are not covered. For example if an insured who suffers from diabetes should have a foot amputated due to disease progression, the loss would not qualify for Ad&d benefits since the loss is illness related

explain blanket health insurance

why did health insurance is an accident only policy issued to an organization to protect a group of individuals engaged and a specified group activity. Such policies are commonly used by schools to cover participants and their athletic programs. Summer camps use these to cover their camps while at camp, and volunteer fire departments use them to cover the volunteers in the course a firefighting duties. Blanket insurance covers participants only when they are actively participating in the covered activities

does life insurance and health insurance share any common underwriting principles ?

yes they share many common underwriting principles

health insurance insures against many risks that could impact what things?

• a person's health • his or her quality of life • his or her family's quality of life

what are some types of limited risk policies?

• accidental death and dismemberment insurance • Hospital Indemnity insurance • critical illness(dread disease) insurance • blanket health insurance • prescription drug insurance • vision insurance • dental insurance

the state take special care to regulate advertisements and solicitations of individual accident and health insurance policies directed at people who are eligible for Medicare. The following acts are considered to be unfair, deceptive, or unreasonably confusing acts when used to solicit or sell individual acts and health insurance to person who are or may be eligible for Medicare

• any act that may induce a person to purchase covers she may not really be able to afford, or which would duplicate any existing policies • encouraging an applicant to admit relevant underwriting information from an application • when first contacting a person, failing to disclose the fact that the person making the contact is an insurance producer • representing that a producer's authorized by or affiliated with a Civic, social, or other non-government organization, unless that is true • using false or misleading statements concerning how long an insurance product may or may not be available • selling a policy that the commissioner has not approved for sale • selling a Medicare supplement policy to any person who is not eligible for Medicare, to a person without asking if the person has the current Medicare eligibility card or to a person who has current Medicare eligibility car • falsifying any documents that the producer is required to complete • falsifying to submit to the insurer within 7 business days the premium collected from an applicant • failing to deliver the applicant within 7 business days a policy that the insurer has issued • taking an application without determining whether the proposed insurance would duplicate any insurance already in force • asking questions in a way that would get an answer that is not factual

what are the sources that Underwriters rely heavily on?

• application •agent's (producer's ) report • attending physician statement •investigative Consumer Report • MIB Group •Medical exams & lab test • HIV testing

field underwriting if the policy application requires a medical exam, the producer is responsible for making sure the exam is scheduled what are producers also required to do? what is taken to make sure the application is complete? And what else has to be done?

• ascertain the suitability of the recommended product for the Africans needs and circumstances • disclose all relevant information about the policy being applied for • explain all sources of the underwriting information, including attending physician statement and medical information Bureau • comply with Fishers marketing and advertising practices many of which are stipulated by state law. • present their recommendations factually & accurately care must be taken to make sure the application is complete and properly sign before submitting it to the insurer. Failure to do so is a common cause of delay in issuing new policies

policies do not want to duplicate coverage as a claim with generate a profit to the insured there is also situations that are simply too high risk. Typical exclusions would include what things?

• catastrophic events • elective cosmetic surgery • workers compensation • social insurance • criminal activity • custodial care

ad&d policies pay lump sum benefit if the insured, through accidental injury does what?

• dies -then the benefit is paid to a beneficiary • loses one or more a limbs (benefit to insured ) • loses eyesight or hearing( total deafness) ( benefit to insured )

just ask the risk to one's Health are many and varied, some of the types of insurance policies that address these risks. Broad categories of health insurance policies include what ?

• disability income policies, providing income replacement when the insured cannot work because of a disability • medical expense policies, covering the cost of medical care and Medical Services • accidental death and dismemberment policies, providing a benefit if the insured dies or is severely injured because of an accident • Medicare supplement policies, offering private insurance coverage that supplements Medicare coverage • long-term care policies, cover the cost of sustained , long-term care provided in a nursing home, at home, or through extended healthcare agencies are facilities • limited benefits policies, cover a specific conditions or providing benefits for specific Health Services • dental insurance, covers the cost of dental treatments

it's a replacement is involved, the applicant must be given a notice of replacement that acknowledges the following things how many copies of a notice is there?

• existing coverage is being terminated • pre-existing health conditions may not be covered under the new policy • a new policy May impose new waiting periods and deductibles • the applicant has been advised to contact the existing Insurance to make sure the replacement isn't his or her best interest • failure to include all material medical information on an application May provide a basis for the insurer to deny any future claims to the funds and premium as though the policy has never been in force one copy of the notice is presented to the applicant and another signed copy is retained by the insured

vision insurance is a type of health insurance that reimburses the insured (up to specify policy limits) for the cost of what?

• eye exams ( usually limited to once per year) • vision correction materials( eyeglasses and contact lenses) every few years as stated • specific eye diseases

what are some losses commonly covered under critical illness policies? common to all policies? is hospitalization required for eligibility?

• heart attack • strokes • coronary disease requiring surgery • cancer • end-stage renal disease(kidney failure ) • major organ transplant • paralysis • multiple sclerosis there are a few limits to what might be covered under a critical illness policy. What is common to all policies is that policy either pays a lump sum of money directly to the policy owner in the event the insured suffers a covered loss, or pays lump Psalms according to a schedule of benefits. The money is available for whatever purpose the policy owner may choose, though the intent is to help pay for the cost of care. Hospitalization is not required as a condition to be eligible for critical illness benefit payments.

what are some questions that are commonly included on health insurance application

• name, sex, ages of all to be covered by the policy • past medical histories of all to be covered by the policy • if other health insurance coverage exists • whether the applicant was ever decline issue of health insurance coverage • the requested mode of premium payment ( monthly, quarterly, annually.)

among the situations calling for e&o insurance are what? what is e&o Insurance intended to cover?

• professional negligence ( such as an unintentional failure to disclose a policy restriction) • inadvertently describing features and benefits incorrectly • failure to perform complete due diligence and other duties that are commonly associated with agent or producer practices under an e&o policy the insured producer is covered for it the cost of Damages, real or alleged. He or she will also be defended by the insurer in any suit that may be brought against the producer. E&o insurance is intended to cover honest mistake by the producer, so it does not cover willful fraud, intentional misrepresentation, and other criminal actions

exclusions normally found in health insurance policies are

• self-inflicted injuries • War military actions • sickness or injury while on active duty in the armed forces • elective cosmetic surgery( not due to an accident or birth defect) • infertility treatments • non commercial airline travel • injuries or sickness for which workers compensation benefits are payable • treatment in a government Hospital • losses incurred while involved in committing a felony or other illegal act

underwriting insurance is a process of selecting and classifying insurable risk. It involves evaluating the risk factors that individual applicants present. the result of the underwriting process determines whether a policy will be issued or denied and, if issued, at What premium level. Key underwriting factors include the applicants what?

•age & sex • occupation & activities outside of work • current physical conditions and past medical history • habits or lifestyle

the selection criteria & the method insurers use to evaluate, classify , & rate insurance applicants are regulated by the various states . state laws prohibit discrimination against any individual on the basis of race, creed , religion , sex , sexual orientation , or physical defects ( including blindness ) when

•determining eligiblitly •setting coverage limits •setting deductibles • identifying exclusions • settling claims Insurance cannot unfairly discriminate in determining which risks to ensure, the terms of conditions of insurance they provide, the benefits they pay, or the continuation of a policy. therefore, insurers and producers cannot unfairly discriminate between persons of same class in essentially same risk in the premiums on rates charged for health insurance, the benefits that a policy will pay, or any other terms and conditions of contract

what does the outline of coverage contain about the policy for the new policyholder ?

•the type of coverage provided • a description of the benefits • a description of the exception and limitations • thmconditions for Renewal, including any reservations by the insurer of its right to change the premium • a statement that the outline summarizes the policy and the policyholder should refer to the policy for the governing provisions