Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IF7 > 6 Assessing the risk > Flashcards

6 Assessing the risk Flashcards

1
Q

PEC

A

Disease, illness or injury that an individual has already suffered from before seeking insurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mortality risk

A

The risk of dying in the next time period (usually the next year)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mortality

A

Statistics used to estimate probably life expectancy of a customer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Morbidity risk

A

That the insured will need medical treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Morbidity

A
  1. The probability of occurrence of certain medical conditions
  2. The frequency these conditions may affect a member
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Considerations when covering cancer

A
  1. High costs
  2. Potential to become chronic
  3. Conditions may become cancerous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

6 Cancer cover options

A
  1. Excluded
  2. Limited term cover
  3. Cover for primary cancer
  4. NICE-only
  5. Maximum amount claimed in one year
  6. No restrictions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Main cancer costs for insurers

A
  1. Cost of chemotherapies drugs
  2. Hospital mark up for preparing drugs
  3. Bed charge
  4. Specialist fees
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What happens when a customer asks their insurer to cover experimental treatment

A

Insurer seeks evidence that the treatment is appropriate and recognised – usually advised by the CMO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Who pays for experimental treatments if authorised by the CMO?

A

European Medical Agency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Purposes of underwriting

A
  1. Determine potential risk
  2. Ensure t&cs are appropriate and profitable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Methods of underwriting

A
  1. General exclusions
  2. PECE
  3. FMU
  4. Moratorium
  5. MHD
  6. CPME
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Options with FMU

A
  1. Allow cover on standard terms
  2. Exclude specific conditions
  3. Exclude, but review at a later stage
  4. Standard terms, but on higher premium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Advantages of mori

A
  1. Saves time
  2. Saves costs
  3. Avoids non-disclosure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Disadvs of mori

A
  1. Lack of clarity for policyholder
  2. Delays at point of claim
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Main problem with CPME

A

New provider dependent on accuracy of original underwriting

17
Q

Customer rights to review

A

A customer could ask their insurer to review an existing rating at any time, although the insurer is not contractually required to do so

18
Q

Tele-underwriting

A

Customers complete a written/online form which is considered by an underwriter

19
Q

Little t underwriting

A

– Customer completes form
– Underwriter follows up

20
Q

Big t underwriting

A

– All information collected by an underwriter

21
Q

Typical FMU questions

A
  1. Any medical conditions?
  2. Any hospital admissions in last 5 years?
  3. Any GP consults in last 12m?
  4. Do you have foreseeable need for treatment
22
Q

Underwriting history assessment factors

A
  1. Age
  2. Gender
  3. Start date of illness
  4. Frequency & reoccurrence potential
  5. Present state of health
23
Q

Individual premium pricing considerations

A
  1. Age
  2. Marital status
  3. Smoking
  4. Postcode
  5. Claims experience
  6. Hospital banding
  7. Type of policy
  8. Excess
  9. Lifestyle
24
Q

High excess medical savings plans

A

Customer self-insures their cover, using the savings to build up a fund to pay for costs in the future, so they can afford to pay high excesses

25
Q

No claims bonus

A

Premiums are discounted for every year no claim is made

26
Q

Health cash plan underwriting

A

– Typically PECE
– Some use discretion

27
Q

Dental insurance underwriting

A

Usually PECE, but can cover for larger group schemes

28
Q

Capitation plan underwriting

A

Requires full check-up at commencement

29
Q

Hospital treatment insurance/major medex/surgical cash underwriting

A

Usually excludes all pre-existing conditions (or uses mori)

30
Q

Travel insurance underwriting

A

Usually PECE, unless the insurer notified

31
Q

PA insurance underwriting

A

Usually PECE

32
Q

PPI underwriting

A

Usually PECE

33
Q

LTC insurance undewriting

A

– Ratings usually applied in the form of an extra premium
– Specific conditions may be excluded

34
Q

Later life products

A

Cash lump sum on needing long-term care

35
Q

IP underwriting

A

– Ratings usually applied in the form of an extra premium
– Specific conditions may be excluded
– Medical evidence often required upfront

36
Q

CI underwriting

A

– Ratings usually applied in the form of an extra premium
– Specific conditions may be excluded
– Family history sometimes considers

37
Q

Additional underwriting sometimes required for specific extra risks

A
  1. Financial questionnaires
  2. Pathology
  3. Occupation/hazardous activities questionnaires

IF7 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions