7. Healthcare products Flashcards
1
Q
Legislation
A
- Highly regulated
- May be required by state
2
Q
Features of short term products
A
- Usually 1 year + renewable
- Can be multiple claims
- Unknown + volatile claim amounts
- Can be delays in reporting + settling claims
3
Q
Features of long term products
A
- Usually ceases on claim
- Claim amount may be known with certainty
- Protection against ill-health/death
- Group versions usually for 1/2 years but may be renewable
4
Q
Short term underwriting
A
- Full medical- Any pre-existing conditions ignored
- Moratorium- Won’t cover conditions that existed during pre-specified period before start of policy
- Medical history disregard
- No worse terms- Cover at least as comprehensive as policyholder’s current policy with no extra underwriting conditions
- Continued medical extension- carry forward cover for medical conditions that existed under previous policy
5
Q
Long term underwriting
A
Medical underwriting
6
Q
Provisions
A
Mainly IBNR
7
Q
Providers
A
- State
- Subsidised care through donors
- Insurance companies
- Mutuals
8
Q
Reimbusment mechanisms
A
- Fee-for-service
- Negotiated-fee-for-service
- Global fee
- Capitation
9
Q
Fee-for-service
A
Providers reimbursed for each service provided
10
Q
Negotiated fee-for-service
A
Tariff/remuneration for each service is pre-defined
11
Q
Global fee
A
Fixed tariff/fee per episode of care with service provider assuming some risk for level of services required per patient
12
Q
Capitation
A
Fixed amount paid per policyholder who has option to use service/not (fee is paid regardless)
13
Q
Medical trends
A
- Public good characteristics + universal access
- Information asymmetry, oversupply + demand
- Rapidly increasing costs of health care services
14
Q
Products
A
- Personal medical insurance
- Critical illness
- Long-term care
- Cash benefits
15
Q
PMI
A
Indemnity based + private medical treatment
