Chapter 4: Risk Management and Insurance Flashcards
When purchasing insurance on the lives of children or grandchildren, why would insurers ask if the policy owner owns insurance on their own life first?
It can be an indication of whether the purchaser views insurance as a risk management tool or simply as a means of enriching themselves in case of a claim.
What are 3 groups that can offer critical illness insurance?
- Employers
- Creditors
- Associations
How are premiums for CII as part of group benefits banded?
Normally based on a 5-year banded rate, meaning a plan member will have the same premium for a given 5-year age band. (Example: 33 year old will have the same premium as a 34 year old, then the 35 year old would have a higher premium)
What is the typical guideline used for determining how much CII is appropriate?
1-2 years of household income
Which type of households tend to incur higher costs in the event of a critical illness?
Households with just one income earner, as the income earner ends up taking on caregiving responsibilities that cause the loss of that income source
What is anti selection?
Anti selection is a term often used in conjunction with adverse selection. It is defined as an increase in the chance for a person to take out an insurance contract because they think their health risk is higher than what the insurance company has allowed for in the premium amount.
Why does cancer coverage in CII typically have a 90-day period where claims are not possible?
Due to anti-selection risks (people who may have a strong reason to suspect they will have a claim in the near future)
When is the premium for a LTC policy purchased as part of a CII rider determined?
Likely not until the conversion privilege has been exercised.
Which rider(s) allow for a CII claim if the individual experiences a disability that renders them unable to work in any capacity, without meeting any other definition?
Total disability or loss of independent existence.
Which definition of disability is used for the waiver of premium rider on a CII policy?
Usually “any occupation” definition of disability.
How does inflation protection on a CII policy work?
Some insurers allow a rider that sees the amount of coverage increase periodically, such as a 5% increase in the face amount every 5 years.
What are the 3 basic types of LTC policies?
- Reimbursement
- Indemnity
- Income
How does a reimbursement LTC policy work?
Under a reimbursement plan, the person insured must submit receipts and can receive up to the monthly maximum in reimbursement.
How does an indemnity LTC policy work?
An indemnity policy will pay up to its face amount as an income benefit once the insurer knows the the insured is incurring that much of an expense. If there is a surplus in the difference between the cost of the expense (facility cost) and the face amount, that will usually extend the benefit period.
How does an income LTC policy work?
Like a traditional disability policy. Once a claim has been submitted, the benefit will be paid until the end of the policy’s benefit period.
When do LTCI policies provide benefits?
When the insured can no longer perform 2 activities of daily living or demonstrates a cognitive impairment.
What are the different types of home care that could qualify to be reimbursed under a LTCI policy?
- Professional care (such as an RN)
- Skilled care (such as a home care attendant, PSW)
- Non-skilled care (family member or friend) - while this works with an income type of policy, it may or may not work for a reimbursement or indemnity style.
What is respite care?
Care facilities not being used on a permanent basis, such as dropping off a parent on your way to work and picking them up on your way home. Or to provide care during a shorter period of time, such as a vacation.
For which type of care home might a LTCI policy have a shortened elimination period?
Palliative care/hospice care
What are Instrumental Activities of Daily Living?
IADLs are used in the underwriting process as they are considered early warning signs for a possible concern around ADLs. These include using the phone, managing finances, driving or taking the bus, shopping, doing laundry, housework, managing medications, preparing meals.
Are ratings on LTCI policies common?
No, although a rating could be applied for height/weight.
What does it mean if a LTCI policy is issued on a modified basis?
A policy could be issued with a shorter benefit period in a smaller face amount than applied for. This is a risk management tool for the insurer.
Do insurers typically add exclusions to LTCI policies?
Due to comorbidity concerns (risk that one condition makes another worse), insurers will typically use a decline rather than an exclusion to manage risk. Exclusions may be used for lifestyle risks though, such as a travel exclusion for someone who regularly travels to dangerous places.
What are common LTCI benefit periods?
100 weeks, 150 weeks, 250 weeks, or lifetime benefits.