Chapter 6 Assessing the risk Flashcards
What is the probability of occurrence of certain medical conditions and the frequency these conditions may effect a member during their expected life
Morbidity risk
Three difficulties in assessing how much premium to charge for cancer cover
Cost - expensive
Its acute but can become chronic
What appears harmless can become serious
What underwriting approach excludes cover for conditions which the insured already has?
Exclusion of all pre-existing medical conditions
What underwriting approach ignores previous medical history
Medical history disregarded
What underwriting approach will only provide cover for pre existing conditions after a certain number of years
Moratorium underwriting
Identify three differences between group and individual PMI underwriting
Anti-selection risk is lower
Often cost plus pricing
It is not medically underwritten
Identify 7 problems facing PMI underwriters
Wider range of medical techniques New or experimental treatments Ageing population Changing health risks Maturing healthcare insurance population more likely to make claim More complex procedures Wonder treatments
Identify 6 types of loyalty scheme
Profit sharing Affinity groups Member get member schemes No claim bonus Self improvement bonus Loyalty bonus after first year
What is medical underwriting
The process by which an insurer assesses the risk of a pre-existing condition and where necessary excludes treatment or amend the policy terms
Identify 6 possible insurer cancer stances
No cover
Limited cover for the use of monoclonal antibody drugs either 1 or 3 years
Cover only where there is evidence of primary cancer
Use of NICE approved drugs only
Maximum amount any one year
NO restrictions
what is a rolling moratorium
ANy conditions to which the insured has had symptoms 5 years prior to purchasing the policy are excluded for first 2 years but if the condition becomes active gain in 2 years is subject to another 2 year moratorium
What is a fixed moratorium
As per the rolling moratorium but no requirement that member is free of symptoms before 2 years moratorium ends
If an insurer agrees to follow a previous insurers exclusions this is known as
CPME or switching exclusions
What is little t underwriting
Form plus telephone call
what is big t underwriting
All information provided on telephone no form completed
