Healthcare Products Flashcards
Step-down care or intermediate care
- Used as a bridge between in-patient and out-patient care.
- Hospital care is extremely expensive and in the case of patients requiring rehabilitation or who are seriously ill, the appropriate level of care may be provided more cost-effectively in a step-down facility, like a rehabilitation centre.
- PMI providers may include cover at step-down facilities or even provide nursing visits to the home as an extension of the in-patient treatment benefit to control costs and ensure appropriate care.
Palliative care
- Focuses on providing relief from the symptoms and stress of a serious illness.
- The goal of palliative care is to improve the quality of life for both the patient and their family.
- It is appropriate at any age and at any stage in a serious illness, and it can be provided alongside curative treatment.
- Palliative care benefits may also be included in PMI products.
ADL definitions
Washing – the ability to maintain an adequate level of cleanliness and personal hygiene
Dressing – the ability to put on and take off all necessary garments, artificial limbs, or other surgical appliances that are medically necessary
Feeding – the ability to transfer food from a plate or bowl to the mouth once food has been prepared and made available
Toileting – the ability to manage bowel and bladder function, maintaining an adequate and socially acceptable level of hygiene
Mobility – the ability to move indoors from room to room on level surfaces at the normal place of residence
Transferring – the ability to move from a lying position in a bed to a sitting position in an upright chair or wheelchair and vice versa.
Alternative definitions to ADLs
There are several assessments used to evaluate a person’s ability to perform work-related tasks, such as Activities of Daily Work (ADWs), Personal Capability Assessments (PCAs), and Functional Assessment Tests (FATs). ADWs focus on routine job activities like email communication, meetings, and report writing, and are particularly relevant in disability insurance contexts. PCAs assess personal abilities like cognitive skills, physical strength, and emotional intelligence. FATs evaluate specific functional tasks, such as mobility, endurance, and manual dexterity, often in clinical or occupational settings. These assessments help gauge a person’s capacity for work and independence.
Advantages and disadvantages of tiered benefits
Advantages:
Cover is more comprehensive
Reduced scope for adverse selection
Reduced scope for symptom exaggeration
Differentiation from competitors l Improved profitability. Disadvantages:
Increased complexity
Defining and obtaining data for different levels of severity of conditions
Creating a fair and consistent sliding scale of benefits
Co-morbidities between conditions may be difficult to model
Claim probabilities are more difficult to model.
Critical illness (CI) insurance
A pure protection product with a benefit payable if the policyholder suffers a critical illness (CI) event during the term of the policy. This product is designed to protect policyholders from illnesses or conditions that are typically perceived by the public to be serious and to occur frequently. In nearly all cases level premiums are paid until the full sum insured is paid, the insured dies, or the term of the policy ends, whichever event occurs first.
Prefunded LTCI
A combination of a savings and protection product. It protects individuals against increased costs should they require long-term care in the future. In most cases the individual is relatively healthy, in other cases they may be close to reaching the threshold for needing long-term care. In both cases, there will be uncertainty over if and when the benefit will start to be paid.
Health cash plan
A policy that pays the policyholder a fixed cash lump sum amount per benefit event. A common form is a hospital cash plan.
Hospital cash plan
A health cash plan that pays the policyholder a fixed amount for hospital treatment depending on the length of stay or the type of healthcare event experienced, for example, a birth event.
Immediate-needs LTCI
Immediate-needs LTCI is purchased by someone who needs long-term care right away but is uncertain of their future lifetime and how their care needs may change during this time. Immediate-needs LTCI is a protection product.
Long-term care insurance (LTCI)
LTCI is a product designed to meet the costs of providing long-term care for individuals whose health is not expected to improve. Long-term care might be defined as including all forms of continuing personal or nursing care and associated domestic services for people who are unable to look after themselves without some degree of support. This may be provided in their own homes or in a state-sponsored or privately-run care home setting. LTCI can be provided on both an indemnity basis and a cash basis.
Major medical expense (MME) plan
The exact definition of MME depends on the country in which it is offered. Generally, it provides a lump sum benefit which is estimated to cover the cost of treatment of a medical event. In the UK, this is a form of PMI product which pays a fixed amount to a policyholder when they undergo surgery.
Private medical insurance (PMI)
Commonly an indemnity-based product providing compensation for the cost of private medical treatment. Although hospital cash plans and major medical expense cover are strictly types of PMI, for the purposes of Subject F108, PMI refers only to the indemnity-based product described above.
Accelerated benefit
A death benefit where the benefit payment is made prior to death. If less than 100% of the total benefit is accelerated, then the contract remains in force and pays out the remainder of the benefit on death. Some life insurance products have a critical illness (CI) accelerator that pays out on the earlier of death or diagnosis of a CI. Where critical illness benefits are offered as an accelerator on a product, no survival period is applied.
