Indiv Health ins Chpt 2 The Products

Question 1

Group conversion

Answer 1

1. If someone leaves group, able to purchase individual health insurance from the same insurer
2. Highly regulated and less important since the implementation of COBRA
3. After COBRA terminates, individual are then eligible for conversion coverage

Question 2

Medicare Supplement and Medicare Advantage (MA)

Answer 2

1. Medicare Supplement
   
   1. 1 Covers the gaps in Medicare, including Coinsurance and deductible
   2. 2 minimum benefit standards and loss ratio requirement
   3. 3 NAIC defines benefit designs which plans must model
2. MA
   
   2. 1 provide benefits of Medicare plus additional benefits for an extra premium
   3. 2 require use of in network providers
   4. 3 no u/w and MA participants must comply with open enrollment requirements and annual bidding

Question 3

Disability Income (DI) coverage
Part 1

Answer 3

1. Intended to cover lost income due to illness or injury
2. Total vs partial vs residual
   
   2. 1 partial disability: those who suffer partial disability can still receive some benefits
   3. 2 residual benefits: after a person had been totally disabled, they could be eligible for partial benefit
3. Waiver of premium provisions
4. Cost of living adjustment
5. Benefit period: maximum period of time for which benefits are payable
6. Elimination period
   
   6. 1 period of disablement that must occur before disability payment start
   7. 2 reduces claim costs and expenses because it eliminates frequent, small claims
7. Renewability
   
   7. 1 non-cancel able: renew ability and premium rate guaranteed in advance
   8. 2 guaranteed renewable: policy is guaranteed to renew, but premium rates can be changed
   9. 3 conditionally renewable: circumstances under which insurer can refuse to renew policies

Question 4

Disability Income (DI) coverage
Part 2

Answer 4

1. Lost income vs indemnity
   
   1. 1 some DI coverage pays a flat amount per week or month
   2. 2 lost income: provides reduced DI payment when insured earns income while disabled
2. Definition of occupation
   
   2. 1 any occ: benefits are payable if an insured is unable to perform duties of any occupation for which they are suited
   3. 2 own occ: benefits are payable if insured is unable to perform duties of their specific occupation
3. Recurring disabilities
4. Social insurance supplements- most DI insurers integrate social security payments

Question 5

Limited Benefits medical coverages

Answer 5

1. Hospital indemnity plans
   
   1. 1 pays a flat amount per day of inpatient hospitalization
   2. 2 typically no underwriting aside from pre-existing condition exclusions
2. AD&D
   
   2. 1 Benefits: Accidental death, dismemberment, days in hospital/ICU/ER, days not able to work
3. Dread disease and critical illness
   
   3. 1 May pay a flat amount for hospital confinement, ambulance, ICU, surgery, loss of time, therapies, and death
   4. 2 may pay a lump sum for heart attack stroke, cancer, or other conditions