Lesson 11 Health Insurance Underwriting Flashcards
Insurance companies reserve the right to have individual underwriting within certain group policies because:
they look at small groups more closely. if there is one “very risky” person among the group the whole group may be required to make high premiums payments to compensate.
3 most important factors in classifying risks
- physical condition
- moral hazards
- occupation
4 Risk ratings
- Preferred- low premium, better than average
- Standard- Normal premium, standard terms and rates
- Substandard- high premium, higher risk
- Uninsurable- decline coverage altogether
3 Primary Factors involved in establishing premiums
- Morbidity
- Interest
- Expenses
True or False:
In individual plans, premiums paid for personal income insurance by an individual are taxed.
True
Are disability benefits tax free to recipients?
Yes
In group plans, are premiums paid by for disability income insurance by employers considered tax deductible?
Yes
True or False:
If a person is self employed all medical care including premiums is tax deductible
True
Are premiums for employees that are also family members fully deductible ?
Yes
Treatments that can be considered deductible medical expenses include:
prescriptions
- insulin
- hospital expenses
- physician/surgeon fees
- nursing care
- dental care
- rehabilitative treatments
- medical insurance premiums
Medical Cost Management utilizes 4 general approaches:
- Mandatory 2nd opinions
- Pre-Certification Review
- Ambulatory surgery
- Case management
Ambulatory Surgery
performed on outpatient basis
Case Management
professional arrangement and coordination of health services.
Disability Income Insurance
Health coverage that provides regular, periodic incomeif insured is disabled or ill
Mandatory 2nd opinion
cost control measure, to be eligible for benefits they must get 2nd opinion before before receiving non life threatening surgery
Medical Cost Management
controlling how policy holders utilize their policies
Medical Expense Insurance
pays benefits for non surgical dr fee’s rendered in hospital. sometimes pays for home and office calls
Pre-Certification
insurers approval of insured entering hospital. many policies require this to keep costs down
Premium Factors
morbidity, interest, expenses
Risk Factors
physical condition, moral hazards, occupation
Substandard Risk
under average or impaired insurance risk due to physical condition, family history, occupation, dangerous habits, etc.
