Lists Flashcards
Main products
1 CI 2 IP 3 LTC 4 Health Cash 5 Major medical expenses 6 PMI 7 Group/individual
Policy conditions should aim to..
1 Intentions - reflect true office intentions
2 Cushion - give cushion against adverse events that can’t be controlled
3 Be simple and unambiguous
Ways which overinsurance can arise from RR
1 From outset 2 Subsequent - salary doesn't keep up with benefits 3 Reduced tax on IP applying to EB 4 Multiple policies 5 Other non-disclosed income
Ways to address overinsurance from RR
1 Msx benefit formula
2 Train sales staff reducing incentive to overinsure
3 Regular review ensure appropriate RR
4 Clear policy conditions highlighting action at claims stage if over-insured
Occupation class multiples
1 = 100% 2 = 175% 3 = 300% 4 = 400%
Disability occupational definitions
1 Can’t do own occupation
2 Own or any suited by education/training
3 Any
4 Own for inital period e.g. 2 years then any
Possibile diability tests
1 FAT
2 ADL
3 ADW
4 PCA (personal capability ass)
Reasons to have a non-zero deferred period?
1 Integrate with employer benefits
2 Reduce cost of claims to insurer and price
3 Reduce admin costs and price
4 Meet true customer needs e.g. not want to submit claim if ill for 2 days with a cold
When can there be benefit escalation? How common?
1 Same rate in and out (most common)
2 Some out, none in (unusual)
3 Some in, no or lower out (common)
How can residence effect risk?
1 Living when underwritten
2 Living when disability occurs
3 Living when benefit payable
When is a CI paid?
In any of the following ways:
1 Upon an event, independent of extent
2 Reaching defined degree of impairment
3 Undergoing a surgical procedure
Characteristics of an illness making it appropriate for CI
1 Condition perceived by public to be serious or occur frequently
2 Each condition covered can be defined clearly with no ambiguity
3 Sufficient data to price it
List some major conditions (90% of claims)
1 Cancer 2 Coronary artery by-pass surgery 3 Heart attack 4 Kidney failure 5 Major organ transplant 6 MS 7 Stroke
List other conditions (75% of policies include)
1 AIDS/HIV from bloody transfusion 2 AIDS/HIV from occupation 3 Alzheimers 4 Aorta graft 5 Benign brain tumour 4 Blind 5 Coma 6 Deaf 7 Heart valce replacement 8 Loss of limb 9 Loss of speech 10 Motor neurone disease 11 Paralysis 12 Parkinsons 13 3rd degree burns
List conditions listed in CI policies that are there due to popular demand and competitiveness
1 CJD 2 Chronic empyhysema 3 Diabetes 4 Pre-senile dementia 5 Rheumatoid arthritis
Main types of disability definition for CI
1 Occupation based
2 Related to ADLs
3 Using working activities/functional assessments
List typical ADL’s
Feeding Dressing Washing Toileting Mobility Transferring
Reasons to offer tiered benefits (payment linked to severity) for CI
1 Comprehensive - benefits offered at lower levels that full CI
2 Anti-selection reduced as payments match financial needs closer
3 Customer satisfaction and retention as multiple claims possible
4 Differentiation - from competition
5 Profits - comparisons more difficult so can make more profit
Areas of difficulty in offering CI tiered benefits?
1 Historic experience not enough for tiers
2 Frequent changing of underlying incidence and transitions before own-experience emerges
3 Overlaps between related illnesses makes pricing difficult and policyholder confused
4 Defintions of stages of benefits that are legal and medically objective and understandable to a consumer are difficult
5 Risks mean high margins, low guarantees and cooperation with reinsurers
6 Non-disclosure of medical condtions becomes even more significant
7 More claims forms
How do tiered benefits meet customer needs?
1 Closer to medical distress and financial needs
2 More comprehensive and fairer
3 Depends on whether policholder pays less/more/same for standard policy covering same conditions
4 Complexity and lack of comparable products means less appeal to prospective p/h and advisors
5 Potential for high degree of claims disputes
3 types of benefit from comperehensive PMI
1 Hospital costs
2 Specialist fees
3 Other features
Name 8 hospital costs
In patient: 1 accomodation 2 bursing care 3 drugs 4 physio Day care with no overnight stay 5 accomodation 6 operating theatre 7 diagnostic procedures Youth 8 Acommodation for 1 parent to stay in hospital with insured dependent child under 12
Name 8 specialist fees
Surgeon fees for in-patient and day care ops Physicial fees for in-patients Out patient treatment: specialist consultation diagnostic procedures physio radiotherapy/chemotherapy/scanning
Name 3 other features to PMI
1 Private ambulance
2 Recuperative care e.g. nursing immediately following in-patient surgical treatment covered
3 Maximum overall limit
4 inclusions in a standard policy
1 Surgery
2 Nursing
3 In-patient tests
4 Hospital accomodation
4 sometimes included in a standard policy
1 Out-patient tests
2 Out-patient consulations with specialist
3 Overseas cover
4 Cash payments for treatment received as in-patient on state healthcare
