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CHAPTER 13: HEALTH AND DISABILITY INSURANCE

WEBHealth Maintenance Organizations (HMOs) An HMO is an entity that contracts with medical facilities, physicians, employers and sometimes individual patients to provide medical care to a group of individuals.

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CHAPTER 18 GROUP HEALTH INSURANCE

WEBCOBRA): Employment is terminated for other than gross misconduct—18 months (up to 29 months if disabled). Reduction in hours worked (resulting in termination from plan)—18 months (up to 29 months if disabled). Death of employee—36 months for dependents. Dependent child no longer qualifies as a dependent—36 months.

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CHAPTER 16 HEALTH INSURANCE POLICY PROVISIONS

WEBChapter 16 Health Insurance Policy Provisions 2 coverage by name or specific description effective on the date of loss, had existed prior to the effective date of coverage of the policy.

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CHAPTER 17 HEALTH INSURANCE APPLICATION, …

WEBCHAPTER 17. CHAPTER 17 HEALTH INSURANCE APPLICATION, UNDERWRITING AND PREMIUMS. Insurers are concerned with morbidity in the health insurance industry. Morbidity is the frequency of illness, sickness, and disease. The morbidity table.

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CHAPTER 12 HEALTH INSURANCE PROVIDERS

WEBCHAPTER 12 HEALTH INSURANCE PROVIDERS. Although the health insurance industry started in the latter part of the 1800s, it did not boom until the 1940s. Today most people realize the need of health insurance due to the escalating cost of care. In the year 2008, the expenditures for health care were 16% of the gross national product.

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CHAPTER 23 INSURANCE CODE

WEBCause or participate in a vehicle collision or other vehicular accident. Present a false or fraudulent claim for a loss due to theft, destruction, damage, or conversion of a motor vehicle, motor vehicle part, or motor vehicle contents. Prepare, make or subscribe any writing to support a false or fraudulent claim.

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Appendix A Ethics and California Insurance Code (12 hour) …

WEBEthics and California Insurance Code (12 hour) Educational Objectives. The “General” Ethics and California Insurance Code educational objectives that apply to all lines of authority appear below. The 12 hours of required Ethics and California Insurance Code education must at a minimum include the material in Appendix A. CHAPTER PAGE.

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CHAPTER 15 ACCIDENTAL DEATH AND DISMEMBERMENT …

WEBAccidental death and dismemberment insurance can cover all of the following except: A. Death that occurs within 90 days of the insured suffering an injury. B. Loss of two limbs. C. Death due to an accident or illness. D. Loss of sight in both eyes. Chapter 15 Accidental Death & Dismemberment Insurance 3 3.

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CHAPTER 7 GROUP LIFE INSURANCE

WEBChapter 7 Group Life Insurance 4 paid by the prior carrier. Benefits for an employee or dependent under a replacement policy cannot be reduced or excluded because of preexisting

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CHAPTER 2 INSURANCE COMPANIES AND DISTRIBUTION …

WEBChapter 2 Insurance Companies and Distribution Systems 6 classes of insurance they transact. Some products sold by insurers are property insurance, casualty insurance, health insurance, life insurance, and annuities.

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CHAPTER 7 GROUP LIFE INSURANCE

WEBinsurance on dependents cannot be in excess of 100% of the insurance on the life of the employee. (CIC 10203.4) The premium for dependent insurance may be paid by the

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CHAPTER 13 HEALTH INSURANCE

WEBCHAPTER 13 HEALTH INSURANCE. Although the health insurance industry started in the latter part of the 1800s, it did not boom until the 1940s. Today most people realize the need of health insurance due to the escalating cost of care. In the year 2008, the expenditures for health care were 16% of the gross national product.

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CHAPTER 13 MEDICAL EXPENSE INSURANCE

WEBChapter 13 Medical Expense Insurance 2 In the usual, customary, and reasonable (UCR) approach, surgical benefits are not listed by dollar amount. Instead the insurer will pay based on the amount physicians in the same geographical area …

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CHAPTER 15 INSURANCE CODE

WEBThe California Insurance Code (CIC) consists of statutes written and passed by the state legislature. The governor signs these statutes into law. The insurance code is changed by the legislature passing a new statute that amends or repeals an existing statute. The code originally consisted of six divisions, but two divisions have been repealed.

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CHAPTER 2 INSURANCE COMPANIES AND DISTRIBUTION …

WEBdemutualization or conversion. (CIC 11535) Reciprocals (interinsurance exchanges) are unincorporated associations of individuals known as subscribers who agree to insure one another. Each subscriber is allocated a separate account in which his/her premiums and interest are recorded.

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CHAPTER 14 DISABILITY INCOME

WEBCHAPTER 14 DISABILITY INCOME. Disability income insurance provides the insured with an income after being disabled due to an accident or illness. It is probably the most overlooked form of insurance. People frequently will purchase life insurance, health insurance, and annuities and forget about disability income insurance.

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CHAPTER 6 UNDERWRITING

WEBAn individual may contact the MIB at the following address: Medical Information Bureau P.O. Box 105, Essex Station Boston, MA 02112 (617) 426-3660

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P&C Educational Objectives

WEB18. Be able to identify the major medical deductibles: (a) Multiple expenses for one individual apply to the stated deductible; 13-19

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