Curso 2-15 Lección 1 PROPÓSITO DE LOS SEGUROS DE VIDA Y DE SALUD / PURPOSE OF LIFE AND HEALTH INSURANCE página 1/22 ENGLISH TABLA DE CONTENIDOS / TABLE OF CONTENTS…

página 2/22 PART 1:PRINCIPLES OF LIFE AND HEALTH INSURANCE LESSON 1: PURPOSE OF LIFE AND HEALTH INSURANCE  SUBJECT The Role of Insurance Industry Overview The Nature of Insurance The Concept…

página 3/22 SECTION1.2: An Industry Overview It is a life fact that death will come at some point; however, the majority of people do not know when. Death is not…

página 4/22 The insurance policy determines the promise that the insurer has established to pay the insured if any loss is incurred respect to the insured material. When a loss…

página 5/22 SECTION 1.4: The Concept of Risk RISK: Defined as the uncertainty about one’s loss. The loss that has to do with all the risks is characterized by a…

página 6/22 1.4.2.  Peril & Hazard: There are elements that cause or give place to risks. In addition, with the two types of risks, there is two other concepts: Peril:…

página 7/22 RISK RETENTION: The reason to retain and accept risk, as well as facing it when it happens. One way to manage a retained risk is a car insurance.…

página 8/22   ADVERSE SELECTION: It is the selection against the company and likeliness of the insured to take advantage of the benefits in the insurance contracts. OVERALL ADVANTAGES OF…

página 9/22 Stock Insurer: The stock companies are private entities. They have the same structure as any corporation, organized and incorporated or built under state laws. Their objective is to…

página 10/22 Stock Insurers are owned by stockholders. Mutual Insurers are owned by policyholders.   The process of turning a mutual insurance company into a stock insurance company is called…

página 11/22 Reinsurers: Reinsurance is a disposition through which an insurance company transfers a portion of the risk to another insurer. Reinsurance companies determine the area to provide and share…

página 12/22 What is the purpose of a “legal reserve”? It is required that the legal reserve ensures the fulfillment of the promises set out in life insurance policies. The…

página 13/22  1.6.1.  Captive vs. Independent Agent The main classifications of Agents are the following: Captive Agent Independent Agent A Captive Agent (also known as career agent) works for one…

página 14/22 The three types of systems that support agency selling insurance through agents and brokers are:   Career Agency System (General Agent – GA) Personal Producing General Agency System…

página 15/22 INTERVENTION BY THE SEC (1959): A year later, the Securities and Exchange Commission (SEC) presented its own challenge to the industry. The variables and variable life insurance annuities…

página 16/22 1.8.1. Domestic Insurer Companies practicing in the state in which it was incorporated. For example, a company incorporated in Florida and it is doing business in Florida. 1.8.2.…

página 17/22 Two things that many producers use as educational tools in sell presentations are the following: The NAIC Buyer’s Guide and The Policy Summary. In Florida, an agent is…

página 18/22 1.10.2. Florida Life and Health Guaranty Association (FIGA) Florida Statutes govern the nonprofit Guarantee Payment of Life and Health Insurance. The purpose of the Florida Insurance Guaranty Association…

página 19/22 SECTION 1.11: Rating Services   These companies are usually paid a fee for several insurance companies to provide these qualifications. Each of these independent rating services focuses on…

página 20/22 Keep records of the copies of the Notification of Application Regarding Replacement Life Insurance; forms of requested comparative information, any proposed sale used, and any registration replacement. Everything…

página 21/22 Some of the most common examples of misrepresentations are:   Falsifying provisions or benefits of a policy or how can it be expected to carry out the policy…

página 22/22 Reduction not be withheld or limited in an amount based on factors that are unjustly discriminatory; No refund will be given if not reflected in the repayment schedule;…

COURSE 2-15 LESSON 2: LAW AND THE INSURANCE CONTRACT SUBJECT Special Contract Agents and Brokers Other Legal Concepts Legal Concepts ————————————————————————————————————————————   Curso 2-15 Lección 2: LA LEY Y LOS…

página 2/6 PART 1: PRINCIPLES OF LIFE AND HEALTH INSURANCE LESSON 2: LAW AND THE INSURANCE CONTRACT SECTION 2.1: GENERAL LAW OF CONTRACT A contract is a legally enforceable agreement;…

página 3/6 2.2.1. Aleatory Random contingency contracts are unequal potential gains or losses for both parties to the insurance contract. Dollar values exchanged cannot be equal. In random contracts there…

página 4/6 So we have learned that a basic requirement for all types of insurance is that the person buying a policy must have an insurable interest in the subject…

página 5/6 Implied Authority implied authority; the authority is not given in writing, but is necessary for the agent to transact insurance. implied authority is conjecture that even though certain…

página 6/6 In contrast, a voidable contract is one in which one party has a legally satisfactory reason to reject or cancel the contract. Void vs Voidable These words sound…

página 1/18 PART 11: PRINCIPLES OF LIFE INSURANCE LESSON 3: LIFE INSURANCE POLICIES, PROVISIONS, OPTIONS AND RIDERS. TYPE OF POLICIES SUBJECT Categories of Life Insurance Term Life Insurance Option to…

página 2/18 PART II: PRINCIPLES OF LIFE AND HEALTH INSURANCE LESSON 3: LIFE INSURANCE POLICIES, PROVISIONS, OPTIONS AND RIDERS SECTION 3.1: Categories of Life Insurance Life insurance in force in…

página 3/18 The word “term” is defined as “the amount of time it takes something with a fixed and final principle” or, more simply, “time”. Term insurance is intended to…

página 4/18 3.2.3. Decreasing Term Decreasing term policy are slightly different; the nominal value does not remain equal (level), because decreases with time. This type of term insurance is usually…

página 5/18 Section 3.4: Whole Life (permanent) Insurance A second type of life insurance plan is the whole life insurance also known as permanent insurance or cash value. Whole life…

página 6/18 Benefits Life / Living Benefits   Another unique feature of all whole life insurance are the living benefits it can provide. Through accumulation value accumulated in the policy…

página 7/18 COMPARISON OF THE MAIN TYPES OF LIFE INSURANCE      Term Life Insurance Permanent life insurance Ordinary Life Insurance Universal Life Insurance Insurance Premium   Initially low, but…

página 8/18 3.5.1. Endowment Premiums Premiums are usually paid from the date of issuance until the maturity date, or may be limited to fewer years or even one payment. With…

  página 9/18   Common Life Policies (or Boards) / Joint Life Policies: It covers two or more people. The use of some type of permanent insurance, it pays the…

página 10/18 Variable insurance products are regulated by the state and the SEC as values. A prospectus (information on the nature and purpose of the plan with full disclosure, the…

página 11/18 Section 3.8: Rights of Ownership Policyholders have different rights that are not available to others. Of course, you know that the policy owner has the right to change…

página 12/18 3.9.5. Grace Period The grace period is a period of time after the due date of payment of the premium for which the policy remains in force even…

página 13/18 When a policy is restored, the incontestable clause usually regenerates. If the policy had carried out a policy loan, repayment of the entire loan amount may be necessary;…

página 14/18 3.9.10. Death Benefits Provision Acelerated The accelerated death benefit provision allows the policy owner to withdraw funds from your life insurance policy before death. This concept differs from…

página 15/18 3.11.2. Reduced Paid – Up Option Under the insurance option paid reduced, the policy owner may request that the cash value of the policy is used to pay…

página 16/18 If dividends are allowed to accumulate in interest, that interest is taxable and Form 1099 is issued.   Participants policy are those in which the policyholder receives dividends…

página 17/18 Riders   Guaranteed Insurability Rider   It allows the insured to purchase specific amounts of additional insurance at specified intervals [usually three years] without evidence of insurability. Waiver…

página 18/18 3.13.5. Dismemberment Benefit Rider The Annex accidental death benefit is sometimes referred to as Annex “double compensation” because it provides an additional amount usually equal to the nominal…

página 1/11    LESSON 4: LIFE INSURANCE PREMIUMS, PROCEEDS AND BENEFICIARIES  SUBJECT Primary Factors in Premium Calculations Policy Proceeds and Settlement Options Treatment of Proceeds Beneficiaries Naming an Entity as…

página 2/11 PART II: PRINCIPLES OF LIFE INSURANCE LESSON 4: LIFE INSURANCE PREMIUMS, PROCEEDS AND BENEFICIARIES Section 4.1: Primary Factors in Premium Calculations Actuaries are mathematicians working with certain factors…

página 3/11 4.1.4. Cash Reserves Vs Cash Value It can be difficult to understand the difference between policy reserves and cash values, but there is a noticeable difference. States require…

página 4/11 4.1.6. Methods of Substandard Risks Rating There are several methods used in assessing the premium rates Substandard risks. If an applicant presents a substandard risk, there are ways…

página 5/11 4.2.1. Single Premium Payment Lump Sum After the death of the insured, the beneficiary receives the proceeds or benefits in a single payment. At one time, these gains…

  página 6/11 4.2.4. Accelerated Benefits The provision of accelerated benefits of the policy allows the death benefit withdraw prematurely in cases of terminal or chronic illness. Within certain limits,…

página 7/11 Section 4.3: Tax Treatment of Proceeds When a policyholder dies, winnings paid a life insurance policy as a death benefit in a lump sum (lump sum) to a…

  página 8/11 Primary Beneficiary The main beneficiary is considered to be the first in line to receive the benefits of the policy; there may be one or more primary…

página 9/11 Section 4.6: Beneficiaries Naming as Individuals We have seen the entities that are not persons as beneficiaries, which are not commonly used. Now let’s see the most common…

página 10/11 Irrevocable clauses may be absolute or reversible:   Absolute: When the beneficiary has an unquestionable (absolute) personal interest in the life insurance contract, even if the beneficiary does…

página 11/11 4.7.3. Spendthrift Trust Clause The clause protects spendthrift trust the benefits of life insurance creditors. Beneficiary’s creditors are prohibited from claiming any of the benefits of the policy…

página 1/7 LESSON 5:  LIFE INSURANCE UNDERWRITING AND POLICY ISSUANCE SUBJECT The Purpose of Underwriting The Underwriting Process The Application Fair Credit Reporting Act of 1970 Field Underwriting Procedures Policy…

página 2/7 PART II: PRINCIPLES OF LIFE INSURANCE LESSON 5: LIFE INSURANCE UNDERWRITING AND POLICY ISSUANCE Section 5.1: Purpose of Underwriting Underwriting is the process by which an insurer determines…

página 3/7 Section 5.3: The Application The application is defined as a form provided by the insurance company, usually completed by the agent and the medical examiner (if applicable), on…

página 4/7 How does the law define false insurance claims?   Knowingly making false or fraudulent statements or representations on or in connection with an application for an insurance policy…

página 5/7   Section 5.4: Fair Credit Reporting Act of 1970   As almost everyone is aware, almost all kinds of financial transactions in our society is based on credit…

página 6/7 The insurance application is an attempt to persuade anyone to buy an insurance product through: the description of benefits or terms of insurance coverage, including premiums or rates…

página 7/7 5.5.5. The Binding Receipt Receipt The receipt binding or binding, also the effective date of the policy is the date of receipt of the initial premium; however, there…

página 1/7 LESSON 6: GROUP LIFE INSURANCE SUBJECT Principles of Group Insurance Features of Group Life Insurance Eligible Groups Group Life Characteristics Other Forms of Life Insurance  —————————————————————————————————————————— LECCIÓN 6:…

página 2/7 PART II: PRINCIPLES OF LIFE INSURANCE LESSON 6:  GROUP LIFE INSURANCE SECTION 6.1: Principles of Group Insurance The basic principle of group insurance is to provide insurance coverage…

página 3/7 Provisions required in group contracts (Sec. 627 558). There is no policy group life insurance is issued in this state unless it contains in substance the provisions (Sec.…

página 4/7 Certificate: An insurance policy group life provide that the insurer will issue the policyholder for delivery to each insured individual certificate containing the group number and description of…

página 5/7 6.4.2. Group Permanent Life Insurance Permanent life insurance group (also known as Whole Life) in the group plan market can be divided into three different types of offers: …

página 6/7 Section 6.5: Other Forms of Life Insurance The group life insurance is typically provided by an employer to cover employees of the company under one master policy and…

  página 7/7 6.5.3. Credit Life Insurance Credit life insurance applies to the relationship between groups of debtors (those who owe) and creditor groups (those who provide). When you buy…

página 1/13 LESSON 7: ANNUITIES – FIXED AND VARIABLE SUBJECT Purpose and Functions of Annuities Annuity Basics Structure and Design of Annuity Income Tax Treatment of Benefits Uses of Annuities…

página 2/13 PART II: PRINCIPLES OF LIFE INSURANCE LESSON 7: ANNUITIES – FIXED AND VARIABLE Section 7.1: Purpose and Functions of Annuities Annuities offer cash contracts with an insurance company…

página 3/13 Section 7.3: Structure and Design of Annuities Annuities can be used as a vehicle to finance many things, especially when large amounts of money are involved and require…

página 4/13 Immediate annuities are typically designed to provide income immediately after retirement. An immediate fixed annuity is a contract between the beneficiary and the insurance company. In exchange for…

página 5/13 7.3.4. Investment Configuration. The configuration of an annuity investment can produce either a guaranteed rate of return or rate of return is not guaranteed.   Although there are…

página 6/13 7.4.1. Exclusion Ratio The beneficiary will receive payments equal when and if the annualized owner (the value of the annuity is applied to a settlement option). Unlike withdrawals,…

página 7/13 Section 7.6: Fixed Annuity If desired fixed rate of exchange, the contract holder can choose fixed annuity. This type of annuity guarantees that the money will accumulate in…

página 8/13 The two characteristics that have the greatest effect on the amount of additional interest that can be credited to an equity indexed annuity are the method of indexing…

página 9/13 Can a variable annuity have written in both groups of employees, as individual? Yes, you can, each covered employee is included in the variable annuity contract issued to…

página 10/13 7.7.1. Accumulation Annuity Units and Units What are the structural components of a variable annuity?   The values in a variable annuity are expressed in terms of units…

página 11/13 What has been the role of the SEC in the development of both variable annuity contracts and contracts for separate accounts? The SEC has been the biggest influence…

página 12/13 Section 7.9: Annuity Investments by Seniors In 2004, the Florida Legislature addressed the special needs of high-end consumers regarding annuity investments. (For purposes of this lesson regarding annuity…

página 13/13 Replacement or Exchange of an Annuity Contract In transactions involving the substitution or exchange of an annuity contract, the agent must provide, in a form, information on the…

página 1/8 LESSON 8: SOCIAL SECURITY SUBJECTS Purpose of Social Security Eligibility: Who is covered by Social Security? How Social Security Benefits are determined? —————————————————————————————————————————— LECCIÓN 8: SEGURO SOCIAL SUBJECT…

página 2/8 PART II: PRINCIPLES OF LIFE INSURANCE LESSON 8: SOCIAL SECURITY SECTION 8.1: Purpose of Social Security   The Social Security Act of 1935 (August 14 – originally known…

página 3/8 FICA taxes are applied to the income of employees up certain limits, called the taxable wage base. A portion of social security benefits tax is assigned to OASDI…

página 4/8 8.2.1. Currently Insured vs. Fully Insured   Credits are the determining factor between being classified as fully insured or currently insured. Once a person becomes fully insured, death…

página 5/8 PIA is the amount equal to the worker’s full retirement benefit at age 66 (or benefits to a worker with a disability). The benefits are usually expressed as…

página 6/8 8.3.1. Social Security Death Benefits   Social Security benefits can be paid in the form of death benefits, retirement benefits and disability benefits.   Lump Sum Death Benefit…

página 7/8  Child’s Benefit Unmarried and under age 18: 50% of the worker’s PIA. Disabled before age 22:  50% profit will continue indefinitely. The maximum retirement benefits apply. The maximum…

página 8/8 A five-month waiting period is required before an individual is entitled to benefits, during which he/she must remain disabled. A second five-month waiting period is not required if…

página 1/9 LESSON 9: LAW AND THE INSURANCE CONTRACT SUBJECT / TEMAS Qualified Versus Nonqualified Plans Employee Retirement Income Security Act (ERISA) Favorable Tax Treatments Defined Contribution Plans Defined Benefits…

página 2/9 PART II: PRINCIPLES OF LIFE INSURANCE LESSON 9: LAW AND THE INSURANCE CONTRACT SECTION 9.1: Qualified Versus Nonqualified Plans   Retirement plans can be categorized as qualified or…

página 3/9 A key factor behind the development of ERISA was also encourage employers to establish health plans for employees that allow them to self-insure. ERISA sets minimum standards for…

página 4/9 SECTION 9.4: Defined Contribution Plans Defined contribution plans against funds deposited literally on behalf of employees. A predetermined amount is contributed and grows over a period of time…

página 5/9  9.6.1. Cash or Deferred Arrangements – 401(k) Plans Employees can take the money as usual in their paycheck or may voluntarily defer a specific amount (the employee decides…

página 6/9 9.7.1. Keogh Plans (HR-10)   The Keogh Plan is a qualified plan that allows owners of unincorporated enterprises to participate in the retirement plan; as an employee. These…

página 7/9 SECTION 9.8: Individual Retirement Plans   The federal government offers incentives for citizens to save for retirement by granting favorable tax treatment in eligible plans. The IRA is…

página 8/9 9.8.2. The Roth Individual Retirement Arrangement (Roth IRA) The Roth IRA is similar to traditional IRA; however, when it comes to taxes, it seems backwards. With traditional IRA,…

página 9/9 The Pension Protection Act of 2006 The Pension Protection Act of 2006 was signed by President George W. Bush on August 17, 2006. The President called the act,…

página 1/9 LESSON 10 : USES OF LIFE INSURANCE SUBJECTS Needs Approach Individual Uses of Life Insurance Business Uses of Life Insurance Employee Benefit Plans ——————————————————————————————————————————   LECCION 10: USOS…

página 2/9 PART II: PRINCIPLES OF LIFE INSURANCE LESSON 10: USES OF LIFE INSURANCE SECTION 10.1: Needs Approach To fully appreciate the purpose and function of insurance, you need to…

página 3/9 10.1.3. Coverdell Education Savings Accounts   Contributions can be saved in a tax base for financing the costs of formal education until the individual reaches age 18. Single…

página 4/9 10.2.4. Blackout Period The suspension period is the time during which Social Security benefits are not payable to the surviving spouse. The period begins when the youngest child…

página 5/9 10.3.1. Options for Divesting   In case that a business owner is no longer able to operate the facility for health reasons, death, or simply decide to sell…

página 6/9 Disability buy-outs are normally entity purchases not cross-purchases. “Economically dead” is a term used to demonstrate the impact of a disabled owner or partner who has a business.…

página 7/9 10.3.3. Key Person Insurance Key person insurance is designed to help protect a business against financial loss that may be caused by the death of a key person…

página 8/9 10.4.1. Salary Continuation Plans   Salary continuation plans are not qualified plans, specifically designed with a large degree of flexibility. A salary continuation plan allows discretion to company…

página 9/9 10.4.3. Deferred Compensation Plans   Employers or employees may institute a deferred compensation plan that allows the employee (usually a key person, such as an owner) to give…

página 1/14 LESSON 11 HEALTH AND ACCIDENT INSURANCE SUBJECT Basic Forms of Health Insurance Coverage How Health Insurance is Purchased? Characteristics of Health Insurance Uses of Health Insurance Group Health…

página 2/14 PART III: PRINCIPLES OF HEALTH INSURANCE  LESSON 11: HEALTH AND ACCIDENT INSURANCE SECTION 11.1: Basic Forms of Health Insurance Coverage   Health costs remain one of the most…

página 3/14 Disability can be defined in one of the three following ways:   Any Occupation: “ACC”; includes the inability to work at any occupation the person is reasonably suited…

página 4/14 11.2.1. Individual Health Insurance Individual health insurance is issued by commercial insurers and service organizations such as contracts between the insured and the company. Although all companies have…

página 5/14 11.3.2. Premium Factors   Health insurance premiums are regularly paid for renewable yearly profits. In other words, health coverage is subject to change from year to year and…

página 6/14 11.3.5. Claims   The health insurance claims process differs from life insurance claims process.   In life insurance (as well as disability and AD&D insurance), the amount of…

página 7/14 11.4.2.  Business Needs for Health Insurance Companies are made up of individuals, and business needs are important. As HMOs are emphasized in preventive health care, health insurance allows…

página 8/14 11.4.4. Key Person Disability Insurance   Key person Insurance is designed to help protect a business against financial loss that may be caused by the death of a…

página 9/14 COBRA Consolidated Omnibus Budget Reconciliation Act of 1985 The Consolidated Omnibus Budget Reconciliation Act of 1985 – COBRA is a federal law guaranteeing an employee the right to…

página 10/14 Group Basic Medical Expense   Basic medical insurance – hospital, surgical and medical expenses – is available for groups. Benefits have been recently extended for most insurers. This…

página 11/14 11.5.5. Group Disability Income Most disability income group plans do not offer coverage to employees hired for at least a period of time (usually 30-90 days). Plans can…

página 12/14 SECTION 11.6: Health Care Reform Act The Affordable Care Act puts consumers back in charge of their health care. Under the Patient’s Bill of Rights, that gives the…

página 13/14 11.6.2. Essential Health Benefits – EHB They constitute a set of categories of health care services that should be covered by certain plans, beginning in 2014. The Affordable…

página 14/14 11.6.4. Employer Mandate Employers with more than 50 employees must provide health insurance or pay a fine of $2,000 per worker each year if any worker receives federal…

página 1/17 LESSON 12: HEALTH INSURANCE PROVIDERS SUBJECT Commercial Insurance Providers Service Providers Health Maintenance Organizations Overview (HMOs) Preferred Provider Organizations (PPOs) Government Health Insurance Programs Medicare Medicaid Workers’ Compensation…

página 2/17 PART II: PRINCIPLES OF HEALTH INSURANCE LESSON 12: HEALTH INSURANCE PROVIDERS SECTION 12.1: Commercial Insurance Providers   Service providers are different from insurance companies. Service providers have subscribers…

página 3/17 12.3.1. HMO Operation HMOs operate almost exclusively through group enrollment plans. An HMO may be owned or sponsored by insurance companies or service companies, but an HMO can…

página 4/17 Prepaid Limited Health Service Organization – PLHSO A PLHSO is any person, corporation, partnership, or other entity, that in exchange for an advance payment, is compromised to provide…

página 5/17 The contract, certificate, or member handbook must be accompanied by an identification card containing at least the following:   The name that the organization offers or the contract…

página 6/17 What requirements does the Florida law contains on maternity coverage if a contract of health insurance or HMO include such coverage?   The Florida statutes require that a…

página 7/17 Requirements related with HIV/AIDS Before the test, the insurer will disclose its intention to test a person for HIV infection or for a specific disease or medical condition…

página 8/17 Exclusive Provider Organization (EPO) Exclusive Provider means a provider of healthcare, or a group of providers of healthcare, which have established a written agreement with the insurer to…

página 9/17 Special Enrollment Period (SEP) for the Working Aged and Working Disabled People who do not enroll in Part B or premium Part A when eligible for the first…

página 10/17 Free Look A policy presented at the Office as supplemental Medicare should:  Contain a definition of “eligible Medicare spending,” which is nothing more than the types of health…

página 11/17 The scheme will be delivered to the applicant submitting the application and with the exception of the direct response policy, it should be given acknowledgment of receipt or…

página 12/17   A Medicare supplement policy or certificate must have the benefits which are designed to meet the cost-sharing amounts under Medicare. They will automatically change to match any…

página 13/17 Post-hospital home health care services (including nursing care, therapy, and the part-time services of home health aides) The first 20 days are covered in full contingent upon the…

página 14/17 12.6.3. Medicare Part C – Medicare Advantage Due to increased eligible participants, programs and Medicare options have been renovated to include Medicare Part C (formerly known as Medicare…

página 15/17 However, if the total drug costs of a beneficiary are more than $6,440, after the beneficiary would have spent another $4,550, then coverage begins again and beneficiaries will…

página 16/17 The project also gives governors more flexibility to design Medicaid benefits, which efficiently and affordably meet the needs of their states and control gaps that allowed people game…

página 17/17 The following is a list of standard coverages: If a worker dies in an accident, the law provides the payment of funeral expenses (up to a limit) and…

página 1/8    LESSON 13 MEDICAL EXPENSE INSURANCE   SUBJECT Purpose of Medical Expense Insurance Basic Medical Expense Plans Major Medical Expense Plans Other Types of Medical Expense Coverage  ——————————————————————————————————————————…

página 2/8 SECTION 13.1: Purpose of Medical Expense Insurance Basic medical expenses insurance (often referred to as first dollar insurance) pays benefits “in advance” without the patient having to pay…

página 3/8 Medical Reimbursement Plan – Medical Indemnity Plan Medical Reimbursement Plan and Medical Indemnity Plan are two different approaches with respect to medical plans. In a medical reimbursement plan,…

página 4/8 Relative Value Scale The relative value scale assigns points to surgical procedures rather than dollar figure. For example, the establishment of a broken finger naturally leads to a…

página 5/8 Major Medical policy provides limits on high profits. It can be used as a separate comprehensive plan or be a supplement to the basic plan. When rising medical…

página 6/8 High Deductible Health Plans (HDHP) A High Deductible Health Plan or HDHP offers low premiums, but requires that the insured pays a relatively high deductible. For a person…

página 7/8 Family deductibles and out-of-pocket expense caps are twice as individual spending. HSA individuals that are 55 years and older can make additional catch -up contributions of $1,000 (2012,…

página 8/8 Discount Medical Plan Organization – DMPO Discount Medical Plan is an arrangement or contract in which a person, for a fee or other consideration, give you access to…

página 1/6   LESSON 14 DISABILITY INCOME INSURANCE   SUBJECT Purpose of Disability Coverage Disability Income Benefits Disability Income Policy Provisions Policy Exclusions  Policy Riders —————————————————————————————————————————– LECCIÓN 14 SEGURO DE…

página 2/6 SECTION 14.1: Purpose of Disability Income Insurance The need for disability income often overlooked. People often associate it with a life insurance, health insurance and even with annuities…

página 3/6 Using the approach of percent-of-income gains (percent-of-earnings approach) policies may vary the amount of benefits to be paid according to the length of disability. For example, the company…

página 4/6 Residual Benefits Amount A residual amount of the benefit is based on the proportion of income actually lost the insured, due to partial disability, taking into account the…

página 5/6 14.3.7. Non-Disabling Injury Provision Some people who have a disability income policy may suffer a disability that is not severe enough to qualify to receive income benefits. This…

página 6/6 14.5.2. Social Security Rider Social Security Annex provides additional income when social security benefits (Social Security, Workers Compensation and Government Programs) are not being received by the insured;…

página 1/3 LESSON 15: ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE-AD&D SUBJECT AD&D Benefits Other Forms of AD&D  ————————————————————————————————————————————-   LECCION 15: SEGURO DE MUERTE, ACCIDENTAL Y DESMEMBRAMIENTO-AD&D  TEMAS Beneficios AD&D Otras…

página 2/3 SECTION 15.1: AD&D Benefits Accidental Death and Dismemberment (AD & D) is usually covered in group insurance plans. These can be written in different ways: Basic Medical Expense…

página 3/3 SECTION 15.2: Other Forms of AD & D Limited risk policies provide accidental death or dismemberment by a particular cause; normally, aviation (which is excluded in most other…

página 1/13 LESSON 16 PRIVATE INSURANCE PLANS FOR SENIORS   SUBJECT Medicare Supplement Policies Long-Term Care (LTC) Insurance ——————————————————————————————————————   LECCION 16 PLANES DE SEGUROS PRIVADOS PARA MAYORES – PARA…

página 2/13 SECTION 16.1: Medicare Supplement Policies The protection of our elderly citizens; the high costs of medical care includes plans to provide long-term care and supplemental insurance plans. NAIC…

página 3/13 16.1.2. Medigap Plans Before June 1, 2010 there were 12 standardized Medigap plans, now there are 10 (Plans A to D, F, G and from K to N).…

página 4/13 DISCLOSURE An insurance policy care qualified long-term (long-term care insurance), must include a statement of disclosure or disclosure within policy and within the statement of coverage, the policy…

página 5/13 POLICY STANDARDS Free Look The insured shall have thirty days after the delivery of an individual policy of long-term care to examine it and return it to the…

página 6/13 Minimum Coverage All policies provide long-term care coverage for at least 24 consecutive months for each person covered for care in a nursing home. All policies provide long-term…

página 7/13 Acute Illness Acute illness is a serious illness that with proper medical treatment, the patient should receive a full recovery (such as influenza) Chronic Illness Chronic illness is…

página 8/13 Adult Day Care Day care centers for adults usually cater to those who are mentally or physically affected, or when other primary care are not accessible. The center…

página 9/13 In general, these associations have four objectives: To stimulate the availability of high quality, safe private long-term care Remove the fear of impoverishment resulting from the need to…

página 10/13 The diagnosis of chronic disease can be done on two levels. Physical Cognitive   A physical diagnosis mean that the individual has been certified as unable to perform…

página 11/13 The provision for renewal of the new policy should be revised in order to ensure that their rights periodically renew the policy.   A direct response insurer issued…

página 12/13 In the case of an applicant who chooses not to appoint an additional person, the resignation must indicate:   Protection against involuntary lapse: I understand that I have…

página 13/13   The insurer may use Form OIR-B2-1786 (1/2007) State Association Disclosure Notice (Partnership Status Disclosure Notice), which was approved and incorporated by reference standard. This notice is provided…

página 1/7 LESSON 17: HEALTH INSURANCE POLICY PROVISIONS SUBJECT NAIC Model Health Insurance Policy Provisions Common Exclusions or Restrictions Renewability Provisions  —————————————————————————————————————–   LECCIÓN 17: PROVISIONES EN PÓLIZA DE SEGURO…

página 2/7 SECTION 17.1: NAIC Model Health Insurance Policy Provisions NAIC (National Association of Insurance Commissioners) developed the Uniform Act Provisions Health Insurance Policies in which 23 provisions described order.…

página 3/7   Payment of Claims: Payment of providing specific claims how and to what claims payments must be made.   Physical Exam and Autopsy: The provision of physical examination…

página 4/7   Conformity with State Statutes: All disputes concerning the statutes of the state where the insured lives, are automatically set at the time the policy is issued.  …

página 5/7 Employee Life The life of a group of individual employees of an employer may be insured by the employer benefits from different persons, under a group policy issued…

página 6/7 Waiver for Impairment Impairment exemptions are used in those areas where a person may have preexisting conditions and still be considered uninsurable. These exemptions exempt specific reasons for…

página 7/7   Guarantee Policy Renewable (Renewable Guaranted Policies) In this type of policy, the insurer has promised that the insured’s policy is renewable, usually up to a certain age…

página 1/6 LESSON 18: HEALTH INSURANCE UNDERWRITING AND PREMIUMS SUBJECT Major Risk Factors in Health Insurance Classification Risk Health Insurance Premium Factors Tax Treatment of Health Insurance Premiums and Benefits…

página 2/6 SECTION 18.1: Major Risk Factors in Health Insurance Key factors evaluated in the underwriting process health insurance are often the same as in all insurance underwriting processes, with…

página 3/6 18.1.4. Occupation Again, anyone involved in a dangerous occupation presents a higher risk. For example, a pilot may present a higher than a person who spends his time…

página 4/6 Interest Just as life insurance, a portion of the premiums are invested to earn interest. This is an important element setting tariffs. Interest income can reduce premium costs.…

página 5/6 SECTION 18.4: Managed Care Managed Care Organizations (MCO) include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO) and Exclusive Provider Organizations (EPO). These contain medical costs and is…

página 6/6 Case Management It is a process that can be deterred by expensive claims. Case managers (CMS) are medical specialists within the insurance company who review cases that can…

página 1/28   FLORIDA SPECIFIC LAWS AND RULES LESSON 19 LAWS AND RULES PERTINENT TO LIFE AND HEALTH INSURANCE SUBJECT Financial Services Regulation Insurers Marketing Practices Code of Ethics Policy…

página 2/28 SECTION 19.1: Financial Services Regulation   19.1.1. Department of Financial Services The Department of Financial Services is headed by the Chief Financial Officer and the Commissioner of Insurance,…

página 3/28 The Office, within existing resources, can spend the funds for professional development of its employees, including, but not limited to, professional fees for employees who are required to…

página 4/28 What role does the Office of Insurance Regulation [OIR]? OIR is responsible for all activities of the Financial Services Commission relating to the regulation of insurance companies and…

página 5/28 19.1.3. Office of Financial Regulation In addition to other powers conferred by Florida Statutes, the Office of Financial Regulations provides: [Sec. 655.012]   General Supervisory Powers; Rulemaking:  …

página 6/28 19.1.4. The State Legislature The State Legislature establishes and maintains the legal framework of state laws on insurance (Insurance Code / The Insurance Code). The legislature established the…

página 7/28 Leeway or “Basket” Provision The Insurance Code contains this provision detailing the terms that allow domestic insurers the right to invest in a certain percentage of its total…

página 8/28 Using the status or licensed as a licensed insurance agent and in any form in connection with placing business with an entity authorized does not include, but are…

página 9/28 A registered agency is not subject to mandatory or discretionary denial, suspension or revocation, however, if any of the directors of the agency registered commits a violation of…

página 10/28 Agents are required to maintain documentation of transactions for three years if the transaction involves the payment of premiums. Florida law requires an agent written report to the…

página 11/28 The insurance agent has the responsibility to provide the public, customers and potential customers the best policies to suit the needs of the individual and the prospect or…

página 12/28 Churning Churning is defined as the practice by which the values of the policy in a life insurance contract or existing annuity is used to buy another policy…

página 13/28 Section 19.4: Code of Ethics The National Association of Life Underwriters (The National Association of Life Underwriters) works for the best interest of policyholders and development opportunities of…

página 14/28 How do you approach the Code of Ethics defamation? Knowingly making, publishing, broadcasting or circulating, directly or indirectly, or assisting, incitement, or encourage manufacturing, publishing, broadcasting or circulating…

página 15/28 For the purposes of this section, the term “individual health insurance” coverage health insurance as described in s. 627.6561 (5) (a) 2., is offered to a person in…

página 16/28 19.5.4. Mental and Nervous Disorders Florida Statutes require all health insurers must provide an optional group in the policy coverage for mental and nervous disorders. This does not…

página 17/28 19.05.13. Bones and Joints of the Jaw and Facial Region Under Florida law, if coverage for diagnostic procedures, including the bones and joints of the skeleton is included;…

página 18/28 Required and optional coverage The word “primary care physician” or “doctor” (“physician” or “medical doctor”) when used in any insurance policy health service plan health care, or other…

página 19/28   This subsection shall not be construed as may affect any other coverage under this part or restrict the scope of coverage of any policy, plan or contract.…

página 20/28 Section 19.7: Group Life Insurance / Group Life Insurance The life insurance group is the same as health insurance or coverage for medical expenses, as to the basics.…

página 21/28 Section 19.9: Retirement Plans Florida law does not regulate retirement plans. ERISA supersedes any state law. ERISA administers standards for funding, participation and vesting, termination of insurance, disclosure,…

página 22/28 Section 19.11: Types of Health Plans an insurance policy of group health issued is required or provided outside the State of Florida to cover a Florida resident to…

página 23/28 19.12.1. Modified Community Rating Community property classification means that all small groups enjoy the same prices for everyone in the same category or class. It must be identical…

página 24/28 Anyone who is a resident of Florida are eligible for coverage under the plan, if the person has been denied coverage for health insurance for at least two…

página 25/28 Guaranteed-Issue Basis: It means an insurance policy to be offered to an employer, employee or dependent of the employee, regardless of their health status, preexisting conditions, or claims…

página 26/28 Disclosure requirements In connection with the offering of a health benefit plan for a small business, a carrier small employer:   You must make a reasonable disclosure and…

página 27/28 Fair Marketing Standards Each carrier employer small (small employer carrier) must actively market the plan coverage health benefits, including standard health benefit basic plans and including any later…

página 28/28 Benefit Plans Offered A carrier Small Employer shall submit to the office, in a format and manner prescribed by the committee, a plan standard health a high deductible…

página 1/9   LESSON 20 AGENT LICENSING. DEFINITIONS SUBJECT Licensing Maintaining a License Unfair Trade Practices Unfair Claims Settlement Practices Definitions  ——————————————————————————————————————————- LECCIÓN 20 AGENTES LICENCIADOS. DEFINICIONES SUBJECT / TEMAS…

página 2/9 Section 20.1: Licensing The Florida statutes provide that no person may be, act as, or advertising or advertise himself as an insurance agent, insurance adjuster or customer representative…

página 3/9 Licensing Requirements The applicant for an insurance license must submit a written application, complete under oath and signed by him, where the required conditions are met and pay…

página 4/9 Cada licenciado, excepto un agente de seguros de título, debe completar un curso de actualización de 5 horas cada 2 años, que es específico para la licencia en…

página 5/9 Acciones Penales y Administrativas / Criminal and Administrative Actions)   Administrativa / Administrative Dentro de 30 días después de la disposición final de una acción administrativa tomada en…

página 6/9 SECCIÓN 20.3: PRACTICAS DESLEALES DE COMERCIO / UNFAIR TRADE PRACTICES   Las sanciones en Florida por violar la Ley de Prácticas Comerciales Desleales son libertad condicional, suspensión o…

página 7/9 20.3.5. DISCRIMINACIÓN INJUSTA / UNFAIR DISCRIMINATION   A las aseguradoras se les prohíbe mostrar ningún tipo de parcialidad hacia las personas en lo que respecta a sus primas…

página 8/9   SECCIÓN 20.5: DEFINICIONES / DEFINITIONS   Transacción de Seguros / Insurance Transaction. Las disposiciones del Código de Seguros definen el término transacciones de seguros como:   solicitud…

página 9/9   Certificado de Autoridad / Certificate of Authority Antes de que cualquier entidad puede operar como una aseguradora en este estado, debe obtener un certificado de autoridad de…

página 1/   PL _ SEGUROS DE SALUD Y VIDA Y ANUALIDADES (INCLUYENDO CONTRATOS VARIABLES)   DOLPHY INSURANCE SCHOOL   Esto no es una muestra del examen oficial de licencia…