Glossary Flashcards
1
Q
Accelerated critical illness benefit
A
- Benefit
- Sum Assured on first of death or diagnosis of critical illness
- Termination of policy if acceleration fully triggered (most cases)
- if portion accelerated, balance on death
2
Q
Activities of Daily Living (ADLs)
A
- Set of functional tests
- Measure incapacity/disability
3
Q
Activities of Daily Working (ADWs)
A
- Alternative set of functional tests
- Measure incapacity/disability
- Focus=workplace
- E.g. Ability to follow instructions
4
Q
Acute illness
A
- Illness/condition
- Non-degenerative
- Cure is reasonable prospect
5
Q
Affinity group
A
- Group of people
- Something definitive in common
- E.g. Membership or employee of particular organisation - but not common employment
6
Q
Age at entry pricing
A
- Pricing practice
- Premiums not subject to age related increases from standard pricing (provided renewed)
- Entry price allows for increasing probability of claim
- Right retained to allow for medical inflation (or excess medical inflation)
- Annual renewal basis
7
Q
AIDS Exclusion (RSA)
A
- Post-2005, no AIDS exclusions on new business
* 2007, best practice guideline (voluntary) to waive exclusions on post-2007 claims
8
Q
Aliasing
A
- Linear dependency among observed covariates
- i.e. covar = linear combo of others
- Equivalent: linear dependency among design matrix’s columns
9
Q
Anti-selection
A
-Tendency for people who believe their risk to be higher than premium allows for to take out cover
OR
for sick/sub-standard people to renew policies or exercise options
-(benefits>premium)
-E.g.
10
Q
Assessment period
A
-Time when insurer will assess condition before decision on accepting a claim
-Under CI or Disability cover - time testing “permanent” condition
Normally <12months given evidence provided
11
Q
Asset share
A
- Retrospective accumulation
- Past premiums, less expenses, less cost of cover at actual rate of return on assets
- Single or group basis
- Aka “earned asset share”/”retrospective earned asset share”
12
Q
Association for Savings and Investment South Africa (ASISA) (RSA)
A
*Industry body in SA representing \+Asset managers \+CIS Management companies \+Linked investment service providers \+Multi-managers \+Life insurance companies
13
Q
ASU Insurance
A
-ST Insurance covering:
+Accident
+Sickness and…
+Unemployment
14
Q
Bancassurance
A
-Companies
-Offer financial services encompassing both
+banking
and
+insurance operations
-Big objective: cross selling between operations
15
Q
Benefit limitation
A
-Caps on annual amounts for specific treatments
=To contain claim costs
16
Q
Brokers/Independent Financial Advisers (IFAs)
A
- Intermediary
- Between seller and buyer of particular insurance contract
- Not tied to either party
17
Q
Bulk rate/Unit rate
A
- Premium rate
- Uniformly per head
- Per membership type
- Age + gender independent
- Large schemes
18
Q
Burning cost
A
-Estimated cost of claims
-For forthcoming insurance period
-Based on past numbers
-Adjustments:
+Book changes
+Cover changes
+Medical inflation
-Can be used to describe historic cost of claims only
19
Q
Capitation
A
- Pricing practice
- Premium = likely claims on individual basis, adjusted for expenses and profit
- Risk passed onto the provider
(risk: funds < treatment costs) - Premiums paid in advance instead of on claim
- Proportion of insurance premium for separated set of medical benefits paid to provider, based on number of people served
20
Q
Cash plan/Health cash plan
A
- Health product
- Pre-specified cash sum on occurrence of certain medical events
- E.g. Hospitalisation
- Typically benefits low relative to true costs
- More cash in hand than indemnity
- Normally coinsurance + Annual limit
21
Q
Categorical variables
A
- Explanatory variables
- For modelling
- Each level distinct + often no natural ordering
- E.g. Gender
22
Q
Chronic illnesses
A
- Illnesses/conditions
- Degenerative and/or incurable
- Treatment purpose = Palliative
23
Q
Claim escalation rates
A
- Rate at which LTCI claims increase
- During course of payment
- Compound annually (unless stated otherwise)
*(RSA): Two categories 1. CPI 2. Fixed % -May be subject to min or max -Gen linked to index + increase pre- and during payment
24
Q
Claim notification period
A
-Claims Management Requirement for insurer to be notified of claims at early stage
-Purpose:
+To improve claims handling procedures by…
++ensuring valid claims are ready to be paid at the end of the deferred period
++enabling early intervention from a claims management perspective
-Categories:
+Set time after incapacity begins
+Set time before end of deferred period
25
Claims history
- Combination of claims paid (total amounts actually paid) and claims incurred (amounts paid + outstanding reserves = claims commenced in a particular year).
- NB for reporting
26
Claims pre-authorisation
-Claims Management Requirement (/recommendation) for insurer approval on certain treatments/surgeries before costs incurred
-Purpose:
++manage care provision
++reduce post-event claim denials
27
Coinsurance
- PMI policy condition
| - Policyholder required to pay for at least part of medical expenses incurred (gen %)
28
Community rating
- Pricing practice
- Charging all/most policyholders the same premium rate
- Irrespective of rating factors
-Sometimes refers to Pricing practice where tabular rates applied irrespective of claims history
29
Comprehensive cover
-Level of cover
-Full reimbursement of...
++all medical costs incurred in hospitals within appropriate bands
++other stipulated treatments
-High limits sometimes apply (p.a. or per risk section
30
Consumer Price Index (CPI) (RSA)
- Index published by StatsSA
| - Measures changes in prices for a basket of goods and services
31
Continuation option
- Benefit
- Insured can choose to continue cover without further health evidence (when it normally would have ceased)
- Terms = healthy person's at age of exit
- E.g. leaving group scheme or term individual scheme
32
Continued Personal Medical Exclusions (CPME)
- Type of No Worse Terms acceptance
| - New PMI undertakes cover for same medical conditions as existed under previous insurance policy (only)
33
Co-payment
- Charge to policyholder
- For certain healthcare services under terms of the policy
- Typically fixed ZAR amounts
- E.g. for doctor visits, prescriptions, hospital admissions
34
Cost plus
- Type of Reinsurance
- Covers excess of pre-agreed claim fund (insured against extreme experience)
- Purpose: to limit possible downside
- Similar to stop loss agreement
35
Council for Medical Schemes (RSA)
- Regulator of medical schemes
| - Falls under Minister of Health
36
Credibility
- Factor representing proportion of final risk premium derived from past experience (vs book rates)
- Relates to experience rating
- Depends on size of scheme
37
Creditor insurance
-Form of cover
-Protection on loan or mortgage
-Full payment out on...
++Death (sometimes only)
++TPD (Total and Permanent Disability)
++Critical Illness
-Temporary repayments possible under...
++Temporary disability
++Retrenchment
38
Critical illness
-Type of insurance contract
-Provides benefit on diagnosis of "critical illness" (or specified illness)
-Two forms:
++Accelerated
++Stand-alone
-E.g. of decrements:
++Cancer
++Heart attack
++Transplant
++Stroke
++Multiple sclerosis
-Requirement for decrement
++Perceived as serious by public (life/lifestyle threatening)
++Perceived to occur frequently
39
Day case admissions
- Treatment practice
- Straightforward operations in hospital surgical units on the day of admission
- Occupy bed during day, discharged same day (no overnight stay)
40
Deferred period
- Period of incapacity before any benefit is paid
| - Feature in CI and LTCI
41
Definition of incapacity
```
-Includes:
++Cognitive impairment
++Inability to perform one or more ADLs
(context LTCI)
-Structure of LTCI benefit generally attributes higher benefit to higher level of incapacity
```
42
Diagnostic treatment
- Medical treatment
- Purpose: identifying medical problem
- E.g. X-rays, laboratory tests, pathology
43
Direct marketing
- Marketing (advertising/selling) of products where customer is invited to apply for product directly with insurer
- No intermediary or third party sales person
- E.g. Mail, newspapers, periodicals, telephone, email, internet
44
Direct sales force
- Salespeople employed by the insurer
- Only sell their products
- Products sold directly
- May operate on self-employed basis
45
Earned premium
-Proportion of premiums written and received that relates directly to the expired period of cover
46
Elective surgery
-Surgery deemed to be non-emergency
47
Excess/Deductible
- The first fixed amount of a claim, for which the insured is responsible to pay, before the insurer will contribute to the claim's cost
- May apply on an individual claim basis, on a policy year aggregate basis, on a per-life basis, or on a per-policy basis
48
Exclusions
-Perils that are excluded from cover provided by a policy
-Big E.g.
++War, terrorism, acts of violence, civil unrest
++Self-inflicted injury, attempted suicide
++Drugs
++Alcohol
++Hazardous pastimes or sports
++Aerial activity (besides as fare-paying passenger)
++Criminal acts
++Failure to seek or follow medical advice
++Treatment relating to standard pregnancy (PMI)
49
Experience rating
- Pricing practice
- Partial or full credibility given to past claims history in assessing premium payable at renewal
- 100% credible if premium only assessed from history (otherwise partially credible)
50
Explanatory variables
- Inputs into model
- Expected to influence
- Rating factors in pricing context
51
Facultative
- Reinsurance with no obligations on insurer or reinsurer to offer or accept risk
- ="Optional"
- Insurer chooses when and where to take it up, and reinsurer decides whether or not to accept
52
Financial Advisory and Intermediary Services Act (FAIS) (RSA)
-Governs intermediary conduct in SA
53
Financial Services Board (FSB)
- Regulator of long-term and short-term insurers in SA
| - Falls under National Treasury
54
Fixed Price Surgery (per-case fee)
- Payment arrangement between PMI insurer and hospital or chain
- All surgical procedures of particular type charged at particular cost per case rate
- Regardless of individual complexity
- Includes all care (may include complications that follow)
- Aka "case rates"/"procedure pricing
55
Free cover
- Benefit level
- Below which member is not subject to individual underwriting
- Group risk arrangement context
- Function of number of members or aggregate of benefits provided
- "Free cover limits"="Non-selection limits"
56
General Practitioner (GP)
- Doctor who provides primary medical care to the individual
- First port of call for all health concerns
- Often holds all individual health records
57
GP Referral
- Common medical protocol
| - Patient referred for secondary medical care after initial consultation with GP
58
Generalised Linear Model (GLM)
- Model
- Flexible generalization of the ordinary least squares regression
- Allows for linear model to be related to response variable via link function and for variance to be function of predicted value
59
Group business
- Insurance type
- Number of individuals covered under single policy
- Members of the group linked I some way (e.g. credit card, employer)
- Often sponsor facilitates payment and administration
- May be compulsory or voluntary
60
Guaranteed premium rates
-Situation where benefit-premium relationship is set from the outset for the duration of the policy
61
Health Maintenance/Management Organisation (HMO)
- Form of Health Organisation (akin to insurance)
- Combines range of coverages on group basis
- Group of medical professionals offer care for monthly subscription
- Only visits within (and cleared by) the HMO network will be covered
- Primary doctor within HMO deals with all referrals
- Common in USA
62
Immediate needs annuity
-Immediate annuity purchased by impaired life requiring long-term care
-Protection against uncertain survival duration through...
++Regular
++Guaranteed
++Lifetime
…payments made to insured in exchange for upfront premium
63
Income protection insurance
-Insurance product
-Provides cover against incapacity (protection against temporary loss of income)
-Benefit:
++Income (usually monthly)
++Paid during disability
++Up to pre-defined age (e.g. 65) or retirement if earlier
-Subject to benefit limits (based on specified income replacement ratio)
-Formerly known as Permanent Health Insurance (PHI)
64
Increase options
-Two types of increases securable without formal underwriting:
++Increases incorporated into original contract (automatic). Premiums may...
* **be level throughout lifetime of policy
* **increase in line with the benefit
* **increase by some other pattern
++increases are costed as they arise. Premium increase may be...
***fixed monetary sum
***be in line with fixed percentage
***be in line with some form of earnings or prices index
(Opportunity for fixed increase is presented periodically to insured. New policy costed normally based on current age and outstanding term)
-Generally on CI and IP plans
65
Incurred But Not Reported (IBNR)
- Describes claims where event has happened but insurer is not yet notified of the event
- Insurer is required to hold reserves against such events (for results and accounts)
66
Indemnity
- Principle that after a loss, the insured will be restored to same financial position as before the loss
- E.g. PMI (generally)
- Cash limits sometimes applicable = not full indemnity
67
Individual business
- Insurance covering individual under single policy document
| - Can cover immediate family members on joint life basis
68
In-patient
-Person who is admitted to hospital and occupies a bed overnight
69
Insurance intermediaries
- Third parties who are independent of any particular financial services company
- Select and recommend products they consider to be the most appropriate for the customer, using various criteria
- Aka brokers/financial advisors
70
Interaction term
- Parameter used to capture the effect of a combination of factors on a response variable
- Used when the effect of one factor varies depending on the value of another
71
International Classification of Diseases (ICDs)
- Classification of Diseases and surgical operations
- Through coding and wording
- Purpose: maintain international standard
- E.g. ICD-9 and ICD-10
72
Investigative surgery
- Surgery with purpose of advancing the diagnosis (nature and extent of complaint)
- Generally covered under PMI products. May not be under MME products
73
Irreversible
- Describes conditions thsy cannot be cured by medical treatment or surgical procedures at the time of the claim
- Generally used to define CI conditions
(e. g. Blindness, deafness, loss of speech, paralysis of limbs)
74
Keyperson cover
-Insurance product taken out by employer to cover key employees
-Two categories of product designs:
++Compensation for loss of profits
++Cover for employee's salary (to facilitate temporary recruitment of replacement)
-Perils:
++Sickness
++Incapacity
++Death
75
Long-term care insurance
-Provides financial security against tidk of needing care as an elderly person (in home or at nursing home)
-Two types:
++Indemnity (pays for all costs of care for remainder of life)
++Cash lump sum or annuity
-Peril:
++Satisfy disability conditions (generally in terms of ADLs)
76
Loss ratio
-Ratio of claims incurred to the relevant premiums
-Claims have allowance for ultimate settlement amounts
-Sometimes claims include expenses
(called Combined Ratio/Operating Ratio)
77
Low cost options (budget policies)
-Cheaper policies with restricted cover
-Generally PMI
...Types of restrictions:
++Excesses
++Contingency on public service waiting periods
++In-patient cover only
-Sometimes CI
...Types of restrictions:
++Restricted list of diseases covered
-Sometimes IP
...Types of restrictions:
++Limited benefit period
78
Major medical expenses (MME)
UK:
-Variant of PMI cover
-Pays fixed amount from schedule (relating to severity)
-Perils:
++Non-investigative and non-cosmetic surgery
USA:
- Comprehensive PMI type
- Reimbursement of costs of primary, secondary and tertiary care, as defined in the policy
79
Managed care
-Process whereby insurer intervenes in the provision of medical care
-Purpose:
++Optimising quality of treatment
++Controlling costs
-Through:
++Preferred provider utilisation
++Claims preauthorisation
80
Means test
-Examination into the financial state of a person to determine their eligibility for public assistance
81
Medical History Disregarded (MHD)
- Underwriting approach
- Policy written without regard to individual's past medical history (no exclusions for pre-existing medical conditions)
- Common in group PMI
- May be offered to individual transferring out of group
82
Medical inflation
-The annual increase in the average cost of medical treatment per insured life
-Can reflect increases due to...
++Increase in treatment costs
++Increase in average incidence
83
Medical savings account
-Fund contributed to by PMI policyholder
-May be used for:
++Copayments
++Amounts above maximum benefit levels
++Treatments not covered by PMI cover
-Contributions are often tax deductible
84
Microinsurance
- Insurance products that are characterised by low premiums and low coverage limits
- Based on pooling or community approach
- Typically targeted at low wealth segments
- Provides social benefit
- Well developed in India and parts of Africa (but still growing market)
85
Moratorium
- Alternative to formal underwriting at outset
- Instead of initial formal underwriting, insurer will not cover medical conditions that existed during a re-specified period, and verify this basis at the point of claim
- Period is typically 2 to 5 years
- Pre-existing conditions will be covered if no treatment, symptoms or advice have taken place for the specified uninterrupted period
- All other conditions covered immediately
86
National Health Insurance (NHI)
-Universal system offering healthcare to:
++ those who contribute
++ those who cannot afford to do so
-Usually a split between purchaser and provider
…Purchaser may either be single entity (e.g. State) or multiple entities (insurers)
87
National Health Service (NHS) (UK)
- UK's public health service
- Originally formed to provide free medical care to all throughout life
- Funded by general taxation
- Increasingly, payments required at point of claim (such as copayments for prescriptions, dental case, glasses, etc.)
88
No claims discount (NCD)
- System of increasing discount to some reference premium applied for each year that no claims are made
- Subject to limit
- For each claim made, level of discount reduces (can even result in higher premium than reference premium)
- Own-experience proxy (better risk segmentation)
89
No Worse Terms (NWT)
- When insurer offers cover at least as comprehensive as policyholder's current policy (with no additional underwriting conditions)
- The renewal or "switch" is accepted on no worse terms
- Under PMI or group business
90
Non-medical limits
- Maximum long-term policy benefits for which one can propose, without needing an automatic medical examination or PMAR
- Not a guarantee that the proposer will not be asked to attend a medical examination
- Right is always reserve to call for additional medical evidence (if felt necessary in light of any info they already have)
91
Non-proportional reinsurance
- Reinsurance protection that covers amounts above pre-defined limits (rather than splitting proportionally)
- Under PMI: often applied to portfolio of risks as a whole than individual risks
- E.g. Stop loss, Catastrophe excess of loss
92
Open enrolment
-Process where insurer is obliged to accept all proposers for insurance at standard rates
93
Original terms
-Method of reinsurance
-Reinsurer has virtually identical contract to insurance company in respect of reinsured portion of the risk
-Reinsurer receives the same gross premiums for its share as insurance company EXCEPT policy fee is normally retained in full
-Reinsurer is responsible for:
++proportionate share of the sum insured under claim event
++proportionate share of the surrender value under surrender event
94
Out-of-pocket costs
-Amounts of medical treatment not covered by PMI or State healthcare
-Paid by person seeking treatment
-Can be result of:
++Co-payments
++Deductibles
++Benefit limits
++Exclusions
95
Out-patient
- Person who attends hospital for treatment or consultation, but does NOT occupy a bed
- Aka "ambulatory treatment"
96
Permanent
- Describes health condition that's expected to last throughout the insured person's life, irrespective of when cover ends or person retires
- Used in relation to claim for TPD benefit under CI contract
97
Personal accident insurance
- Type of insurance
- Provides specified fixed benefit amounts in event that the insured suffers the loss of a limb, or another specified injury
98
Personal capability assessment (PCA)
- Alternative way of assessing disability
- Largely independent of age and occupation of person being assessed
- Involves assessment to complete everyday tasks of living
- E.g. climbing stairs, bending, lifting, carrying
99
Policy limit
- Maximum amount that can be paid out under a policy
- Sometimes expressed over defined period of time (e.g. annual limit)
- Some indemnity policies limit benefits payable under particular sections of the policy --> partial indemnity
100
Pre-Existing Conditions (PEC) Exclusion
- Exclusion terms where cover not provided in respect of the policy's standard covered conditions where the insured life has already suffered from the condition
- Commonly includes conditions where other previously suffered conditions result in a materially higher risk of that condition occurring
- Used in PMI and CI
101
Preferred Provider Organisation (PPO)
-Medical establishments, outside of which a PMI policy may:
++not provide cover to
++limit the scale of its reimbursement
-Policies with such restrictions will typically have cheaper premium
-Insurer will have special arrangements with the organizations (often financial)
102
Prescribed Minimum Benefits (PMBs) (RSA)
-Minimum package of benefits re-introduced in the Medical Schemes Act of 1998
-Consist of...
++PMB-DTP (270 Diagnoses and Treatment Pairs, introduced in Jan 2000)
++PMB-EMC (Emergency Medical Conditions, introduced in Jan 2003, usually included in PMB-DTP)
++PMB-CDL (diagnosis, treatment and medication according to therapeutic algorithms for 25 defined chronic conditions introduced in Jan 2004)
103
Primary Care
- Advice and treatment provided by a general practitioner
| - Generally a nurse practitioner in public sector
104
Private Medical Attendant's Report (PMAR)
- Report sough by insurer
- To provide further insight into an individual's state of health
- At the proposal or claim stage
105
Private Medical insurance (PMI)
- Insurance product
- In return for premiums, insurer promises to pay certain sums of money, on occurrence of certain medical events
- Generally classified as a short-term insurance
- Events are frequently surgical in nature (esp. in UK)
- Benefits are usually indemnifying
106
Profit sharing
-Practice where insurer rewards a group for better-than-expected-experience through a share in the profit arising
-Group scheme business
-Share may be expressed as:
++Cash refund
++Discount against the future premium
107
Reported But Not Settled (RBNS)
- Claims that the insurer has been notified of, but where the sum insured due has yet to be agreed and paid
- Insurer is required to hold reserves against these claims (results and accounts)
108
Residence (location)
-Clause limiting the location/countries in which a policyholder may be resident to, to make a valid claim
(ensures effective claims management)
-Esp. in group cover, but may be seen in individual
109
Residential facilities
- Long-term care facilities that provide supervision and assistance in ADLs with medical and nursing services when required
- E.g. Assisted living facilities, homes for the elderly
110
Response variable
- Outputs from a model (what a model tries to predict)
- Likely to be affected by the explanatory variables
- E.g. in pricing, response variable = premium
111
Reviewable premium
- Form of premium
- Allows insurer to alter premiums if aspect of the premium basis for the portfolio as a whole (e.g. prospective claims) is different from what was originally expected
- Offered in CI
- Most companies with reviewable rates, undertake reviews every 5 years (though experience monitoring done more regularly)
112
Rider benefits
- Extra benefits that can be added to a basic policy
- Either at commencement of cover, or at defined policy anniversaries
- Benefits underwritten at outset and normally affect premium rates (and possible underwriting requirements)
- Some riders offered at no additional charge (for marketing reasons)
- E.g. in CI: rehabilitation benefits or hospital cash
113
Risk equalisation
-System in some markets whereby profits/losses on specified policies/risks are pooled and reapportioned among participating insurers, so that each shares in the average market experience
114
Risk premium
- Method of reinsurance
- Used when long-term insurer wishes to reinsure only the risk element (mortality/morbidity) of a policy
- Insurer and reinsurer agree on a set of risk premium factors to be applied to the benefit reinsured (e.g. age, gender, smoker status -> depending on legislation)
- Under health contracts, these risk premium rates are often used as the basis of the insurer's office premium rates
115
Secondary care
-Advice and treatment as provided by hospitals, consultants and other specialists, usually after referral by the patient's GP
116
Service Level Agreement (SLA)
-Contract between service provider and procurer of services
-Sets out the services':
++nature
++quality
++scope
++penalties (under service failure)
-E.g. contract between insurer and Third Party Administrator
117
Smoker/Non-smoker rates
-For long term contracts, most companies offer different rates based on smoker status
-Purpose:
++Reflects different morbidity/mortality of smokers vs non-smokers
-Generally doesn't apply to pricing of larger group schemes (more experience-rated)
-Definition of smoker status may vary between insurers
118
Social Health Insurance (SHI)
- System that only provides health cover to those who can afford to contribute
- Those who can afford to contribute are compelled to do so
- Services are provided by private sector
- Public sector provides for those who can't afford to contribute
119
Solvency II (UK)
- Set of regulatory requirements implemented on 1 Jan 2016
- Aim of EU solvency rules:
1. Ensuring that insurance undertakings are financially sound and can withstand adverse events
2. Protecting policyholders and the stability of the financial system as a whole (as a result of 1.)
120
South African Insurance Association (SAIA) (RSA)
-Industry body of short-term insurers
121
Stand-alone critical illness plans
-Policies that only provide cover against critical illnesses
-Do not provide/accelerate any benefit in the event of death
(stand-alone rider adds pure CI benefit to product)
-Policy terminates following payment of CI benefit
-Occasionally, such policies may offer nominal sum in the even of death (if before CI was suffered)
122
Statistics South Africa (StatsSA) (RSA)
- Government agency
- Responsible for compiling and analyzing South Africa's economic, social and demographic statistics
- E.g. CPI, trade figures, labour market data, periodic census of the population, health statistics
123
Stop loss
- Reinsurance contract
- Insurer's claims exposure will be restricted at some multiple of premium
- Arrangement stipulates loss ratio above which reinsurer becomes responsible for all/the majority of further claims
- Similar to cost plus
124
Surplus reinsurance
- Reinsurance arrangement
| - Long-term insurer will cede all sums that exceed its retention on each individual life, to the reinsurer
125
Switch
- Process whereby an existing policyholder (individual or group) changes insurer on renewal
- Possibly without further underwriting, or with reduced underwriting (e.g. declaration of good health)
126
Telemarketing
- Marketing of products via the telephone
- Usually enquiries are generated by direct marketing with customer calling-in
- Aim = complete application procedures over telephone
- Policy will then be dispatched together with a direct debit instruction completion, and a copy of the completed application for signature by applicant (confirming answers given to underwriting questions)
127
Terminal illness
- Medical condition
| - Expected to result in person's death within short period
128
Tertiary care
- Medical care
- Only provided in specialist centres (for specialist investigation and treatment)
- Usually on referral from secondary medical care personnel
- E.g. neurosurgery, burns care
129
Third Part Administrator (TPA)
- Administrator
- Providing claims processing and/or other services
- To self-funded group health programs or PMI insurers
130
Tied agents
- Salespeople
- Act more independently than direct salesforce (more operational freedom + can employ their own salespeople)
- Sell only the products of one insurance company ("tied")
- Aka appointed representatives
131
Total and Permanent Disability
- Disability cover
- Often included within CI product
- Permanency of disability distinguishes it from income protection cover (definition of "permanent" NB)
- "Total" means failure of ability to perform a major or substantial part of the job/function
132
Treating Customers Fairly (TCF) (RSA)
-Best practice guideline from ASISA (2011)
-For engaging with consumers at all stages (product design, marketing, advice, complaints, pre- and post-sale, claims management, etc.)
-6 key outcomes:
++Having the right business culture (governance: responsibility sits with board and senior management)
++Market needs approach (not product push approach)
++Communicating information in a way that is clear, fair, balanced and not misleading
++Giving appropriate advice
++Ensuring products meet the needs of the largest market, contain clear, understandable info and are sold through the appropriate distribution channels
++Ensuring ease of product switching, claiming and making complaints
133
Treatment protocol (RSA)
-Set of guidelines setting out the optimal sequencing of diagnostic testing and treatment for specific conditions
134
Treaty
- Formal agreement between insurer and reinsurer
- Sets out terms of reinsurance arrangement
- Imposes obligation on reinsurer to automatically accept business ceded within the scope of the treaty
- Also usually imposes similar obligation on the insurer to pass business onto reinsurer that falls within the scope and other terms of the treaty
135
Voluntary group
- Describes collection of policyholders for whom membership of a PMI scheme is voluntary
- May include affinity groups or employment groups
136
Waiting period
- Feature adopted by insurer
- Specified period after policy inception during which benefits will not be paid
- May also be applied to any additional benefit taken up after inception (from the amendment date)
- Aka "no-claim period"
137
Waiver of premiums
-Practice whereby premium for CI policy is covered in addition to the main benefit provided by the policy in the event of disability
138
World Health Organisation (WHO)
-Autonomous health organization
-Set up in 1948
-Aim:
++Assisting the population in the attainment of the highest possible level of health
-Actions:
++Proposes...
***Conventions
***Agreements
***Regulations
++Makes recommendations about...
***Nomenclature of diseases
***Causes of death
***Public health practices
++Develops, establishes and promotes:
***International standards (concerning foods and biological/pharmaceutical/similar substances)
139
Written premiums
- Regular premium business:
* *Annualised amount of premiums for all policies commencing or renewing in a given period
- Single premium business:
* *Wholly written
