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Glossary Flashcards

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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
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2
Q

Activities of Daily Living (ADLs)

A
  • Set of functional tests

- Measure incapacity/disability

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3
Q

Activities of Daily Working (ADWs)

A
  • Alternative set of functional tests
  • Measure incapacity/disability
  • Focus=workplace
  • E.g. Ability to follow instructions
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4
Q

Acute illness

A
  • Illness/condition
  • Non-degenerative
  • Cure is reasonable prospect
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5
Q

Affinity group

A
  • Group of people
  • Something definitive in common
  • E.g. Membership or employee of particular organisation - but not common employment
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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
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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

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8
Q

Aliasing

A
  • Linear dependency among observed covariates
  • i.e. covar = linear combo of others
  • Equivalent: linear dependency among design matrix’s columns
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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.

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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

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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”
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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
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13
Q

ASU Insurance

A

-ST Insurance covering:
+Accident
+Sickness and…
+Unemployment

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14
Q

Bancassurance

A

-Companies
-Offer financial services encompassing both
+banking
and
+insurance operations
-Big objective: cross selling between operations

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15
Q

Benefit limitation

A

-Caps on annual amounts for specific treatments

=To contain claim costs

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16
Q

Brokers/Independent Financial Advisers (IFAs)

A
  • Intermediary
  • Between seller and buyer of particular insurance contract
  • Not tied to either party
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17
Q

Bulk rate/Unit rate

A
  • Premium rate
  • Uniformly per head
  • Per membership type
  • Age + gender independent
  • Large schemes
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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

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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
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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
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21
Q

Categorical variables

A
  • Explanatory variables
  • For modelling
  • Each level distinct + often no natural ordering
  • E.g. Gender
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22
Q

Chronic illnesses

A
  • Illnesses/conditions
  • Degenerative and/or incurable
  • Treatment purpose = Palliative
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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
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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

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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
SP1
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