Day 64 ……12/2

1. Day 64……12/2 What is the difference between Homeowners insurance and Renters insurance? BB30 Business Law 4.02 Summer 2013

2. Health Insurance • Traditional Health Insurance (Major Medical Coverage) • 1. What type of coverage does Major Medical Coverage offer? • basic coverage if a catastrophic loss occurs. • 2. What is the main reason for those who elect this type of coverage? • prevent the insured from having financial ruin from a long term illness or injury. • 3. What is a characteristic of major medical coverage? • very high deductibles (as high as $10,000) and low premiums BB30 Business Law 4.02 Summer 2013

3. Annual Deductible • 1. What is an annual deductible? • 2. How does this work? • Major Exclusions for Coverage • Certain causes and conditions listed in the policy that are not covered • 1. For heath care policies, what do major exclusions include? • Maternity coverage, major elective surgeries • 2. Why do health care insurance providers have these exclusions? BB30 Business Law 4.02 Summer 2013

4. Possible lengthy waiting periods • 1. What is a “waiting period” in a health insurance policy? • the time that elapses after the insured’s policy is active, before specific exclusions will be covered. (Ex. Maternity coverage) BB30 Business Law 4.02 Summer 2013

5. Group Insurance Coverage • 1. What is group health insurance coverage? • coverage provided by a group which is normally the insured’s employer or other inclusive group • 2. Why is group health insurance usually better for an employee? • rates tend to be lower BB30 Business Law 4.02 Summer 2013

6. premium insurance policy exclusion deductible insured perils risk loss claim insurer BB30 Business Law 4.02 Summer 2013

7. What is one benefit of being on a Group Health Plan? Day 65……12/3 BB30 Business Law 4.02 Summer 2013

8. Managed Health Care • 1) HMO – Health Maintenance Organization • 1. Do HMO’s allow you to pick your primary care physician? • yes, it is required • 2. How is the majority of your health care provided when you have an HMO as your health insurance? • It is provided through your physician BB30 Business Law 4.02 Summer 2013

9. 2) PPO – Preferred Provider Organization 1. What is a PPO health insurance? a health plan that has contracts with a network of "preferred" providers from which you can choose. more flexible. 2. Do PPO’s require you to pick your primary care physician? No. No referrals needed if staying in network. Requires pre-authorization. May be reimbursed for portion of expense BB30 Business Law 4.02 Summer 2013

10. 3)POS – combination of both – Point of Service 1. What is POS type health care insurance? Must select PCP. May go out of network but will pay most of cost. 2. What are the benefits (if any) of this type of policy? Out of network referrals are covered BB30 Business Law 4.02 Summer 2013

11. Individual Insurance Coverage • Available from most of the same providers. • Higher cost. Low percent o Americans have Individual Healthcare coverage, BB30 Business Law 4.02 Summer 2013

12. Supplemental Health Insurance Coverage • a. Cancer Insurance Coverage • does not replace healthcare. • pays only if you are diagnosed – Lump sum. • b. Dental Insurance Coverage • group or individual. • restrictions; orthodontic work • maximum benefit • c. Long Term Medical Coverage • provides for long-term care outside of hospital BB30 Business Law 4.02 Summer 2013

13. d. Vision Insurance Coverage • optometrist and ophthalmologists BB30 Business Law 4.02 Summer 2013

14. Government Insurance Coverage • Medicare • Part of the federal Social Security program. • Can also pay benefits to qualified disabled individuals under age 65 • Covers most individuals that are age 65 or older. • Covers individuals under age 65 who need long term kidney dialysis treatment or kidney transplants • Medicaid (Federal-State) • Provides health insurance coverage to low income groups. • Coverage varies by each State. BB30 Business Law 4.02 Summer 2013

15. Medigap- Supplement • sold by private companies • can help pay some of the health care costs that Original Medicare doesn't cover; • (copayments, coinsurance, and deductibles) • Disability Insurance Coverage • monthly benefits to a disabled wage earner to reimburse income during a period of total or partial disability. BB30 Business Law 4.02 Summer 2013

16. If your life insurance value goes directly to your spouse (upon your death), what is he/she listed as on your policy? Day 66…….12/4 BB30 Business Law 4.02 Summer 2013

17. Beneficiaries the recipient of the proceeds of the policy when the named insured dies. Contingent Beneficiary entitled to the policy proceeds if the primary beneficiary has predeceased the insured. multiple contingent beneficiaries = equally a beneficiary can apply for the proceeds simply by filling out the insurance company's claim form and submitting it to the company along with a certified copy of the death certificate. BB30 Business Law 4.02 Summer 2013

18. Life Insurance contract where an insurer agrees o pay an agreed-upon sum of money to a party upon a particular person death • Term Insurance • A. Term Life Insurance • provides coverage for a specific period • lower premium than whole, universal life policies for higher coverage • B. Increasing Term Insurance • term insurance premiums increase with term BB30 Business Law 4.02 Summer 2013

19. C. Decreasing Term Insurance face amount of the policy when purchased. as years pass, the death benefit will decline. D. Level Term Insurance fixed annual premium for a fixed number of years. BB30 Business Law 4.02 Summer 2013

20. Permanent Life Insurance Whole Life Insurance provides lifetime protection accrues a cash value premiums remain unchanged during the insured’s lifetime. Universal Life Insurance similar to whole life insurance flexible premiums that can be increased or decreased based on the insured’s needs. BB30 Business Law 4.02 Summer 2013

21. Variable Life Insurance similar to universal life insurance insured can control where the policy cash value is invested with any capital gains tax liability. BB30 Business Law 4.02 Summer 2013

22. Life Insurance Optional Rider Coverage Riders are attachments to existing policies for additional coverage for family members. Dependent Children generally provide level term coverage on the life of your children Spouse Rider provide level term coverage on the life of the insurer’s spouse Guaranteed Insurability policy can be altered without the need to reapply and prove your insurability. BB30 Business Law 4.02 Summer 2013

23. Day 67…….12/5 Which life policy allows you to choose your investment funds? BB30 Business Law 4.02 Summer 2013

24. Accidental Death and Dismemberment In the event of an accidental death, this insurance will pay benefits in addition to any life insurance only up to a set amount. BB30 Business Law 4.02 Summer 2013

25. Cost factors • How Much Insurance Do I Get? • Needs Approach • How much will it take for the insured’s family to live? • Human Life Value • How much is a person worth? – Lost income BB30 Business Law 4.02 Summer 2013

26. Statistical Basis for Life Insurance • Mortality tables • provide probabilities based on deaths per 1,000 living that are expected to die in a given year. (Ex: A 17 year old male has a life expectancy of 58.94 years or age 75.94) • Morbidity tables • show the rate of disease, illness or sickness among groups of people according to age or other factors such as gender or occupation. BB30 Business Law 4.02 Summer 2013

27. Insurance Fraud • 1. What is insurance fraud? • 2. What are some of the most common types of fraud that are reported in North Carolina? • Automobile Repair • 1. What are some of the common methods that automobile fraud occurs? • 2. Whom should customers who believe fraud may have been committed against them for an auto repair, report it to? • Billing of Medical Services • 1. What type billing incidents may be fraud? • 2. Whom should a person who believes fraud may have been committed for services they did not receive, report the incident to? • Automobile Accidents • 1. What types of incidents or suspects accidents may constitute fraud? • 2. What should you do if you suspect you are a victim of this type offraud? BB30 Business Law 4.02 Summer 2013

28. Property Claims Adjusting • 1. What is this type of fraud? • 2. Why has this type of fraud been so common in North Carolina in the past several years? • Adjusting • 1. What is “adjusting” in the insurance property insurance industry? • 2. How does adjusting work, when the adjuster is doing a professional job and not trying to defraud a consumer? • 3. What are some of the most common methods that fraudulent adjusters may utilize to defraud a consumer • 4. Whom would you contact if you believed you were a victim of adjusting fraud. BB30 Business Law 4.02 Summer 2013