风险管理与保险 齐瑞宗课件17_第1页
风险管理与保险 齐瑞宗课件17_第2页
风险管理与保险 齐瑞宗课件17_第3页
风险管理与保险 齐瑞宗课件17_第4页
风险管理与保险 齐瑞宗课件17_第5页
已阅读5页,还剩71页未读 继续免费阅读

付费下载

下载本文档

版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领

文档简介

LossofHealth

Chapter17©2005,Thomson/South-Western©2005SouthwesternChapterObjectivesDescribethesimilaritiesanddifferencesamongcommercialinsurers,traditionalBlueCrossandBlueShieldassociations,andthenewfor-profitBluesorganizationsExplainthemajorcharacteristicsofhealthmaintenanceorganizationsandexplainhowpoint-of-serviceplansandpreferredproviderorganizationsdifferfromthemComputetheamountofthecoveredlossthatwouldbereimbursablefromaninsurerGiventheamountofthelossandapplicabledeductibles,coinsuranceprovisions,andlimitsDistinguishamongformsofbasichealthinsurancepoliciesanddescribesthreeformsofmajormedicalinsurance2ChapterObjectivesListseveralcharacteristicstoconsiderwhenpurchasinglong-termcareanddisabilityincomeinsurancecontractsExplainthenatureandstructureofMedicarebenefitsandtheapproachusedtostandardizeMedigappoliciesExplainthemandatoryandallowableprovisionsinindividualhealthinsurancewithrespecttograceperiods,reinstatement,claimprocedures,occupationalissues,misstatementofagewhenapplyingforcoverage,andtheexistenceofmorethanonepolicycoveringthesamelossDescribehealthcarereformsrecentlyenactedorcurrentlyunderconsiderationintheUnitedStates3IntroductionThehighcostofhealthcare,combinedwithconcernsaboutthelackofavailabilityofhealthinsuranceforsomepersonsHasledtoarapidlychangingenvironmentinwhichhealthcareisdeliveredintheUnitedStates4HealthInsuranceProvidersHealthinsuranceisprovidedbyseveraltypesoforganizationsCommercialinsurersBlueCrossandBlueShieldassociationsHealthmaintenanceorganizations(HMOs)Point-of-service(POS)plansPreferredproviderorganizations(PPOs)WhenpaymentforhealthexpensesisprovidedasanemployeebenefitManyemployerssetupself-insurancearrangementstoeitherreplaceorsupplementcoverageobtainedfromoneormoreofthesetypesofprovidersSomehealthinsuranceisprovidedbytheMedicareandMedicaidsystemsSocialinsurancearrangementssetupthroughthefederalandstategovernments5InsurersandtheBluesUntilrecently,commercialinsurersandBlueCrossandBlueShield(theBlues)associationswerelegallyverydifferentintermsofstructureThoughfromtheperspectiveofanindividualinsuredtheyappearedtobeverysimilarTheBlueswereoriginallydesignedtobenonprofitorganizationsAllowingtheirsubscriberstoprepaysometypesofhealthcareexpensesBlueCrossassociationsfocusedontheprepaymentofhospitalexpensesBlueShieldgroupscoveredphysicians’servicesWhencombined,medicalexpensecoverageofferedbytheBluescanbevirtuallyidenticaltothatavailablefromcommercialinsurers6InsurersandtheBluesBeginninginthemid-1990sthestructuraldifferencesbetweentheBluesandinsurersbeganerodingInanefforttobecomemorecompetitive,Bluesinseveralstatesbeganformingoracquiringfor-profitsubsidiariesAnumberoftheBluesorganizationsconvertedtoafor-profitstatusintheirentiretyTheBlueswereindependentgroupsorganizedbydoctors,hospitals,andothermedicalserviceprovidersinaparticulargeographicregionTheyagreedtomeetcertaincommonstandardsinexchangeforauthorizationtousetheBluesnameManystatesgrantedtheBluespreferentialtaxtreatmentbecauseoftheirnonprofitstatus7InsurersandtheBluesAschangesinthehealthcaredeliverysystemevolvedManyBluesfoundthemselvesinsuringalargepercentageofindividualswhohaddifficultyobtaininghealthinsuranceelsewhereCausedtheBluestoexperiencesubstantialfinanciallossesAdditionally,traditionalnot-for-profitBlueshavemorelimitedaccesstocapitalthanfor-profitstockcompanies8HealthMaintenanceOrganizations(HMOs)Bythebeginningofthe21stcentury,morethan80millionpersonsintheU.S.wereenrolledinHMOsAllaredesignedtoprovidetheirmemberscomprehensivehealthserviceswithinawell-definedgeographicalareaTheHMOispaidasetfeepermonthbyitsmembersAnditprovidesallnecessarymedicalservicesCoverageisusuallybroaderthanthatprovidedbyinsurersBothcostcontrolandpreventionofhealthproblemstendtobeemphasizedBystressingregularhealthcare,earlydiagnosisandtreatment,anddiseasepreventionHMOscanbeeffectiveinhelpingthemembersidentifyandcorrectsmallhealthproblemsbeforetheybecomemajorones9HealthMaintenanceOrganizations(HMOs)PersonsbelongingtoanHMOgenerallymustreceiveallmedicalcarefromphysiciansassociatedwiththatHMOEachpersonchoosesaprimarycarephysicianwithintheHMOThisdoctorisresponsibleforcoordinatingallmedicalcareforthepatientIncludingaccesstomedicalspecialistsPrimarycarephysiciansaresometimesreferredtoasgatekeepersMostmedicalspecialtiesarerepresentedwithintheHMOButifhighlyspecializedtreatmentisrequired,patientscanbereferredtootherdoctorsatnoadditionalcosttothepatientArrangementsalsoexistwithhospitalsintheareafortheprovisionofhospitalserviceswhenneeded10HealthMaintenanceOrganizations(HMOs)GrouppracticeHMOAlargegroupofphysicianssharefacilitiesandsupportpersonnelandworkoutofoneorafewmainlocationsThedoctorsarenotemployeesoftheHMORather,asagrouptheyhaveacontractualagreementwiththeHMOtoprovidethemedicalservicesneededCompensationarrangementsvary,butmostarepaideitheronTheamountofservicesprovided(calledafee-per-servicebasis)orCapitationbasisPaymentofaspecified,periodicamountbasedonnumberofpatientsforwhichaphysicianisresponsibleRegardlessoftheamountofmedicalservicesprovidedtoeachone11HealthMaintenanceOrganizations(HMOs)StaffmodelHMODoctorsareemployeesoftheHMOandarepaidsalariesIndividualpracticeHMOHasnocentralizedlocationPhysiciansworkoutoftheirindividualofficesandusuallyarepaidonafee-per-servicebasisManypeoplepreferindividualpracticeHMOsBecauseofthegreaterchoiceofphysiciansthatisusuallyprovidedandthenumberofdifferentlocationsinwhichmedicaltreatmentcanbesought12Point-of-ServicePlansSometimesreferredtoasanopen-endedHMOCanbeorganizedinallofthesamewaysasanHMOThephilosophiesofcomprehensivecare,prevention,andcostcontrolarepresentinbothtypesofplansTheprimarydifferencebetweenaPOSplanandanHMOIndividualsinPOSplanshavemorefreedomofchoiceinselectingdoctorsandothermedicalcareprovidersPOSmembershavetheoptionofusingeitherthePOSprovidersordoctorsunaffiliatedwithPOSplan13Point-of-ServicePlansBecauseoftheemphasisonpreventionandcostcontrolCarecanusuallybeprovidedinamorecost-effectivemannerifmembersusePOSdoctorsthaniftheygooutsidetheplanforcareToencouragepatientstoselectPOSprovidersPatientsmustpayasignificantlylargershareofthemedicalbillswhentheyusenon-POSdoctorsTheflexibilityofPOSplanshasmadethemquitepopularBetween1997and2001themarketshareofPOSplansgrewfrom17to22percentWhilethemarketshareofHMOsdroppedfrom31to23percent14PreferredProviderOrganizations(PPOs)CurrentlyholdasignificantlylargershareofthehealthcaremarketthaneitherHMOsorPOSplansAbouthalfofpeoplereceivingtheirhealthinsurancethroughtheiremployersaremembersofPPOsMostPPOsofferareductioninthepriceofhealthcareserviceinreturnforcertainconcessionsbythesponsoringorganizationForexample,doctorsinaparticularPPOmightagreetolowertheirfeesby15%forPPOparticipantsInexchangeforthelowerfees,theemployersagreetoProvidethePPOwithaminimumnumberofpatientseachmonthPaytheirpremiumspromptlyEncouragetheiremployeestotakeadvantageofhealtheducationprogramsthataredesignedtolessenhealthproblemsandlowercosts15PreferredProviderOrganizations(PPOs)HealthservicesprovidedthroughPPOarrangementsmaybeextensiveInotherinstances,servicesprovidedbyPPOsareextremelynarrowandmaybefocusedonlyonaparticulartreatmentSuchasvisioncareorprescriptiondrugsAmajordifferencebetweenPPOsandPOSplansPPOsgenerallydonotuseprimarycarephysicianstocoordinateindividuals’medicalcare16MedicaidandMedicareMedicaidGenericnameforthevarietyofstate-administeredprogramsthatprovidemedicalcaretolow-incomepersonsWhocanshowsufficientfinancialneedtoqualifythemforassistanceFinancedbybothfederalandstatetaxrevenuesBenefitsvarysomewhatamongthestatesCareprovidedthroughMedicaidhasbeengrowingatdouble-digitratesforseveralyears17MedicaidandMedicareMedicareDesignedtomeetthegrowingneedforhealthinsuranceforpersonsage65orolderAswellasthoseunderage65whohavebeenreceivingSocialSecuritydisabilitybenefitsforatleasttwoyearsHastwobasicpartsAcompulsoryhospitalplanAvoluntarymedicalplanCalledsupplementalmedicalinsuranceBeginningin2006,athirdpartwillbeaddedOfferingoptionalprescriptiondrugbenefitstoMedicarebeneficiaries18MechanicsofCostSharingManyhealthplanscontaincost-sharingprovisionsthatapplyatthetimeofthelossCanbeeffectivewaytohelpcontroltheuseofmedicalservicesBecauseinsuredsaremoreawareofthecostoftreatment19DeductiblesDeductiblesareusedinhealthinsurancetocombinetheriskmanagementtoolsofriskretentionandtransferThemostcommondeductiblearrangementinhealthinsuranceisthecalendar-yeardeductibleCoveredlossesaregeneratedthroughoutthecalendaryearuntiltheyexceedthestateddeductibleOnlyafterthatpointdoestheinsuredreceiveanyreimbursementfromthepolicyPer-causedeductibleEachnewsicknessoraccidentalinjuryresultsintheassessmentofadeductibleSometimesdeductiblesareappliedonafamilybasisratherthanonanindividualbasisAnothervariationistowaiveindividualdeductiblesaftertwoorthreemembersofthesamefamilyhavehadclaimsexceedingtheirapplicablecalendar-yeardeductibles20CopaysHMOsandPOSplanssometimeschargepatientsasmalldollaramountforsometypesoftreatmentThisamountisadeductibleappliedonaper-servicebasisGenerallyreferredtoasacopay21CoinsuranceThepolicyspecifiesthattheinsurerwillpayapercentage(often80%)ofthecoveredlossaftertheapplicabledeductiblehasbeensatisfiedCoinsuranceisaparticularlyimportantelementofPOSandPPOplansItoftenprovidestheprimaryfinancialincentiveforencouraginginsurerstoseekmedicalcarefromaparticularnetworkofdoctors Forexample,onearrangementistopay90%ofexpensesafterasmalldeductibleIfthepatientreceivescarefromaproviderwithinthenetworkHowever,ifthepatientreceivescarefromadoctorwhoisoutsidethenetworkThereimbursementratemaybeonly60%22CapsIfthepolicyhasbothadeductibleandcoinsurancepremiumThecostsharingwithamajorhealthproblemcanbesubstantialPoliciesofcoinsuranceprovisionsmayincludeanupperlimitontheamountofcostsharingrequiredSometimescoinsurancecapsareimpliedratherthanstatedexplicitlyOut-of-pocketcapAppliesthelimittoamountsthattheinsuredpaysforbothcoinsuranceandapplicabledeductibles23MaximumLimitsAfewhealthinsuranceplanshavenolimitontheamountofbenefitsthatcanbepaidforcoveredexpensesWhereasothershavealifetimemaximumthatappliestothesumofallbenefitspayableundertheplanHowever,lifetimemaximumsmaybeabletoberestoredAllowinganindividualtocollectmorethantheoveralllifetimemaximumstatedinthepolicyAutomaticrestorationofthemaximummayoccurgraduallyovertime24MaximumLimitsAsanalternativetoagradualrestorationprocessSomehealthpoliciesallowinsuredstoprovideevidenceofinsurabilitythatisthenusedtojustifyrestorationoftheentirelifetimemaximumallatonceSuchevidenceusuallyconsistsofamedicalexaminationshowingthattheindividualmeetsthesamehealthstandardsrequiredfornewapplicantsforhealthinsuranceAhealthinsurancepolicymayhavevariousinternalmaximumsthatapplytoparticularhealthproblemsTreatmentforalcoholanddrugabuse,forexample,isofteninsuredformuchlessthanthecoverageprovidedforothertypesofhealthproblemsInternalmaximumsservetoprotecttheinsurerfrompotentiallyexcessiveclaims25HealthExpenseInsuranceFigure17-1showsadiagramofthegroupingsusedtoclassifyhealthinsurancepoliciesNosharpdistinctionamongpoliciesexistsastothetypeofmedicalexpenseforwhichindemnityisprovidedInsuredsshouldfamiliarizethemselveswiththeirspecificcoveragesBecausethereismuchlessstandardizationamonghealthexpensecoveragethanformanyothertypesofinsurance26Figure17-1:HealthInsuranceClassifications27HospitalInsuranceAhospitalinsurancecontractisoneofthebasichealthinsurancepoliciesBasichealthinsurancepolicieshavefewercost-sharingprovisionsthanpoliciesthatarenotconsideredtobebasichealthcontractsHospitalinsurancepoliciesprovideindemnificationofnecessaryhospitalizationexpensessuchasRoomandboardwhenhospitalizedLaboratoryfeesNursingcareUseoftheoperatingroomCertainmedicinesandsuppliesSpecificdollarlimitsforhospitalroomandboardmaybestatedinthecontract28HospitalInsuranceSomecontractslimitcoveragebyspecifyingamaximumtimeperiodforwhichcostswillbereimbursedforanyoneillnessorinjuryCoveredexpensesotherthanroomandboardareoftenreferredtoancillarychargesCertainexclusionsarecontainedinhospitalinsurancepoliciesManypoliciesexcludeconvalescence,custodial,orrestcare;voluntaryhospitalstaysforsometypesofcosmeticsurgeries;private-dutynursing;andphysicalexaminationsunrelatedtothetreatmentofaninjuryorasickness29SurgicalInsuranceCoversphysicians’feesassociatedwithcoveredsurgeriesBothinpatientandoutpatientsurgicalproceduresareusuallycoveredinordertopreventunnecessaryhospitalizationswhenaprocedurecanbeperformedwithoutanovernightstayinahospitalSomesurgicalpoliciespayonlythefeeschargedbythedoctorwhoactuallyperformsthesurgeryWhereasotherpoliciesalsoprovidecoverageforchargesassociatedwithassistantsurgeonsandanesthesiologists30SurgicalInsuranceManysurgicalpolicieswerewrittenonascheduledbasisinthepastSeveralsurgicalprocedureswerelistedinthepolicytogetherwiththespecifiedmaximumspayableforeachoneHowever,itisbetterfortheinsuredifthepolicyiswrittenonannonscheduledbasisCoveredproceduresareinsureduptothefullamountofwhatisreasonableandcustomaryInjudgingwhetheraparticularexpenseexceedswhatisreasonableandcustomaryInsurersanalyzetherangeoffeesprevailingintherelevantgeographicalareaatthetimethesurgeryisperformedIfthefeeismorethanwhatwouldbechargedbymostothersurgeonsthensomeofthechargeswillbedisallowedandwillnotbeeligibleforreimbursement31RegularMedicalExpenseInsuranceUsuallywritteninconjunctionwithotherbasiccoveragesratherthanasastandalonecontractMostpoliciesprimarilycoverphysicians’servicesotherthanforsurgicalproceduresSomepoliciesrequirethattheindividualbehospitalizedWhereasothersdonothavethisrestrictionCoveragemaybewrittentopayreasonableandcustomaryfeesOrtheremaybespecificlimitsassociatedwitheachcoveredserviceTypicalexclusionsusuallyrelatetoroutinephysicalexaminations,dentalcare,andvisioncare32MajorMedicalInsuranceUsuallyhavehigherlimitsandfewerexclusionsthendohospital,surgical,andregularmedicalexpensecontractsSomemajormedicalpoliciesaredesignedtobecoordinatedwithunderlyingbasichealthinsuranceOthersaredesignedtoreplacebasichealthcoverageandinsureallmedicalexpenseswithinonepolicyCalledacomprehensiveformUsuallyhavesubstantialdeductiblesandcoinsuranceprovisionsNearlyalwayswrittenonareasonable-and-customary-feebasis33MajorMedicalInsuranceCoversallofthesametypesofexpensesinsuredbyhospital,surgical,andregularmedicalexpensecontractsAdditionally,aftersatisfactionofapplicablecost-sharingprovisionsMajormedicalpoliciesmaycoverexpensesnotaddressedbybasichealthcontractsSuchasprescriptiondrugs,ambulanceservices,physicaltherapy,crutches,andwheelchairsExcessmajormedicalUsuallypaysonlyafteranothermajormedicalpolicyhasexhausteditslimits34DentalInsuranceAnewerformofhealthexpensecoverageCoverageservicestypicallyincludefillings,crowns,extractions,bridgework,dentures,rootcanaltherapy,Xrays,treatmentofgums,andorthodonticsPreventivecaresuchasoralexaminations,Xrays,andsemiannualcleaningsarenearlyalwayscoveredMostpolicieshaverelativelylowannuallimitsandsomelimitcoveragebyapplyingfeeschedulesforvariousdentalproceduresDeductiblesandcoinsuranceprovisionsnormallyareusedfornonpreventivetypesofcareCostsharingisusuallywaivedforroutineexaminations,cleanings,andXrays35Long-TermCareInsuranceWithincreasedlifeexpectanciesandanagingpopulationThereisanincreaseinriskoflossassociatedwiththeeventualneedofmanypersonsfornursinghomecareorotherassistancewithdailylivingThemarketforlong-termcare(LTC)insuranceisgrowingrapidlyAllstateshaveadoptedlegislationregulatingLTCinsuranceSomestandardizationisachievedforaproductthatisstillevolving36Long-TermCareInsuranceItisimportanttoconsiderthefollowingpointswhencomparingdifferentLTCpoliciesSomepoliciescoveronlythenamedinsuredWhereasotherscovertheinsured’sspouseaswellPoliciesmustspecifytheconditionsthattriggerbenefitpaymentsToqualifyforfavorabletaxtreatmenttheLTCpolicymustmakebenefitsavailablewheninsuredscannotperformtwoormoreofthefollowingactivitiesofdailylivingEating,bathing,toileting,transferring,dressing,andcontinenceMostpoliciesspecifyamaximumdailybenefitandanoverallminimumlimitonthenumberofdaysforwhichthebenefitwillbepaid37Long-TermCareInsuranceWhenselectingapolicy,insuredsusuallymustselectaneliminationperiodAformofadeductibleForexample,apolicywithatwenty-dayeliminationperiodwouldnotpaybenefitsduringthefirsttwentydaysofacoveredstayinanursinghomeorothereligiblefacilityThelongertheeliminationperiod,thelowerwillbethepremiumSomeearlyLTCpoliciesexcludedlossesrelatedtoAlzheimer’sdiseaseOrpaidonlyforskilledandintermediatenursinghomecareandnotcustodialcareManypolicieshaveoptionsthatmakebenefitsavailableforadultdaycare,homehealthcare,andothermiscellaneousformsofassistancethatmightbeneededbypeopleatanadvancedage38MedicareCurrentlyincludesbothacompulsoryhospitalinsuranceplanandavoluntaryandmedicalinsuranceplanThehospitalinsurance,oftenreferredtoasPartA,providescoverageinthefollowingmainareasInpatienthospitalcareSkillednursinghomecareHomehealthservicesHospicecare39MedicareMedicare’ssupplementarymedicalinsurance(PartB)coversdoctorbillsandrelatedexpensesthataremedicallynecessaryPersonscoveredunderPartAareautomaticallycoveredunderPartBUnlesstheyrejectthecoverageAmonthlypremiumisalsochargedforPartBWhichhasitsownsetofdeductiblesandcoinsuranceprovisions40MedicareCurrentlyallPartBbeneficiariespaythesameflatmonthlypremiumHowever,in2007theMedicarereformlawpassedin2003,beneficiarieswithincomesexceedingacertainamountwillpayhigherpremiumsExpensescoveredunderPartBBillsforphysicians’services,physicalandoccupationaltherapy,speechpathology,diagnosticXrayandlaboratorytests,bloodtransfusions,radioactiveisotopetherapy,medicalequipmentandsupplies,ambulanceservices,organreplacements,andartificiallimbsandeyes41MedicareIngeneral,neitherPartAnorPartBwillpayforthefollowingServicesthatarenotmedicallynecessaryPaymentscoveredbyworkers’compensationbenefitsServicesperformedbyarelativeServicesrenderedoutsidetheUnitedStatesRoutinephysicals,eyeexams,hearingaids,dentalcare,footcare,andcosmeticsurgeryPrescriptiondrugstakenathomeMostimmunizationsPrivatenurses42MedicareOneofthelargestgapsleftbyMedicareisthelackofcoverageforprescriptiondrugsBeginningin2006optionalprescriptiondrugcoveragewillbeavailableThemonthlypremiumwillinitiallybeabout$35Witha$250deductibleAfterthat,thebeneficiarywillpay25%ofthecostfordrugcostsupto$2,25043MedicareBecauseoftheexistenceofdeductibles,coinsurance,andcoveragelimitationsintheMedicareprogramManypersonspurchasedprivateinsuranceto“fillinthegaps”SometimesreferredtoasMedigapinsuranceThesepoliciesarethesubjectofpastcontroversiesallegingdeceptivesalespracticesandcoveragesStandardizationofMedigappoliciesisachievedthroughasystemdevisedbytheNAIC44OtherHealthExpenseInsuranceManyotherspecializedformsofhealthinsuranceareavailableincludingPrescriptiondrugcoveragethatisseparatefrombothmajormedicalandbasichealthinsurancecoveragesVisioncareinsuranceCoversthecostandeyeglasses,contactlenses,andperiodicroutineeyeexamsDreaddiseasecoverageDesignedtopayexpensesassociatedonlywithparticulardiseasessuchascancerAccidentinsurance45DisabilityIncomeInsuranceProvidesperiodicincomepaymentstotheinsuredwhileheorsheisunabletoworkasaresultofsicknessorinjuryBenefitdurationBenefitsterminateattheearlierofAssoonasthedisabilityendsWhenbenefitshavebeenpaidforthemaximumbenefitdurationperiodShort-termdisability(STD)insuranceusuallypaysbenefitsforuptosixmonthsLonger-termdisability(LTD)insurancearrangementspayforalongerperiodoftime,suchas5or10years46DefinitionofDisabilityContractswithverystrictdefinitionstendtobelessexpensiveandlessusefultoinsuredsForexample,ifaninsuredisnotconsidereddisabledunlessconfinedtohisorherhomeexceptfortripstoseeadoctorFewpeoplewouldqualifyforbenefitseventhoughtheirhealthconditionsmaypreventthemfromearningalivingMostpolicieslinktheirdefinitionstoone’sabilitytoworkSomepoliciesrequiretheinsuredtobeunabletoengageinanytypeofpaidworkinordertocollectbenefitsOthertypesprovidetheinsuredisdisablediftheyareunabletoperformthemajordutiesofanyoccupationforwhichheorsheisreasonablysuitedthrougheducation,training,orexperience47DefinitionofDisabilityThemostliberaldefinitionistheownoccupationdefinitionTheinsuredisconsidereddisabledifunabletoperformthemajordutiesofhisorherownoccupationResultsinthehighestpremiumsMostLTDpoliciesthatusethisdefinitiondosoforaninitialperiodtimeAfterwhichthedefinitionchangestothelessliberal“anyoccupationforwhichreasonablysuited”48DefinitionofDisabilityManyLTDpoliciesalsoprovidesomecoverageforpartialdisabilityButthismayberestrictedonlytothoseperiodsthatfollowaperiodoftotaldisabilityThedefinitionofpartialdisabilityoftenissimilartothedefinitionoftotaldisabilityAsanalternative,partialdisabilitymaybedefinedsolelyintermsofaperson’searningsContractsthatusethistypeofincome-relateddefinitionusuallyspecifythataninsuredisconsideredtohavesomeresidualdisabilitythatqualifieshimorherforpartialdisabilitypaymentsAslongasearningsarelessthansomepercentageoftheformerlevel49EliminationPeriodBothSTDandLTDpoliciesuseeliminationperiodsWhenadisabilityoccurs,nobenefitsarepayableduringtheeliminationperiodThus,theyarereallydeductiblesthatreducepremiumsbyeliminatingcoverageforsmalllossesThelongertheeliminationperiodthelowerthepremiumThepremiumsavingstendstodecreaseatadiminishingrateastheeliminationperiodbecomeslongerSometimesSTDpolicieshavedifferenteliminationperiodsthatdependonthecauseofthedisabilityDisabilitiesduetosicknessaresubjecttolongereliminationperiodsthanthoseresultingfromanaccident50BenefitLevelDisabilityinsurancepoliciesaredesignedtoreplaceonlyapercentageofearningsSothattheinsuredhasafinancialincentivetorecoverandreturntoworkBenefitlevelsof50to75percentarecommonSubjecttooverallmaximumlimitsSomepoliciesprovideforcost-of-livingadjustmentsinbenefits51BenefitLevelInsuredsshouldbeawarethatiftheyarecompletelyunabletoengageinanytypeofgainfulemploymentduetoaccidentorillnessSocialSecuritymayprovidesomedisabilityincomebenefitsforcoveredpersonsafterafive-montheliminationperiodHowever,ifthedefinitionofdisabilityintheinsurancepolicyismoreliberalthantheSocialSecuritydefinitionThenaninsuredmaybeeligibleforinsurancebenefitsbutnotforSocialSecuritypaymentsInsurersofferSocialSecurityincomeoptionsthatcanbeaddedtobasicdisabilityincomepoliciesThebasicmonthlypaymentisincreasedbyastatedamountiftheinsuredisreceivinginsurancebenefitsthatdoesnotqualifyfordisabilitypaymentsunderSocialSecurity52ContinuationProvisionsUsedtodescribethecontractualrightsregardingtherenewalofahealthinsurancepolicyPolicieswithmoreguaranteesforrenewalwillhavehigherpremiumsTheimportanceoftheseprovisionshasdiminishedwiththepassagein1996oftheHealthInsurancePortabilityandAccountabilityActRequiresinsurerstocontinuetorenewtheirhealthexpenseinsurancepoliciesregardlessofthehealthoftheinsuredsDoesnotaffectthecontinuationrightsofothertypesofhealthpolicies53ContinuationProvisionsAtermcontractexpiresattheendofaspecifiedperiodoftimeandcannotberenewed

温馨提示

  • 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
  • 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
  • 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
  • 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
  • 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
  • 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
  • 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。

最新文档

评论

0/150

提交评论