a. primary, secondary payor
b. Medicare and Choice
2. Medicaid
3. Social security benefits
4. Badger Care
E. Other insurance concepts
1. Total, partial, and residual disability
2. Owner’s rights
3. Dependent children benefits
4. Primary and contingent beneficiaries
5. Modes of premium payments (monthly, quarterly, annually, semiannual, etc.)
6. Nonduplication and coordination of benefits (e.g., primary vs. excess)
7. Occupational vs. nonoccupational
8. Tax treatment of premiums and proceeds of insurance contracts (e.g., disability income, and medical expense, etc.)
9. Managed care
F. Field underwriting procedures
1. Completing application and obtaining necessary signatures
2. Explaining sources of insurability information (e.g., MIB Report, Fair Credit Reporting Act, etc.)
3. Upon payment of initial premium, giving prospect conditional receipt, and explaining the effect of that receipt (e.g., medical exam, etc.)
4. Submitting application (and initial premium, if collected) to company for underwriting
5. Assuring delivery of policy to client
6. Explaining policy and its provisions, riders, exclusions, and ratings to clients
7. In cases where initial premium did not accompany application, obtaining signed statement of continued good health, and obtaining premium for transmittal
8. Contract law
a. Requirements of a contract
b. Insurable interest
c. Warranties and representations
d. Unique aspects of the health contract
(1) Conditional
(2) Unilateral
(3) Adhesion
V. Wisconsin Health Insurance Law -- 3 Hours
A. General policy provisions
1. Right of return
2. Right of insurer to contest
3. Pre-existing conditions
4. Application responsibilities for accident and health
5. Grace periods
B. Mandated benefits
1. Handicapped children
2. Newborn children
3. Declined risks
4. Alcoholism, drug abuse, and mental and nervous disorders
5. Home health care
6. Skilled nursing care
7. Kidney disease treatment
8. Diabetes
9. Maternity benefits
10. Nurse practitioners
11. Optometrists
12. Chiropractic
13. Adopted children
14. Grandchildren
15. Mammograms
16. Lead screening
17. TMJ coverage
18. Hospital/anesthesia coverage for dental care
19. Breast reconstruction
C. Wisconsin Medicare supplements
D. Requirements of Medicare supplements
E. Special nursing home and long term care regulations for nursing home and long term care policies
F. Special provisions, sale of group or individual health to small employers
G. HIPAA (Health Insurance Portability and Accountability Act)
H. Continuation and conversion privileges
I. Cancer insurance and other dread disease
J. Marketing methods and practices
1. Advertising Company approval of advertising
2. Suitability
3. Outline of coverage
4. Policy replacement
5. Identification of insurer (advertiser)
6. Testimonials, endorsements, or commendations by third parties
7. Disparaging comparisons and statements
K. Health Insurance Risk-Sharing Plan (HIRSP)
