APPENDIX 4 - ACCIDENT AND HEALTH INSURANCE COURSE REQUIREMENTS
SECTION A
I. Principles of Insurance -- 1 Hour
A. Definition of risk
B. Risk management
C. Insurable and noninsurable risk
D. Pooling concept--law of large numbers
E. Types of insurance companies
F. Reinsurance
II. General Wisconsin Insurance Laws -- 4 Hours
A. Duties and powers of Insurance Commissioner--statutory and rule-making
B. Knowledge of administrative action process, including hearings and penalties
C. Purpose of licensing, including procedures and who must be licensed
D. Record keeping and changes in agent status, including change of name or address
E. Agent license expiration, revocation, suspension, and limitation
F. General regulations regarding misrepresentation, knowledge of acts of agent, rebating
G. Regulation of specific insurance contract changes regarding cancellation, nonrenewal, notice of proof of loss, and payment of claims
H. Unfair claims methods and practices--timely payment of claims
I. Fair rating practices
J. Home and telephone solicitation requirements
K. Section 628.32, Wis. Stat., written disclosure of fees other than commissions L. Controlled business
M. Proper exchange of business
N. Unfair marketing practices
1. Misrepresentation
2. Unfair inducement
3. Unfair discrimination
4. Extra charges
5. Influencing employers
6. Unfair use of official position
7. Returning indicia of agency
8. Churning
9. Twisting
10. Restraint of competition
11. Unfair restriction of contracting parties choice of insurer
O. Insurance contracts in Wisconsin
III. Ethics -- 3 Hours
A. Fiduciary duties and responsibilities
B. Conflict of interest
C. Ethical marketing practices, including fair and ethical treatment of policyholders
D. Appropriate claims practices
E. Suitability of product to client
F. Social responsibility of insurance agent
G. Agent/company relationships
H. Maintaining appropriate insurance expertise
SECTION B
IV. Accident and Health Insurance--9 Hours
A. Purpose of accident and health insurance
B. Types of policies
1. Medical expense policies
a. Basic hospital, medical, and surgical policies (base or scheduled policies)
b. Major medical policies
c. Comprehensive major medical policies
d. Long Term Care
e. Health Maintenance Organizations (HMO)
f. Preferred Provider Organization (PPO)
g. Multiple Employer Trusts (MET)
h. Multiple Employer Welfare Association (MEWA)
i. Service organizations (Blue Plans)
2. Disability income
a. Individual disability income policy
b. Business overhead expense policy
c. Business disability buyout policy
d. Group disability income policy
3. Accidental death and dismemberment
4. Group insurance
a. Group conversion
b. Differences between individual and group contracts
c. General concepts
d. COBRA
5. Medicare supplement and Medicare select policies
C. Policy provisions, clauses, and riders
1. Mandatory (uniform policy) provisions
a. Entire contract
b. Time limit on certain defenses (incontestable period)
c. Grace period
d. Reinstatement
e. Notice of claim
f. Claim forms
g. Proof of loss
h. Time of payment of claims
i. Payment of claims
j. Physical examination and autopsy
k. Legal actions
l. Change of beneficiary
2. Optional provisions
