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
a. Change of occupation
b. Misstatement of age
c. Illegal occupation
3. Other provisions and clauses
a. Insuring clause
b. Free look (10-day, 20-day, etc.)
c. Consideration clause
d. Probationary (waiting) period
e. Elimination (waiting) period
f. Waiver of premium
g. Exclusions
h. Pre-existing conditions
i. Recurrent disability
j. Coinsurance
k. Deductibles
4. Riders
a. Impairment rider
b. Guaranteed insurability rider
c. Multiple indemnity rider (double, triple)
5. Rights of renewability
a. Noncancellable
b. Cancelable
c. Guaranteed renewable
d. Conditionally renewable
e. Optionally renewable
f. Period of time
D. Social insurance
1. Medicare
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.)
