Introduction
Insurance is a very important part of modern life and business. In this paper I will discuss the basic concepts of insurance, claims-made and occurrence liability policies, factors for selecting an insurance company and policies, and the difference between workers compensation and liability insurance.
What is insurance?
Insurance is a two-way legal agreement between the insurer and the customer. The customer, which may be an individual, business, or other entity, agrees to pay the premiums as required, in exchange for monetary protection from the insurer for any possible substantial loss. Customers usually obtain insurance, not to cover the trivial incidents of life or business, but to cover the potential significant losses which could be a financial hardship for them. The premiums of all customers of the insurance company are pooled together. The insurance applies statistical analysis to determine the chance that a particular event might occur to one of their customers. From this analysis they can determine the premiums which must be collected and the claims which must be paid to keep the insurance company financially profitable. There are many type of insurance including life, property and casualty, car, health, and disability. Each is very specific for what losses then will cover and reimburse (Pareto, n.d.).
“Claims-made” and “Occurrence” Liability
With “claims-made” policies, claims must be submitted within the time of insurance coverage and the event must have occurred after the retroactive date. The retroactive date is usually set at the start date of the new policy to prevent having to cover for past events. If cancelling a claims-made policy or changing over to an occurrence policy, it i...
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...about Workers’ Compensation insurance. Retrieved August 16, 2010 from http://www.cutcomp.com/about.htm
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Nonprofit Risk Management Center. (n.d.). Who’s afraid of claims made? Retrieved August 14, 2010 from http://www.nonprofitrisk.org/library/articles/insurance05002003.shtml
Pareto, C. (n.d.). Intro to insurance. Investopedia. Retrieved August 14, 2010 from http://www.investopedia.com/university/insurance/default.asp
Rotarius, T. & Liberman, A. (2000, September). Professional liability insurance for health care organizations—Several significant considerations. The Health Care Manager 19 (1), 59. Retrieved August 1, 2010 from http://proquest.umi.com/pqdweb?did=59216125&sid=1&Fmt=2&clientId=29440&RQT=309&VName=PQD
Underwriting is the assessment of risk that a potential customer may have, this allows the company to offer the customer a certain amount of coverage. This is something critical for
Allstate insurance is the second largest property and casualty insurance company by premiums in the United States. Allstate insurance handles about 12% of the U.S home and auto insurance market. (Allstate, 2014). Many of Allstate’s customers fall under what one could refer to as a traditional selection of insurance for automobiles. Recently, Allstate has noticed a major shortcoming in lifestyle insurance, which includes coverage for motorcycles, boats, and other recreational vehicles, in comparison to its competitors. The motorcycle insurance sector is a 10.4 billion dollar industry and growing (PRWEB, 2012). The U.S. Department of Transportation website reports some astounding figures, including that 5,370,035 motorcycles were registered three years before the article, 7,138,476 motorcycles registered at the time of the article, and grew to 9,477,243 registered motorcycles at the end of 2012 (NHTSA, 2013). It is obvious as to why Allstate would identify motorcycle insurance as a worthy lifestyle product to devote marketing research dollars into in order to develop new strategies for cornering a share of the market.
A risk classification is how much risk you are in when you buy insurance. For example if you were to buy health insurance, but you have a heart condition your insurance will cost a lot more. The insurance company can determine this in many different ways, for health insurance you will typically take a physical before you get insured. Another situation where risk comes to play in insurance would be car
Cost of medical care continues to increase and reimbursement is declining, therefore it is vital for the organization to consider types of payers that the service will attract. Knowledge of the types of insurance provided and the percentage of patients with Medicare, Medicai...
Insurance is as ancient as Babylon. The first policy dates back to 2100 B.C.; specifically, it is the Code of Hammurabi. A loan from a trader made certain his valuable cargo traveled safe from the harm of thieves or storms (Marples). The term changed drastically through the ages, and insurance is now a mess of premiums, tiers, and co-payments. It may most commonly be known as a negative number on a check stub that ensures health and safety. There exists not one company that covers everything on just one plan, but a step forward may change that.
In order to fully understand the uninsured and underinsured problem that hospital administrators face the cause must be examined. The health outcomes of uninsured individuals are generally worse than those who are insured. Uninsured persons are more likely to experience avoidable hospitalizations, diagnosed at later stages of disease, hospitalized on an emergency or urgent basis, and more seriously ill upon hospitalization (Simpson, 2002) Because the uninsured often lack an ongoing relationship with a health-care provider, they are less likely to receive preventive care and diagnostic tests (Kemper, 2002). Many corporations balance their budget through cost cuts and other moves, but have been slammed with an increasing load of uninsured patients, coupled with reduced payments from government and private insurance programs. In 2000, 564,476 uninsured patients came through Health and Hospitals Corporations health care centers, a 30 percent increase from 1996. In the same period, Congress reduced Medicare reimbursements to hospitals, while Medicaid reimbursements to primary care clinics remained basicall...
The health cover that I use is the Cigna Global Health Insurance plan which the best and created in tailoring our needs fit. The health insurance option is a core cover that is comprehensive and is easy to access for the network of the unrivaled professionals. The cover is a 24-7 service access for the medical treatment and for the medical advice.
...ral Mission Of Health Insurance." Hastings Center Report 22.6 (1992): 12. Academic Search Complete. Web. 31 Mar. 2014.
Medicare Part C is the same as (Medicare Advantage). Medicare Advantage Plans include all the benefits of Parts A and B, which cover hospital and medical costs.
The concept of Health Insurance and managed health care the inventions of the twentieth century that were started as prepaid health care. The early insurance concept was merely a way for people to pay medical bills not a way of protecting individual financial assets as the case is today. Overall the health care industry has endured significant changes since its inception.
After hours of independently researching the field of Actuarial Science, I contacted Mr. Michael Miller. Mr. Miller is the Director of Insurance Pricing at Catlin Inc., a private insurance company in Atlanta, Georgia. With a Masters of Science in Mathematics and classification as a Fellow of Casualty Actuarial Society, Mr. Miller has thrived in the field of Actuarial Science for twenty years. He has even achieved the position of President of the Casualty Actuarial Society of the Southeast.
When an individual buys health insurance, he/she enters into a contract (policy) with the insurance company so that for a monthly premium, the insurance company will provide cover for medical expenses incurred. The level of cover and the health care providers allowed will range between different products. Coverage will include visits to doctors or hospitals, prescriptions, cost of medical examinations or immunisations, as well as other medical expenses. The payment from the insurance company can either be made directly to the policyholder or to the health care provider concerned.
The life cycle of an insurance claim is the process of an health insurance claim. It goes from the time the claim is submitted by the provider to the time it is paid by the insurance carrier. There are four basic steps to the life cycle of an insurance claim. Those four steps are submission, processing, adjudication, and payment or denial. It all begins with the patient initial phone call setting up an appointment. Even if the patients is new or past or is calling because of an referral, the phone call is critical. You must ask the patient questions to get more information regarding the reason to the appointment. For example, did they confirm the date of birth, or verify the necessary insurance information regarding eligibility and benefits.
According to the Health Insurance Association of America, health insurance is defined as "Coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment" [2]. Health insurance processing is one of the few complex processes that take place after visiting the provider. Applying for claims is carried out after pre authorization. Pre authorization is an integral part of utilization management.
"1- The name of the insured, or of some person who effects the insurance on his