LOMA301
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LOMA 301
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Chapter 1 Overview of
Insurance Administration
Insurance Administration
Insurers' Ethical Duties to Customers
Equity in Risk Acceptance
Prompt and Equitable Claim Handling
Honest, Objective and Fair Customer Service
Privacy and Confidentiality of Customer Information
Adequate Financial Resources
Insurance Administration Functions
Underwriting
Claim Administration
Reinsurance
Customer Service
Other Insurance Funcions
Marketing
actuarial
accounting and treasury Operations
Legal and Compliance
Human Reousrce
Information Technology
admnistartiion Systems
Technology Components
Technology Platform
Application Sofaware
Databases
Communications technology
Electronic Mail
Electronic Data interchange(EDI)
Electronic commece
Technologies that Enhance Insurance
Administration Processes
Administration Processes
Business process managemnet BPM
Straight through processing STP
Database Management System and Data Mining
Predictive Modeling
Business Rule Engines
Document Management Systems
Automated Workflow Systems
System Integration
Security
Quality Control
Chapter 2 New Business Processing
and underwriting principles
and underwriting principles
New Business Process
Process
Field Underwriting
underwriting philosophy
Teleunderwriting
Data Entry and Review
Underwriting
Policy Issue
Underwriting Quality Control
Underwriting Principles
Risk Assessment
Risk Classification
Underwriting Philosophy and Underwriting Guidelines
Equitable to the insureds
Equitable to the insurer
Deliverable by the producer
Underwriting Organization
Job Positions
Authority Levels
Autohority to Approve Specified Coverage Limits
Authority to Rate or decline cases
Organization Systems
Case Assignment System
Type of Application or Policy Change
Geographic Origin
Producer Submitting Application
Work Division System
Independent underwriting
Team underwriting
Jet unit underwriting
Jet issue electronic system
realtime underwriting
Committee underwriting
Chapter 3 Legal Aspects of Underwriting
Premium Receipts
temporary insurance agreement(TIA)
Types
Binding premium receipt
Conditional premium receipt
approval premium receipt
only after application is approved as standard or better than average risk
insurability premium recipts
insured was insurable at least as a standard risk on a certain date specified
Insurable Interest
wagering aggrement illegal
Regulatory Compliance Issue Affecting
Individual Insurance Underwriting
Individual Insurance Underwriting
Privacy Protection
U.S. Federal Fair Credit Reporting Act
consumer report
investigative consumer report
adverse action
U.S. Federal Gramm-Leach-Bliley Act
nonpublic personal information
U.S State Laws and Regulations
Personal information & Privileged information
Pretext interview Prohibited
Canadian Federal and Provincial Laws
Nondiscrimination
Medical Testing
HIV Testing
Genetic Testing
Replacements
twisting
churning
Money Laundering and Financing Terrorists
Regulatory Compliance Issues Affecting
Group Insurance Underwriting
Group Insurance Underwriting
U.S. State Regulatory Requirements
U.S. Federal Regulatory Requirements
Employee Retirement Income Security Act
Federal Employment Laws
Canadian Regulatory Requirements
Canada Pension Plan CPP
Quebec Pension Plan
Underwriting Standards
Reviewing Applications for Proper Completion
material misrepresentation
rescission
contestable period
Processing Applications Promptly
Documenting underwriting
underwriting worksheet
Chapter Underwriting Individual Life
Insurance: Assessing Mortality Risk
Medical Risk Factors
Sources of Medical Information
Application for insurance
evidence of insurability
nonmedical basis
nonmedical supplement
nonmedical limit
paramedical report
answers to medical history questions
medical report
MIB Group, Inc.
MIB information cannot be used as the basis for establishing a proposed insured's eligibility
Physicians
attending physician
attending physician's statement(APS)
examining physician
specialized medical questionnaire
Medical Tests
Electrocardiogram, Urinalysis, Blood chemistry profile, Oral specimen test
Personal History Interviews
Inspection Reports
Pharmaceutical Database
Assessing Medical Factors
Impairments
Age
Sex
Build
Personal Risk Factors
Sources of personal Information
The Application for Insurance
Producer
Motor Vehicle Record
Inspection Report
Personal Questionnaires
Assessing Personal Factors
Occupation
accident hazard
health hazard
Driving History
Avocations
Tobacco Use
Alcohol Use
Drug Abuse
Subject of Physical Abuse
Criminal History
Civilian and Military Aviation
Military Status
International Residence and Travel
Foreign Citizenship
Chapter 5 Underwriting Individual Life Insurance:
Financial Underwriting and Risk Classification
Financial Underwriting
assess the proposed insured's financial condition to determine whether
the proposed insured need s the coverage
a reasonable relationship exists between the need for the coverage and the amount of coverage
the premiums are affordable
Risks Deterred by Financial Underwriting
Lapse
persistency rate
Antiselection
Speculation
life settlement
Money Laundering
Sources of Financial Information
application for insurance
financial status
current income
net worth
producer
inspection report
Tax Documents
Financial Questionnaire
Financial Statements
owner's equity
determine the dollar amount of the owners' shares in a business
balance sheet
income statement
Statement of cash flows
Assessing Life Insurance Needs and Financial Factors
Financial need
Family income protection
Estate Settlement
Charitable contributions
Financial Status
Current Income
Earned income
Unearned income
Potential income
Net workth
Bankruptcy
Insurance in Force
Overinsurance
Tools to Determine the Appropriate amount of Insurance
Factor tables
amount
For example: multiple of current gross earned income by age
Percentage-of-income rule
premium
Risk Classification
Numerical Rating System
Debits
Credits
underwriting manual
Charging for substandard Risks
Table Rating Method
extra-percentage table
Flat Extra Premium Method
temporary flat extra premium
permanent flat extra premium
Combining Method
Chapter 6 Niche Policies, Business Life Insurance
Replacements, and Supplemental Benefits
Underwriting Niche Policies
Multi-Life Policies
Joint Life insurance policy
Last survivor life insurance policy
Juvenile Insurance Policies
waiver of premium for payor benefit
Direct Response Policies
guaranteed-issue basis
Underwriting Business Life Insurance
Needs
Business continuation needs
buy-sell agreement
Key-person life insurance
employee benefits needs
employee benefit plan
split-dollar life insurance plan
creditor protection need
creditor insurance
Financial Assessment of a Business
business financial supplement
Business Valuation
Asset-based approach
income-based approach
Market approach
Solvency, Liquidity, and Profitabiltiy
Financial ratio analysis
Solvency
debt-to-equity ratio
total debt / Owners' equity
liquidity
current ratio
current assets / current liabilities
quick ratio
liquid assets / current liabilities
profitability
return-on-equity ratio
net income / Owner's equity
Underwriting Consideration for Various
Types of business Life Insurance
Buy-Sell Agreements
sole proprietorship
amount of insurance based on the value of the business
partnership
cross-purchase agreement
each partner agrees to purchase a share
entity agreement
partnership agrees to purchase share
Key-person Life Insurance
split-dollar life insurance plans
Creditor Insurance
Underwriting Policy Replacements
internal replacement
external replacement
Section 1035 exchange
tax-free replacement
Underwriting Supplemental Benefits
Waiver of Premium for Disability Benefit
Accidental Death Benefit
Family Benefit
Guaranteed Insurability Benefit
purchase additional insurance of the same type
Accelerated Death Benefits
Terminal Illness Benefit
life expectancy of 12 months or less
Dread disease benefit
critical illness
long-term care insurance benefit
Chapter 7 Underwriting Group Life Insurance
Group Underwriting Process
Process
Request for Proposal
Proposal for Insurance
Master Application
Master Group Insurance Contract
Information Sources for Group Underwriting
Request for Proposal
open claimants
insured receiving short- or long-term disability income benefit
census
Producer's Letter
ERISA Documents
self-insured group plan
fully insured group plan
Master Application
probationary period
plan administrator
enrollment card
Plan
Contributory plan
noncontributory plan
Risk Factors for Group Underwriting
The Group Prospect
Reason for Existence
Type of Group
single-employer group
multiple-employer group
association groups
professional association group
affinity group
debtor-creditor group
Size
Nature of Business
Geographic Location
Age Distribution
Turnover of Group Membership
Participation in the Plan
Classes
Expected Persistency
Prior Coverage and Claims Experience
The Proposed Coverage
Plan of Insurance
eligibility period
the probationary period is followed by this period
actively at work provision
Plan Administration
Insurer-administered plan
elf-administered plan
third-party administrator(TPA)
Rating Methods for group cases
Manual Rating
Experience Rating
expected claim experience
experience refund
Blended Rating
Combine Manual and Experience Rating
Credibility factor
to the group's experience
Rating Approaches for Small Groups
Manual rating
Pooling
combine small groups into one big group
Step rates
Post-Issue Underwriting for Group Insurance
Underwriting of late Enrollees
late enrollees
Renewal Underwriting
Chapter 8 Overview of Claim Administration
Claim Philosophy and Claim Practices
Claim Evaluation Process
Claim Staffing and Organization
Staffing
Authority Levels
Organizational Systems
Relationships with other insurer Functions
Legal Issues Affecting Claim Administration
Pay
compensatory damages
deny a claim improperly
punitive damages
behavior that si so egregious
Unfair Claims Settlement Practices
actions that are considered unfair
Privacy
Financing Terrorists
Fraud
Insurance Fraud
Insurance Fraud Prevention Model Act
Defamation
damage the reputation
Invasion of privacy
Claim Fraud
Special investigative unit(SIU)
Quality Control
market conduct examinations
Technology
auto-adjudication
Chapter 9 administering Life
Insurance Claims
Insurance Claims
Evaluating Life Insurance Claims
Claim Form
Proof of death
Verifying the Coverage Was in Force
Verifying that the Deceased is Covered
Verifying the Death Occurred
death certificate
Death outside north America
Disappearance of the Insured
presumptive death certificate
Reappearance of the Insured
Determining Whether the Policy is Contestable
Determining whether the death is covered
Aviation,avocation, and Suicide Exclusions
Change in Health statement
Calculating the amount of the Policy Proceeds
and How they are payable
and How they are payable
Basic Death Benefit
Additions to the Basic Death Benefit
Deductions from the basic Death Benefit
Settlement Option Administration
interest option
fixed-period option
fixed-amount option
life income option
Determining who is Entitled to
Receive the policy proceeds
Receive the policy proceeds
No Named Beneficiary
Policy owner or the policy owner's estate
Death of the beneficiary
Contingent beneficiary
Disqualification of the Beneficiary
Disappearance of the Beneficiary
public curator
Change in Beneficiary
revocable Beneficiary
irrevocable beneficiary
preferred beneficiaries
Assigned Policy
assignment
absolute assignment
collateral assignment
Adverse Claimants
interpleader
Community Property Laws
Exculpatory statutues
allow insurer to pay proceeds according to the terms of a policy without fear of double liability
Divorce
Simultaneous Deaths
the insured survived the beneficiary
survivorship clause
Handling Supplemental Benefits
Waiver of Premium for Disability Benefit
Accidental Death Benefit
Family Benefit
Accelerated Death Benefit
Chapter 10 Reinsurance Overview
Roles of Insurance Companies in Reinsurance Arrangements
direct writer
reinsurer
retrocessionaire
Insolvency
Indemnity Reinsurance
Types
Assumption Reinsurance
entirely transfer blocks of
assumption certificates
to policy owner
Indemnity Reinsurance
Traditional indemnity reinsurance
Basic Financial Aspects of Indemnity Reinsurance
Reinsurance premium
Policy Reserves
allowance
Acquisition expense
Maintenance expense
Gross reinsurance premium - Allowance = net reinsurance premium
premium taxes
Purposes of Indemnity Reinsurance
for the Direct Writer
for the Direct Writer
Manage Capacity
amount of risk it can afford to pay on a single risk
the total amount of risk it can accept, underwriting capacity
the amount of risk a direct writer transfer to resinsure
retention limit
financial capacity
Ease surplus strain
surplus strain
surplus relief
Reduce Fluctuations in claim payment
Obtain product, underwriting, claim
and reinsurance information and expertise
and reinsurance information and expertise
Cession Arrangement in Reinsurance
Automatic Reinsurance
retention limit
automatic binding limit
minimum cession
jumbo limit
Facultative Reinsurance
both choose
Facultative-Obligatory Reinsurance
only direct writer choose
Risk-Sharing Arrangement
Nonproportional Reinsurance and Proportional Reinsurance
Nonproportional
Catastrophe coverage
a single catastrophic event resulting in multiple claims
a total amount of claims within a period that exceeds a stated amount
Cession Amounts in Proportional Reinsurance
Excess-of-retention arrangements
Net Amount at risk - Retention Limit = Excess of Retention
Quota Share Arrangement
excess quota share arrangement
retention limit is minused
first-dollar quota share arrangement
Plan of Reinsurance
Coinsurance
Coinsurance allowance
Share monetary responsibility
Funds withheld coinsurance
limit cash flow
Modified Coinsurance
direct writer hold all and give reinsurer share of interest earning
Yearly Renewable Term Reinsurance
death benefit - cash value = net amount at risk(NAR) = reinsurance liability amount
Reinsurance Agreement
defining the reinsurance coverage
scope of the agreement
parties to the agreement provision
entire agreement provision
duration of agreement provision
recapture provision
termination of the agreement
Reinsurance coverage
cession arrangement
method for determine the amount of risk the direct writer cede
reinsurance plan
reinsurance administration procedure
procedure for beginning reinsurance coverage
reporting requirement
Record Inspection
Changes to reinsurance coverage
continuation provision
conversion provision
reinstatement provision
termination of reinsurance
reduction of reinsurance
Claim
Contest
Court action
Rescission
good faith
Potential problem between a direct
writer and a reinsurer
writer and a reinsurer
Errors and omission
Error and Omission provision
Arbitration
Arbitration provision
Insolvency
Insolvency provision
Reinsurance Rate and payment
financial provision
Chapter 11 Reinsurance Administration
Reinsurance Staffing and System
Reinsurance Analyst
other staff involved in reinsurance activities
reinsurance marketing officer
reinsurance information system
Administering new business
preplacement of Reinsurance
review a direct writer's request for coverage
establish appropriate record and reserve capacity for the case
Comparing the request for coverage to the reinsurance agreement
Verifying the reinsurer's retention and financial capacity
Assessing the risk
Arranging retrocession as needed
Placing the reservation of capacity
date of expiry
follow up on reservation for capacity
drop notice
extension request
placement of Reinsurance
reinsurance certificate
administering in-force business
IN-Force Policy report
Policy Exhibit
summary changes
Policy Change report
Billing Statement
Reserve Listing
Processing Changes in Reinsurance Coverage
Processing Billing Statement
Administering Terminate of Reinsurance
Administering Claims under reinsured policies
Establishing the Claim File
Verifying Claim-Related Information
retrocession claim file
right of recommendation
Reviewing the Proof of Loss
determining whether the claim is fraudulent or contestable
contestable claim
Determining the reinsurer's Claim Liability
refer to the most recent billing statement for the current NAR
Approving the Claim Liability
Settling the Claim Liability
Netting off
Notifying Retrocessionaires of a Claim Liability
Auditing Reinsurance Operation
Internal Audits
External Audits by the reinsurer
access to record provision
Preparing for an external audit
Gathering Information and Reviewing Record
Evaluating and Documenting the Audit Finding
analysis of problem
internal trip report
audit report
following up after the external audit
Chapter 12 Effective Customer Service
Qualities of Effective Customer Service
prompt
courteous
complete
convenient
accurate
confidential
Benefit of Providing Effective Customer Service
Customer Service Organization
Staffing
traditional team
semi-autonomous team
self-directed team
levels of authority
Organization
Organization by Product
Organization by Territory
customer contact center
Organization by distribution system
Organization by customer
Organization by method of communication
Telephone
Paper correspondence
Email
Web site
Organization by Service Request
Legal Issues Affecting Customer Service
Delivering Effective Customer Service
Service for policyowner, Insureds, Beneficiaries and Producers
Service for Group Policyholder and Group insured
Service for Producers
determining Strategies for Effective Customer Service
Automating and simplifying Customer Service Delivery
Computer Network
Knowledge Management System
Databases
Document management systems and automated workflow systems
self-service Options
interactive voice response system
Ensuring Excellent Telephone Communication
Documenting Customer Service Guidelines and Procedures
Customer Service and Conservation
customer loyalty
conservation through communication with policyowners
conservation of Orphan Policyonwer
conservation through superior claim service
conservation through customer feedback
conservation through procuders
persistency bonus
Chapter 13 Customer Service Practices
Customer Service Quality Control
Quantitative Performance Measurement
Service level/accessibility to the customer
service level
Number of blocked calls
Average speed of answer
Abandonment rate
Misdirected calls
Timeliness
turnaround time
first contact resolution
quality
quality rate
error rate
productivity
processes completed
Qualitative Performance Measurement
Customer satisfaction survey
Observation and monitoring
Mystery Shoppers
Complaint Monitoring
Customer Service Transaction
Routine Customer Service Transaction
Providing Information and Answering Questions
Changing names and addresses
Administering Policy Changes
Increasing the Amount of Coverage
Decreasing the Amount of Coverage
Change in Type of Insurance
Adding or Deleting Riders
Handling Premium Payments
policy grace notice
Handling returned Mail
Handling Complaint
escalation processes
Complaint teams
Fulfilling Other Customer Need
More Complex Customer Service Transactions
Converting a policy
Terminating a policy
Reinstating a Policy
Redating
Chaning a Beneficiary
Contingent Beneficiary
Concurrent Beneficiaries
Irrevocable Beneficairy
Class Designation
Per stirpes beneficiary designation
Per capita beneficiary designation
Assigning Policy Ownership
Administering Loans and Dividends
loan repay
Dividend Plan
Coupon Plan
Automatic deduction plan
Lump sum plan
Partial loan repayment plan
automatic premium loan provision
participating policy
divisible surplus
policy dividend
Handling Variable Life Insurance Products
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