1-Organization of insurer
Consolidation means that the number of firms in the financial services industry has declined over time because of merger and acquisition.
Convergence means that financial institutions can now sell a wide variety of financial products that earlier were outside their core business area.
An effective organizational structure benefits a company by:
Responsibility
Authority
Accountability
Delegation
The Organization Chart :An organization chart also shows the company’s chain of command, or the structure of authority that flows downward in the organization from the higher levels to the lower levels.
Pyramidal Structure and Levels of Authority:The pyramidal structure illustrates that the authority in a company starts at the top with one person or a small group of people, Authority is then distributed through the chain of command to ever-larger numbers of people throughout out the company.
2- TYPES OF INSURERS ORGANIZATION
Insurance organizations are classified by basis of risk coverage [life, general,health, property, auto]. their agency system [independent, exclusive, direct selling]and formation from legal point of view – stock or mutual.
Stock insurers
Mutual insurers
Lloyd’s of London
Reciprocal exchanges
In this presentation we will deal with Insurance organizations, their operational structure, insurer’s function and key business terms used in this sector.
To know more about Welingkar School’s Distance Learning Program and courses offered, visit:
http://www.welingkaronline.org/distance-learning/online-mba.html
1-Organization of insurer
Consolidation means that the number of firms in the financial services industry has declined over time because of merger and acquisition.
Convergence means that financial institutions can now sell a wide variety of financial products that earlier were outside their core business area.
An effective organizational structure benefits a company by:
Responsibility
Authority
Accountability
Delegation
The Organization Chart :An organization chart also shows the company’s chain of command, or the structure of authority that flows downward in the organization from the higher levels to the lower levels.
Pyramidal Structure and Levels of Authority:The pyramidal structure illustrates that the authority in a company starts at the top with one person or a small group of people, Authority is then distributed through the chain of command to ever-larger numbers of people throughout out the company.
2- TYPES OF INSURERS ORGANIZATION
Insurance organizations are classified by basis of risk coverage [life, general,health, property, auto]. their agency system [independent, exclusive, direct selling]and formation from legal point of view – stock or mutual.
Stock insurers
Mutual insurers
Lloyd’s of London
Reciprocal exchanges
In this presentation we will deal with Insurance organizations, their operational structure, insurer’s function and key business terms used in this sector.
To know more about Welingkar School’s Distance Learning Program and courses offered, visit:
http://www.welingkaronline.org/distance-learning/online-mba.html
FiNsure 360 Insurance For Start Up Investment Advisors/Financial Institutionsldag32
A guide to both required and elective lines of insurance and risk management products for start-up Investment Advisors, Hedge & Private Equity Funds
Life insurance can be an important part of your financial strategies, helping to ensure a more secure financial future for your loved ones when you're gone
1-INSURANCE COMPANY OPERATIONS
The most important insurance company operations consist of the following:
Ratemaking
Underwriting
Production
Claim settlement
Reinsurance
Insurers also engage in other operations, such as accounting, legal services, loss control, and information systems.
2-RATING AND RATEMAKING
Ratemaking refers to the pricing of insurance and the calculation of insurance premiums .
A rate is the price per unit of insurance.
An exposure unit is the unit of measurement used in insurance pricing, which varies by line of insurance.
The person who determines rates and premiums is known as an actuary . An actuary is a highly skilled mathematician who is involved in all phases of insurance company operations, including planning, pricing, and research.
3-UNDERWRITING
Underwriting refers to the process of selecting, classifying, and pricing applicants for insurance . The underwriter is the person who decides to accept or reject an application.
Statement of Underwriting Policy:Underwriting starts with a clear statement of underwriting policy.
An insurer must establish an underwriting policy that is consistent with company objectives.
4-PRODUCTION
The term production refers to the sales and marketing activities of insurers. Agents who sell insurance are frequently referred to as producers .
Life insurers have an agency or sales department. This department is responsible for recruiting and training new agents and for the supervision of general agents, branch office managers, and local agents.
Property and casualty insurers have marketing departments. To assist agents in the field, special agents may also be appointed.
A special agent is a highly specialized technician who provides local agents in the field with technical help and assistance with their marketing problems.
5-CLAIMS SETTLEMENT
Every insurance company has a claims division or department for adjusting claims. This section of the chapter examines the basic objectives in adjusting claims, the different types of claim adjustors, and the various steps in the claim-settlement process.
Basic Objectives in Claims Settlement:
Verification of a covered loss
Fair and prompt payment of claims
Personal assistance to the insured
6-REINSURANCE
Reinsurance is an arrangement by which the primary insurer that initially writes the insurance transfers to another insurer (called the reinsurer) part or all of the potential losses associated with such insurance .
The primary insurer that initially writes the insurance is called the ceding company .
The insurer that acceptspart or all of the insurance from the ceding com pany is called the reinsurer .
The amount of insurance retained by the ceding company for its own account is called the retention limit or net retention .
The amount of insurance ceded to the reinsurer is known as the cession
Life and Health Insurance FIN 3660 Chapter 2 The Life and .docxSHIVA101531
Life and Health Insurance FIN 3660
Chapter 2
The Life and Health Insurance Industry
Objectives
Distinguish among the three types of business organizations and explain why insurance companies must be organized as corporations.
Distinguish among stock insurers, mutual insurers, and fraternal benefit societies.
Describe the financial services industry and explain how insurance companies function within that industry.
Identify two primary types of insurance regulation in most countries.
Describe the roles that the federal and state governments play in U.S. insurance regulation.
2
Types of Business Organizations
Businesses are structured in three basic ways.
A sole proprietorship is owned and operated by one person. The owner receives all profits and is responsible for all the debts of the business.
A partnership is a business that is owned by two or more people known as partners. They divide the profits, and generally each of them is personally responsible for all the debts of the business.
A corporation is a legal entity that is created by the authority of a governmental unit and is separate and distinct from the people who own it. Corporations are different from other businesses in two ways. First, because they can be sued, can enter into contracts, and can own property. The assets and liabilities belong to the corporation itself, not the owners; thus, a corporation continues beyond the death of any or all of its owners.
An asset is an item of value, such as cash, buildings, or investments.
A liability is a company’s debt or future obligation.
Equity represents the owners’ interest; the amount on which owners have a claim.
3
Types of Insurance Company Organizations
1. Stock Corporations
Most corporations, including most life and health insurers, are stock corporations, a corporation whose ownership is divided into units known as shares, or shares of stock. A stockholder, or shareholder, is a person or organization who owns stock in the corporation.
Stock insurance companies are insurers organized as stock corporations.
Stockholders elect a board of directors, who are responsible for overseeing the company’s management.
Stockholder dividend is a portion of the corporation’s earnings paid to the owners of its stock.
4
Mutual Insurance Companies
2. Mutual Companies
This is an insurance company that is owned by its policyowners, who elect the company’s board of directors.
Mutual insurers historically have been older and larger than stock insurers and thus provide a significant amount of the life insurance in force.
5
Fraternal Benefit Societies
3. Fraternal Benefit Societies
Fraternals are nonprofit organizations that are operated solely for the benefit of their members and provide social, as well as insurance, benefits to their members.
Members of such societies share ethnic, religious, or vocational backgrounds, although some allow membership to the general public.
Members elect the officers of a fraternal society who manage its ...
FiNsure 360 Insurance For Start Up Investment Advisors/Financial Institutionsldag32
A guide to both required and elective lines of insurance and risk management products for start-up Investment Advisors, Hedge & Private Equity Funds
Life insurance can be an important part of your financial strategies, helping to ensure a more secure financial future for your loved ones when you're gone
1-INSURANCE COMPANY OPERATIONS
The most important insurance company operations consist of the following:
Ratemaking
Underwriting
Production
Claim settlement
Reinsurance
Insurers also engage in other operations, such as accounting, legal services, loss control, and information systems.
2-RATING AND RATEMAKING
Ratemaking refers to the pricing of insurance and the calculation of insurance premiums .
A rate is the price per unit of insurance.
An exposure unit is the unit of measurement used in insurance pricing, which varies by line of insurance.
The person who determines rates and premiums is known as an actuary . An actuary is a highly skilled mathematician who is involved in all phases of insurance company operations, including planning, pricing, and research.
3-UNDERWRITING
Underwriting refers to the process of selecting, classifying, and pricing applicants for insurance . The underwriter is the person who decides to accept or reject an application.
Statement of Underwriting Policy:Underwriting starts with a clear statement of underwriting policy.
An insurer must establish an underwriting policy that is consistent with company objectives.
4-PRODUCTION
The term production refers to the sales and marketing activities of insurers. Agents who sell insurance are frequently referred to as producers .
Life insurers have an agency or sales department. This department is responsible for recruiting and training new agents and for the supervision of general agents, branch office managers, and local agents.
Property and casualty insurers have marketing departments. To assist agents in the field, special agents may also be appointed.
A special agent is a highly specialized technician who provides local agents in the field with technical help and assistance with their marketing problems.
5-CLAIMS SETTLEMENT
Every insurance company has a claims division or department for adjusting claims. This section of the chapter examines the basic objectives in adjusting claims, the different types of claim adjustors, and the various steps in the claim-settlement process.
Basic Objectives in Claims Settlement:
Verification of a covered loss
Fair and prompt payment of claims
Personal assistance to the insured
6-REINSURANCE
Reinsurance is an arrangement by which the primary insurer that initially writes the insurance transfers to another insurer (called the reinsurer) part or all of the potential losses associated with such insurance .
The primary insurer that initially writes the insurance is called the ceding company .
The insurer that acceptspart or all of the insurance from the ceding com pany is called the reinsurer .
The amount of insurance retained by the ceding company for its own account is called the retention limit or net retention .
The amount of insurance ceded to the reinsurer is known as the cession
Life and Health Insurance FIN 3660 Chapter 2 The Life and .docxSHIVA101531
Life and Health Insurance FIN 3660
Chapter 2
The Life and Health Insurance Industry
Objectives
Distinguish among the three types of business organizations and explain why insurance companies must be organized as corporations.
Distinguish among stock insurers, mutual insurers, and fraternal benefit societies.
Describe the financial services industry and explain how insurance companies function within that industry.
Identify two primary types of insurance regulation in most countries.
Describe the roles that the federal and state governments play in U.S. insurance regulation.
2
Types of Business Organizations
Businesses are structured in three basic ways.
A sole proprietorship is owned and operated by one person. The owner receives all profits and is responsible for all the debts of the business.
A partnership is a business that is owned by two or more people known as partners. They divide the profits, and generally each of them is personally responsible for all the debts of the business.
A corporation is a legal entity that is created by the authority of a governmental unit and is separate and distinct from the people who own it. Corporations are different from other businesses in two ways. First, because they can be sued, can enter into contracts, and can own property. The assets and liabilities belong to the corporation itself, not the owners; thus, a corporation continues beyond the death of any or all of its owners.
An asset is an item of value, such as cash, buildings, or investments.
A liability is a company’s debt or future obligation.
Equity represents the owners’ interest; the amount on which owners have a claim.
3
Types of Insurance Company Organizations
1. Stock Corporations
Most corporations, including most life and health insurers, are stock corporations, a corporation whose ownership is divided into units known as shares, or shares of stock. A stockholder, or shareholder, is a person or organization who owns stock in the corporation.
Stock insurance companies are insurers organized as stock corporations.
Stockholders elect a board of directors, who are responsible for overseeing the company’s management.
Stockholder dividend is a portion of the corporation’s earnings paid to the owners of its stock.
4
Mutual Insurance Companies
2. Mutual Companies
This is an insurance company that is owned by its policyowners, who elect the company’s board of directors.
Mutual insurers historically have been older and larger than stock insurers and thus provide a significant amount of the life insurance in force.
5
Fraternal Benefit Societies
3. Fraternal Benefit Societies
Fraternals are nonprofit organizations that are operated solely for the benefit of their members and provide social, as well as insurance, benefits to their members.
Members of such societies share ethnic, religious, or vocational backgrounds, although some allow membership to the general public.
Members elect the officers of a fraternal society who manage its ...
Health insurance typically covers various medical services, including hospitalization, medication, diagnostic tests, and sometimes preventive care. The specific coverage and benefits depend on the terms and conditions of the insurance policy.
https://www.nivabupa.com/health-insurance-plans.html
"The Case For Annuity," by Phil Wasserman. This book shows an unbiased view on annuities, how they can offer you secure income streams, and growth potential while having no market risk or volatility.
Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
Lecture slide titled Fraud Risk Mitigation, Webinar Lecture Delivered at the Society for West African Internal Audit Practitioners (SWAIAP) on Wednesday, November 8, 2023.
how to swap pi coins to foreign currency withdrawable.DOT TECH
As of my last update, Pi is still in the testing phase and is not tradable on any exchanges.
However, Pi Network has announced plans to launch its Testnet and Mainnet in the future, which may include listing Pi on exchanges.
The current method for selling pi coins involves exchanging them with a pi vendor who purchases pi coins for investment reasons.
If you want to sell your pi coins, reach out to a pi vendor and sell them to anyone looking to sell pi coins from any country around the globe.
Below is the contact information for my personal pi vendor.
Telegram: @Pi_vendor_247
US Economic Outlook - Being Decided - M Capital Group August 2021.pdfpchutichetpong
The U.S. economy is continuing its impressive recovery from the COVID-19 pandemic and not slowing down despite re-occurring bumps. The U.S. savings rate reached its highest ever recorded level at 34% in April 2020 and Americans seem ready to spend. The sectors that had been hurt the most by the pandemic specifically reduced consumer spending, like retail, leisure, hospitality, and travel, are now experiencing massive growth in revenue and job openings.
Could this growth lead to a “Roaring Twenties”? As quickly as the U.S. economy contracted, experiencing a 9.1% drop in economic output relative to the business cycle in Q2 2020, the largest in recorded history, it has rebounded beyond expectations. This surprising growth seems to be fueled by the U.S. government’s aggressive fiscal and monetary policies, and an increase in consumer spending as mobility restrictions are lifted. Unemployment rates between June 2020 and June 2021 decreased by 5.2%, while the demand for labor is increasing, coupled with increasing wages to incentivize Americans to rejoin the labor force. Schools and businesses are expected to fully reopen soon. In parallel, vaccination rates across the country and the world continue to rise, with full vaccination rates of 50% and 14.8% respectively.
However, it is not completely smooth sailing from here. According to M Capital Group, the main risks that threaten the continued growth of the U.S. economy are inflation, unsettled trade relations, and another wave of Covid-19 mutations that could shut down the world again. Have we learned from the past year of COVID-19 and adapted our economy accordingly?
“In order for the U.S. economy to continue growing, whether there is another wave or not, the U.S. needs to focus on diversifying supply chains, supporting business investment, and maintaining consumer spending,” says Grace Feeley, a research analyst at M Capital Group.
While the economic indicators are positive, the risks are coming closer to manifesting and threatening such growth. The new variants spreading throughout the world, Delta, Lambda, and Gamma, are vaccine-resistant and muddy the predictions made about the economy and health of the country. These variants bring back the feeling of uncertainty that has wreaked havoc not only on the stock market but the mindset of people around the world. MCG provides unique insight on how to mitigate these risks to possibly ensure a bright economic future.
how can I sell pi coins after successfully completing KYCDOT TECH
Pi coins is not launched yet in any exchange 💱 this means it's not swappable, the current pi displaying on coin market cap is the iou version of pi. And you can learn all about that on my previous post.
RIGHT NOW THE ONLY WAY you can sell pi coins is through verified pi merchants. A pi merchant is someone who buys pi coins and resell them to exchanges and crypto whales. Looking forward to hold massive quantities of pi coins before the mainnet launch.
This is because pi network is not doing any pre-sale or ico offerings, the only way to get my coins is from buying from miners. So a merchant facilitates the transactions between the miners and these exchanges holding pi.
I and my friends has sold more than 6000 pi coins successfully with this method. I will be happy to share the contact of my personal pi merchant. The one i trade with, if you have your own merchant you can trade with them. For those who are new.
Message: @Pi_vendor_247 on telegram.
I wouldn't advise you selling all percentage of the pi coins. Leave at least a before so its a win win during open mainnet. Have a nice day pioneers ♥️
#kyc #mainnet #picoins #pi #sellpi #piwallet
#pinetwork
How Does CRISIL Evaluate Lenders in India for Credit RatingsShaheen Kumar
CRISIL evaluates lenders in India by analyzing financial performance, loan portfolio quality, risk management practices, capital adequacy, market position, and adherence to regulatory requirements. This comprehensive assessment ensures a thorough evaluation of creditworthiness and financial strength. Each criterion is meticulously examined to provide credible and reliable ratings.
how to sell pi coins in South Korea profitably.DOT TECH
Yes. You can sell your pi network coins in South Korea or any other country, by finding a verified pi merchant
What is a verified pi merchant?
Since pi network is not launched yet on any exchange, the only way you can sell pi coins is by selling to a verified pi merchant, and this is because pi network is not launched yet on any exchange and no pre-sale or ico offerings Is done on pi.
Since there is no pre-sale, the only way exchanges can get pi is by buying from miners. So a pi merchant facilitates these transactions by acting as a bridge for both transactions.
How can i find a pi vendor/merchant?
Well for those who haven't traded with a pi merchant or who don't already have one. I will leave the telegram id of my personal pi merchant who i trade pi with.
Tele gram: @Pi_vendor_247
#pi #sell #nigeria #pinetwork #picoins #sellpi #Nigerian #tradepi #pinetworkcoins #sellmypi
1. Elemental Economics - Introduction to mining.pdfNeal Brewster
After this first you should: Understand the nature of mining; have an awareness of the industry’s boundaries, corporate structure and size; appreciation the complex motivations and objectives of the industries’ various participants; know how mineral reserves are defined and estimated, and how they evolve over time.
How to get verified on Coinbase Account?_.docxBuy bitget
t's important to note that buying verified Coinbase accounts is not recommended and may violate Coinbase's terms of service. Instead of searching to "buy verified Coinbase accounts," follow the proper steps to verify your own account to ensure compliance and security.
where can I find a legit pi merchant onlineDOT TECH
Yes. This is very easy what you need is a recommendation from someone who has successfully traded pi coins before with a merchant.
Who is a pi merchant?
A pi merchant is someone who buys pi network coins and resell them to Investors looking forward to hold thousands of pi coins before the open mainnet.
I will leave the telegram contact of my personal pi merchant to trade with
@Pi_vendor_247
2. MAIN CLASSIFICATION OF INSURANCE PROVIDERS
I. PRIVATE INSURERS
II. GOVERNMENT INSURERS
Some of the private insurers we are going to look are prohibited in Florida and some are not
insurers at all, though they would appear to be
Provider is any physician, hospital, organization or other person or institution that furnishes
health care services and is licensed or otherwise authorized to practice in Florida.
3. MAIN CLASSIFICATION OF INSURANCE PROVIDERS
I. PRIVATE INSURERS
1. Stock insurers
2. Mutual insurers
3. Assessment Mutual insurers
4. Reciprocal insurers
5. Lloyd's of London
6. Risk Retention Groups
7. Reinsurers
8. Fraternal Benefit Societies
9. Service Insurers
10. Home Service insurers
11. Self insurers
4. MAIN CLASSIFICATION OF INSURANCE PROVIDERS
II. GOVERNMENT INSURERS
1. Social Security (OASDI)
2. Social Security Hospital Insurance
3. Supplemental Medical Insurance
4. Medicaid
5. Workers' Compensation
6. U.S. Armed Services and Veterans
5. I. PRIVATE INSURERS 1.1. STOCK INSURER
Stock insurance companies are private organization with the same structure as any
corporation, organized and incorporated under state laws for the purpose of making a profit for its
owners, the stockholders.
A Stock insurer is a publicity – trade insurance company that is owned and controlled by a group of
stockholders whose investment in the company provides the safety margin necessary for the issuance
of guaranteed, fixed premium , nonparticipating policies.
Stock Insurance companies are private organization characterized by the following features:
• Nonparticipating policies
• Owned by stockholders
• Provides profit to stockholders
• Majority stockholder controls company
• Lower rates
Stock insurers are incorporated insurers whose capital is divided into shares. Stock insurance companies
are owned by the stockholders who are responsible for electing the firm’s board of directors. Dividends
are paid to stockholders and are considered taxable income.
6. I. PRIVATE INSURERS 1.2. MUTUAL INSURER
Mutualization occurs when a stock company becomes a mutual company. Mutualization is the
conversion of an insurer’s corporate ownership from a stock company to a mutual company by buying
backs all the shares of stock and retiring them.
Mutual life Insurance companies are corporation and, by laws, must be incorporated in order to write
insurance. Mutual insurers are incorporated insurers with no permanent capital stock. Unlike stock
insurers, mutual insurers are owned by the policyholders. A mutual company exist to serve the
insurance needs of those policyholders. Anyone purchasing insurance from a mutual insurer is both a
customer and an owner (mutually) with rights to vote for the board of director members.
7. I. PRIVATE INSURERS 1.2. MUTUAL INSURER
Mutual Insurance are characterized by the following features:
• Participating policies
• Owned by policyholders
• Vote for directors and trustees
• Directors and management have controls
• Typically higher rates
The operating objective of a mutual life insurance company is to provide insurance to its owners (the
policyholders) at the lowest possible net cost.
Stock insurers are owned by stockholders.
Mutual insurers are owned by policyholders.
Demutualization is the process of converting a Mutual Insurance company to Stock Insurance company.
A mutual insurer may convert to a stock insurer with the approval of the insurance department of its
domiciliary state. In the conversion process, a mutual insurer offer policyholders cash or stock. The
company may then also make a public stock offering. Both, stock and mutual companies can write
life, health and property and casualty insurance.
8. I. PRIVATE INSURERS 1.3. ASSESSMENT MUTUAL INSURER
Even though assessment insurance companies are prohibited in Florida, they are addressed in the
Florida Manual. So briefly, we will go over the basic details. There are two methods upon which these
insurers charge premiums.
A pure assessment mutual company bases premium cost on the loss sharing method. Members do not
pay premium in advance and the total loss experience is divided among the members so each pays a
portion of the total. The advance premium assessment mutual charges specific premium amounts. If
the actual loss is less than the total of the collected premium, members received a refund in the forms
of dividend payments. If the actual loss is more than the total premium amount collected, members’
premium rates will be increased to adjust accordingly.
Assessment plan insurance companies are not legally permitted to operate in Florida, except in the case
of certain multiple employer welfare arrangements.
9. I. PRIVATE INSURERS 1.4. RECIPROCAL INSURERS
Like mutual insurance companies, reciprocal insurers are owned by the company’s policyholders. In a
reciprocal insurer structure, each policyholder insures the risk of the other policyholder (reciprocity).
If one subscriber incurs a loss, an equal portion of the loss is distributed among each individual
subscriber.
Reciprocal are managed by attorney – in – fact. An attorney – in – fact es a person who holds a power
of attorney and therefore is legally designated to transact business and execute documents on behalf of
another person. The attorney – in – fact’s power and responsibilities depend on the specific powers
granted in the power of attorney document. An attorney – in – fact is an agent of the principal.
10. I. PRIVATE INSURERS 1.5. LLOYD’S OF LONDON
Lloyd’s of London is actually not considered an insurer. Instead, it is an association of individuals and
companies that individually underwrite insurance. Lloyd’s of London gather and disseminates
underwriting information, helps its associates settle claim and disputes, and provides coverage that
might otherwise be unavailable in certain areas.
Lloyd’s of London is different from other insurers since it is a market, not a company. Lloyd’s of London
focus on education, training, and enterprise, and is responsible for risk management and profitability
targets across the market. Lloyd’s of London lays down guidelines for all syndicates and operates a
business planning and monitoring process to safeguard high standards of underwriting and risk
management, thereby improving sustainable profitability and enhancing the financial strength of the
market.
REMEMBER: Even with the similarities, Lloyd’s of London is NOT considered an insurer.
11. I. PRIVATE INSURERS 1.6. REINSURERS
Reinsurance is an arrangement through which one insurance company transfer a portion of a risk it has
assumed to another insurer. A reinsurance arrangement providers an area for sharing loss as a hedge
against catastrophic loss to any one company.
A reinsurer relationship occurs when one insurer (the ceding company) transfer or relinquishes a
portion of a covered risk to another insurer (the reinsurer).
1.7. RISK RETENTION GROUP
Risk Retention Group (RRGs) are a form of mutual insurer as well. RRGs provide liability coverage to
insure group of individual who are of the same group (or class).
12. I. PRIVATE INSURERS 1.8. FRATERNAL BENEFIT SOCIETIES
Certain criteria must be met in order for an entity to qualify as a fraternal benefits society.
To be considered a fraternal, the organization must:
Have a lodge system, complete with ritual or ceremonial routines
Be nonprofit, governed by elected officials, and
Offer insurance only to its members.
Fraternal benefits societies are based on religious, national or ethnic lines, any profits derived within
the society are considered nontaxable.
Most fraternal today issue certificates and annuities with many of the same provisions found in policies
issued by commercial insurers.
13. I. PRIVATE INSURERS 1.9. HOME SERVICE INSURERS
Another and more commonly used for this insurer is debit insurer, it is a form of industrial insurance
with lesser values. Face amounts are relatively small (typically $1,000.00 to $2.000.00). premium
payments are made on a weekly or monthly basis and are collected personally by agent at the policy
owner’s home.
Industrial life insurance used to account for a significant amount of life insurance policies in force.
Typical incomes were lower in the past and people just weren’t as aware of the need for adequate life
insurance as they are today. The abundance of group insurance plans has also attributed to the decline
of these smaller policies. Overall participation is estimated to have fallen to less than one percent.
14. I. PRIVATE INSURERS 1.10. SERVICE INSURERS
Service insurers technically do not provide insurance to their members. These organization contract for
and sell medical and hospital care services. Medical care services are provided in exchange for
premium paid.
The most familiar plans are HMO and PPO plans.
15. WHAT IS A HEALTH MAINTENANCE ORGANIZATION (HMO)?
A health Maintenance Organization is a Health care delivery system which provides comprehensive
health care services for its members. The members are typically enrolled on a group basis by their
employer. The employer pays a fixed periodic contribution in advance for the services of participating
physicians and cooperating hospitals. The employee may also contribute to the prepayment in some
groups.
HMO retain a network of service providers (physicians, hospitals, facilities, etc). Subscribers
(members/insured) pay a fixed periodic premium in advance of any treatment. HMOs require insured
to be assigned a primary care physician (PCP) who oversees the subscriber’s main health care and can
provide specialist referrals if necessary.
Most health issues also require an authorization through the insurance company before claims are paid.
HMOs and Florida laws pertaining to HMO operations within the state are addressed in more depth
later.
HMOs are known for stressing the provision of preventive health care and early treatment programs.
16. WHAT IS A PREFERRED PROVIDER ORGANIZATION (PPO)?
Following the passage of legislation in 1983, insurance companies were authorized to enter into
"alternative rates of payment" agreements with licensed health care providers. Those entering into the
agreements are called PPOs.
The concept is that if one provider or a group of providers has a large volume of business from a group
of insured, it can afford to give them health care at lower guaranteed costs. This savings in health care
costs can then be used to prevent health insurance premiums from increasing for that particular group
of insured.
PPO are considered points of service (POS) companies, the PPO will contract with specific providers who
will in turn provide discounts on health care services. Unlike HMOs, PPOs do not require insured to have
a PCP. PPOs require deductibles and coinsurance and provide monetary incentives for members to use
the physicians who are on their approved provider list.
For instance, a typical coinsurance amount for a preferred provider visit is 80/20 (20.0% being the
insured’s responsibility). If the member goes out of the network to use a physician who is not in the
PPOs network, the coinsurance may raise up to 60/40 (40.0% being the insured’s responsibility).
17. I. PRIVATE INSURERS 1.11. SELF-INSURERS
Self – insurers create their own reserves to provide coverage for future losses. Self – insurance is a risk
management method whereby an eligible risk is retained, but a calculated amount of money is set aside
to compensate for any potential future losses.
Normally, catastrophic risks are not self – insured as they are highly unpredictable and high loss – value.
Self insurance is often used by large companies for workers’ compensation purposes and for funding
pension plans. Self – insurers will bear the loss up to a maximum amount look to an insurance company
to provide insurance above a certain maximum level of loss.
18. II. GOVERNMENT INSURERS
All of the insurers mentioned previously are private insurers. Federal and state government insurance
programs are commonly known as social insurance programs.
All of the following are government insurance programs, though each has its own criterion for benefits.
Social Security, Medicare, and Medicaid programs.
19. GOVERNMENT INSURANCE CRITERION
Social Security (OASDI) Dependent payment are life
Insurance
Social Security Hospital Insurance (HI)Disability coverage
Aged over 65
Supplemental Medical Insurance (SMI) Disable eligible for Social Security
(commonly known as MEDICARE) benefits
End – stage renal disease
MEDICAID Poor, indigent, disable children, renal
stage disease
Workers’ Compensation Employment accidents
Service members
US Armed Services and Veterans Group Life
Veterans Group Life
National Service Life.