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Policy Schedule Page A policy schedule is the outline of the coverage provided by your insurance policy. This is usually the first page or first few pages of a policy package you might receive from your insurance provider. This page within the policy outlines all policy data such as the policy number, benefit amount and premium. It is important to understanding your policy schedule, and ensuring that all the information is correct, will ensure that any claim is paid out without delay. A policy schedule forms part of the insurance contract made between the insurer and insured. A schedule is an insurance term that basically means a list. There are many ways this term is used in the insurance industry but in this case, a policy schedule is a list detailing the coverage you have purchased. Examples of details listed on a schedule includes: Limits of insurance, a list of who is insured, the deductible, personal details, the type and plan of insurance cover in force, the Policy durat

Partial Disability It is policy provision or rider pays the inability of the insured to perform one or more of the important duties of his or her occupation. When a disability income policy covers partial disability, the benefit is usually equal to a specified percentage (e.g., 50 percent) of the total disability benefit for a limited time period (e.g., 3, 6, or 9 months). This is different from a Total disabilities which are, indeed, the more debilitating and often longer-lasting disabilities. The disability is usually due to illness or an on the job injury. This includes situations where a person may be able to return to work but cannot do their former job or can only do a lower-paying job. Common causes of partial disabilities may include: Accident Heart attacks Cancer Neck and back problems Diabetes Fibromyalgia Depression Gastrointestinal problems COVID-19 Specific Loss Benefits. Benefits are paid if a work related injury results in loss of vision and or hearing.

Own Occupation An insurance policy that covers individuals who become disabled and are unable to perform the majority of the occupational duties that they have been trained to perform. Persons covered under an own occupation policy may find another job and still receive full benefit payments. Your own occupation means your whole job, not each responsibility on its own. You may be perfectly capable of completing each part of your job on an individual basis, but incapable of doing them all together. In that case, you qualify as disabled. A policyholder can receive benefits if you are unable to work in your "own occupation," but allow you to seek employment elsewhere. Doctors frequently purchase own-occupation policies. If a doctor can not work in their regular occupation but are willing and able to work in some other capacity, this definition means you can get your full benefit payment even while holding another kind of job. If the surgeon in the above scenario had disabil

Health maintenance organizations (HMOs) A health maintenance organization (HMO) is a network or organization that provides health insurance coverage for a monthly or annual fee. An HMO is made up of a group of medical insurance providers that limit coverage to medical care provided through doctors and other providers who are under contract with the HMO. The purpose of a Health Maintenance Organization is to focus on overall patient wellness and preventive healthcare while keeping costs low for its members by only covering in-network physicians and facilities. There are four basic models of HMOs: group model, individual practice association (IPA), network model, and staff model. This plan usually limits coverage to care from doctors who work for or contract with the HMO. It generally will not cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. An HMO contracts allow for premiums to be lower since

Outline of Coverage A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions. It is separate booklet that you received when you applied and which is available upon request; it is part of the policy, lists the covered amounts, Medicare coinsurance and Medicare deductible, and contains other important customer information. Insurance companies usually provide policyholders with an outline of coverage that summarizes the benefits provided. This document help you make an informed choice, some jurisdictions require an Outline of Coverage (OOC) document. An Outline of Coverage provides a brief description of the important features of your plan. An outline of coverage must be delivered to a prospective applicant for a long-term care insurance contract or certificate at the time of initial solicitation through means that prominently direct the attention of the recipient to

Preferred Provider Organization (PPO) A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. In other words groups of doctors and hospitals that contract with an insurer to provide medical services at a prearranged cost, thus allowing insureds to choose among these groups. In this case, you pay less if you use providers that belong to the plan's network. A substantial discounts on regularly charged rates to subscribed members. With a PPO, typically you are not required to coordinate your care through a single primary-care physician, as you are with an HMO, so you have a bit more flexibility if you need to see a specialist. However, it is up to you to make sure that specialists and any other health-care providers you visit do participate in your PPO network. If you have a PPO, medical services you receive from out-of-network providers may not be covered or may be paid at a lower level. HMOs a

Exclusive provider organizations (EPOs) An exclusive provider organization, or EPO, is a health insurance plan that only allows you to get health care services from doctors, hospitals, and other care providers who are within your network. Your insurance will not cover any costs you get from going to someone outside of that network. EPO plans only cover the cost at doctors or health providers that are within your network. Emergency care is covered, even if it’s out of your network You do not need a referral if you want to see a specialist with EPO insurance. In a real sense of it an EPO is a hybrid between an HMO and PPO plan. You will usually pay more in premiums for an EPO plan than you would for an Health Maintenance Organization (HMO) but less than you would with a Preferred Provider Organization (PPO) or point of service (POS) #benewinsurance #insurtech #inclusiveinsurance #insurance #reinsurance #takaful

Noncommunicable Diseases Noncommunicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors. Noncommunicable diseases (NCDs), are collectively responsible for almost 70% of all deaths worldwide, they including: -Alzheimer’s Disease -Cancer -Epilepsy -Osteoarthritis -Osteoporosis -Cerebrovascular Disease (Stroke) -Chronic Obstructive Pulmonary -Disease (COPD) -Coronary Artery Disease -Heat Stroke -High Blood Pressure or -Hypertension -Obesity and Overweight -Diabetes -Depressive Disorders -Substance Abuse: Alcohol -Substance Abuse: Ecstasy Key facts from World Health Organization (WHO) about noncommunicable diseases: ✓Noncommunicable diseases (NCDs) kill 41 million people each year, equivalent to 71% of all deaths globally. ✓Each year, more than 15 million people die from a NCD between the ages of 30 and 69 years; 85% of these "prematur

Optional Benefit Optional Benefit means a benefit included in this Policy which is included at the option of the Policyholder with the agreement of the Company and in respect of which the relevant rider is attached to this Policy and which is described as an affirmed benefit and for which additional premiums are payable to the Company. Optional benefits are usually available in the form of riders. They add additional coverage to the basic policy. Riders are optional, extra terms that go into effect along with your basic policy, often at an additional cost. Simply put, a rider provides additional coverage and added protection against risks. Although these benefits are not required by law, they are fairly common in the workplace. In fact, some of these benefits are so common that employees come to expect them as a “given.” These benefits may include: Paid sick time Paid vacation Dental insurance Vision insurance Life or disability insurance Retirement plan options Whether or n

Occupation Class in Liability Insurance An underwriting category in which insureds are placed based on their specific, customary job dutie. Less hazardous jobs are grouped, while riskier ones join together to form different occupational classes. Your occupation class determines the premiums you have to pay for disability insurance. In general, higher occupation classes have a lower risk of becoming disabled, require more education, and have a higher earned income. As you move down the occupation classification scale, jobs require more physical exertion, less skill, and have a higher absenteeism rate. Most companies offer five different occupation classes from least hazardous to most: 4A, 3A, 2A, A, and B. Some also have class C, which is even more hazardous than B. 4A: Accountants Actuaries Architects Computer consultants, analysts, and programmers Dental specialists Most engineers with consulting and office duties only Most executives with consulting and office duties onl

Non-Cancelable, Guaranteed Renewable Policy A non-cancellable and guaranteed renewable policy guarantees that there will be no changes to your premium schedule, your monthly benefits or your policy benefits up to age 65 (or another specified age) unless you request them. Cancelable refers to the fact that most insurance contracts can be terminated by the insurer or the insured at any time. If an individual policy is not a cancelable policy, then it will probably be designated guaranteed renewable or noncancelable. Under a non-cancelable, guaranteed renewable policy, the insurer cannot change any aspect of the policy or its premiums for the life of the contract, as long as all premiums are paid by the end of each grace period. The difference between a guaranteed renewable policy and a non cancelable policy is that a non-cancelable policy typically has a 20% additional premium charge versus guaranteed renewable only policies does not guaranteed level rates. Since most people cannot

Medical Underwriting A method of evaluating an applicant’s health and medical history to determine if a policy will be issued and if so, the appropriate rates and exclusions. Examples an underwriter for a health insurance company will review medical details, while a loan underwriter will assess factors like credit history. An underwriter's job is complex. They have to determine an acceptable level of risk and what's eligible for approval based on their risk assessment. When insurers are allowed to consider pre-existing conditions, medical underwriting is the process they use to find pre-existing conditions and factor them into eligibility, pricing, and coverage. In recent years, regulations have limited the use of medical underwriting in determining rates. Regulations can change, and health care regulation is highly controversial in some jurisdictions. For example in the US medical underwriting for new enrollees is no longer used for major medical coverage in the indiv

Mandatory Rehabilitation (Case study: Mental Health) To encourage disabled persons to participate in rehabilitation programs, some policies include a mandatory rehabilitation provision. This provision states that if an individual refuses to cooperate or participate in a rehabilitation program, benefits will be terminated. A typical example of a rehabilitation clause may be as follows; "In the case of medical treatment a participant must receive appropriate medical treatment beginning with the onset of the condition involved and continuing throughout both the Elimination Period and any subsequent payment period. This will normally mean treatment that involves more than examination or testing. It must be reasonable and customary, performed or prescribed by a Physician or, whenever considered necessary by the Company, a medical specialist. Treatment must be carried out as frequently as the condition requires. Partcipant's responsibilities while disable during any period of di