Individual Health Insurance Certification

Health insurance protects financial security as a person anticipates and moves through life’s various stages.  Adequate health insurance helps to build and maintain financial security by shielding a person from financial setbacks that could compromise that security should ill health or injury occur at any stage in life.  Employer funding of health insurance has declined significantly over the past 30 years which places more responsibility on the individual to provide his or her own financial protection.

Agents and Brokers ensure their clients to have products of value that provide peace of mind and protect against significant losses.  The client becomes the policy owner and the insurer backs the promises in the contract. Underwriting is an essential function in all forms of insurance. It is the process of evaluating an insurance applicant, making decisions about the applicant’s acceptability for insurance coverage, and determining the appropriate basis on which to provide coverage and charge a premium.  

NABIP created this course for professionals to better assist their clients in working towards an immediate goal of becoming protected against insurer insolvency and unfair treatment by insurers. Health insurance is arguable the most heavily regulated type of insurance; it protects almost irreplaceable personal values that are directly related to health and well-being, earning a living, and the conduct of life’s basic activities. Purchasing individual health insurance is a process that relies on a number of fundamental components such as insurability of health-related expenses, sources for individual health insurance, and the market for individual health insurance.  This course will educate you on the Affordable Care Act, the purchasing process for individual medical expense coverage differences and comparisons from the purchasing process for individual disability and long-term care.

Medical expense policies provide the benefits for health care services purchased on an individual basis.  Historically, principal policies were limited to hospital and physician services related to inpatient care and surgery and had fixed or scheduled benefit limits.  The Affordable Care Act expanded coverage requirements with the inclusion of essential health benefits, eliminated lifetime and annual maximum limits, eliminated health status as underwriting criteria and eliminated pre-existing condition clauses for medical expense plans.  

Learning Objectives: 

• Understanding the three component forms of individual health insurance and how other health insurance programs affect the need for individual health insurance
• How current environmental developments influence the individual health insurance market
• History and review of  health insurance from earlier decades to the present
• Understanding the Affordable Care Act and the changes it brought to individual medical expense policies and the types of state regulations that affect individual health insurance policies
• Understanding  income-tax treatment of health insurance policies
• Obtain full knowledge of all  factors that make a health insurance risk insurable and the unintended consequences that insurers must guard against
• Understanding the state health insurance exchange marketing entity and its components
• The offer and acceptance of a binding contract created in the proposal process with the submission of a properly completed application
• The importance of true and complete information in an insurance application and how a medical expense policy can be retroactively rescinded
• The key and miscellaneous provisions of an insurance contract
• The goal and requirements of the Uniform electronic Transactions Act and its effect on insurance transactions
• The general nature of major medical insurance policies
• The characteristics that make managed care plans effective
• The ways preferred provider organization arrangements and HMOs function
• How to determine which medical expense plan is the best fit