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8.0 Health Basics

Learning Objectives​

Upon completion of this chapter, you should be able to:

  1. Define the terms accident, sickness, peril, and pre-existing condition.
  2. Describe the primary types of losses and benefits typically covered under Accident and Health insurance policies.
  3. Identify and classify the various underwriting actions that an underwriter may take when evaluating an application.
  4. Recognize four common sources of information used in the underwriting process.
  5. Explain the potential consequences associated with replacing an existing health insurance policy.

Overview​

The purpose of this chapter is to introduce the student to the types of perils, losses, and benefits associated with health insurance. The chapter also examines the process of completing a health insurance application, the underwriting process, and the procedures involved in delivering a health insurance policy.

Health insurance—often referred to as Accident and Health Insurance or Accident and Sickness Insurance—is purchased by the policyowner. The policyowner has control of the policy, is responsible for paying the premiums, and holds all contractual rights associated with the policy. In many cases, the policyowner and the insured may be the same individual, although they can also be different parties.