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Textbook
1. General Insurance Concepts
1.1 Insurance Basics and Foundational Concepts
1.2 Managing Risks
1.3 Transferring Losses
1.4 Insurance Sources
1.5 Marketing Systems and Producer Authority
1.6 Insurance Contracts
2. Producer Roles and Receipt Types
3. Underwriting
4. Health Insurance Basics
5. Required Policy Provisions
6. Optional Policy Provisions
7. Medical Expense Insurance
8. Group Health Insurance
9. The Affordable Care Act (ACA)
10. Disability Income Insurance
11. Accidental Death and Dismemberment Insurance
12. Long Term Care Insurance
13. Dental Insurance
14. Section 125 Plans and Limited Policies
15. Federal Government Programs
16. Medigap and Medicaid
17. Health Insurance Taxation
Wrapping up
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1.2 Managing Risks
Achievable Health
1. General Insurance Concepts

Managing Risks

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Insurance is purchased to protect you against the risk of economic loss from:

  • Dying too soon (life insurance)
  • Living too long (annuities)
  • Becoming ill, injured, or disabled (health insurance)

Insurance is a social device designed to transfer the risk of economic loss to a common pool of funds. Many people who share the same risk contribute to this pool.

Life and health insurance policies are contractual agreements between the insurance company (the insurer) and the policy owner (the insured). These contracts pay benefits when a specified event occurs (death, disability, accidental injury, or illness), as long as the required consideration (the premium) has been paid. Some health coverages, such as medical expense insurance, indemnify the insured by reimbursing the actual loss. Life insurance does not: a life has no measurable dollar value, so a life policy is a valued contract that pays the amount stated in the policy.

Insurance contracts are unilateral, meaning only one party makes an enforceable promise (the insurer). Insurance contracts are also aleatory, meaning the outcome depends on chance and the value exchanged by each party may not be equal.

Risk is commonly defined as exposure to adversity or danger. In insurance, risk means the possibility of financial loss. Risk is the basic issue insurance deals with - it’s why insurance exists. There are two types of risk: pure and speculative.

Pure risk involves only the possibility of loss and can be managed through insurance. The purpose of insurance is to indemnify, or restore, the insured to their original financial position. Insurance is not designed to give a person an opportunity for gain or profit.

Speculative risk includes the possibility of gain. Gambling and investing in the stock market are good examples. You may lose money, but you may also come out ahead. Speculative risk is not insurable.

Risk management is how you deal with the possibility of financial loss. There are five ways to manage risk:

  1. Avoid
  2. Reduce
  3. Retain
  4. Share
  5. Transfer

The first method is to avoid risk. For example, a person might avoid the risk of wrecking a car by not driving.

Risk may be reduced by examining your exposures and eliminating them. For example, a person reduces the risk of health problems by exercising and eating right.

A risk is retained when a person decides to assume financial responsibility for certain events. Examples of risk retention include self-insuring and deductibles.

A deductible is common to most property insurance policies. It is the initial amount of a covered loss for which the insured is responsible. For example, if an insured suffered a $5,000 loss and the policy included a $500 deductible, the insured would be responsible for the first $500 and the policy would pay the remaining $4,500.

A deductible is a common form of risk retention. It allows insurers to reduce the cost of coverage because the insured is assuming a portion of the risk.

A business owner taking on a partner is an example of risk sharing.

The final method of managing risk is to transfer the risk to another party. For many risks, the best way to transfer them is through insurance. Risk transfer means placing the burden of possible economic loss on someone else. When insurance is purchased, a large, uncertain loss is exchanged for a small, certain loss: the premium.

Insurance companies exist for this basic purpose. By definition, insurance companies are the only organizations that have the authority to assume someone’s risk of financial loss.

Lesson summary

Insurance plays a crucial role in safeguarding individuals against various risks like dying too soon, living too long, or becoming ill or disabled. Key concepts in insurance are:

  • Risk in insurance involves the possibility of financial loss, with pure risk only entailing loss while speculative risk includes potential gain, making the latter uninsurable.
  • Risk management strategies include avoiding, reducing, retaining, sharing, and transferring risks, with insurance being a common risk transfer method.

Chapter vocabulary

Definitions
Aleatory
A contract in which the number of dollars to be given up by each party is not equal. Insurance contracts are aleatory because the policyholder pays a premium and may collect nothing from the insurer or may collect a great deal more than the amount of the premium if a loss occurs.
Indemnity, Principle of
A general legal principle related to insurance that holds that the individual recovering under an insurance policy should be restored to the approximate financial position he or she was in prior to the loss. A legal principle limiting compensation for damages to equivalence to the losses incurred.
Pure Risk
Circumstance including the possibility of loss or no loss but no possibility of gain.
Risk
Uncertainty concerning the possibility of loss by a peril for which insurance is pursued.
Risk Management
Management of the varied risks to which a business firm or association might be subject. It includes analyzing all exposures to gauge the likelihood of loss and choosing options to better manage or minimize loss.
Speculative Risk
Uncertainty as to whether a gain or loss will occur. An example would be a business enterprise where there is a chance that the business will make money or lose it. Speculative risks are not insurable.
Unilateral Contract
A contract, such as an insurance policy, in which only one party to the contract, the insurer, makes any enforceable promise. The insured does not make a promise but pays a premium, which constitutes the insured’s part of the consideration.

Purpose of Insurance

  • Protects against three core risks:
    • Dying too soon (life insurance)
    • Living too long (annuities)
    • Illness, injury, disability (health insurance)
  • Social device transferring risk of economic loss to a shared pool of funds

Insurance Contracts

  • Agreement between insurer (company) and insured (policy owner)
  • Benefits paid upon specified event, contingent on premium payment
  • Indemnify: reimburse actual loss (e.g., medical expense insurance)
  • Life insurance is a valued contract: pays stated amount, not actual “value” of life
  • Unilateral: only insurer makes an enforceable promise
  • Aleatory: value exchanged may be unequal; outcome depends on chance

Risk Basics

  • Risk = possibility of financial loss; central issue insurance addresses
  • Pure risk: only possibility of loss or no loss; insurable
    • Insurance aims to indemnify/restore, not create profit
  • Speculative risk: possibility of gain or loss (e.g., gambling, investing); not insurable

Risk Management Methods

  • Five strategies:
    • Avoid
    • Reduce
    • Retain
    • Share
    • Transfer
  • Avoid: eliminate exposure entirely (e.g., not driving)
  • Reduce: minimize exposure (e.g., exercise, healthy habits)
  • Retain: assume responsibility for loss (e.g., self-insurance, deductibles)
  • Share: distribute risk among parties (e.g., business partnership)
  • Transfer: shift risk to another party, typically via insurance

Deductibles

  • Initial amount of covered loss insured must pay
  • Example: $5,000 loss, $500 deductible → insured pays $500, insurer pays $4,500
  • Common risk retention tool; lowers insurer’s cost, thus policy premiums

Role of Insurance Companies

  • Exchange large uncertain loss for small certain cost (premium)
  • Only entities legally authorized to assume another’s risk of financial loss

Chapter Vocabulary

  • Aleatory: unequal exchange of value between parties in a contract
  • Principle of Indemnity: restore insured to pre-loss financial position
  • Pure Risk: possibility of loss or no loss, no gain possible
  • Risk: uncertainty of loss from an insurable peril
  • Risk Management: analyzing/minimizing exposures to loss
  • Speculative Risk: possibility of gain or loss; not insurable
  • Unilateral Contract: only insurer makes enforceable promise; insured pays premium

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Managing Risks

Insurance is purchased to protect you against the risk of economic loss from:

  • Dying too soon (life insurance)
  • Living too long (annuities)
  • Becoming ill, injured, or disabled (health insurance)

Insurance is a social device designed to transfer the risk of economic loss to a common pool of funds. Many people who share the same risk contribute to this pool.

Life and health insurance policies are contractual agreements between the insurance company (the insurer) and the policy owner (the insured). These contracts pay benefits when a specified event occurs (death, disability, accidental injury, or illness), as long as the required consideration (the premium) has been paid. Some health coverages, such as medical expense insurance, indemnify the insured by reimbursing the actual loss. Life insurance does not: a life has no measurable dollar value, so a life policy is a valued contract that pays the amount stated in the policy.

Insurance contracts are unilateral, meaning only one party makes an enforceable promise (the insurer). Insurance contracts are also aleatory, meaning the outcome depends on chance and the value exchanged by each party may not be equal.

Risk is commonly defined as exposure to adversity or danger. In insurance, risk means the possibility of financial loss. Risk is the basic issue insurance deals with - it’s why insurance exists. There are two types of risk: pure and speculative.

Pure risk involves only the possibility of loss and can be managed through insurance. The purpose of insurance is to indemnify, or restore, the insured to their original financial position. Insurance is not designed to give a person an opportunity for gain or profit.

Speculative risk includes the possibility of gain. Gambling and investing in the stock market are good examples. You may lose money, but you may also come out ahead. Speculative risk is not insurable.

Risk management is how you deal with the possibility of financial loss. There are five ways to manage risk:

  1. Avoid
  2. Reduce
  3. Retain
  4. Share
  5. Transfer

The first method is to avoid risk. For example, a person might avoid the risk of wrecking a car by not driving.

Risk may be reduced by examining your exposures and eliminating them. For example, a person reduces the risk of health problems by exercising and eating right.

A risk is retained when a person decides to assume financial responsibility for certain events. Examples of risk retention include self-insuring and deductibles.

A deductible is common to most property insurance policies. It is the initial amount of a covered loss for which the insured is responsible. For example, if an insured suffered a $5,000 loss and the policy included a $500 deductible, the insured would be responsible for the first $500 and the policy would pay the remaining $4,500.

A deductible is a common form of risk retention. It allows insurers to reduce the cost of coverage because the insured is assuming a portion of the risk.

A business owner taking on a partner is an example of risk sharing.

The final method of managing risk is to transfer the risk to another party. For many risks, the best way to transfer them is through insurance. Risk transfer means placing the burden of possible economic loss on someone else. When insurance is purchased, a large, uncertain loss is exchanged for a small, certain loss: the premium.

Insurance companies exist for this basic purpose. By definition, insurance companies are the only organizations that have the authority to assume someone’s risk of financial loss.

Lesson summary

Insurance plays a crucial role in safeguarding individuals against various risks like dying too soon, living too long, or becoming ill or disabled. Key concepts in insurance are:

  • Risk in insurance involves the possibility of financial loss, with pure risk only entailing loss while speculative risk includes potential gain, making the latter uninsurable.
  • Risk management strategies include avoiding, reducing, retaining, sharing, and transferring risks, with insurance being a common risk transfer method.

Chapter vocabulary

Definitions
Aleatory
A contract in which the number of dollars to be given up by each party is not equal. Insurance contracts are aleatory because the policyholder pays a premium and may collect nothing from the insurer or may collect a great deal more than the amount of the premium if a loss occurs.
Indemnity, Principle of
A general legal principle related to insurance that holds that the individual recovering under an insurance policy should be restored to the approximate financial position he or she was in prior to the loss. A legal principle limiting compensation for damages to equivalence to the losses incurred.
Pure Risk
Circumstance including the possibility of loss or no loss but no possibility of gain.
Risk
Uncertainty concerning the possibility of loss by a peril for which insurance is pursued.
Risk Management
Management of the varied risks to which a business firm or association might be subject. It includes analyzing all exposures to gauge the likelihood of loss and choosing options to better manage or minimize loss.
Speculative Risk
Uncertainty as to whether a gain or loss will occur. An example would be a business enterprise where there is a chance that the business will make money or lose it. Speculative risks are not insurable.
Unilateral Contract
A contract, such as an insurance policy, in which only one party to the contract, the insurer, makes any enforceable promise. The insured does not make a promise but pays a premium, which constitutes the insured’s part of the consideration.
Key points

Purpose of Insurance

  • Protects against three core risks:
    • Dying too soon (life insurance)
    • Living too long (annuities)
    • Illness, injury, disability (health insurance)
  • Social device transferring risk of economic loss to a shared pool of funds

Insurance Contracts

  • Agreement between insurer (company) and insured (policy owner)
  • Benefits paid upon specified event, contingent on premium payment
  • Indemnify: reimburse actual loss (e.g., medical expense insurance)
  • Life insurance is a valued contract: pays stated amount, not actual “value” of life
  • Unilateral: only insurer makes an enforceable promise
  • Aleatory: value exchanged may be unequal; outcome depends on chance

Risk Basics

  • Risk = possibility of financial loss; central issue insurance addresses
  • Pure risk: only possibility of loss or no loss; insurable
    • Insurance aims to indemnify/restore, not create profit
  • Speculative risk: possibility of gain or loss (e.g., gambling, investing); not insurable

Risk Management Methods

  • Five strategies:
    • Avoid
    • Reduce
    • Retain
    • Share
    • Transfer
  • Avoid: eliminate exposure entirely (e.g., not driving)
  • Reduce: minimize exposure (e.g., exercise, healthy habits)
  • Retain: assume responsibility for loss (e.g., self-insurance, deductibles)
  • Share: distribute risk among parties (e.g., business partnership)
  • Transfer: shift risk to another party, typically via insurance

Deductibles

  • Initial amount of covered loss insured must pay
  • Example: $5,000 loss, $500 deductible → insured pays $500, insurer pays $4,500
  • Common risk retention tool; lowers insurer’s cost, thus policy premiums

Role of Insurance Companies

  • Exchange large uncertain loss for small certain cost (premium)
  • Only entities legally authorized to assume another’s risk of financial loss

Chapter Vocabulary

  • Aleatory: unequal exchange of value between parties in a contract
  • Principle of Indemnity: restore insured to pre-loss financial position
  • Pure Risk: possibility of loss or no loss, no gain possible
  • Risk: uncertainty of loss from an insurable peril
  • Risk Management: analyzing/minimizing exposures to loss
  • Speculative Risk: possibility of gain or loss; not insurable
  • Unilateral Contract: only insurer makes enforceable promise; insured pays premium

More from General Insurance Concepts

  • Insurance Basics and Foundational Concepts
  • Transferring Losses
  • Insurance Sources
  • Marketing Systems and Producer Authority
  • Insurance Contracts