Case Application for
Private Medical Insurance
Products & Functions:
An introduction
PMI1B
This case application can be used as a further learning support
in your studies.
Copyright © Insurance Institute of Ireland 2011
This Case Application is issued by Insurance Institute of Ireland (III) to members taking courses and/or examinations of the III. It may not be used in whole or in part for any course of study/examination of any other body whatsoever without prior permission in writing of the III. This Case Application, or any part there of, may not be made available in any library and it may not be reproduced, in whole or in part, stored in a retrieval system or transmitted in any form or by any means – electronic, electrostatic, magnetic, mechanical, photocopying, recording or otherwise, without prior permission in writing of the III.
INTRODUCTION
Case applications have been developed to allow an active learning environment that can be described as student centred activity based. The case studies have an element of both a project-based and problem-project-based learning approach.
The following is a summary of the course content for the PMI1B module that will be explored upon in the case application:
PMI1B Material Facts Underwriting Procedures HealthCare Product Types
PMI Product Providers & The Products In The Irish PMI Market Personal General Insurance Products
The Personal Insurance Market Policy Wordings & Premium Payment
Confidentiality & Data Protection Consumer Protection
Should you have any queries during your studies, please contact the Student Services Department of the III at (01) 6456600 or [email protected].
In addition, we have a Module Feedback Questionnaire. This questionnaire is designed to give students the opportunity to provide comments and feedback on this module and is available on www.iii.ie
PMI1B
CASE APPLICATION PMI1B
Dominic and Daisy live in Tallaght whom both are approaching 65 and are currently employed. Their son, John, has recently graduated from college and has taken up a job in the financial services sector. The family have one car which John also uses to travel to football training and matches.
TUTORIAL
Case application questions in relation to each PMI1B chapter :
1 MATERIAL FACTS
Daisy is currently completing various household insurance proposal forms for a quotation. She has been advised that, ‘Every circumstance is material, which would influence the judgment of
a prudent insurer in fixing the premium or determining whether he will take the risk.’ Material
facts in their true form do not apply in the Irish PMI market. However, they do play a vital role in the wider risk-rated general insurance market. Explain to Daisy the importance of utmost good faith in risk assessment and insurance.
2 UNDERWRITING PROCEDURES
“The principles of the Irish PMI Market restrict underwriting, renewals and cancellations” states
the headline in Dominic’s newspaper. Dominic reads on to understand why this is so. Discuss.
3 HEALTHCARE PRODUCT TYPES
Dominic is overwhelmed by the variety of health insurance policy types and their coverage. He asks ‘Is Private Medical Insurance just all the other policy types under one policy ?. Explain to Dominic why this is not so.
4 PMI PRODUCTS PROVIDERS AND THE PRODUCTS IN THE IRISH PMI MARKET
“Private Medical Insurers are changing benefits and launching new plans on a regular basis
particularly in the corporate arena”. Describe a corporate policy of your choice from each of
5 PERSONAL GENERAL INSURANCE PRODUCTS
Daisy contacts BeSure Insurance Company to discuss their motor insurance coverage for the family car. Outline the scope of coverage that you think that Daisy would need for the family car.
Dominic has taken out Personal Accident and Sickness cover in the event of suffering an accident or is off work due to sickness. Explain the basic cover, limitations and exclusions that one would find under this relatively simple form of cover.
6 THE PERSONAL INSURANCE MARKET
Now that he is earning a living for himself, John, Dominic and Daisy’s only child, decides to take out his own private medical insurance policy. However, he is not sure where to go. Outline to John the various distribution channels which private medical insurance can be obtained.
In his new role in the financial services sector, John has been asked to present to his colleagues on the following topic ‘Briefly describe the main functions of the relevant insurance industry
organisations, identifying any regulatory role’. Help John complete this task.
7 POLICY WORDINGS & PREMIUM PAYMENT
“There are more exceptions / exclusions on my motor and private medical insurance policies
than there are perils covered” says Dominic after a long day at work. Describe the general
exceptions that might appear on Dominic’s motor insurance policy and the exclusions which are specific to his PMI policy.
“All policies contain a list of conditions”. Explain to Dominic the requirements imposed by each
common policy condition.
8 CONFIDENTIALITY & DATA PROTECTION
“On August 20, 2008, the Data Protection Commissioner released a code which had been specifically modified for the insurance industry. The Code was prepared against a backdrop of significant public concern, arising from media reports that personal information held by the Gardaí and by the Department of Social & Family Affairs was being routinely accessed by
9 CONSUMER PROTECTION
Dominic is approaching 65 and is concerned that given his age, his renewal for Private Medical Insurance will be refused. Despite reading the Equal Status Acts 2000 to 2004, his fears remain. Explain to Dominic how and why PMI is exempt from certain elements of this equality legislation.
DISCUSSION QUESTION
“Insurance companies can provide various products that can be purchased to meet specific perils”.
Jack, age 28, is married with two children (aged 1 and 10). He runs his own catering company and has 5 employees including a full time delivery driver. Jack is concerned about his lack of family and business insurance coverage and is looking for protection against the financial effects of untoward events.
You have been appointed as Jack’s broker and are required to provide advice to Jack regarding his portfolio of risks. Identify and discuss insurance coverages that would provide Jack with the appropriate and desired protections should a loss occur.
