Personal Finance Tips

Economically Feasible Cost

To be insurable, the chance of loss must be small. The cost of an insurance policy consists of the pure premium, or amount actually needed to make loss payments, and the expense portion. If the chance of loss approaches 100%, the cost of the policy will exceed the amount that the insurance company is obligated to pay under the contract.

For example, it would be possible for a life insurance company to issue a $1,000 policy on a man 99 years of age. The net premium alone, however, would be about $980, to which would have to be added an amount for expenses which would bring the premium total to more than the amount of insurance. To make life insurance rates attractive, the premium has to be far less than the face of the policy.

Chance of Loss Must Be Calculable

Some probabilities of loss can be determined by logic alone-for example, the probabilities involved in the flip of a coin. Others must be determined empirically, that is, by a tabulation of past experience with a projection of that experience into the future.

All types of insurance probabilities are determined on an empirical basis. There are some chances of loss, however, which cannot be determined either by logic or from past experience. Unemployment is an example. Unemployment occurs with such a degree of irregularity that, as yet, no one has succeeded in working out a method of determining its future incidence.

This is one reason why unemployment insurance is not sold by private insurance carriers. If there are no available statistics on chance of loss, it is impossible to predict losses, in spite of a large number of exposures.

Unlikely to Produce Loss to Majority Simultaneously

No insurance company can afford to insure a type of loss which is likely to happen to any great percentage of those exposed to it. True, life insurance companies insure their policyholders against death even though it is well established that every one of them will die eventually.

The life insurance company is really insuring its policyholders against premature death. Its rates and reserve accumulations are fixed in such a way that it can pay claims as the claims mature without causing financial hardship to the company.

If all the policyholders of a life insurance company should die prematurely, this company would be just as bankrupt as would a fire insurance company whose policyholders all lost their houses by fire.

Unemployment runs aground on this last barrier, too. Those individuals whose jobs were secure could never be sold unemployment insurance. Prospective customers would be drawn solely from those who felt their employment situations to be insecure.

When a business recession occurred, hosts of the insureds would lose their jobs at the same time. It would be equivalent to a life insurance company having a large percentage of its insureds die at the same time.

Insurance is an arrangement whereby the unfortunate few who lose are indemnified by the fortunate many who escape loss. Particularly those whose financial well being depends on it, which is often the case with the families of term life insurance policyholders. If the many, however, suffer the loss, then the few will prove inadequate to indemnify them properly, except at an uneconomic premium.

In order to guard against catastrophic losses, fire insurance companies, for example, seek a wide distribution of exposures and set up underwriting standards which prohibit the concentrations of business in small sections of a city. They also put a clause in their policies excluding losses due to wars, thus relieving them of the danger of catastrophic losses resulting from atomic warfare.

Seems sort of obvious, doesn’t it? But, there are different ways to notify the company that you’ve had a loss. And when you notify the insurance company can make a big difference in how your claim is handled.

The first place to look for information is on your policy. Many policies will have a telephone number listed for reporting a claim. However, I’ve seen policies that require the policyholder to notify the company in writing. So, make sure that the method of reporting your claim is acceptable to the insurance company. Likely, your agent has his name and telephone number on the policy. If so, call him and report the loss also.

Sometimes, an agent will have settlement authority to handle small losses, such as homeowner’s losses under $2,000.00. In that kind of instance, the agent could handle the claim for you. I’ve found this situation to be rare, though. Occasionally, captive agents (agents that work for only one company, like Allstate, Nationwide or Liberty Mutual) will have a small amount of settlement authority.

The first thing you should remember is that the agent is licensed by the Department of Insurance in his state to be an agent. There is a separate license for claims adjusters. It’s actually a violation of insurance regulations for an agent to do claims adjusting. It’s not his job to handle your claim, but to assist you in buying the coverage that’s right for you. Agents can be very helpful by making calls on your behalf if you’re having problems in your claim. They can be helpful in finding out key names and phone numbers for insurance company personnel that are handling your claim. If the agent has a large number of policyholders with that company, and his clientele represents a large amount of premium to that insurance company, it can be very helpful to have the agent call on your behalf when you’re having problems.

After all, it’s all about customer service, and keeping the promises made in the insurance policy.

Sometimes, the agent or an office secretary/customer service representative will fill out a claim form (called an ACORD form), and submit the claim form to the insurance company on your behalf. In this age of the Internet, frequently the claim form is electronic, and the agent will submit the electronic form by computer.

If the agent notifies the company on your behalf, and uses some type of form, ask the agent to send you a copy of the completed form. Then, you’ll be certain that the claim was submitted, and the date the claim was submitted.

Many times, however, the agent will have to refer you to the claims department of the insurance company. Your policy may have a telephone number for the claims department listed on the policy, and instructions how to make a claim.

Your policy requires you to notify the insurance company “in a timely manner” after you’ve had a claim. What is timely? It varies policy to policy. But each state has statutes of limitation that limit the amount of time after a claim occurrence that a claim can be made. Check with your state’s Department of Insurance to determine the statute of limitation where you live…or where the loss occurred. You’ll find a list of all of the Insurance Departments of all 50 U.S. states and their phone numbers in the Appendix, and at the website address shown below.

For example: you live in Minnesota, and own a retirement home in Florida. The Florida house gets hit by a hurricane. The statutes for Florida would apply.

WARNING: If you wait more than a month after your loss to notify the insurance company, they will be instantly suspicious. In those cases, you should expect to receive one of two forms from the insurance company before they begin their investigation of the loss:

Non-Waiver Agreement. This basically states that the insurance company is going to do a thorough investigation of the claim, but that their investigation does not commit them to pay the claim. It states that they do not waive any of their rights under the policy, and that the insured does not waive any of his rights by cooperating with the investigation. The insurance company wants the insured to sign this form. However, if the Insured refuses to sign the form, the insurance company will send him a….

Reservation of Rights letter. This states basically the same thing as a Non-Waiver Agreement, but the Insured does not have to sign it.

Don’t forget to write in your claim journal the date, time, who you spoke with, the phone number you called, and what was said when you reported your claim. That information could be very valuable later if you have problems with your claim.

Most likely, you’ll receive a claim number from the company when you report the loss. Write the claim number in your journal!!! Don’t expect the insurance company to quickly send you a form that has the claim number on it. Sometimes, it may be many days before the claims department sends you any correspondence, and you will likely need to speak with them before then.

WARNING: What about a situation in which someone else is at fault, and you’re making a claim against the other person’s insurance company? This could happen in an auto accident, or if someone causes damage to your house, or your contents. EVEN IN THIS SITUATION, you must notify your own insurance company that you’re involved in a claim.

The reason is that third party claims don’t always turn out well for you, the claimant. Sometimes, the other person’s insurance company denies liability or denies coverage. Sometimes, the other person’s insurance company drags the process out. Sometimes, the other person’s insurance company makes a settlement offer far below the fair value of the claim. Months may pass, and you have suffered a financial loss that is not getting paid.

What if you, or someone in your family, is injured in the claim…and the other guy’s insurance company won’t accept liability?

Those things might occur weeks or months after a loss. In many cases, you can short-cut that process and make a claim against your own insurance policy to repair the damages. Then your insurance company will do something called “Subrogation.” That is, they will pay your claim, and then contact the other person’s insurance company and demand reimbursement, including your deductible.

So, if you don’t report your claim right away, the policy might allow that insurance company to deny your claim based upon late reporting.

Besides, your policy REQUIRES you to notify the insurance company “promptly” after you have a loss of covered property. That requirement is there no matter who is at fault for the damages.

Don’t get caught in this technicality! Don’t lose your right to collect what you deserve when you notify the insurance company.

Perhaps this is an unnecessary statement of the obvious, but the point of insurance is to give people a financial safety net. Should an emergency or disaster strike, money you would struggle to find is paid out by your insurance company. But the squeeze has been on for the last decade as medical costs and the prices of essential drugs have been rising fast. In fact, so fast that the insurers cannot pass on all the increases to their policyholders. It was hard to raise premium rates while the economy was doing well. It became impossible to raise premiums when the recession hit without there being investigations by each state’s Commissioners for Insurance and complaints from everyone else.

There comes a point when the insurer cannot get any more blood from the stone and has to sacrifice profits. This has left the medical profession, the hospitals and clinics in a winning position, while the pharmaceutical industry’s profits have continued to rise despite the recession. At the other end of the spectrum, the patients are the losers. There are some who discover the small print in their policies denies cover for the very illnesses they have. There are others whose savings are not enough to pay the deductibles and co-payments. And then there are those whose policies are cancelled when they make a claim for a chronic disease or disorder.

There is a new piece of research from the Commonwealth Fund, an independent, non-profit body. In 2007, it carried out a detailed survey among 2,600 people aged between 19 and 64. When their coverage was analysed, 20% were found significantly underinsured. Why was this happening? Because they were already spending more than 10% of their income on health coverage, whether as premiums, deductibles or both. When the underinsured were added to the uninsured, this represented 42% of adult Americans. Like the uninsured, this forces the underinsured to think twice before they have treatment with more than half either refusing treatment or struggling with debt because of treatment.

In the push for healthcare reform, the focus has been on the uninsured. But this fails to recognize the injustice suffered by the underinsured. No one should be forced to choose between refusing needed treatment and potential bankruptcy. It is therefore going to be an interesting year in prospect as the reform slowly comes into force. Both the poor and the middle class need access to cheap health insurance with reasonably comprehensive coverage. This will further squeeze the insurance industry because it will be denied the right to refuse coverage to those with pre-existing conditions and will be forced to establish group health insurance for those who have struggled to find affordable plans. In all of this, the key to success will be the ability of government and the insurers to impose more control over costs. President Obama has negotiated with the pharmaceutical industry and there is some agreement to hold down prices for those in Medicare and Medicaid. The for-profit healthcare industry also sees some self-interest in moderating its price increases and has given undertakings to the Administration. If some of the pressure is removed from the insurance industry, premium rates will stabilize and the reforms should offer a more fair system to all with a health plan. We can only hope for the best while we wait and see what happens.

Many people are complaining about their health insurance costs, having a dramatic increase in rates over a short period of time. Some policyholders have noticed that their rates increased by 30% over the last two years and that definitely rings a bell, when a good portion of your income is spent on health insurance. In this time when every spare dollar counts, people are looking for ways to minimize their expenses and insurance, whether health, car or homeowners, is the first thing that comes in mind when cutting costs. Some people choose to drop health coverage altogether, ending up with astronomic bills for any medical service they get. Others are more careful with their decisions and first investigate what other types of health insurance can bring to the table. Here are some things to consider if you want to minimize your insurance costs.

Should I get individual or group health insurance plan?

There are a lot of questions about group and individual health insurance. Of course, group plans are very convenient in the sense that you can insure your entire family and pay out a single premium rather than have multiple separate policies, which only multiply the annoying paperwork. However, group health insurance usually has higher rates as it should guarantee that even high risk customers within the group have adequate coverage. This, of course, makes the healthier group members pay for the risk they share with the less healthy members. Such a situation can be acceptable if there are different health issues among different members. But if your family is healthy in general it would be more cost effective to purchase separate individual policies for each member, because the rates in individual plans are based on your particular health situation and if it’s OK then you will get much lower rates than with a group health insurance plan.

Outline your exact insurance needs and get an appropriate plan

If you are looking for cheap health insurance you first have to determine what your exact insurance needs are. Analyze your conditions, see how often you go to the doctor and what particular services you are using most frequently, and choose a plan that gives you the base rates for your exact needs. With so many different plans out there on the market you should definitely find the one that will give you cheap health insurance and will address all of your needs to the proper extent.

Finding cheap health insurance while self-employed

Those workers who are self-employed often find it hard to get adequate coverage for a low price. The group health insurance benefits that an employer can give their workers don’t apply here, and in most cases self-employed specialists have to go with independent individual health insurance plans that can sometimes be quite expensive. However, if you are leaving a workplace with good group health insurance benefits, you may fall under COBRA regulations in certain circumstances and continue receiving group health benefits while already being self-employed. If your previous employer didn’t have any group health benefits, it would be better to go independently.

This February, the Department of Health and Human Resources has issued a report identifying an alarming trend for insurance companies to seek premium rate increases. This is not limited to one or two states. This is not limited to one or two percentage increases in the rates. This is all the leading insurance companies asking for the right to significantly higher premiums: in Michigan hikes of 56%, in California hikes of 39%, and so on. If this only affected small numbers of policyholders, it might have passed unnoticed. But, with millions of policyholders affected across the country, these rate increase requests have attracted the full scrutiny of the federal government. Secretary Sibelius has been leading the attack, using the requests to push the reform agenda forward.

Because of the national anger, some companies have paused. WellPoint had proposed the increases take effect from March 1. Any increases, even if approved by the states, will now be delayed until May at the earliest. This decision is partly in response to the summons of WellPoint’s chief executive officer to Washington to justify the requested increases. Insurance companies find themselves in a difficult political situation. Their management teams accept a duty to maximize profits for the benefit of the stockholders. They look around at an America seriously affected by the recession. Increasing numbers of people are unable to afford the premiums, some because of unemployment, others because of a squeeze on credit. More worrying from the insurance industry is that more healthy people are deciding not to insure at all. This means the group of people left holding policies has a higher percentage of those with existing health problems. Without more healthy people in the group paying premiums and not claiming, it becomes more expensive to insure those less healthy people who remain. It is also a verified fact that hospitals and healthcare service professionals have also been increasing their fees and charges. The pharmaceutical companies have increased the price of almost all the most commonly used drugs. The insurance industry is under pressure from both sides. As Secretary Sibelius points out, however, this is not a completely accurate picture. Every year, insurance companies are required to submit reports to all the US states in which they are licensed to sell policies. This data shows many companies actually increased the number of policyholders during 2009.

The market in health insurance plans is complicated by the political situation. Democrats and Republicans are two armies unable to agree a truce long enough for some reform to be made. As it stands, there is no immediate likelihood that medical costs will be controlled. If the costs continue to rise faster than inflation, insurers will have no choice other than increasing their premiums. If they do not, they will not have enough cash in hand to pay out on all the claims. This means, for the average person, it will become increasingly difficult to find cheap health insurance. For those with a pre-existing condition, group health insurance will be the only option but, for those plans, premiums are rising at their fastest rates. For years, it has been obvious that the healthcare industry is broken. It would be ironic if, having come this close to some meaningful reforms, we not only saw the reform bills lost in Washington, but also found every major insurer imposing massive premium increases. That really would be the final nail in the coffin.