CE- Claims Adjuster Academy

comparison of the new policy and the policy to be replaced. The comparison must at least include the following: • Renewability of the two policies. • Pre-existing conditions that affect coverage in the two policies. • Bene fi ts provided by the two policies.

UNIT 3

Part 2.2: The Insurance Agent Types of Agents

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VIDEO

Agent and Insurer Responsibilities

Solicitation and Advertising

Certain lines of insurance require speci fi c duties on an agent and an insurer when it comes to sales and marketing of its product (Bonner, 2020). Individual health insurance is an example of one of these lines. Though it may not be as common of a product as individual life insurance, individual health insurance is still a viable product sold by agents in the United States. As with all other things, “insurance” agents must follow certain state requirements, which may vary from state to state. The purpose of these requirements is to protect applicants and policyholders and to ensure agents and insurers are being treated fairly and ethically. Since most of these requirements are technically laws, they fall more under “legal behavior” than “ethical behavior,” but that does not mean understanding and following them is not as important as being ethical. Here is a brief and general description of these requirements. Be sure to check with the laws in your own state as well (https://statutes.capitol.texas.gov/?link=IN).

There are things an agent cannot do when soliciting or advertising an individual accident and health policy. For instance, it is unethical for an agent to convince an applicant to over-insure, omit pertinent underwriting information, and to sell a policy to someone the agent knows is eligible to receive Medicaid.

Disclosure of Information

An agent must make an applicant aware of the Insurance Information and Privacy Protection Act (National Association of Insurance Commissioners, 1992), which will be covered in detail later in the course. This Act is similar to the Fair Credit Reporting Act (1971) , which will also be discussed.

Modi fi cations to the Application

An agent cannot make changes to an applicant’s application, even if he or she knows the answer provided by the applicant is a mistake. If an agent makes a change to an application without the applicant’s knowledge and initialing, the entire policy could be contested. If a mistake is made by the agent while helping the applicant complete the application, the best thing he or she can do is void it and start another application. Other Agent and Insurer Responsibilities Individual health insurance is not the only product that comes with speci fi c requirements. Medicare supplements (TDI, 2021e) and life insurance (TDI, d also require special care and due diligence. Be sure to check with your state’s requirements if you have any questions about your responsibilities.

Duplication of Insurance Form

In the sale of an individual accident and health policy that duplicates other coverage, a Duplication of Insurance Form is used (Texas Administrative Code, 1999). The form must be signed by the policyholder, submitted to the insurer and kept on fi le, be a separate document, and be executed at the time of the application.

Written Comparison

If the individual accident and health policy being presented will replace an existing policy, the agent must provide the applicant with a written