Insurance

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Term Life Insurance

Term life insurance pays out its face value (the value specified on the policy) if the policyholder dies during the period specified in the policy. People may purchase term life coverage for 1, 5, 10, or 20 years. It works best for covering defined costs in the case of death, such as to pay off short-term loans. Younger people also buy term life insurance because of its affordability, perhaps its biggest advantage. Young families, in particular, often need more coverage than they could afford through permanent insurance. Term life can provide fairly large amounts of coverage with relatively low premiums.

However, some people need longer-term coverage to provide for such expenses as a 30-year home mortgage loan or estate taxes imposed after the insured person’s death. Term insurance can play a part in covering certain long-term expenses, if the insurer can design policy options to match the need.

Using term insurance policies to deal with long-term risks poses two serious problems: (1) An insured person’s health may decline to the point that the insurance company will no longer wish to extend a policy for another term. To protect against this problem, a policyholder can consider adding an option to make a policy guaranteed renewable, an agreement in which an insurance company must continue to provide coverage if the policyholder wants it. (2) The premiums of guaranteed renewable term life policies, or any term policy, commonly increase with each renewal. Often the increasing premiums become so high that policyholders decide to drop their coverage, sometimes before the need for the coverage disappears.

Policyholders using term life insurance to protect against long-term risks should consider buying convertible term insurance, which can be changed to permanent coverage. Convertible term life policyholders can switch their coverage as soon as they can afford additional premium costs. Once this switch is made, costs usually remain stable.

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Permanent Life Insurance

Permanent life insurance pays its face value whenever policyholders die, as long as they have complied with policy requirements. Most types of permanent life insurance policies also provide a cash surrender value, which returns some money to people who cancel their policies. This practice helps maintain fairness within large groups of policyholders.

If the risk that caused some people to buy their insurance, such as an outstanding debt, should disappear, those people would probably decide to discontinue their coverage, often called “surrendering the policy.” But they would also have overpaid for the amount of risk protection delivered by the time they ended coverage. Cash surrender rules allow individuals who surrender their policies to take some or most of their overpayments out of the group without hurting those who retain their policies.

Insurance companies commonly sell three different categories of permanent life insurance: (1) whole life, (2) universal life, and (3) variable life. Although some insurance companies may use different names to market their policies, most fall into one of these three categories.

Whole life insurance spreads the cost of insurance coverage over a person’s entire life through a payment plan of regular, equal installments. People’s early payments into a whole life plan actually exceed what they would have had to pay for similar amounts of term insurance coverage. But these overpayments accumulate in whole life policies to a cash-surrender-value fund. The fund returns money to those who end their coverage and also keeps premiums from going up for people who do not end their coverage. Whole life policyholders may take out loans using their insurance as collateral, which they can either repay with interest or deduct from their death benefit (face-value benefit at death).

Another type of policy, known as endowment life insurance, resembles whole life but runs for less than the full life of the policyholder. Endowment policies pay out their face value at the contract’s end, even if the insured is still living. Because endowments have short terms, they also have higher premiums than do whole life policies, which in turn force the policyholder to save more.

Universal life insurance policies are permanent plans that incorporate some features of term life plans. Although more flexible than whole life, universal life policies transfer less of policyholders’ total risk to the insurance company. Typically, a universal life policy has a flexible target premium, which the insurance company calculates will keep the plan in force for life for a particular group of policyholders. Policyholders may pay somewhat more or less than the target premium, depending on their current financial circumstances.

When an insurance company collects universal life premiums for a particular policy period, it allocates a portion of that premium to pay claims if policyholders die during the policy period. This is called the policy’s mortality charge, which is the equivalent of a term life insurance premium. The company then deposits the remainder of the universal premium in an investment account that earns interest. The amount that results is called the policy’s accumulation value. The accumulation value minus any charge for surrendering the policy equals its cash surrender value. The company repeats the same calculation each month, deducting the mortality charge from the accumulation value in months when no premium is paid.

Variable life insurance works much like whole life except that the insurance company invests overpayments from all policyholders in the stock market instead of in accounts that earn a regular rate of interest. The performance of stock investments varies. Therefore, the insurer and policyholders cannot know the exact cash surrender values of policies in advance. Instead, their value depends on the performance of the stocks bought with money from premiums.

Some variable life policies also allow the death benefit to vary with stock market performance. Variable universal life, a variety of policy introduced in the 1980s, combines the stock market investment feature of variable life insurance with the flexible premium feature of universal life.

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Health and Disability Insurance

Illnesses and disabilities can lead to enormous medical care expenses and also can prevent people from being able to earn income, so insurance can provide important economic relief. Health insurance protects people against the costs and consequences of illness and injury. Disability income insurance, or disability insurance, provides money for ordinary living expenses if an accident or illness prevents a policyholder from working. Employer-sponsored workers’ compensation plans provide limited coverage that applies only to job-caused or -related disabilities.

In many countries, government programs provide both health care services and insurance support for health care. The provincial governments of Canada, for instance, provide a fairly wide range of medical services to all of the country’s residents. Many governments also provide limited forms of disability insurance. People should understand what kinds of coverage government programs provide in order to determine what protection they need from private policies.

About 20 percent of people in the United States purchase individual health insurance to cover medical costs. Policies that cover all expenses for what is defined as medically necessary treatment provide better protection than do ones that limit benefits to accidents, cancer, or other specific causes for treatment.

Most people buy health insurance as part of a group. Group health plans generally have lower premiums than do individual plans. In 1995 in the United States, employee benefit plans, group plans sponsored by many employers, provided medical coverage for about 60 percent of nonelderly individuals and families. More employers offer insurance to cover medical expenses than coverage for income loss due to disability.

Independent insurance companies and health care providers manage most employee health insurance plans, and most insurers work with a number of businesses. Similar plans exist in Canada, but they provide more limited coverage because they build upon the substantial base provided by government-funded health plans. In addition to employers, many professional associations, unions, and other organizations offer benefit plans to their members.

Some very large businesses may provide their own group insurance plans, known as self-insured health plans. Many government regulations that apply to standard insured plans do not apply to self-insured health plans. Therefore, people covered under self-insured plans have limited recourse in the event of a dispute over medical service or insurance coverage.

Many health insurance plans offer separate policies for very specific kinds of insurance, in addition to general medical care. For instance, dental coverage, if purchased, pays for routine care and often a portion of the costs of more complex dental procedures. Vision care insurance pays for visits to eye doctors as well as a portion of the price of prescription corrective eyewear. Another type of policy provides long-term care for critically ill or terminally ill patients. These coverages, when added to general health insurance, lead to higher premium costs.

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Government Programs

The governments of many countries provide a basic level of health and disability insurance and services for their citizens. In the United States, the Medicare program, operated by the Social Security Administration, helps assure that people with disabilities and senior citizens have access to health services. Medicaid programs, funded by both state and federal revenues, also operate in all 50 states to provide medical care for the poor (see Medicare and Medicaid).

Medicare medical insurance, which helps pay for routine medical care, is funded by contributions from the elderly and by general federal revenues. The U.S. government takes a tax out of people’s paychecks to fund Medicare hospital insurance, which helps pay for hospital care.

Canada also has provincially administered health insurance programs called Medicare (in most provinces) that are very different from the U.S. program of the same name. Under the Canadian Medicare program, each province and territory provides a wide range of health coverage to all residents. See also National Health Insurance.

The U.S. Social Security program provides some disability protection for workers through its Old-Age, Survivor’s, and Disability Insurance program, or OASDI. The federal government takes a portion of people’s incomes in taxes earmarked specifically to pay for OASDI. The disability portion of OASDI provides fairly minimal coverage, and it does not cover short-term disabilities. Thus, people who want adequate compensation in the event of disability usually try to have a combination of government-provided and employer-provided or individual plans. Similarly in Canada, the Canada Pension Plan and the Quebec Pension Plan provide limited disability benefits to workers who have contributed to the system.

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Private Health and Disability Insurance

The health insurance sold by private U.S. insurance companies promises to indemnify (reimburse) the insured for covered medical expenses. A contract of indemnification puts the ultimate responsibility for the entire bill with the policyholder. Doctors and hospitals often submit their bills directly to insurers as an administrative courtesy designed to speed up their payments. Any portion of a bill not paid by an insurer becomes the policyholder’s own responsibility to pay.

Health insurance plans that offer only indemnity coverage are known as fee-for-service plans. Today, however, many people cover the costs of health care through managed care plans, which promise to actually manage or provide, not simply insure, medical services covered by their policies. People who use managed care rarely or never go through a process of indemnification, because their contracts guarantee the provision of health care services instead of repayment for the cost of those services. In some cases, a managed care plan may use a process of indemnification to pay for services given by health care providers who are not part of the plan. The common types of managed care include (1) health maintenance organizations, (2) preferred provider organizations, and (3) point-of-service plans.

A health maintenance organization (HMO) agrees to provide patients with whatever medical services they need usually given by health care providers who are part of the HMO in exchange for their monthly premium payment. HMOs tend to provide good coverage of routine health care services, but limit the choices of which doctors and hospitals patients can use.

Preferred provider organizations (PPOs) have contracts with health care providers who will charge favorable rates for services to insured members. PPO members choose a primary care physician who is responsible for referring patients to specialists. Policyholders must pay higher amounts for services received from health care providers not in the PPO network.

Point-of-service (POS) plans provide a combination of PPO network benefits with the option of receiving indemnity coverage for care outside the network. Health care service within a POS network works the same as in a PPO.

In most U.S. states and in parts of Canada, a system of independent insurance providers known as Blue Cross and Blue Shield member plans offer many types of health insurance coverage. Blue Cross and Blue Shield plans were the first to offer a form of prepaid health care coverage, beginning in the 1930s. Today they offer HMO, PPO, POS, and fee-for-service coverage. Collectively, Blue Cross and Blue Shield member plans are the largest provider of managed care services in the United States.

The individual disability insurance offered by private insurance companies often has fairly strict coverage qualifications. Plans commonly offer to provide between 50 percent and 60 percent of a person’s income should he or she suffer a disability. Many people purchase individual disability insurance to augment the coverage provided by group plans and government disability-income insurance.

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