Frequently Asked Questions

 

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Private Passenger Automobile

Medical Expense (Health) Ins

Disability

Life Insurance

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Private Passenger Automobile
bulletWhy is automobile insurance sometimes referred to as 
a "packaged policy?" What are the parts of the package?
bulletI have an older car whose current market value is very 
low - do I really need to purchase automobile insurance?
bulletSuppose I lend my car to a friend, is he/she covered under 
my automobile insurance policy?
bulletWhat coverage does my automobile insurance policy 
provide me when I rent a car?
bulletWhat is the difference between collision physical damage 
coverage and comprehensive physical damage coverage?
bulletWhat should I do if I have an accident?
bulletWhy does the premium for my automobile insurance go up 
if I have an accident 
or if I get a ticket?
How can I get insurance for my motorcycle?
bulletWhat is no-fault insurance?
bulletWhat do I gain and what do I lose by giving up my tort rights?
bulletI live in a state where I can elect either no-fault coverage 
or traditional tort coverage. Which one should I choose?
bulletWhat factors can affect the cost of my automobile insurance?
bulletWhat should I consider when purchasing automobile insurance?
bulletHow can I lower my automobile insurance rates?

Medical Expense (Health) Insurance
bulletWhat are the principal types of medical expense insurance coverage?
bulletIs medical expense coverage available for substance abuse and mental illness?
bulletWhat types of expenditures are commonly excluded under major medical expense plans?
bulletWhat are  these costs?
bulletWhat is the coinsurance clause in medical expense plans and how does it work?
bulletWhat is the difference between coinsurance and co-payment?
bulletWhat is a preexisting conditions clause and what is the effect of its inclusion in major medical expense plans?
bulletHow does the medical expense coverage offered by Health Maintenance Organizations (HMOs) differ from the coverage provided under basic and major medical expense plans?

Disability
bulletIf I cannot afford to buy both life insurance and disability insurance, which coverage should I buy?
bulletHow much disability insurance should I own?
bulletWhat type of disability income insurance is best; insurance covering short-term disabilities only or policies that cover long-term disabilities?
bulletWhat are the primary differences between short-term disability (STD) and long-term disability (LTD) insurance policies?
bulletWhat is an elimination, or waiting, period and how does its definition differ between STD and LTD insurance policies?
bulletWhat is a maximum benefit period and how does its definition differ between STD and LTD insurance policies?
bulletWhat types of "definitions of disability" are commonly included in STD and LTD insurance policies?
bulletIn addition to coverage of partial or total disabilities and temporary or permanent disabilities, what other aspects of a "definition of disability" are important to consider when purchasing disability income insurance?
bulletAre disability insurance policies available that do not express the eligibility for disability benefits in terms of an "occupational" definition?
bulletDo all disability insurance policies cover losses arising from both accident and sickness?
bulletWhat specific causes of disability, if any, are generally excluded from coverage in disability insurance contracts?
bulletThe terms "non-cancelable" and "guaranteed renewable" are often used when referring to disability income insurance policies. What do these terms imply, and how do they differ?
bulletWhat factors affect the premium cost for disability income insurance?
bulletHow do the lengths of the waiting (elimination) period and the maximum benefit period affect the premium cost of disability insurance?
bulletWhy is it frequently true that group long term disability (LTD) insurance purchased at work is less expensive than individually purchased LTD insurance?
bulletWhat is the federal income tax treatment surrounding benefits received from a disability insurance policy?
bulletWhere can more information on disability insurance be obtained?

Life Insurance
bulletHow much life insurance should an individual own?
bulletWhat about purchasing life insurance on a spouse and on children?
bulletShould term insurance or cash value life insurance be purchased?
bulletHow does mortgage protection term insurance differ from other types of term life insurance?
bulletCan an existing life insurance policy be used to provide for the repayment of an outstanding mortgage loan?
bulletCredit life insurance is frequently recommended in conjunction with the taking out of an installment loan when purchasing expensive appliances or a new car, or for debt consolidation. Is credit life insurance a good buy?
bulletWhat is the tax treatment of life insurance cash values, dividends, and death benefits?
bulletWhat is participating whole life insurance?
bulletI have heard a lot about universal life insurance. How is this type of life insurance different from traditional whole life insurance?
bulletWhich type of cash value life insurance policy, universal life (UL) or participating whole life (WL) , is a "better buy" financially?
bulletWhat is variable life (VL) insurance, and how is it different from universal life (UL) and participating whole life (WL)?

 

 

 

 

Automobile Insurance:

Why is automobile insurance sometimes referred to as a "packaged policy?" What are the parts of the package?

Before the 1950's, if a person wanted to purchase all the coverage that the modern day automobile insurance policy provides, he or she would have had to purchase at least four separate policies. Changes in the laws that regulate the sale of insurance now allow the insurance industry to sell policies that combine the separate coverage’s into one all encompassing policy.

The main advantages of combining the various coverage’s are lower expenses, and therefore a lower cost to consumers, and the convenience of being able to purchase the property, automobile liability and other coverage’s in a single policy. The standard private passenger automobile insurance policy can have up to four different coverage’s. Only the first coverage is standard - the remaining three coverage’s are optional.

Part A provides liability coverage that protects the insured from lawsuits arising from either the negligent operation or ownership of a covered automobile. There are two coverage’s provided in Part A - bodily injury liability (BIL) and property damage liability (PDL).

1.BIL provides coverage for the bodily injury claims of people you negligently injure in an accident.  2.PDL provides coverage for any third party property damage claims that the courts determine you are responsible to pay.

Part B provides medical payments to the policy owner and any other passengers in the car when there is an accident.

Part C provides uninsured motorist and underinsured motorist protection for the policy owner.

Both coverage’s are designed to compensate the injured policy owner when the negligent driver has an insufficient amount of liability insurance under his/her own policy. Typically, Part C covers only bodily injury losses, but property damage losses are included in some states.

Part D covers damages to your car when it is involved in an accident.

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I have an older car whose current market value is very low - do I really need to purchase automobile insurance?

Most states have enacted compulsory insurance laws that require drivers to have at least some automobile liability insurance, Part A. These laws were enacted to ensure that victims of automobile accidents receive compensation when their losses are caused by the actions of another individual who was negligent.

Except for the minimum liability coverage’s that you may be required to purchase, many people with older cars decide not to purchase any of the physical damage coverage’s. It is often the case that the cost of repairing the damages to an older car is greater than its value. In these cases, your insurer will usually just "total" the car and give you a check for the car's market value less the deductible.

Many people forgo the Part D coverage’s because of the relatively low values of their automobiles.

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Suppose I lend my car to a friend, is he/she covered under my automobile insurance policy?

Whenever you knowingly loan your car to a friend or an associate, he or she will be covered under your automobile insurance policy. In fact, even if you do not give explicit permission each time a person borrows your car, they are still covered under your automobile insurance policy as long they had a reasonable belief that you would have given them permission to drive the car.

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What coverage does my automobile insurance policy provide me when I rent a car?

The answer to this question is not as easy as it once was. In the not-too-distant past, most automobile insurance policies would extend coverage to rental cars whenever you rented one. This is not quite true anymore.

In most cases, your personal automobile insurance policy will provide coverage only when you are renting a car on vacation. Many insurance companies no longer extend personal automobile insurance coverage when you are traveling on business. The best way to find out
what rental car coverage you have under your automobile policy is to call your insurance agent/company.

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What is the difference between collision physical damage coverage and comprehensive physical damage coverage?

Both collision and comprehensive are Part D coverage’s.

Collision is defined as losses you incur when your automobile collides with another car or object. For example, if you hit a car in a parking lot, the damages to your car will be paid under your collision coverage.

Comprehensive provides coverage for most other direct physical damage losses you could incur. For example, damage to your car from a hailstorm will be covered under your comprehensive coverage.

It is important to know the differences between the collision and comprehensive coverage’s for a couple of reasons.  First, in order to make an informed purchasing decision about these optional coverage’s, you need to know the difference between them.

Second, the deductibles under the collision and comprehensive coverage’s are often different in amount.

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What should I do if I have an accident?

The duties you need to perform after you have an accident are prescribed both by state law and by the terms of your contract. Obviously, the first thing you should do is make sure everyone is all right and call an ambulance if one is needed.

Second, for most accidents in most states, the police should be notified.

Third, you should give the other driver(s) involved in the accident your name, address, telephone number, and the name of your insurance company and/or your insurance agent. You also need to get this same information from the other driver(s).

Fourth, at the first opportunity, you should contact either your insurance agent or your insurance company to notify them that you have been involved in an accident.

Finally, there are a number of conditions in the insurance contract that you must satisfy in order to receive compensation from your insurer.  For example, you need to cooperate with your insurer during any investigation undertaken during the claims settlement process. Failure  to complete any of these actions can, and sometimes does, result in non-payment by your insurance company for losses that otherwise would have been covered.

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Why does the premium for my automobile insurance go up if I have an accident or if I get a ticket?

Actuaries and statisticians who have studied the claiming behavior of people involved in accidents have long known that people who have either had an accident or received a ticket recently are more likely to have another accident in the next couple of years than people whose recent driving record has been incident free.

Insurance companies use this information not to punish people who have had an accident, but to charge them the premium that most accurately reflects their likelihood of having an accident. People who are more likely to have accidents should reasonably be expected to pay higher premiums.

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How can I get insurance for my motorcycle?

Motorcycle insurance can be obtained by adding a miscellaneous-type vehicle endorsement to your existing automobile insurance policy. This endorsement will also provide coverage for mopeds, motor homes, dune buggies and other such vehicles.


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What is no-fault insurance?

With no-fault insurance, the victims of an automobile accident are compensated by their own insurance company, regardless of who caused the accident. This outcome is different from what occurs under the traditional tort system of compensating victims of an accident.

In the tort system, the party who is at fault is required to compensate the victims of the accident. The idea behind no-fault insurance is to keep small claims from being settled in our expensive legal system. To accomplish its purpose, no-fault insurance restricts the injured person's right to sue the negligent driver in those instances where the loss falls below a certain threshold.

Two types of thresholds are typically used: verbal thresholds and dollar thresholds. A dollar threshold prescribes a dollar limit that a claim must reach before the injured party regains his or her tort rights, and therefore the ability to sue.

A verbal threshold uses a written description to determine when the injured person regains his or her tort rights. For example, a person might regain his or her tort rights when the accident caused a serious handicap, such as permanent loss of a bodily function.

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What do I gain and what do I lose by giving up my tort rights?

Proponents of no-fault insurance argue policy owners gain a number of things by giving up their right to sue in minor accidents. For example, under no-fault insurance you typically pay lower automobile insurance premiums, collect claims payments faster, and spend less time in court.  The biggest thing you lose by giving up your right to sue is the ability to collect payments for pain and suffering. No-fault insurance only pays your direct economic losses, such as hospital bills, lost wages, etc. It does not compensate you for any pain and suffering damages that you may incur as a result of an accident.

However, in most serious accidents, where the likelihood of incurring these non-economic losses is greatest, you regain your tort rights and therefore the ability to sue the negligent party for pain and suffering.

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I live in a state where I can elect either no-fault coverage or traditional tort coverage. Which one should I choose?

A number of states allow policy owners to choose whether they would like no-fault insurance or traditional tort coverage. Which one you choose depends upon your tolerance towards the risk that you may not be able to sue for pain and suffering damages in all accidents.

However, since the thresholds where you regain your tort rights are usually low, many policy owners choose the no-fault coverage because the premium can be substantially reduced by doing so.

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What factors can affect the cost of my automobile insurance?

A number of factors can affect the cost of your automobile insurance - some of which you can control and some which are beyond your control. The type of car you drive, the purpose the car serves, your driving record, and where you live can all affect how much your automobile insurance will cost you.

Even your marital status can affect your cost of insurance. Statistics show that married people tend to have fewer and less costly accidents than do single people.

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What should I consider when purchasing automobile insurance?

There are a number of factors you should consider when purchasing any product or service, and insurance is no different.

Here is a checklist of things you should consider when purchasing automobile insurance.

First, purchase the amount of liability coverage which makes sense for you.

Second, you should decide which optional coverage’s you want.  For example, do you want the optional physical damage coverage’s in Part D or is the market value of your car too low to warrant purchasing them.

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How can I lower my automobile insurance rates?

There are a number of things you can do to lower the cost of your automobile insurance. The easiest thing to do is to shop around. It is not surprising to find quotes on automobile insurance that can vary by hundreds of dollars for the same coverage on the same car. When you shop, be careful to make sure each insurer is offering the same coverage. Many insurers use the ISO policy forms, but this is not always the case.

Another way to lower the cost of your automobile insurance is to look for any discounts that you may qualify for. For example, many insurers will offer you a discount if you insure multiple cars under the same policy, or if you have had a driver education class in the last five years. Be sure to ask your agent or your company about their discount plans.

Another easy way to lower the cost of your automobile insurance is to increase the deductible. Simply raising your deductible from $250 to $500 can lower your premium sometimes by as much as five or ten percent. However, you should be careful to make sure that you have the financial resources necessary to handle the larger deductible.

Although we make every effort to insure accuracy in the information provided, we cannot make any guarantees as to this accuracy. We urge you to consult your lawyer, accountant or tax advisor for specific legal or tax advice.

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Medical Insurance:

What are the principal types of medical expense insurance coverage?

Medical expense insurance is broadly classified into two principal types of coverage: base (or basic) plans and major medical plans. Base plans generally consist of either hospital expense coverage, surgical expense coverage, or both. Basic hospital and surgical expense plans generally provide coverage on a first-dollar basis (i.e., no deductible) and provide 100 percent reimbursement of covered expenses, up to a relatively low maximum of $10,000, $25,000, $50,000 or $100,000. Major medical plans, in contrast, apply a deductible to initial expenses, generally ranging from $100 to $500 per calendar year. After the deductible is satisfied, major medical plans typically reimburse 80 percent of eligible expenses up to a relatively high maximum, e.g., $500,000 or $1,000,000. Some major medical plans reimburse eligible expenses at 70 percent; some plans also provide unlimited lifetime benefits. Major medical plans typically cover a broad list of medical expenditures, including hospital expense, surgical expense, physician (non-surgical) expense, private duty nursing, diagnostic X-ray and laboratory services, prescription drug expense, artificial limbs and organs, ambulance services, and many other types of medical expenses when prescribed by a duly licensed physician. Thus, in comparison with basic plans, major medical plans provide much broader coverage, with higher limits, but these plans require the insured to share in the cost of medical care through deductibles and coinsurance (i.e., 20 or 30 percent of eligible expenses above a deductible amount).

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Is medical expense coverage available for substance abuse and mental illness?

Major medical expense plans also generally provide coverage for treatment of substance abuse (e.g., alcoholism and drug usage) and mental illness. A higher coinsurance percentage (e.g., 50 percent) and a lower lifetime benefit limit (e.g., $25,000 or $50,000) generally applies, however. In addition, the extent of coverage may depend on whether treatment is provided on an in-patient or out-patient basis.

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What types of expenditures are commonly excluded under major medical expense plans?

Although providing very broad coverage, major medical plans typically contain a number of exclusions. Common exclusions include medical expenditures arising from: (1) convalescent or custodial care; (2) physical examinations, unless required for the treatment of an injury or illness (it should be noted that some plans now cover this expenditure); (3) cosmetic surgery unless required to correct a condition resulting from an injury or a birth defect; (4) occupational injuries and illnesses that are otherwise covered under a Workers' Compensation law; and (5) routine dental and vision care (care required for treatment of an injury and dental and eye surgery are frequently covered, however). Other common exclusions relate to benefits provided by government agencies (e.g., VA hospitals) and expenses paid under other insurance programs, including Medicare.  Even though major medical plans provide broad coverage, insureds still incur certain "out-of-pocket" costs.

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What are  these costs?

An insured's "out-of-pocket" costs under major medical expense plans include the deductible, cost-sharing amounts arising from the operation of the coinsurance clause, and medical expenditures that are deemed by the plan to be in excess of "reasonable and  customary" charges. Only charges that are "reasonable and customary" for a specific type of service, in a particular location or geographic area, are eligible for reimbursement under medical expense plans. The definition of "reasonable and customary" may vary somewhat from one medical expense plan to another.

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What is the coinsurance clause in medical expense plans and how does it work?

Coinsurance, sometimes called "percentage participation," requires the insured to share in the cost of medical care. Under an 80/20 coinsurance provision, the medical expense plan pays 80 percent of eligible medical charges above any deductible. The insured is required to pay the remaining 20 percent. Other coinsurance arrangements, e.g., 70/30 or 90/10, are sometimes used. In the event of large or catastrophic medical expenses, an insured might suffer severe financial hardship due to the operation of the coinsurance clause. To compensate for this possibility, many major medical expense plans contain a coinsurance cap, or stop-loss limit. This provision places a limit on the insured's out-of-pocket costs in a  given year arising from the operation of the coinsurance clause. The size of the coinsurance cap generally ranges from $2,000 to $3,000, depending on the plan, although limits as low as $1,000 are sometimes used. Once the coinsurance cap has been reached, all eligible expenses above this amount are paid in full, up to the plan's overall limit of coverage.

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What is the difference between coinsurance and co-payment?

On occasion, these terms have been used interchangeably. However, it is preferable to define the two terms differently, despite their similarity of purpose. Under a co-payment or co-pay provision, the insured usually is required to pay a set or fixed dollar amount (e.g., $3, $5, or $10) each time a particular medical service is used. Co-pay provisions are frequently found in medical plans offered by health maintenance organizations (HMOs) where a nominal co-payment is applied to each office visit and to each prescription that is filled.

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What is a preexisting conditions clause and what is the effect of its inclusion in major medical expense plans?

A preexisting condition is often defined as a medical condition (i.e., an injury or illness) that required treatment during a prescribed period of time, e.g., 3 or 6 months, prior to the insured's effective date of coverage under the major medical expense plan. Sometimes, a preexisting condition is defined to include medical conditions that were known to the insured, even though no treatment was provided during the prescribed period. A preexisting conditions clause excludes coverage for preexisting conditions for possibly as long as 12 months after the effective date of coverage. Because the definition of a preexisting condition, and the provisions of the clause itself, may differ considerably from one plan to another, it is recommended that newly insured individuals (and prospective insureds) completely familiarize themselves with this policy provision.

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How does the medical expense coverage offered by Health Maintenance Organizations (HMOs) differ from the coverage provided under basic and major medical expense plans?

Basic and major medical expense plans are generally classified as indemnity contracts. These plans indemnify, or reimburse, the insured for medical expenses incurred and typically require the completion and filing of claim forms. In addition, these plans usually contain deductible and coinsurance cost sharing provisions and may restrict coverage for certain types of medical care expenditures.  Indemnity plans, however, provide the insured with substantial freedom relative to the choice of physician, including whether a primary care physician or a specialist will be seen. In contrast, HMO coverage emphasizes comprehensive (including preventive) care and typically contains very few exclusions, no (or small) deductibles, and nominal co-payments. However, there is much less freedom of choice of physician under traditional HMO coverage since the patient is typically required to be under the care of a primary care physician who serves as a "gatekeeper." In this role the primary care physician determines whether the services of a specialist are needed, in addition to determining what other medical services are required for  treatment. Some HMOs today offer a point-of-service option, whereby patients may opt for indemnity type coverage (with a deductible and coinsurance) when they desire medical treatment outside the HMO network.

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Disability:

 

If I cannot afford to buy both life insurance and disability insurance, which coverage should I buy?

Both life insurance and disability insurance are important and vital to the financial security of most individuals. In some instances, however, financial resources are inadequate to purchase the needed amounts of both types of insurance. Generally speaking, throughout the typical working lifetime (e.g., ages 20-65), the probability of an individual suffering a major disability (e.g., a disability lasting 3 months or longer) is considerably greater that the likelihood of dying. The probability of a young worker suffering a major disability is as much as 6 (or more) times the probability of dying; the multiple is still 2 or more even at the higher working ages. These relative probabilities would suggest that the purchase of disability income insurance is a more important purchase than is the purchase of life insurance.

Another factor supporting this view is that, in the case of disability, total expenses of the family unit will also be higher due to the costs of caring for the disabled worker.

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How much disability insurance should I own?

The recommended amount of disability income insurance generally ranges from 60-70 percent of pretax income. The applicable percentage for higher-income persons is usually somewhat lower than the percentage recommended for lower-income individuals, due primarily to differences in income taxes. Amounts considerably less than full replacement of earnings are recommended due to a reduction in income taxes and decreases in commuting and other work-related costs that are likely to occur in the event of disability. On the other hand, medical, rehabilitation and certain other expenses are often higher for disabled individuals creating a need for larger amounts of replacement income. In determining how much disability income insurance to buy, any benefits payable under Workers' Compensation, Social Security, and employer-provided disability benefits under pension or group insurance plans should also be considered. Whether the disability benefits themselves are subject to income taxation should also be factored into this determination. The assistance of a professional insurance adviser normally should be sought in making this determination.

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What type of disability income insurance is best; insurance covering short-term disabilities only or policies that cover long-term disabilities?

Assuming that only one of these types of disability insurance products will be purchased, sound risk management principles would suggest the purchase of long-term disability (LTD) insurance. LTD insurance protects the insured against disabilities that may last many years, or even a lifetime, and thus provides protection against large losses of potentially catastrophic magnitude. Although long-term disabilities occur less frequently than disabilities of a relatively short duration (e.g., several weeks or even a few months), the loss of income for a short duration can be more easily absorbed by the family unit than can an income loss that lasts for several years or longer.

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What are the primary differences between short-term disability (STD) and long-term disability (LTD) insurance policies?

These two types of insurance coverage differ most importantly in terms of the length of the elimination (waiting) period, the length of the maximum benefit period, coordination of the benefits payable under the policy with benefits payable under social insurance programs (e.g., Social Security and Workers' Compensation), and the "definition of disability" incorporated into the contract language.

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What is an elimination, or waiting, period and how does its definition differ between STD and LTD insurance policies?

The elimination, or waiting, period in disability insurance refers to the length of time between the onset of a qualifying disability and the point in time when benefits under the disability insurance policy first become payable. In STD plans, waiting periods may range from 0 days to 3, 7, 10 or 14 days, depending on the specific insurance  policy and the cause of disability. Disabilities resulting from accidents often are subject to shorter elimination periods (e.g., 3 or 7 days) than are disabilities caused by sickness. In LTD plans, elimination
periods generally range from 3 to 6 months, or longer, for disabilities arising from both accidents and illnesses.

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What is a maximum benefit period and how does its definition differ between STD and LTD insurance policies?

The maximum benefit period in disability income insurance refers to the maximum length of time during which benefits will be payable to an insured with an ongoing, qualifying disability. By definition, STD insurance policies are those policies whose maximum benefit period does not exceed two years (24 months) in length. Typically, however, STD insurance provides coverage for benefit periods lasting a maximum of 13 or 26 weeks. In contrast, LTD insurance policies typically provide benefits (contingent on continued disability, of course) for as long as 5 years, to age 65 or 70, or even lifetime.

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What types of "definitions of disability" are commonly included in STD and LTD insurance policies?

 Some disability income insurance contracts provide coverage only for "total and permanent" disabilities. Others provide coverage for "total and permanent" disabilities, "partial disabilities," and "temporary" disabilities. Some policies providing "partial" disability coverage require that the "partial" disability be proceeded by a period of "total" disability. Since these terms are often confusing, with their definitions differing somewhat from one policy to the next, it is recommended that insureds discuss this issue at length with their insurance adviser.

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In addition to coverage of partial or total disabilities and temporary or permanent disabilities, what other aspects of a "definition of disability" are important to consider when purchasing disability income insurance?

 The way in which a disability is defined, especially as it relates to the inability of the insured to perform a particular occupation, is exceedingly important. Several insurers market policies that define total disability in terms of the inability of the insured to perform the usual and customary duties of his or her "own occupation"--the job the insured was doing at the time of the injury or onset of sickness. Other policies define total disability in terms of the inability to perform the regular duties of "any occupation." "Any occupation" is often defined as a job for which the insured has the necessary skills and training and, possibly, at a salary commensurate with the one in which the insured was employed at the time of the incident. The "own occupation" definition is more liberal to the insured and is frequently recommended over an "any occupation" definition. Sometimes a "split definition" is used which incorporates an "own occupation" definition for an initial period (e.g., 2 years), followed by an "any occupation" definition thereafter.

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Are disability insurance policies available that do not express the eligibility for disability benefits in terms of an "occupational" definition?

Some insurers market disability insurance policies that define disability not in terms of a particular occupation, but rather simply in terms of the amount of income actually lost. Under these contracts, if an insurable event occurs such as an accident or illness, then disability benefits are payable to the extent that the insured suffers a loss of income that exceeds a threshold amount, e.g., a loss of 20 percent or more of the individual's earnings prior to the happening of the insured event. When the threshold amount is exceeded, the policy pays a benefit that is based on the percentage of total "prior earnings" lost due to the disability.

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Do all disability insurance policies cover losses arising from both accident and sickness?

 No. Some policies cover only disabilities arising from an accidental injury, providing no coverage for disabilities caused by sickness. A careful reading of the contract is recommended to determine the extent of coverage provided under the disability insurance policy that you are considering purchasing. Sound risk management suggests the purchase of a policy that covers disabilities arising from either an accident or an illness.

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What specific causes of disability, if any, are generally excluded from coverage in disability insurance contracts?

Generally, injuries that are intentionally self-inflicted or caused by war or an act of war are excluded. Disability policies may also include a "preexisting conditions" exclusion whose purpose is to exclude from coverage, during an initial period (e.g., the first one or two policy
 years), a disability arising from an undisclosed health condition that was both present within a prescribed time period prior to policy issuance and required medical treatment or otherwise caused symptoms that normally would require medical care. Through the "military suspense provision," coverage under a disability insurance policy is suspended during any period that the insured is on active duty in the military.

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The terms "non-cancelable" and "guaranteed renewable" are often used when referring to disability income insurance policies. What do these terms imply, and how do they differ?

"Non-cancelable" policies provide insureds with the right to renew their policies each year, typically to age 65, by the timely payment of the required premium. A guaranteed premium is stipulated in the contract and may not be changed by the insurer. During the non-cancelable period, the insurer is precluded from canceling the contract or otherwise making any unilateral change in the policy benefits. "Guaranteed renewable" contracts also provide insureds with the right to renew their policies to age 65 (typically) through the timely payment of the premium. However, under "guaranteed renewable" policies, the insurer retains the right to change premiums if it does so for all insureds in the same rating class. The insurer is not permitted to cancel the policy or unilaterally amend the policy benefits during the period that the policy is guaranteed renewable. Further, under both types of contracts, the insurer is not permitted to increase the premiums, on a selective basis, only for those insureds  whose health status has deteriorated. Because of the premium
 guarantee feature, "non-cancelable" policies may be somewhat more expensive than "guaranteed renewable" policies. In general, disability policies containing a "guaranteed renewable" or a "non-cancelable" feature provide better protection to an insured, albeit possibly at a higher cost, than do "conditionally renewable" or other similar types of disability insurance policies that give the insurer a right to refuse to renew coverage for reasons stated in the policy (and typically also give the insurer the right to increase premiums and change benefits so long as these changes apply to all insureds in the same class).

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What factors affect the premium cost for disability income insurance?

A number of contract features and options affect the premium cost
 for disability income insurance. Several of the more important factors are (1) the amount of weekly or monthly benefit purchased, (2) the  length of the elimination (waiting) period, (3) the length of the maximum benefit period, (4) whether or not the disability insurance benefits are coordinated with social insurance benefits, (5) the occupational class of the insured, (6) the definition of disability, and (7) whether the policy is non-cancelable or guaranteed renewable.

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How do the lengths of the waiting (elimination) period and the maximum benefit period affect the premium cost of disability insurance?

The elimination (waiting) period in disability income insurance serves the same purpose as a deductible in medical expense, automobile and other types of insurance. It eliminates initial, or "first-dollar," benefits from coverage under the insurance policy. As such, longer waiting periods result in lower premiums. There is a similar, but opposite, relationship between varying maximum benefit periods and the premium cost for disability income insurance. As the length of the maximum benefit period increases, total premium cost also increases. When limited dollars are available to purchase disability income insurance, it is generally recommended that longer waiting periods be selected so that longer maximum benefit periods can be afforded. Of course, the amount of cash reserves available to the insured as a
 "safety net" should also be factored into the determination of the length of the waiting period that is selected.

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Why is it frequently true that group long term disability (LTD) insurance purchased at work is less expensive than individually purchased LTD insurance?

There are a number of reasons why group LTD may be purchased by employees at a lower premium cost than what these same individuals can purchase on their own, away from their place of employment. First, an employer often contributes toward the premium cost of group LTD coverage, thereby reducing the out-of-pocket cost to employees. Secondly, group LTD plans almost always coordinate their benefits (i.e., plan benefits are reduced) with any disability benefits payable under Workers' Compensation or Social Security. In contrast, individual disability income insurance typically pays benefits in addition to any benefits payable under social insurance programs. Third, individual policies often contain a longer maximum benefit period, a "non-cancelable" feature, a "cost-of-living" benefit rider, and an option to purchase additional insurance--expensive features not always found in group LTD policies. Fourth, marketing and sales, administrative, underwriting and other expenses are usually lower for employer-provided group insurance than for insurance purchased individually from an agent.

 

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What is the federal income tax treatment surrounding benefits received from a disability insurance policy?

The answer to this question depends on who paid the insurance premiums. If the insured paid the premiums with after-tax dollars, then the disability benefits should be received income tax-free. In contrast, if an employer paid part or all of the premiums then an equivalent portion of the benefits are generally taxable to the insured (in this instance, however, an income tax credit may be available to the insured). In any event, your tax adviser should be consulted with respect to the probable income tax treatment of any disability income coverage that you currently have or are contemplating purchasing.

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Where can more information on disability insurance be obtained?

A free copy of the Consumer's Guide to Disability Insurance can be obtained from the Health Insurance Association of America, 555 13th Street N.W., Suite 600 East, Washington, D.C. 20004-1109.

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Life Insurance:

How much life insurance should an individual own?

Rough "rules of thumb" suggest an amount of life insurance equal to 6 to 8 times annual earnings. However, many factors should be taken into account in determining a more precise estimate of the amount of life insurance needed. Important factors include income sources (and amounts) other than salary/earnings, whether or not the individual is married and, if so, what is the spouse's earning capacity, the number of individuals who are financially dependent on the insured, the amount of death benefits payable from Social Security and from an employer-sponsored life insurance plan, whether any special life insurance needs exist (e.g., mortgage repayment, education fund, estate planning need), etc. It is recommended that a person's insurance adviser be contacted for a precise calculation of how much life insurance is needed.

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What about purchasing life insurance on a spouse and on children?

In certain circumstances, it may be advisable to purchase life insurance on children; generally, however, such purchases should not be made in lieu of purchasing appropriate amounts of life insurance on the family breadwinner(s). It is of utmost importance that the
income earning capacity of the primary breadwinner be fully protected, if possible, through the purchase of the required amount of life insurance before contemplating the purchase of life insurance on children or on a non-wage earning spouse. In a dual-earning household, it is important to protect the income earning capacity of both spouses. Life insurance on a non-wage earning spouse is often recommended for the purpose of paying for household services lost at this individual's death.

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Should term insurance or cash value life insurance be purchased?

Although a difficult question--one whose answer will vary depending on circumstances--several principles should be followed in addressing this issue. It must first be recognized that in any life insurance purchasing decision, there are at least two basic questions that must be answered: (a) "How much life insurance should I buy?" and (b) "What type of life insurance policy should I buy?" The question contained in (a) involves an "insurance" decision and the
 question contained in (b) requires a "financial" decision. The "insurance" question should always be resolved first. For example, the amount of life insurance that you need may be so large that the only way in which this needed amount of insurance can be afforded is through the purchase of term insurance with its lower premium. If your ability (and willingness) to pay life insurance premiums is such that you can afford the desired amount of life insurance under either type of policy, it is then appropriate to consider the "financial" decision--which type of policy to buy. Important factors affecting the "financial" decision include your income tax bracket, whether the need for life insurance is short-term or long-term (e.g., 20 years or longer), and the rate of return on alternative investments possessing similar risk.

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How does mortgage protection term insurance differ from other types of term life insurance?

The face amount under mortgage protection term insurance decreases over time, consistent with the projected annual decreases in the outstanding balance of a mortgage loan. Mortgage protection policies are generally available to cover a range of mortgage repayment periods, e.g., 15, 20, 25 or 30 years. Although the face amount decreases over time, the premium is usually level in amount. Further, the premium payment period often is shorter than the maximum period of insurance coverage--for example, a 20-year mortgage protection policy might require that level premiums be paid over the first 17 years.

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Can an existing life insurance policy be used to provide for the repayment of an outstanding mortgage loan?

Yes; the purchase of a new mortgage protection term insurance policy is usually not required by the lender. An existing policy, either term or cash-value life insurance, can be used for many purposes, including paying off an outstanding mortgage loan balance in the event of the insured's death.

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Credit life insurance is frequently recommended in conjunction with the taking out of an installment loan when purchasing expensive appliances or a new car, or for debt consolidation. Is credit life insurance a good buy?

Credit life insurance is frequently more expensive than traditional term life insurance. Further, if you already own a sufficient amount of life insurance to cover your financial needs, including debt repayment, the purchase of credit life insurance is normally not advisable due to its relatively high cost.

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What is the tax treatment of life insurance cash values, dividends, and death benefits?

The "interest build-up" portion of the annual increase in the policy's cash value is not taxed currently to the policy owner. Dividends generally are considered to be a "return of premium" and are not taxable to the policy owner. Although in the typical case, life insurance death proceeds will not be subject to income taxation, these proceeds may be subject to federal estate taxation. If the insured has any elements of ownership in the policy at the time of his/her death, the proceeds are incredible in the insured's gross estate for federal estate tax purposes. State inheritance taxes and federal gift taxes may also apply to life insurance policies/proceeds under specific circumstances. You should contact your tax adviser regarding questions concerning the possible income, estate and gift tax consequences surrounding any life insurance that you currently own or are contemplating purchasing.

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What is participating whole life insurance?

Participating (par) whole life insurance has been marketed for many years in the US The participating feature allows for the payment of dividends to policy owners when actual experience justifies such payment. Substantial amounts of participating whole life insurance is still sold today, principally by the large mutuals.

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I have heard a lot about universal life insurance. How is this type of life insurance different from traditional whole life insurance?

Both traditional whole life (WL) and universal life (UL) products are examples of cash-value life insurance. However, there are several important differences between these two products. While WL policies contemplate the payment of fixed, level premiums and provide for level death benefits, UL policies offer adjustable death benefits and flexible premiums that can be varied according to changing circumstances. This is a rather simplistic comparison, however, since policy owner dividends under participating WL insurance contracts can be used to offset a portion of the premium payment otherwise required; in addition, dividends can be used to increase the policy's death benefit. Because of these and other possible uses of policy owner dividends, an argument can be made that participating WL insurance possesses some (but not all) of the same flexibility/adjustability that is possessed by UL policies. Another important difference between WL and UL relates to product transparency. In UL policies, it is easy for policy owners to look at the internal operations of the policy and to examine the relationships among various policy elements (premiums, cash values, interest credits, mortality charges, and expenses) and how they interact with each other. Please note that Dividends are not guaranteed.
 

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Which type of cash value life insurance policy, universal life (UL) or participating whole life (WL) , is a "better buy" financially?

There is no simple answer to this question. The best performing product (from a financial perspective), whether UL, WL or some other type of cash value life insurance, will likely be the one offered by the insurer that enjoys the best future experience as it relates to interest earnings, actual expenses and mortality costs. Insurers earning the highest investment income, and who also incur the lowest expenses and the lowest mortality costs, are in the best position to offer life insurance at the lowest cost. This is true whether the cash value life insurance product being offered is UL or WL. Thus, it will be necessary for prospective insureds and their advisers to carefully examine the financial aspects of each product under consideration, irrespective of whether the product is UL or WL.
 

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What is variable life (VL) insurance, and how is it different from universal life (UL) and participating whole life (WL)?

Variable life insurance is a type of fixed-premium whole life insurance policy where changes in the policy's cash values and death benefits are directly related to the investment performance of an underlying pool of assets. Policy owners typically can choose among several investment options as to where the assets backing the policy's cash values will be invested. The various investment options offered in the contract generally possess different risk/return relationships and frequently include a money market fund, a bond fund, and one or more common stock funds. Although the policy's death benefit is directly related to the actual performance of the invested assets, the policy may prescribe that the death benefit will not fall below a minimum amount (usually the initial face amount) even if the invested assets
depreciate in value by a substantial amount. Because the policy owner assumes all of the investment risk, there is no similar "floor" below which cash values may fall. In recent years variable universal life (VUL) insurance has become a more popular product than VL. VUL
combines features of both UL and VL and, in essence, is the flexible premium version of VL.

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Variable Life insurance policies are sold by prospectus, which includes information on charges, expenses, and risks. To receive a current prospectus, please contact Bernard Mallan at (856) 866-9599. You should read the prospectus carefully before investing or sending any money.