Advanced Diploma in Insurance

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1 THE CHARTERED INSURANCE INSTITUTE 790 Advanced Diploma in Insurance Unit 790 Private medical insurance October 2011 examination Instructions Three hours are allowed for this paper. Do not begin writing until the invigilator instructs you to. Read the instructions on page 3 carefully before answering any questions. Provide the information requested on the answer book and form B. You are allowed to write on the inside pages of this question paper, but you must NOT write your name, candidate number, PIN or any other identification anywhere on this question paper. The answer book and this question paper must both be handed in personally by you to the invigilator before you leave the examination room. Failure to comply with this regulation will result in your paper not being marked and you may be prevented from entering this examination in the future. 1908

2 The Chartered Insurance Institute 2011

3 Unit 790 Private medical insurance Instructions to candidates Read the instructions below before answering any questions Three hours are allowed for this paper which carries a total of 200 marks, as follows: Part I 8 compulsory questions 48 marks Part II 1 compulsory question 50 marks Part III 3 questions selected from marks You should answer all questions in Part I, the compulsory question in Part II and three out of the five questions in Part III. The number of marks allocated to each question part is given next to the question and you should spend your time in accordance with that allocation. You are advised to spend no more than 45 minutes on Part I. Read carefully all questions and information provided before starting to answer. Your answer will be marked strictly in accordance with the question set. You may find it helpful in some places to make rough notes in the answer booklet. If you do this, you should cross through these notes before you hand in the booklet. It is important to show each step in any calculation, even if you have used a calculator. If you bring a calculator into the examination room, it must be a silent battery or solar-powered non-programmable calculator. The use of electronic equipment capable of being programmed to hold alphabetic or numerical data and/or formulae is prohibited. You may use a financial or scientific calculator, provided it meets these requirements. Answer each question on a new page. If a question has more than one part, leave six lines blank after each part PTO

4 PART I Answer ALL questions in Part I. Each question is worth six marks. Note form is acceptable where this conveys all the necessary information. 1. Outline: (a) four reasons why International Classification of Disease (ICD) codes were devised; (4) two reasons why private medical insurers use ICD codes in the claims assessment process. (2) 2. (a) Describe briefly how employee assistance programmes operate under company sponsored private medical insurance. (3) Explain briefly three examples of the services they provide. (3) 3. Explain briefly the function of and the benefits to be gained from: (a) automatic call distribution; (3) computerised telephony integration. (3) 4. Outline the doctrine of subrogation and its application to private medical insurance. (6) 5. (a) Explain briefly the qualitative and quantitative methods of research available to a private medical insurer that is assessing the suitability of its product range for the needs of its customers. (4) Give one example of either method of research identified in part (a) above. (2) 6. Explain briefly home nursing in the context of private medical insurance and state the extent to which insurers are prepared to offer cover for home nursing. (6)

5 7. Within the National Health Service describe briefly the provision of: (a) primary care; secondary care. (4) (2) 8. Outline six ways that an employer can limit the cost of its group private medical insurance scheme. (6) Questions continue over the page PTO

6 PART II Compulsory question. This question is worth 50 marks. 9. As a young man, Mr Green used amphetamines for non-medical purposes and developed a mild addiction but, following rehabilitation, he is no longer dependant. His application for private medical insurance is to be subject to full medical underwriting. (a) Describe fully the application process that the insurer will adopt and how this will impact on Mr Green. (30) Discuss: (i) the insurer s considerations in whether to obtain a report for Mr Green; (5) (ii) the operation of the Access to Medical Reports Act 1988 including Mr Green s rights under it. (15)

7 Part III questions can be found on pages 8 and PTO

8 PART III Answer THREE of the following FIVE questions. Each question is worth 34 marks. 10. A customer applying for private medical insurance has recently undergone a predictive genetic test and has disclosed the result to the insurer in support of the application for cover. (a) Discuss what is meant by genetic testing and its effect on the insurer s underwriting processes. (18) In connection with the Association of British Insurers Code of Practice on Genetic Testing, explain: (i) the protection afforded to the client s confidentiality; (11) (ii) the role of the insurer s Chief Medical Officer. (5) 11. (a) Evaluate the likely attitude of an insurer when considering claims under individual comprehensive private medical insurances that reveal the following conditions: (i) (ii) (iii) (iv) Mr A, has always been obese and is now experiencing chest pains which are probably due to the onset of angina; (4) Mr J, is in the early stages of stomach cancer that first emerged after his policy started and at present is treatable. His specialist has suggested that a revolutionary type of experimental treatment, alongside traditional medicine, would improve the possibility of a complete recovery; (7) Miss Q, fell awkwardly playing netball and fears she has damaged a cartilage in her knee; (4) Mrs Y, has intermittent breathing difficulties although she has no previous history of asthma. (6) Describe the rights that these customers have under the Data Protection Act 1998 with regard to the personal information held by the insurer. (13) 12. (a) Discuss ways in which the National Health Service (NHS) and private medical insurance are complementary in providing healthcare services to residents of the UK. (22) (c) Describe how private medical insurers use cash benefits and six-week schemes to encourage the use of NHS facilities. (6) Explain the effect that the tax treatment of premiums paid and benefits received by holders of individually-rated policies can have on the purchase of private medical insurance in the UK. (6)

9 13. (a) Evaluate how the objectives of the Financial Services Authority affect the obligations it places upon insurers wishing to transact private medical insurance (PMI) and related business in the UK. (20) The Association of British Insurers Statement of Best Practice is designed to ensure that the information needs of an individual are met when buying PMI cover. Describe the publications that a prospective policyholder can expect to receive and explain the key issues these publications cover. (14) 14. (a) Analyse the concept of worksite marketing from the perspective of an insurer or broker offering private medical insurance and related products to groups of employees. (10) Discuss the benefits and risks of worksite marketing specific to: (i) the insurer; (9) (ii) the broker; (5) (iii) employers; (4) (iv) employees. (6)

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