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301-TXTPDF-18.pdf
Front Cover
Table of Contents
Preface
Introduction
Chapter 1: Insurance Administration and the Customer Experience
Insurance Administration Areas
Primary Administration Functions
Other Insurance Functions
The Customer Experience
Customer Experience Management
The Customer Journey
Developing a Customer-Centric Culture
Challenges to Implementing Customer Experience Management Measures
Insurers’ Ethical Duties to Customers
Equity in Risk Acceptance
Honest, Objective, and Fair Customer Service
Protection of Customer Information
Prompt and Equitable Claim Handling
Adequate Financial Resources
Chapter 2: Considerations for Insurance Administration
Regulatory Compliance
Privacy
Fraud
Unfair Trade Practices
Quality Control
Metrics
Data Visualization Tools
Administration Systems and Strategies
Process and Technology Management
Paperless Processing
The Power of Data
Data Management
Information Security
Data Interpretation and Analysis
Chapter 3: The New Business Process and Underwriting Principles
The New Business Process
Field Underwriting
Data Entry and Review
Making the Underwriting Decision
Policy Issue
New Business/Underwriting Quality Control
Underwriting Documentation
Audits
Metrics
Underwriting Principles
Risk Assessment
Risk Classification
Underwriting Philosophy and Guidelines
Underwriting Organization
Job Positions
Authority Levels
Workflow Organization
Efficiencies in Underwriting
Automated Underwriting
Simplified Underwriting
Chapter 4: Individual Life Insurance: Assessing Mortality Risk
Sources of Medical Information
The Application for Insurance
The MIB Group, Inc.
Physician Reports
Medical Tests
Personal History Interviews
Inspection Reports
Pharmaceutical Databases
Assessing Medical Risk Factors
Impairments
Age
Gender
Build
Sources of Personal Information
Assessing Personal Risk Factors
Occupation
Driving History
Avocations
Tobacco Use
Alcohol Use
Drug Abuse
Physical Abuse
Criminal History
Aviation Activity
Military Status
International Residence and Travel
Foreign Citizenship
Chapter 5: Individual Life Insurance: Financial Underwriting and Risk Classification
Financial Underwriting
Risks Deterred by Financial Underwriting
Sources of Financial Information
Assessing Life Insurance Needs and Financial Factors
Tools to Determine the Appropriate Amount of Insurance
Risk Classification
Numerical Rating System
Charging for Substandard Risks
Chapter 6: Underwriting Specialized Individual Life Insurance Products
Underwriting Niche Policies
Multi-life Policies
Juvenile Insurance Policies
Direct-to-Consumer Policies
Underwriting Business Life Insurance
Business Needs Met by Life Insurance
Financial Assessment of a Business
Underwriting Considerations for Types of Business Life Insurance
Underwriting Policy Replacements
Section 1035 Exchanges
Underwriting Supplemental Benefits
Disability Benefits
Family Benefits
Guaranteed Insurability Benefits
Accidental Death Benefits
Accelerated Death Benefits
Chapter 7: Underwriting Group Life Insurance
The Group Underwriting Process
Requesting Coverage
Creating a Proposal for Insurance
Completing the Master Application
Delivering the Master Group Insurance Contract
Risk Factors for Group Underwriting
The Group Prospect
The Proposed Coverage
Rating Methods for Group Cases
Calculating Premium Rates for Large Groups
Calculating Premium Rates for Small Groups
Post-issue Underwriting
Underwriting of Late Enrollees
Renewal Underwriting
Chapter 8: Reinsurance: Insurance for Insurers
Overview of Reinsurance
Roles of Insurance Companies in Reinsurance Arrangements
Purposes of Reinsurance
Benefits of Indemnity Reinsurance for the Direct Writer
Cession Arrangements
Risk-Sharing Arrangements
Reinsurance Administration
Reinsurance Staffing and Systems
Administering New Business
Administering In-Force Business
Administering Terminations of Reinsurance
Chapter 9: Effective Customer Service
Customer Service for Insurance Companies
Customer Service Providers
Benefits of High-Quality Customer Service
Customer Service and the Customer Experience
The Customer Service Function
Staffing
Organization
Technology for Effective Customer Service Administration
Technology for Sharing Customer Service Information
Technology for Customer Service Interactions
Data Analysis in Customer Service
Legal Issues Affecting Customer Service
Complaints
Privacy
Chapter 10: Customer Service Practices
Routine Customer Service Transactions
Providing Information
Changing Names and Addresses
Making Policy Changes
Administering Premium Payments
Issuing Duplicate Policies
Handling Customer Complaints
Complex Customer Service Transactions
Beneficiary Changes
Policy Assignments
Policy Conversions
Dividend Payments
Policy Loans
Policy Terminations
Policy Reinstatements
Administration of Variable Products
Customer Service and Policy Conservation
Policyowner Communications
Financial Professional Engagement
Management of Unassigned Policyowners
Claims Processing
Customer Service Quality Control
Quantitative Performance Measures
Qualitative Performance Measures
Chapter 11: Overview of Claim Administration
Claim Philosophy and Claim Practices
The Claim Evaluation Process
Claim Administration Staffing and Organization
Staffing
Organizational Systems
Relationships with Other Insurance Functions
Efficiencies in Claim Administration
Automated Workflow Systems
Express Claim Processing
Auto-Adjudication
Legal and Compliance Issues Affecting Claim Administration
Regulations Governing Claim Administration
Unfair Claim Settlement Practices
Unclaimed Benefits
Privacy Protection
Claim Fraud
Financing Criminal Activities
Quality Measurement for Claim Administration
Internal Evaluation of Performance
External Evaluation of Performance
Chapter 12: Claim Administration Practices
Administering Life Insurance Claims
Verifying Coverage Was in Force
Verifying That the Deceased Is Covered
Verifying That Death Occurred
Verifying That the Cause of Death Is Covered
Determining Whether the Policy Is Contestable
Determining the Proper Payee
Calculating Policy Proceeds
Administering Settlement Options
Administering Claims for Supplemental Benefits
Waiver of Premium for Disability Benefit
Accidental Death Benefit
Family Benefits
Accelerated Death Benefits
Administering Claims for Reinsured Policies
Establishing the Claim File
Verifying Claim-Related Information
Settling Reinsured Claims
Denying Payment of Benefits
Glossary
Index
Back Cover
End of Text
Insurance Administration
Fifth Edition
Online Course
Portal with
Course Enrollment.
See inside for details.
Insurance Administration
Fifth Edition
ONLINE COURSE PORTAL
The LOMA 301 Course Portal, available online at learning.loma.org via your “Upcoming
Learning” page, includes numerous multi-media features designed to reinforce and
enhance your learning experience and help you prepare for the exam. Among these
features are numerous “Learning Aids” that illustrate key concepts presented in the
assigned course materials, the Test Preparation Guide’s popular interactive Practice
Questions and Sample Exam with answer feedback, and the “Top 10 Tough Topics”
review of the most challenging topics in this course. If you are not already using the
online Course Portal but would like access to the many additional study resources for this
course, please follow the log-in instructions provided in your Enrollment Confirmation
e-mail, or call 1-800-ASK-LOMA or e-mail education@loma.org for assistance.
Copyright © 2018 LL Global, Inc. All rights reserved.
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LOMA (Life Office Management Association, Inc.) is an international
association founded in 1924. LOMA is committed to a business partnership
with the worldwide members in the insurance and financial services industry to
improve their management and operations through quality employee development,
research, information sharing, and related products and services. Among LOMA’s
activities is the sponsorship of several self-study education programs leading
to professional designations, including the Fellow, Life Management Institute
(FLMI) program. For more information on all of LOMA’s education programs,
please visit www.loma.org.
Statement of Purpose: LOMA Educational Programs Testing and Designations
Examinations described in the LOMA Education and Training Catalog are
designed solely to measure whether students have successfully completed the
relevant assigned curriculum, and the attainment of the FLMI and other LOMA
designations indicates only that all examinations in the given curriculum have
been successfully completed. In no way shall a student’s completion of a given
LOMA course or attainment of the FLMI or other LOMA designation be construed
to mean that LOMA in any way certifies that student’s competence, training, or
ability to perform any given task. LOMA’s examinations are to be used solely for
general educational purposes, and no other use of the examinations or programs
is authorized or intended by LOMA. Furthermore, it is in no way the intention of
the LOMA staff to describe the standard of appropriate conduct in any field of
the insurance and financial services industry, and LOMA expressly repudiates
any attempt to so use the curriculum and examinations. Any such assessment of
student competence or industry standards of conduct should instead be based on
independent professional inquiry and the advice of competent professional counsel.
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Copyright © 2018 LL Global, Inc. All rights reserved.
Insurance Administration
Fifth Edition
LOMA Education and Training
Atlanta, Georgia
www.loma.org
Information in this text may have changed or been updated since its publication date.
For current updates visit www.loma.org.
Copyright © 2018 LL Global, Inc. All rights reserved.
www.loma.org
LOMA 301 Course Project Team
Insurance Administration, Fifth Edition is the result of the dedicated efforts of a project team of
LOMA staff members and consultants who were responsible for writing and editing the text’s
content; developing learning aids and study materials to accompany the textbook; and oversee-
ing the production of the text and the Course Portal.
Jennifer W. Herrod, FLMI, PCS, AIAA, PAHM, ARA, AIRC
Gene Stone, FLMI, ACS, CLU
Shawn Cuthbert
Brian M. Felt, FLMI, ACS
Patsy Leeuwenburg, Ph.D., FLMI, FLHC, ASRI, ACS, AAPA,
AIAA, AIRC, ARA, PAHM
Melanie E. Luna, M.Ed., FLMI, ACS, AIRC
Miriam A. Orsina, FLMI, FSRI, PCS, AAPA, ARA, PAHM
Vivian Heeden, FLMI, FSRI, FFSI, CLU, CLHC, AIRC, AAPA,
AIAA, PCS, ARA
Nicole C. Horner, ALMI, ACS
Robert D. Land, FLMI, ACS
Brian M. Felt, FLMI, ACS
Robert D. Land, FLMI, ACS
Project Managers:
Workflow Coordinator:
Text Authors:
Manuscript Editor:
Examinations Editor:
Permissions:
Copy Editor:
Production Proofreader:
Indexer:
Graphics Design Manager: Marlene McAuley
Text & Cover Design:
Portal & Infographic
Designer:
Learning Aids Developers: Patsy Leeuwenburg, Ph.D., FLMI, FLHC, ASRI, PAHM, ACS,
Top Ten Tough
Topics Developers:
Publication Distribution: Kelly M. Korb, FLMI, ALHC, ACS, AIAA, AIRC, PAHM
Amy Stailey, ACS, ALMI
Susan Austin
Jack Coram
AAPA, AIAA, AIRC, ARA
Tonya Vaughan, ALMI, ACS
Vivian Heeden, FLMI, FRSI, FFSI, CLU, CLHC, AIRC, AAPA,
AIAA, PCS, ARA
Melanie Green, FLMI, ACS, AIAA
Tonya Vaughan, ALMI, ACS
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Copyright © 2018 LL Global, Inc. All rights reserved.
Copyright © 2018 LL Global, Inc. All rights reserved.
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This text, or any part thereof, may not be reproduced or transmitted in any
form or by any means, electronic or mechanical, including photocopying,
recording, storage in an information retrieval system, or otherwise, without
the prior written permission of the publisher.
While a great deal of care has been taken to provide accurate, current, and
authoritative information in regard to the subject matter covered in this book,
the ideas, suggestions, general principles, conclusions, and any other informa-
tion presented here are for general educational purposes only. This text is sold
with the understanding that it is neither designed nor intended to provide the
reader with legal, accounting, investment, marketing, or any other types of
professional business management advice. If legal advice or other expert assis-
tance is required, the services of a competent professional should be sought.
This text contains a number of examples and hypothetical scenarios.
The names, characters, organizations, and events in these examples and sce-
narios are fictional. Any resemblance to any actual persons, living or dead, or
actual organizations or events is entirely coincidental.
ISBN 978-1-57974-461-8
Copyright © 2018 LL Global, Inc. All rights reserved.
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