My premiums for Kaiser were increased for the second year in a row. They want me to pay $767.00 PER MONTH in 2008. This is just for me, no family, no dental, no eyeglasses. And doctor's visits still cost me $25. Isn't this a shocker?
So I've been applying for alternate coverage, and have even considered a medical discount account, which isn't even insurance. Even that costs $250.00 per month, with a one time sign up fee. But then if I needed hospitalization or surgery my family would have to sell the house and all get jobs shelling peanuts or something.
I feel like I belong in a Michael Moore movie. Maybe there are some seats left in the boat for Cuba. When I saw "Sicko" I cried all the way through it, sad for all the other people who don't have medical care, and the sorry state of our government vis a vis health insurance. Now that my own tit is in the wringer I'm mad as hell.
Another consideration I had was to let my insurance lapse altogether and hold my breath until I reach 65 (six years from now) and Medicare can cover me, if it still exists. Of course I wouldn't be able to leave the house for fear of accident.
Shopping for medical insurance is much like helping a high school senior apply to college. It makes you want to pull your hair out and puke on it. After three or four hours at the computer filling out forms, I just have to walk away and do something completely different to detox.
Fortunately, there are some options in that regard: I can hold the baby, for one. This is deeply comforting to me. Cooking is also nice, especially with a glass of wine. Television doesn't do the trick- it only makes me madder. I am currently lost in MFK Fisher. (Was she a great big rich snob, or was it simply a different time?)
Rant concluded.
Should I keep COBRA or try another health insurance
I recently left my job at Yahoo! in Northern California and am relocating to Portland, Oregon to try my hand at self-employment. Extending my existing medical coverage with COBRA will cost me, my wife, and our three-year-old son $1200/month, which seems absolutely insane. Please help me understand the risks or consequences of waiving COBRA and getting new a new insurance plan.
Continuing my Aetna PPO option through COBRA will cost me more than double every other quote listed on eHealthInsurance in Oregon for our family, even for those plans that appear to be comparable. (My existing plan has a $750 annual deductible, $2,750 maximum out-of-pocket, and $15 co-pay for office visits and preventive care with no deductible.)
What's so great about COBRA that it costs more than double everything else? Am I going to screwed with some sort of pre-existing condition nonsense by not continuing coverage from my previous employer? What are the risks by giving up COBRA? Plus, will I even be able to use COBRA if I'm moving from California to Oregon? (Aetna doesn't appear to offer individual coverage in Oregon, so is every doctor out-of-network?)
And finally, is there anything I should look out for when buying through eHealthInsurance? If anyone has specific recommendations for Oregon providers, that would be wonderful.
Continuing my Aetna PPO option through COBRA will cost me more than double every other quote listed on eHealthInsurance in Oregon for our family, even for those plans that appear to be comparable. (My existing plan has a $750 annual deductible, $2,750 maximum out-of-pocket, and $15 co-pay for office visits and preventive care with no deductible.)
What's so great about COBRA that it costs more than double everything else? Am I going to screwed with some sort of pre-existing condition nonsense by not continuing coverage from my previous employer? What are the risks by giving up COBRA? Plus, will I even be able to use COBRA if I'm moving from California to Oregon? (Aetna doesn't appear to offer individual coverage in Oregon, so is every doctor out-of-network?)
And finally, is there anything I should look out for when buying through eHealthInsurance? If anyone has specific recommendations for Oregon providers, that would be wonderful.
Peoples Health Insurance
If you don’t have a health insurance, probably it’s time to get one. Peoples Health Insurance will help you find an insurance that will suit your needs.
Choosing for the right health insurance plan is confusing; Peoples Health Insurance will help you or educate you on the various types of plans that are available and how each one works. At peopleshealthinsurance.com, you can get quotes, compare plan prices and benefit options and apply y online. If you have any questions, a live representative is available. What’s great about peopleshealthinsurance.com is that their service is free.
Choosing for the right health insurance plan is confusing; Peoples Health Insurance will help you or educate you on the various types of plans that are available and how each one works. At peopleshealthinsurance.com, you can get quotes, compare plan prices and benefit options and apply y online. If you have any questions, a live representative is available. What’s great about peopleshealthinsurance.com is that their service is free.
Get Life Insurance Online
You can get a quote for car insurance online -- why not an easy online quote for life insurance as well?
Just put in some quick easy details into the LifeInsure.com website and voila -- a quote that you can use.
Life insurance isn't sexy. It's not even mandatory, such as is auto insurance. It may not even be something you want to think about -- but you should. Before it's too late.
Having the right life insurance, and the adequate life insurance, should be part of the financial protection you need to protect your family. Not only for your final expenses, but what about filling the void of your income should you pass?
How else will your family cope with the rent, mortgage, car payment, etc., in the days and weeks after you go than with a life insurance payment?
Just something to think about.
Just put in some quick easy details into the LifeInsure.com website and voila -- a quote that you can use.
Life insurance isn't sexy. It's not even mandatory, such as is auto insurance. It may not even be something you want to think about -- but you should. Before it's too late.
Having the right life insurance, and the adequate life insurance, should be part of the financial protection you need to protect your family. Not only for your final expenses, but what about filling the void of your income should you pass?
How else will your family cope with the rent, mortgage, car payment, etc., in the days and weeks after you go than with a life insurance payment?
Just something to think about.
Health Insurance Rules
Many dual income couples, include their children on each group health insurance plan to maximize benfits. However, without some sort of system in place to help the health insurance companies coordinate benefits, it’s possible that either you or your doctor would be reimbursed for more than 100 percent of the actual cost of your claim.
To prevent this, health insurance companies typically designate one parent’s health insurance plan as the primary plan and the other as the secondary plan. (That’s why the patient questionnaire at your doctor’s office asks for information on primary and secondary coverage.) The primary plan is responsible for paying covered expenses up to the limits of the policy. If any unpaid costs are left over, the secondary coverage kicks in.
THE DATE OF BIRTH DETERMINES WHICH HEALTH INSURANCE PROVIDES COVERAGE
The birthday rule is often used to determine which plan is primary and which is secondary. Under this rule, the plan of the parent whose birthday occurs first in the calendar year is designated as primary. The date of birth is the determining factor not the year so it doesn’t matter which spouse is older.
Like most rules, the birthday rule has exceptions:
- If both parents share the same birthday, the parent who has been covered by his or her plan longest provides the primary coverage for the children.
- If one spouse is currently employed and has health insurance through a current employer, and the other spouse has coverage through a former employer, the plan belonging to the curently employed spouse would be primary.
- In the event of divorce or seperation, the plan of the parent with custody generally provides primary coverage. If the custodial parent remarries, the new new spouse’s coverage becomes secondary. And finally, the non custodial parent’s health insurance plan would provide a third layer of insurance protection. This order of payment can be altered by a court issued divorce decree or by agreement, but the health insurance companies must be notified.
THESE ARE JUST HEALTH INSURANCE RULES NOT THE LAW
Keep in mind that these practices are common among health insurance companies, but they are not governed by law. Practices may vary from one insurer to another. Read your policy carefully to make sure you understand how your insurance company handles dual coverage. If the policy coverage is unclear, ask for help from your employers benefit specialist or your insurer’s customer service department.
To prevent this, health insurance companies typically designate one parent’s health insurance plan as the primary plan and the other as the secondary plan. (That’s why the patient questionnaire at your doctor’s office asks for information on primary and secondary coverage.) The primary plan is responsible for paying covered expenses up to the limits of the policy. If any unpaid costs are left over, the secondary coverage kicks in.
THE DATE OF BIRTH DETERMINES WHICH HEALTH INSURANCE PROVIDES COVERAGE
The birthday rule is often used to determine which plan is primary and which is secondary. Under this rule, the plan of the parent whose birthday occurs first in the calendar year is designated as primary. The date of birth is the determining factor not the year so it doesn’t matter which spouse is older.
Like most rules, the birthday rule has exceptions:
- If both parents share the same birthday, the parent who has been covered by his or her plan longest provides the primary coverage for the children.
- If one spouse is currently employed and has health insurance through a current employer, and the other spouse has coverage through a former employer, the plan belonging to the curently employed spouse would be primary.
- In the event of divorce or seperation, the plan of the parent with custody generally provides primary coverage. If the custodial parent remarries, the new new spouse’s coverage becomes secondary. And finally, the non custodial parent’s health insurance plan would provide a third layer of insurance protection. This order of payment can be altered by a court issued divorce decree or by agreement, but the health insurance companies must be notified.
THESE ARE JUST HEALTH INSURANCE RULES NOT THE LAW
Keep in mind that these practices are common among health insurance companies, but they are not governed by law. Practices may vary from one insurer to another. Read your policy carefully to make sure you understand how your insurance company handles dual coverage. If the policy coverage is unclear, ask for help from your employers benefit specialist or your insurer’s customer service department.
Travel Insurance
Travel Insurance is an essential part of any trip and is something that should not be put aside. Most soon-to-be travelers usually have heard about travel insurance, but might not know the specific reasons why they need travel insurance. This is an important article about frequently asked questions for travel insurance. This article also provides a link for further reading about travel insurance.
What is travel insurance protection?
Travel insurance is a type of insurance that covers you financial for any losses or illness that may unfortunate occur while you is on your trip. Travel insurance can be bought for international or national (within your country) trips.
Why should I buy travel insurance?
Since travel insurance protects you while traveling, this will help and provide the necessary protection you will need in the occurrence of a unfortunate event. Any individual traveling anywhere without travel insurance will be in a dangerous situation if an accident occur.
What is the coverage for travel insurance?
Travel insurance should provide coverage for medical cost, transportation to a medical facility, and reimburse you for certain or some nonrefundable costs due to a interrupted trip, and financial loss of funds.
How much does travel insurance cost?
How much the cost of your travel insurance will be depends on your insurance company provider and their policy. The cost of travel insurance usually will range up to 12 percent of the cost of your vacation/trip.
Is travel insurance really important and how many people actually get paid for their claims? Travel insurance is highly recommended, there are usually about 10% of people who file claims. Sometimes some travelers make have taken a overly expensive trip that they would have to pay out of their own money if they have not bought travel insurance.
What is the medical care coverage?
When there is a case of illness or serious injury, medical transportation to an appropriate medical facility, and medical treatment will be covered. You should also have coverage for if it is deem necessary to bring you back home.
Does travel insurance cover business trips?
This will depend on the insurance company. Most insurance companies will provide travel insurance for a business trip, but the coverage may be separate from the standard coverage.
How long will travel insurance provide coverage for me?
You can often buy travel insurance starting from as little as two weeks, up to a year. Different insurance companies may vary with their service of coverage.
When is the best time to buy travel insurance coverage?
The best time to buy travel insurance is as soon as possible before you go on your trip or vacation. You want your travel insurance active during your whole trip.
What will happen if my money is lost or stolen?
If you can not receive traveler checks replacements many insurance companies provide a service where a travel agent can arrange a money transfer or traveler check for you to receive. You will have to ask more about this to your travel insurance provider.
What is travel insurance protection?
Travel insurance is a type of insurance that covers you financial for any losses or illness that may unfortunate occur while you is on your trip. Travel insurance can be bought for international or national (within your country) trips.
Why should I buy travel insurance?
Since travel insurance protects you while traveling, this will help and provide the necessary protection you will need in the occurrence of a unfortunate event. Any individual traveling anywhere without travel insurance will be in a dangerous situation if an accident occur.
What is the coverage for travel insurance?
Travel insurance should provide coverage for medical cost, transportation to a medical facility, and reimburse you for certain or some nonrefundable costs due to a interrupted trip, and financial loss of funds.
How much does travel insurance cost?
How much the cost of your travel insurance will be depends on your insurance company provider and their policy. The cost of travel insurance usually will range up to 12 percent of the cost of your vacation/trip.
Is travel insurance really important and how many people actually get paid for their claims? Travel insurance is highly recommended, there are usually about 10% of people who file claims. Sometimes some travelers make have taken a overly expensive trip that they would have to pay out of their own money if they have not bought travel insurance.
What is the medical care coverage?
When there is a case of illness or serious injury, medical transportation to an appropriate medical facility, and medical treatment will be covered. You should also have coverage for if it is deem necessary to bring you back home.
Does travel insurance cover business trips?
This will depend on the insurance company. Most insurance companies will provide travel insurance for a business trip, but the coverage may be separate from the standard coverage.
How long will travel insurance provide coverage for me?
You can often buy travel insurance starting from as little as two weeks, up to a year. Different insurance companies may vary with their service of coverage.
When is the best time to buy travel insurance coverage?
The best time to buy travel insurance is as soon as possible before you go on your trip or vacation. You want your travel insurance active during your whole trip.
What will happen if my money is lost or stolen?
If you can not receive traveler checks replacements many insurance companies provide a service where a travel agent can arrange a money transfer or traveler check for you to receive. You will have to ask more about this to your travel insurance provider.
Safe harbor" exemptions
The analysis of reasonableness and significance is an estimate of the probability of different gain or loss outcomes under different loss scenarios. It takes time and resources to perform the analysis, which constitutes a burden without value where risk transfer is reasonably self-evident.
Guidance exists for insurers and reinsurers, whose CEO's and CFO's attest annually as to the reinsurance agreements their firms undertake. The American Academy of Actuaries, for instance, identifies three categories of contract as outside the requirement of attestation:
- Inactive contracts. If there are no premiums due nor losses payable, and the insurer is not taking any credit for the reinsurance, determining risk transfer is irrelevant.
- Pre-1994 contracts. The attestation requirement only applies to contracts that were entered into, renewed or amended on or after 1 January 1994. Prior contracts need not be analyzed.
- Where risk transfer is "reasonably self-evident."
"Risk transfer is reasonably self-evident in most traditional per-risk or per-occurrence excess of loss reinsurance contracts. For these contracts, a predetermined amount of premium is paid and the reinsurer assumes nearly all or all of the potential variability in the underlying losses, and it is evident from reading the basic terms of the contract that the reinsurer can incur a significant loss. In many cases, there is no aggregate limit on the reinsurer's loss. The existence of certain experience-based contract terms, such as experience accounts, profit commissions, and additional premiums, generally reduce the amount of risk transfer and make it less likely that risk transfer is reasonably self-evident."
Is there a brightline test?
Neither FAS 113 nor SAP 62 defines the terms reasonable or significant. Ideally, one would like to be able to substitute values for both terms. It would be much simpler if one could apply a test of an X percent chance of a loss of Y percent or greater. Such tests have been proposed, including one famously attributed to an SEC official who is said to have opined in an after lunch talk that a 10 percent chance of a 10 percent loss was sufficient to establish both reasonableness and significance. Indeed, many insurers and reinsurers still apply this 10/10" test as a benchmark for risk transfer testing.
It should be obvious that an attempt to use any numerical rule such as the 10/10 test will quickly run into problems. Implicit in the test is keeping the 10/10 that either are upper bonds for the comment made by the SEC official therefore, the rest of this paragraph doesn't apply. Suppose a contract has a 1 percent chance of a 10,000 percent loss? It should be reasonably self-evident that such a contract is insurance, but it fails one half of the 10/10 test.
It does not appear that any brightline test of reasonableness nor significance can be constructed.
Excess of loss contracts, like those commonly used for umbrella and general liability insurance, or to insure against property losses, will typically have a low ratio of premium paid to maximum loss recoverable. This ratio (expressed as a percentage), commonly called the rate on line for historical reasons related to underwriting practices at Lloyd's of London, will typically be low for contracts that contain reasonably self-evident risk transfer. As the ratio increases to approximate the present value of the limit of coverage, self-evidence decreases and disappears.
Contracts with low rates on line may survive modest features that limit the amount of risk transferred. As rates on line increase, such risk limiting features become increasingly important.
[edit] When is a policy really insurance?
An operational definition of insurance is that it is
- the benefit provided by a particular kind of indemnity contract, called an insurance policy;
- that is issued by one of several kinds of legal entities (stock insurance company, mutual insurance company, reciprocal, or Lloyd's syndicate, for example), any of which may be called an insurer;
- in which the insurer promises to pay on behalf of or to indemnify another party, called a policyholder or insured;
- that protects the insured against loss caused by those perils subject to the indemnity in exchange for consideration known as an insurance premium.
In recent years this kind of operational definition proved inadequate as a result of contracts that had the form but not the substance of insurance. The essence of insurance is the transfer of risk from the insured to one or more insurers. How much risk a contract actually transfers proved to be at the heart of the controversy.
This issue arose most clearly in reinsurance, where the use of Financial Reinsurance to reengineer insurer balance sheets under US GAAP became fashionable during the 1980s. The accounting profession raised serious concerns about the use of reinsurance in which little if any actual risk was transferred, and went on to address the issue in FAS 113, cited above. While on its face, FAS 113 is limited to accounting for reinsurance transactions, the guidance it contains is generally conceded to be equally applicable to US GAAP accounting for insurance transactions executed by commercial enterprises.
[edit] Does the contract contain adequate risk transfer?
FAS 113 contains two tests, called the '9a and 9b tests,' that collectively require that a contract create a reasonable chance of a significant loss to the underwriter for it to be considered insurance.
9. Indemnification of the ceding enterprise against loss or liability relating to insurance risk in reinsurance of short-duration contracts requires both of the following, unless the condition in paragraph 11 is met:
a. The reinsurer assumes significant insurance risk under the reinsured portions of the underlying insurance contracts.
b. It is reasonably possible that the reinsurer may realize a significant loss from the transaction.
Paragraph 10 of FAS 113 makes clear that the 9a and 9b tests are based on comparing the present value of all costs to the PV of all income streams. FAS gives no guidance on the choice of a discount rate on which to base such a calculation, other than to say that all outcomes tested should use the same rate.
Statement of Statutory Accounting Principles ("SSAP") 62, issued by the National Association of Insurance Commissioners, applies to so-called 'statutory accounting' - the accounting for insurance enterprises to conform with regulation. Paragraph 12 of SSAP 62 is nearly identical to the FAS 113 test, while paragraph 14, which is otherwise very similar to paragraph 10 of FAS 113, additionally contains a justification for the use of a single fixed rate for discounting purposes. The choice of an "reasonable and appropriate" discount rate is left as a matter of judgment.
Indemnification
The technical definition of "indemnity" means to make whole again. There are two types of insurance contracts; 1) an "indemnity" policy and 2) a "pay on behalf" or "on behalf of"[3] policy. The difference is significant on paper, but rarely material in practice.
An "indemnity" policy will not pay claims until the insured has paid out of pocket to some third party; i.e. a visitor to your home slips on a floor that you left wet and sues you for $10,000 and wins. Under an "indemnity" policy the homeowner would have to come up with the $10,000 to pay for the visitors fall and then would be "indemnified" by the insurance carrier for the out of pocket costs (the $10,000)[4].
Under the same situation, a "pay on behalf" policy, the insurance carrier would pay the claim and the insured (the homeowner) would not be out of pocket anything. Most modern liability insurance is written on the basis of "pay on behalf" language[5].
An entity seeking to transfer risk (an individual, corporation, or association of any type, etc.) becomes the 'insured' party once risk is assumed by an 'insurer', the insuring party, by means of a contract, called an insurance 'policy'. Generally, an insurance contract includes, at a minimum, the following elements: the parties (the insurer, the insured, the beneficiaries), the premium, the period of coverage, the particular loss event covered, the amount of coverage (i.e., the amount to be paid to the insured or beneficiary in the event of a loss), and exclusions (events not covered). An insured is thus said to be "indemnified" against the loss events covered in the policy.
When insured parties experience a loss for a specified peril, the coverage entitles the policyholder to make a 'claim' against the insurer for the covered amount of loss as specified by the policy. The fee paid by the insured to the insurer for assuming the risk is called the 'premium'. Insurance premiums from many insureds are used to fund accounts reserved for later payment of claims—in theory for a relatively few claimants—and for overhead costs. So long as an insurer maintains adequate funds set aside for anticipated losses (i.e., reserves), the remaining margin is an insurer's profit.
PRINCIPLE OF INSURANCE
Commercially insurable risks typically share seven common characteristics.[1]
A large number of homogeneous exposure units. The vast majority of insurance policies are provided for individual members of very large classes. Automobile insurance, for example, covered about 175 million automobiles in the United States in 2004.[2] The existence of a large number of homogeneous exposure units allows insurers to benefit from the so-called “law of large numbers,” which in effect states that as the number of exposure units increases, the actual results are increasingly likely to become close to expected results. There are exceptions to this criterion. Lloyd's of London is famous for insuring the life or health of actors, actresses and sports figures. Satellite Launch insurance covers events that are infrequent. Large commercial property policies may insure exceptional properties for which there are no ‘homogeneous’ exposure units. Despite failing on this criterion, many exposures like these are generally considered to be insurable.
Definite Loss. The event that gives rise to the loss that is subject to insurance should, at least in principle, take place at a known time, in a known place, and from a known cause. The classic example is death of an insured on a life insurance policy. Fire, automobile accidents, and worker injuries may all easily meet this criterion. Other types of losses may only be definite in theory. Occupational disease, for instance, may involve prolonged exposure to injurious conditions where no specific time, place or cause is identifiable. Ideally, the time, place and cause of a loss should be clear enough that a reasonable person, with sufficient information, could objectively verify all three elements.
Accidental Loss. The event that constitutes the trigger of a claim should be fortuitous, or at least outside the control of the beneficiary of the insurance. The loss should be ‘pure,’ in the sense that it results from an event for which there is only the opportunity for cost. Events that contain speculative elements, such as ordinary business risks, are generally not considered insurable.
Large Loss. The size of the loss must be meaningful from the perspective of the insured. Insurance premiums need to cover both the expected cost of losses, plus the cost of issuing and administering the policy, adjusting losses, and supplying the capital needed to reasonably assure that the insurer will be able to pay claims. For small losses these latter costs may be several times the size of the expected cost of losses. There is little point in paying such costs unless the protection offered has real value to a buyer.
Affordable Premium. If the likelihood of an insured event is so high, or the cost of the event so large, that the resulting premium is large relative to the amount of protection offered, it is not likely that anyone will buy insurance, even if on offer. Further, as the accounting profession formally recognizes in financial accounting standards (See FAS 113 for example), the premium cannot be so large that there is not a reasonable chance of a significant loss to the insurer. If there is no such chance of loss, the transaction may have the form of insurance, but not the substance.
Calculable Loss. There are two elements that must be at least estimable, if not formally calculable: the probability of loss, and the attendant cost. Probability of loss is generally an empirical exercise, while cost has more to do with the ability of a reasonable person in possession of a copy of the insurance policy and a proof of loss associated with a claim presented under that policy to make a reasonably definite and objective evaluation of the amount of the loss recoverable as a result of the claim.
Limited risk of catastrophically large losses. The essential risk is often aggregation. If the same event can cause losses to numerous policyholders of the same insurer, the ability of that insurer to issue policies becomes constrained, not by factors surrounding the individual characteristics of a given policyholder, but by the factors surrounding the sum of all policyholders so exposed. Typically, insurers prefer to limit their exposure to a loss from a single event to some small portion of their capital base, on the order of 5 percent. Where the loss can be aggregated, or an individual policy could produce exceptionally large claims, the capital constraint will restrict an insurers appetite for additional policyholders. The classic example is earthquake insurance, where the ability of an underwriter to issue a new policy depends on the number and size of the policies that it has already underwritten. Wind insurance in hurricane zones, particularly along coast lines, is another example of this phenomenon. In extreme cases, the aggregation can affect the entire industry, since the combined capital of insurers and reinsurers can be small compared to the needs of potential policyholders in areas exposed to aggregation risk. In commercial fire insurance it is possible to find single properties whose total exposed value is well in excess of any individual insurer’s capital constraint. Such properties are generally shared among several insurers, or are insured by a single insurer who syndicates the risk into the reinsurance market.
A large number of homogeneous exposure units. The vast majority of insurance policies are provided for individual members of very large classes. Automobile insurance, for example, covered about 175 million automobiles in the United States in 2004.[2] The existence of a large number of homogeneous exposure units allows insurers to benefit from the so-called “law of large numbers,” which in effect states that as the number of exposure units increases, the actual results are increasingly likely to become close to expected results. There are exceptions to this criterion. Lloyd's of London is famous for insuring the life or health of actors, actresses and sports figures. Satellite Launch insurance covers events that are infrequent. Large commercial property policies may insure exceptional properties for which there are no ‘homogeneous’ exposure units. Despite failing on this criterion, many exposures like these are generally considered to be insurable.
Definite Loss. The event that gives rise to the loss that is subject to insurance should, at least in principle, take place at a known time, in a known place, and from a known cause. The classic example is death of an insured on a life insurance policy. Fire, automobile accidents, and worker injuries may all easily meet this criterion. Other types of losses may only be definite in theory. Occupational disease, for instance, may involve prolonged exposure to injurious conditions where no specific time, place or cause is identifiable. Ideally, the time, place and cause of a loss should be clear enough that a reasonable person, with sufficient information, could objectively verify all three elements.
Accidental Loss. The event that constitutes the trigger of a claim should be fortuitous, or at least outside the control of the beneficiary of the insurance. The loss should be ‘pure,’ in the sense that it results from an event for which there is only the opportunity for cost. Events that contain speculative elements, such as ordinary business risks, are generally not considered insurable.
Large Loss. The size of the loss must be meaningful from the perspective of the insured. Insurance premiums need to cover both the expected cost of losses, plus the cost of issuing and administering the policy, adjusting losses, and supplying the capital needed to reasonably assure that the insurer will be able to pay claims. For small losses these latter costs may be several times the size of the expected cost of losses. There is little point in paying such costs unless the protection offered has real value to a buyer.
Affordable Premium. If the likelihood of an insured event is so high, or the cost of the event so large, that the resulting premium is large relative to the amount of protection offered, it is not likely that anyone will buy insurance, even if on offer. Further, as the accounting profession formally recognizes in financial accounting standards (See FAS 113 for example), the premium cannot be so large that there is not a reasonable chance of a significant loss to the insurer. If there is no such chance of loss, the transaction may have the form of insurance, but not the substance.
Calculable Loss. There are two elements that must be at least estimable, if not formally calculable: the probability of loss, and the attendant cost. Probability of loss is generally an empirical exercise, while cost has more to do with the ability of a reasonable person in possession of a copy of the insurance policy and a proof of loss associated with a claim presented under that policy to make a reasonably definite and objective evaluation of the amount of the loss recoverable as a result of the claim.
Limited risk of catastrophically large losses. The essential risk is often aggregation. If the same event can cause losses to numerous policyholders of the same insurer, the ability of that insurer to issue policies becomes constrained, not by factors surrounding the individual characteristics of a given policyholder, but by the factors surrounding the sum of all policyholders so exposed. Typically, insurers prefer to limit their exposure to a loss from a single event to some small portion of their capital base, on the order of 5 percent. Where the loss can be aggregated, or an individual policy could produce exceptionally large claims, the capital constraint will restrict an insurers appetite for additional policyholders. The classic example is earthquake insurance, where the ability of an underwriter to issue a new policy depends on the number and size of the policies that it has already underwritten. Wind insurance in hurricane zones, particularly along coast lines, is another example of this phenomenon. In extreme cases, the aggregation can affect the entire industry, since the combined capital of insurers and reinsurers can be small compared to the needs of potential policyholders in areas exposed to aggregation risk. In commercial fire insurance it is possible to find single properties whose total exposed value is well in excess of any individual insurer’s capital constraint. Such properties are generally shared among several insurers, or are insured by a single insurer who syndicates the risk into the reinsurance market.
INSURANCE
INSURANCE
in law and economics, is a form of risk management primarily used to hedge against the risk of a contingent loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium. Insurer, in economics, is the company that sells the insurance. Insurance rate is a factor used to determine the amount, called the premium, to be charged for a certain amount of insurance coverage. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.
in law and economics, is a form of risk management primarily used to hedge against the risk of a contingent loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium. Insurer, in economics, is the company that sells the insurance. Insurance rate is a factor used to determine the amount, called the premium, to be charged for a certain amount of insurance coverage. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.
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