Life and Health Insurance

When to Use

Explain life, health, disability, and LTC products and how individual vs group markets differ
Walk through underwriting: risk classification, evidence of insurability, rate classes, appeals
Clarify policy mechanics: face amount, beneficiaries, riders, exclusions, contestability
Describe health plan design: networks, cost sharing, essential health benefits (ACA overview)
Frame Medicare/Medicaid program context at overview level (not enrollment legal advice)
Outline claims and benefits administration: life death claims, health claims, appeals, EOBs
Compare distribution models (career agent, independent, broker, MGA, worksite)
Interpret life/health metrics (lapse, persistency, loss ratio, MLR, benefit ratio)
Outline state DOI, NAIC, ACA, and HIPAA privacy concepts—not legal or actuarial sign-off