Health fundamentals
Health (Accident & Sickness) insurance covers the financial consequences of sickness, injury, and disability. Half of the “L&H” track. All STABLE.
Important distinction for the Glacis strategy: the Glacis Tech-E&O product serves a healthcare customer vertical, but the coverage is Casualty (professional liability), not Health. The Health line below is about medical/ disability insurance — a different product family. See 03 Lines of authority.
Core concept: morbidity
Section titled “Core concept: morbidity”Health pricing is driven by morbidity — the likelihood of sickness or disability (contrast mortality for life). The younger/healthier the pool, the lower the expected claims.
Three loss types health insurance addresses
Section titled “Three loss types health insurance addresses”- Medical expense — the cost of care (doctor, hospital, drugs).
- Disability income — replacing income lost when you can’t work due to injury/illness.
- Long-term care (LTC) — extended custodial/nursing care.
How health differs from life and property
Section titled “How health differs from life and property”- It’s a mix of reimbursement (pay actual expenses) and valued/indemnity (pay a fixed amount, e.g., a daily hospital benefit).
- Renewability is a big deal (can the insurer cancel/raise rates?) — see 02 Health provisions.
- Strong statutory and federal overlay — ACA, COBRA, HIPAA, Medicare/Medicaid — much of which is volatile and VERIFY.
Underwriting & classification
Section titled “Underwriting & classification”- Individual health uses application/medical underwriting (limited by law in some markets); group health uses group underwriting (the group’s characteristics, not each individual’s).
- Pre-existing condition treatment is heavily regulated (and changed materially under the ACA) — see provisions.
Group vs individual
Section titled “Group vs individual”- Individual — purchased directly; the applicant is the insured.
- Group — through an employer/association under a master contract; members get certificates of coverage; usually little/no individual medical underwriting.
The federal/statutory layer (concepts stable, specifics VERIFY)
Section titled “The federal/statutory layer (concepts stable, specifics VERIFY)”- ACA (Affordable Care Act) — guaranteed issue, essential health benefits, marketplace, no pre-existing-condition exclusions.
- COBRA — continuation of group coverage after qualifying events.
- HIPAA — privacy of health information + portability. (HIPAA privacy is also a Tech-E&O exposure for healthcare AI — see 07 Tech E&O for healthcare AI.)
- Medicare / Medicaid — government programs (see 01 Health coverages).
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