How do Life Insurance Companies Make Money?

  • Life Insurance

Life insurance seems like a pretty good deal. You pay $30 a month for 20 or 30 years and in the event of your death, your family gets a sizeable cash sum, often in excess of $250,000. Every 12 seconds someone dies in the United States and these deaths occur across all demographics (although the majority are over 70) and from a myriad of causes.

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If a life insurance company can afford to pay a $500,000 sum on a policy that’s collected less than $20,000, how can it afford to stay in business when life is so fragile, death is always a certainty, and they’re in it for the profit?

Contrary to what you might think, insurance companies don’t rely entirely on luck or underhanded tactics to stay in the black. There are actually three ways that an insurance company makes money and ensures those profits remain stable.

Underwriting

Underwriting is the process of taking a calculated financial risk in exchange for a fee. The word was coined as the underwriter, the “risk-taker”, would sign their name underneath a detailed outline of all risks they were willing to take.

Underwriting is performed by all life insurance companies and it’s a careful, considered process through which they can balance their profit and loss. There is no guarantee with the underwriting process and it’s not uncommon for them to lose money over the course of a financial year. However, what they lose one year may be offset by what they earn in another year.

How Insurance Companies Profit from Underwriting

Insurance is based on statistical analysis and probability. If you’re a healthy 20-year old with no preexisting medical conditions and no genetic issues, you’re considered to be very low risk. 

An insurance company may offer you a $500,000 payout on a 30-year term in exchange for a policy that costs less than $1,000 a year. They’re only making $30,000 over the term, but they know there’s a good chance you’ll live well beyond your 50th year, which means all of that $30,000 is profit.

In fact, statistically speaking, a 20-year old has a less than 6% chance of dying within 30 years and this applies to the general population. Once you account for medical issues, family health problems, smoking, drug use, dangerous jobs, and a plethora of other high-risk conditions, that figure drops to an infinitesimal sum.

The insurance company knows that if they have 50 healthy 20-year-olds on 30-year $500,000 policies, there’s a good chance that between 0 and 2 will collect. This means they will collect $1.5 million and payout between $0 and $1 million. 

The odds of a 20-year-old dying within that term increase if they have abused drugs/alcohol in the past, have a preexisting medical condition or their parents died of genetic disorders before they turned 50. In such cases, the underwriters will calculate the risks and create a policy that allows them to cover their costs.

By the same token, a life insurance company may refuse to provide a 30-year term to a 52-year-old, because according to the statistics, one out of every two will die within that term and they simply couldn’t offer realistic premiums.

Of course, these are just rough estimates, but it gives you a general idea of how life insurance companies operate. It’s also the reason why your premiums increase significantly if you are a smoker (smokers live 10 years less on average) are obese (obesity is considered to be as much of a mortality risk as smoking) or have a problematic medical history.

Canceled and Lapsed Coverage

Your life insurance policy can stop or be canceled at any time. Let’s return to the example of the 20-year-old paying premiums worth $1,000 a year. They may have taken out the life insurance policy because they just got married or they experienced a bout of paranoia after learning about a friend who died young.

But what happens when that relationship ends and that paranoia fades away; what happens if they go from being comfortably employed, to unemployed and desperate? They’re not the ones who will benefit from that payout, so they may decide that they’re just wasting their money, in which case they stop making the payments and the policy lapses. If this happens, the life insurance company gets all of the premiums and none of the liability.

Whole life insurance policies can also be cashed out. They build money through dividends and this entices the owner to give it all up for a big payday. If they’re struggling financially and realize they have a big balance waiting for them on their life insurance policy, they may be tempted to cash the check, close the account, and walk away with the windfall, thus removing all liability from the insurance company.

Refusing to Pay Out

Life insurance companies can also make money by refusing to pay out and pointing to a discrepancy. This is not part of their business strategy, and they don’t actively seek to scam their customers because, quite simply, they don’t need to. Thanks to underwriting, cash outs, lapse policies and investing, life insurance is a profitable enterprise without needing to resort to underhanded tactics.

However, they can and will refuse payouts if they determine that the contract was somehow breached. This can happen in any number of ways and for a myriad of reasons:

The Cause of Death Wasn’t Covered

Most causes of death are covered by most life insurance policies. However, there are some exceptions, including suicide. Many policies refuse to cover suicide at all, while others refuse to cover it if it occurs within the first 2 years of the policy.

More than 40,000 people take their own lives every year in the United States and it’s a common issue across all demographics. It’s also on the increase and is now the 10th biggest killer in the United States. 

As heartless as it might seem for an insurance company to refuse a payout for someone who took their own life, it’s important to remember that their underwriting is based purely on probability, and because suicide is one of the biggest killers in young men, it’s something that has to be considered.

The policy should state clearly which causes of death are covered and which ones are not. It’s also something you can discuss with the insurance company when you take out your policy.

Important Information was Not Disclosed

This is the most common reason for a payout to be refused. In some cases, the applicant is looking for cheaper premiums and knows that a few seemingly innocent lies will shave tens of dollars off their premiums. 

The policyholder may also assume that certain information isn’t relevant or be too ashamed to disclose it. For instance, if they were cautioned for driving under the influence of drugs or alcohol it may not seem relevant to the underwriting process, but if they die in a road traffic accident it could prevent a payout.

In the majority of cases, however, they simply forget. A life insurance policy is something you fill out in one sitting and something that requires you to list all previous medical conditions, hospital visits, and health complaints. It’s easy to forget a few things here and there.

There is No Beneficiary

A life insurance policy can only be paid directly to an heir when they are named as a beneficiary. If there is no beneficiary, it will be paid to the policyholder’s estate, from which their heirs can make their claim.

This becomes problematic if the policyholder has a lot of debt, as the debtors will then line up to take their share from the estate. It can also make life difficult for loved ones trying to make a claim on that estate. It’s always recommended, therefore, to name beneficiaries on the life insurance policy and to back this up by writing a will.

The Contestability Period

The above issues become more prevalent during something known as the contestability period. This begins as soon as the policy goes into effect and it can last for 1 or 2 years, depending on the policyholder’s state of residence.

If the policyholder dies during this period, the life insurance company will seek to contest it by looking at all of the details and ensuring they match. They will check the cause of death against previously filed medical reports and will make sure the correct information was supplied at the time the policy was filed and that there are no discrepancies.

Once this period passes, it’s unlikely there will be any issues, but they can still occur. The insurance company may, for instance, investigate the claim if they believe it was purchased for the sole benefit of the beneficiaries (for example, the policyholder purchases it knowing they were going to commit suicide or were about to die).

Summary: Payouts are Rare

Studies suggest that as few as 2% of all term policies pay out, and the most common reason for non-payment is that the policyholder survives the term. This is a statistic that detractors like to quote and it’s often followed by a claim that life insurance is just institutionalized gambling. 

To an extent, they’re right. You’re essentially gambling against a house that always wins and, like a casino, it always wins because, for every player that wins, 10 others will lose. The difference is that life insurance provides some much-needed peace of mind while you’re alive and ensures your loved ones are covered in the event that anything happens to you.

Source: pocketyourdollars.com

Car Insurance: Liability vs. Full Coverage

December 31, 2018 &• 5 min read by Taylor Cenicola Comments 0 Comments

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Most people need car insurance in order to drive legally. Car insurance has two main categories: liability and full coverage.

The two types of car insurance will cover you in different circumstances. They also come at two very different prices. This article will cover the difference between the two types of car insurance coverage.

Liability Coverage 

Liability car insurance is simply insurance that covers your liability. In other words, liability coverage will pay for any damage to other property or people. You must pay out of pocket for your own damage though.

Liability coverage has two other subcategories as well.

Bodily Injury

Bodily injury coverage is exactly what it sounds like. This type of coverage covers medical expenses for the other party in the event you have an accident. Without bodily injury protection, you have to pay their medical expenses.

You can choose the amount of bodily injury coverage that you want to purchase. Keep in mind that most states require drivers to have bodily injury liability insurance to legally drive a vehicle.

Property Damage

Property damage coverage is also exactly what it sounds like. This covers physical damage to property, which usually means a vehicle. It may cover other property damage too, but this depends on the coverage.

Full Coverage

Full coverage car insurance is likely what most people think of when they search for auto insurance. Full coverage insurance will cover your vehicle in the event of an accident.

It may also cover your vehicle for than just an accident too, but this depends on the terms of the policy. Some policies cover acts of God, which means you will have coverage for natural disasters and other natural events. Some examples include the following:

  • Falling objects
  • Flooding
  • Theft
  • Other unforeseen circumstances

Legally Required Coverage

The coverage required by law varies depending on the state. Forty-seven states require liability insurance. The amount varies depending on the state. However, if you use a loan to purchase to a vehicle, then your loan provider will require you to purchase full coverage insurance. Lenders do this so they can receive money if you have an accident, or the car gets damaged.

Do I Need Full Coverage?

The decision to get full coverage or liability coverage is one that depends on a wide range of factors and your risk tolerance. This section will cover all the factors you should consider before deciding what insurance to choose. However, this section will not recommend a policy type for you to purchase. Simply consider the factors listed below when shopping for auto insurance.

Things to Consider

The following are a few considerations to make when deciding the level of insurance coverage you will need:

Your Ability to Purchase a Vehicle: one of the most important things to consider is your ability to purchase a new vehicle in the event of an accident. Remember, if you total a vehicle, then you will likely need a rental car for a few days while you search for a new car.

Also, you might have money at the moment, but if you’re in a money crunch and wreck your car, then you might have a problem purchasing a vehicle. Make sure to keep your ability to purchase a new vehicle in mind before dropping full coverage.

Vehicle Resale Value: another important factor is the resale of your vehicle. For instance, if you have a junk car, then paying for full coverage might not be worth it. Your insurance company will most likely total the car in the event of even the most minor accident because the cost of repairs exceeds the total loss in value of the vehicle. The car’s value might not even exceed the deductible, which means you might have to pay out of pocket!

On the other hand, if you have a very expensive vehicle, then full coverage will mean your wallet will not hurt as much in the event you wreck your vehicle. Your insurance company may even pay to fix the vehicle rather than writing it off. This just depends on the cost of the repairs and the total value of your car.

Policy Cost: the price difference between a liability insurance policy and a full coverage insurance policy will vary depending on a lot of factors such as your driving record, type of vehicle, zip code, and even the color of your car. It will also depend on your credit score!

Despite all those factors, sometimes only a marginal difference in price between the two policies exists. If the price difference is small enough, then it might make more sense to purchase the comprehensive coverage.

Risk Tolerance: one of the more critical factors in deciding the type of coverage you want is your risk tolerance. Insurance, by definition, is merely paying to transfer your risk to another party. You will have to analyze all the factors and determine the amount of risk you want to have.

Loan: if you have a loan on your vehicle, then you will have to purchase full coverage insurance for the amount of your loan. You might have the ability to lower the total coverage to your loan amount though. You will have to contact your lender to check.

Final Thoughts

The difference between liability insurance and full coverage insurance is a very large one in a legal sense and a benefit sense. It can also make a financial difference. You want to know exactly what type of coverage you purchase before signing a contract.

Make sure to fully review the policy and understand exactly what it covers and does not cover. This understanding is especially important for a full coverage plan since they tend to be very large.

More importantly, understand exactly what type of insurance fits your needs. Sometimes purchasing a liability plan make more sense for you and sometimes purchasing full coverage makes more sense for you. The above checklist should help you find the right type of insurance for your needs.

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A Guide to Coinsurance and Copays

A Guide to Coinsurance and Copays – SmartAsset

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Having health insurance makes it possible to receive medical care while only paying a fraction of that care’s true cost. Insurance doesn’t cover everything, however. Some of the cost of your care is still up to you to pay, and that cost comes in two primary forms: copays and coinsurance.

What Is a Copay?

A copay is a flat amount of money that you’re responsible for paying for a health care service. Copays typically apply for things like a doctor’s appointment, prescription drug or medical test. The amount of your copay is dependent on your specific health insurance plan.

You can typically expect to pay your copay when you check in for your service, be it an annual physical, dental cleaning or blood test. Copays are typically lower amounts ranging from $10 for something like a generic drug prescription to around $65 for a visit to a medical specialist.

Depending on your insurance plan, copays may not take effect until after you reach your deductible. Your deductible is the amount of money you must pay out-of-pocket before your insurance provider starts to pitch in. Deductibles reset at the beginning of every year.

When you are reviewing your plan information and you see the phrase “after deductible” or “deductible applies” in reference to your copays, that’s an indication that the copay is only in place once you meet your deductible. On the other hand, if you see “deductible waived,” that’s a sign that your copay is in place from the beginning. It may go without saying, but the latter situation is vastly preferable to you.

What Is Coinsurance?

Coinsurance is another method of splitting the cost of medical coverage with your insurance plan. A coinsurance is a percentage of the cost of services. You pay the percentage, and your insurance company foots the rest of the bill. So, if you have a $8,000 medical bill and a 20% coinsurance, you would be on the hook for $1,600.

Coinsurance typically only comes into play after you hit your deductible. Further, you may have differing coinsurance percentages for the same services depending on your provider network. If you have a preferred provider organization (PPO) plan, your coinsurance could be a higher percentage for providers outside your network than it is for providers in your network.

Similarly, your coinsurance may not apply to providers outside your network if you have a health maintenance organization (HMO) plan or an exclusive provider organization (EPO) plan. That’s because these plans typically don’t provide any out-of-network coverage.

Copay vs. Coinsurance

Copay and coinsurance are very similar terms. They both have to do with portions of the cost of your health care that’s under your responsibility. Because of that, and their similar names, it’s easy to confuse the two. There are a couple of important distinctions to keep in mind, however.

The most notable difference between copays and coinsurance is that copays are always a flat amount and coinsurance is always a percentage of the cost of the service. Another difference is that some copays can be in place before you hit your deductible, depending on the specifics of your plan. With coinsurance, you have to hit your deductible first.

Bottom Line

If you’re choosing between health insurance plans, make sure to examine the provided copays and coinsurance for each option. While they may not be the most important factor to consider, a high copay can be quite a pain, especially over the course of years of appointments and procedures.

Tips for Staying on Top of Medical Expenses

  • One of the best ways to stay ahead of surprise medical expenses is to have an emergency fund in place for just such a situation. If you can manage it, have three to six months worth of expenses stashed away in a high-yield savings account. That way, if you’re dealing with medical bills or have to step away from work, you’ll have a bit of a cushion.
  • If you’re not sure how an unexpected medical expenses would fit into your finances, consider working with a financial advisor to develop a financial plan. Finding the right financial advisor that fits your needs doesn’t have to be hard. SmartAsset’s free tool matches you with financial advisors in your area in 5 minutes. If you’re ready to be matched with local advisors that will help you achieve your financial goals, get started now.

Photo Credit: ©iStock.com/DuxX, ©iStock.com/SARINYAPINNGAM, ©iStock.com/Aja Koska

Hunter Kuffel, CEPF® Hunter Kuffel is a personal finance writer with expertise in savings, retirement and investing. Hunter is a Certified Educator in Personal Finance® (CEPF®) and a member of the Society for Advancing Business Editing and Writing. He graduated from the University of Notre Dame and currently lives in New York City.
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