Are prescription drugs covered under an HMO?

Most HMOs provide prescription drug coverage, but the medications must be on the plan’s formulary (approved drug list). Some prescriptions may require prior authorization or step therapy before being covered.

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What does a low loss ratio indicate?

A low loss ratio indicates that the insurer is paying fewer claims relative to the premiums collected, which could mean better profitability but may also suggest strict claim approvals.

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What challenges do actuaries face?

Actuaries deal with regulatory changes, evolving risks, data limitations, technological advancements, and economic uncertainty in their financial assessments.

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What is the role of a TPA in group health insurance policies?

In group health insurance, TPAs handle claims administration for corporate employees, assist in setting up cashless treatments, maintain medical records, and ensure compliance with the insurer’s terms. They also help with wellness programs and employee benefit management.

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What is the role of Lloyd’s in Marine Hull Insurance?

Lloyd’s of London is a major marketplace where underwriters provide Marine Hull Insurance coverage, often specializing in high-risk vessels or complex maritime operations.

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Does renters insurance cover water damage?

Renters insurance covers water damage from events like burst pipes, accidental overflows, and leaks from appliances. However, it does not cover flood damage from natural disasters or sewer backups unless you purchase additional flood insurance. Always review your policy’s water damage exclusions.

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What happens if a reinsurer fails?

If a reinsurer fails, the primary insurer is responsible for all claims. To reduce this risk, insurers work with highly rated reinsurers and may use retrocession (where a reinsurer transfers some of its risks to another reinsurer).

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How does comprehensive coverage work in case of theft?

If your vehicle or property is stolen, comprehensive coverage reimburses you for the actual cash value (ACV) minus the deductible, based on your policy terms.

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