An insurer would be committing Unfair Discrimination if coverage was denied based upon Quizlet

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-Private insurers offer insurance to people through the individual market
-Private insurance is sold on a voluntary basis (MOSTLY)
-Some forms of insurance is offered through private insurers are compulsory.
-There are two groups of commercial insurers: Stock insurers, and Mutual Insurers .

-There are various types of private insurers,including: Stock insurers (commercial), Mutual insurers (commercial), Noncommercial organizations, Fraternal benefit societies, Lloyd's Associations, Risk retention groups, Risk purchasing groups, Reciprocal exchanges, Reinsurers, Assessment insurers and Excess and surplus lines.

-Service providers, or noncommercial organizations, are not technically "insurers" and do not sell insurance.
-They are better described as service organizations that provide prepaid health plans for medical, surgical, and hospital expenses.
-Service providers sell medical services to members, who are termed subscribers.
-The insured is not reimbursed for the medical services received.Instead, the service organization pays benefits directly to the health care providers the subscribers' use.
-Two common types of service providers are:
HMOs- Health Maintenance Organizations, and
PPOs- Preferred Provider Organizations.

-HMOs provide the medical care and finances required to fund health care services. Subscribers obtain medical care through hospitals and physicians that have contracted with the HMO.
-PPOs provide discounted medical services to members.
-A group wishing to provide health care services to its members forms a PPO. The PPO receives a special discounted rate by using certain medical practitioners, hospitals and clinics. In exchange, the PPO will refer members to these medical professionals. An insurance company may contract with a PPO to provide medical services to insureds.
-Unlike stock or mutual insurers, noncommercial organizations are nonprofit entities offering strictly health insurance coverage.

Producers
Producers are people who sell, solicit and negotiate insurance. This term encompasses agents and brokers. In some states, solicitors are licensed to work as insurance producers.
Agents
Agents are insurance producers who represent the insurer, not the insured. Life and health agents cannot bind insurance (commit insurers to provide coverage by a written or oral agreement); however, property and casualty agents can bind insurance.

Brokers
Brokers are insurance producers who represent the insured, not the insurer. Brokers work for several different insurers. Brokers' duties are similar to agents' in soliciting coverage, collecting applications and initial premiums, and delivering policies; however, brokers cannot bind insurance.
Solicitors
Solicitors are licensed salespeople who work for an agent or broker. Solicitors perform the duties of brokers; however, like brokers, they cannot bind coverage.
Consultants
Consultants provide insurance advice to insureds for a fee. Consultants work for insureds, not insurers.

Misrepresentation; Any written or oral statement that does not accurately describe a policy's benefits, conditions, or coverage is considered a misrepresentation. A misrepresentation is simply a lie.
-Any statement representing a health discount plan (HMO) as a form of insurance is a misrepresentation.
-Relating only the benefits and not including a description of conditions or limitations is misrepresenting the policy.
-Suggesting a policy is better suited for a prospective applicant than the facts would indicate to a reasonable person is misrepresentation.
Defamation;
Defamation is any false, maliciously critical, or derogatory communication - written or oral - that injures another's reputation, fame, or character. Both individuals and companies can be defamed.
Rebating; Rebating occurs if a buyer of an insurance policy is given anything of significant value as an inducement to purchase or renew a policy.
Any inducement in the sale of insurance that is not specified in the insurance contract itself is a rebate. For instance, splitting a commission with a prospect is not a part of the insurance contract and, therefore, constitutes a rebate. Rebates include not only cash, but also personal services or items of value.
Keep in mind that most states do not consider a small token gift, under $25.00, used for advertising is not considered rebating.

Discrimination;Discrimination is a necessary part of the insurance business. So long as these principles are applied equally to each and every applicant or policyholder, discrimination is fair. When these principles are applied only to certain individuals within a group, the discrimination is unfair.
Unfair DiscriminationUnfair discrimination is the unequal application of the principles used to approve, rate, set premiums, and issue insurance policies. Every state has laws prohibiting unfair discrimination in insurance. In general, they state that no insurance producer may unfairly discriminate between individuals of the same class and equal expectation of life in the rates charged for the policy or between individuals of the same class and of the same hazard in the amount of premium rates, in any manner whatsoever.
Denying coverage or charging a different premium based on race, martial status, or blindness is illegal.
-Boycott, Coercion, and Intimidation;
They use power unethically and unprofessionally to attempt to force a company or individual to behave in a certain way. The difference is the means used to get the desired result.
Coercion; Coercion generally manipulates through the prospect of something desirable. An agent's subtly suggested offer to recommend the prospective client for membership in a selective club if the person purchases a particular policy is coercive, for instance.
Boycott Boycott is a form of intimidation in which an individual or group refuses to do business with a company or individual, either to drive them out of business or to force them to act in certain way.
Intimidation manipulates through the threat of a negative result. The loss of business and the denial of coverage are examples of intimidation.
Penalties; Following an investigation and a hearing, if the Department of Insurance finds that any person or insurer is engaged in any unfair marketing or unfair claims practice, the Commissioner may issue a cease and desist order prohibiting the individual or company from continuing the practice. Failure to comply with the cease and desist order can result in a substantial fine. In addition, fines and loss of license may also be imposed for a company or person guilty of violating the Unfair Trade Practices Act.