In this type of administration, the administrative function is performed by the policyholder. This is more common for groups of 100 or more people where the policy owner has the facility to meet the demand of the administrative responsibility.
Self-insurance is “having no formal plan with a particular carrier”.
You may encounter service schedules on older group plans, where the benefits are graded on the basis of employees years of service, with the highest benefit for the most senior employee. Service schedules are generally frowned on by most underwriters.
Sole Proprietor - You are a sole proprietor (self-employed individual) if:
Your business is not incorporated;
You have sole responsibility for decision making;
You receive all profits and are responsible for all losses; and
You report your business income on a T1 Individual income tax return.
You will encounter these only on large-group cases. They are drawn up by a broker or consultant to determine detailed handling of various aspects of a group. The questions asked may rule out certain bids.
Statement of Health
The form used to establish the insurability of an applicant who did not enroll when first eligible or who re-enrolls. The statement asks specific questions about recent medical treatment and requests the insured's authorization to check this information with hospitals and attending physicians.
Provisions that minimize fluctuations in claims experience as an insurance company’s charge for carrying the risk.