Chapter 9 第九章

Chapter 9第九章 Life and Health Insurance人身保險與健康保險

Insurance: Planning and Control保險：計畫與控制 • Life insurance marketing is very confusing – recommendations and policy language differ.人身保險市場是令人混淆不清─推薦保單及保險專業術語 • Medical care is costly and sophisticated, with little incentive to economize costs.醫療照顧非常昂貴且複雜化 • Employers, employees, and the unemployed face increasing costs and restrictions on health care.員工、雇主及未受僱者面臨增加的成本與醫療照顧的衝擊 Prentice Hall Inc.

Understanding the Logic Behind Insurance明瞭保險背後的邏輯 • Insurance is an example of risk pooling – individuals share their financial risks to catastrophic losses from death, accidents, or health problems.保險是風險分攤的例子─以群體來分擔個體因死亡、意外或疾病所產生的財務風險 Prentice Hall Inc.

Life Insurance Policy Terms人身保險條款 • Premium – the monthly cost of the policy保費─保單的每月成本 • Face value – the benefit due upon death 面值─死亡時保單上所載明提供的金額 • Insured – the person whose life is covered by the policy被保險人─保單上所記載生命受保障的人 • Policy owner – the individual or business that pays for and owns the policy要保人─擁有保單的個人或企業 • Beneficiary – the recipient of the benefit upon the death of the insured受益人─被保險人死亡時，指定收到保險利益之人 Prentice Hall Inc.

Life Insurance May Not Be Necessary for the Following下列的人可能不需人身保險 • Single person without dependents單身且無人何親人 • Double-income married couple without dependents雙薪、已婚且無人任何親人子女 • Married, but unemployed, individual without dependents已婚但無工作，無任何子女親人 • Retired persons已退休的人 Prentice Hall Inc.

Life Insurance May Be Necessary for Those有哪些人可能需要人身保險 • With dependents有親人 • Who are a married, single-income couple, with children已婚，單薪且有子女 • Who are business owners企業擁有者 • Whose estate exceeds the estate tax-free transfer threshold ($1M in 2002 and 2003 and increasing to $1.5M in 2004 and 2005)遺產價值高於免課遺產稅的移轉門檻(2002年與2003年為一百萬美元， 2004與 2005年增加ㄧ百五十萬美元) Prentice Hall Inc.

Determine Your Life Insurance Needs: Two methods記算你的人身保險需求：兩種方法 • The earnings multiple approach:盈餘乘數法 • To replace the annual salary stream of a bread winner for X years, normally 5 – 15 times gross salary is recommended.，通常是建議你年收入總額5-15倍 • The needs approach:需求估算法 • To meet the needs of the household after the death of a breadwinner, both current and in the future.為了符合死亡後能繼續維持目前的生活型態時，所需要的保險保障 Prentice Hall Inc.

The Earnings Multiple Approach盈餘乘數法 • Adjust salary down to compensate for the reduction in household expenses.將薪資收入減去少掉一個人的生或費用 • Choose the PVIFA i%, n yr to match the assumed after-tax and after-inflation earnings on the policy settlement.選擇合適的年金現值因子PVIFA i%, n yr,其中盈餘必須經過稅後即通貨膨脹的調整 • The longer the income stream replacement, the greater the multiple. The higher the assumed earnings, the lower the multiple.你希望取代的年數越長，盈餘成數越高，你認為可以從保險中所賺取的報酬率越低，盈餘成數越低 Prentice Hall Inc.

Earnings Multiple Approach Formula盈餘乘數法公式 Life Insurance Needs = Income x (1 –% of income spent on the deceased) x (PVIFA i%, n yr) 人身保險需求=收入 x ( 1 - 家庭收入花費減少的百分比) x (PVIFA i%, n yr) Prentice Hall Inc.

The Needs Approach –需求估算法The Seven Funds七個基本因素 • Immediate needs funds立即需要基金 • Debt elimination funds償還債務基金 • Immediate transitional funds立即過渡型基金 • Dependency funds家屬基金 • Spousal life income funds配偶生活收入基金 • Educational funds for child or spouse子女或配偶的教育基金 • Retirement income funds退休收入基金 Prentice Hall Inc.

The Needs Approach –需求估算法The Calculation計算方式 • Add all funding needs to determine total need (remember to adjust all needs to a present value figure).將所有需求加總求得總需求(記得將所有的需求換算成現在的價值) • Subtract current insurance coverage and other available assets.減去現有保單承保範圍與其他可用的資產 • This determines amount of additional insurance coverage necessary.得到的數據即是所需加保的 Prentice Hall Inc.

Major Types of Life Insurance人身保險的主要型態 • Term insurance定期人身險 • Cash-Value insurance現金價值保險 Prentice Hall Inc.

Term Insurance定期保險 • Death benefit coverage for a specific term of time在保單承保ㄧ個特定的期限 • Only valid if the insured dies during the term of coverage在承保期間內死亡才有效 • Least expensive form of insurance較少的保險費用 Prentice Hall Inc.

Cash-Value Insurance現金價值保險 • Provides a death benefit and an opportunity to accumulate savings提供一個死亡給付及一個累積的儲蓄計畫 • Provides permanent insurance提供持續的保險 • Examples – Whole life, Universal Life, Variable Life例如─終身人身保險，萬能人身保險與變額人身保險 Prentice Hall Inc.

Types of Term Insurance定期保險的型態 • Renewable term insurance可更新定期人身保險 • “Reentry” term insurance再登入定期人身保險 • Decreasing term insurance遞減型的定期人身保險 • Group term insurance團體定期人身保險 • Credit or mortgage group life insurance信用或抵押團體人身保險 • Convertible term life insurance 可轉換定期人身保險 Prentice Hall Inc.

Types of Cash-Value Insurance現金價值保險的型態 • Whole life insurance –for those who need permanent life insurance protection終身人身保險─提供給需要永久人身保護的人之保險 • Universal life insurance –for those who want a flexible policy that combines term protection and tax-deferred savings萬能人身保險─提供了需要結合定期保障與延遲繳稅的儲蓄特色合，且較富彈性的保險 • Variable life insurance –for those who want to take risks and manage their own investments with an opportunity for tax-deferred savings變額人身保險─瞄準那些想要管理自己的投資和願意接受風險的人 Prentice Hall Inc.

Whole Life Insurance and Its Features終身人身保險及它的特色 • Permanent protection永久性的保障 • Fixed premium保費固定 • Fixed death benefit死亡給付固定 • Fixed cash-value that grows tax-deferred固定現金價值帶有租稅遞延的利益 • Much less death protection than term for the same price與定期保險相比較，在相同的價錢下，提供較少的死亡保障水準 • Yield on cash value portion is not competitive with yields on alternative investments現金價值部份的殖利率與其他投資選項比，不具競爭性 Prentice Hall Inc.

Universal Life Insurance and Its Features萬能人身保險及它的特色 • Permanent protection永久性的保障 • Flexible premium payments with unbundling:固定保費分別計價 • Mortality charge or term insurance死亡保險成本或定期保險 • Cash value or savings現金價值或儲蓄 • Administrative expenses管理費 • Flexible death benefits 固定死亡給付 • Cash-value fluctuates depending on the amount paid into the policy現金價值隨保單給付金額而波動 Prentice Hall Inc.

Universal Life Insurance and Its Features (cont’d)萬能人身保險及其特色 • Returns fluctuate widely報酬波動相當大 • Policies often lapse because of the flexibility to not make premium payments保單常因為彈性支付保費而至保費不足時導致失效 • Savings may not accumulate as expected due to fluctuations in return and high expense charges因為報酬率與高費用的波動，導致儲蓄無預期中累積得多 Prentice Hall Inc.

Variable Life Insurance and Its Features變額人身保險及其特色 • Permanent protection; returns are earned on a tax-deferred basis永久的保障，利益是基於租稅緩課的基礎 • Allows for either a fixed (straight variable) or flexible (variable universal) premium允許固定(純粹變額)或是波動(變額萬能)的保費 • Flexible death benefit and fluctuating cash value, reflecting the mutual fund investment performance 彈性的身故利益與波動的現金價值，反映在共同的基金投資 Prentice Hall Inc.

Term Versus Cash-Value:Which Type is Right for You定期與現金價值何種型態適合你 • For most people, term is the best alternative:對多數人言，定期是最好的選擇 • Relatively low cost相對地成本低 • Affordable coverage when life insurance is needed the most當人身保險的需求是最重要時，可以提供保障 • Becomes very expensive with age, but may be unnecessary保費隨年齡增加愈貴，但可能是不需要的 Prentice Hall Inc.

Term Versus Cash-Value: Which Type is Right for You (cont’d)定期與現金價值何種型態適合你(續) • Cash-value insurance offers tax advantages:現金價值保險提供的租稅利益 • Savings grow tax-deferred and are passed on without incurring estate taxes.儲蓄兩有租稅緩課利益，死後無須課遺產稅 • Other investment plans are better relative to cash-value insurance.其他投資計畫可能比現金價值保險好 Prentice Hall Inc.

Contract Clauses and Riders to Meet Your Need符合你需求的合約條款與追加條款 • Understanding 10 common features of most policies明瞭多數保單的10個一般特性 • Choosing a settlement option:理賠的選擇 • Life annuity settlements終身年金理賠 • Choosing riders that meet your needs選擇符合你的追加條款 Prentice Hall Inc.

#1. The Beneficiary Provision受益人條款 • Allows for the naming of primary and contingent beneficiaries允許登記一個主要和次要的受益人 • May name an irrevocable beneficiary that cannot be changed without permission of the beneficiary可以指定ㄧ位不可撤換的受益人，除非受益人同意撤換 Prentice Hall Inc.

#2. The Coverage Grace Period寬限期間 • Automatic extension of 30 or 31 days that the owner has to pay the premium without the policy lapsing自動延展期間一般為30 – 31天，保單擁有者須支付保費而保單並未終止 Prentice Hall Inc.

#3. The Loan Clause貸款條款 • Only exists on policies with a cash value依存在保單的現金價值 • Allows the owner to borrow against the cash value of the policy允許按照保單的現金價值來借貸 Prentice Hall Inc.

#4.The Nonforfeiture Clause不可沒收條款 • Provides options for policy holders to terminate their policies early:提供保單遲有人選擇放棄領取身故理賠金的權利 • Receive the cash value收到保單的現金價值 • Exchange cash value for a paid-up policy with a reduced face value以保單現金價值去換一個面額較小的已付清保單 • Exchange cash value for a paid-up term policy with the full face value以保單面額去換一個已付清的定期保險 Prentice Hall Inc.

#5. The Policy Reinstatement Clause保險恢復條款 • Option for restoring a lapsed policy within 3 to 5 years of the expiration允許你可在保單到期後三到五年內去恢復你的保險 • Generally requires all past due premiums, loans, and interest be paid before reinstatement一般會要求在恢復保險以前，繳清過去所積欠的保費、貸款或利息， Prentice Hall Inc.

#6. The Change of Policy Clause變更保險條款 • Allows the policy holder to change the type of policy in effect允許保險人變更保險的種類 Prentice Hall Inc.

#7. The Suicide Clause自殺條款 • States that the insurance company will not pay death benefits if the insured commits suicide within 2 years of when the policy took effect保險公司對於自購買保險起兩年內發生自殺死亡的案例，不支付保險理賠金 Prentice Hall Inc.

#8. The Payment Premium Clause保費支付條款 • Explains the options available for the payment of the premiums, such as monthly or annually是規定投保人支付保費的方式，通常有月付或是年付的方式 Prentice Hall Inc.

#9. The Incontestability Clause無可置疑條款 • Declares that the insurance company cannot dispute the validity of the policy after a certain time period has passed, normally 2 years聲明保險公司不能在保險生效後的一特定期間內，通常是兩年，去質疑保單的有效性 • This clause provides very important protection to the beneficiary against policy cancellation.此條款保障了受益人以防保險被取消 Prentice Hall Inc.

# 10. Settlement Options理賠方式的選擇 • Lump-sum settlement – one time payout upon death of the insured一次付清─，一旦身故則一次付清理賠金 • Interest-only settlement – periodic payments of the interest earned by the principal只付理賠利息─將理賠金存在保險公司，並定期收到此存款利息的部份 Prentice Hall Inc.

Settlement Options (cont’d)理賠方式的選擇(續) • Installment-payments settlement – periodic payments, normally for a fixed period, of both the principal and interest分期付款理賠─本金和利息的部份再依固定期間內定期支付一定的數額 • Life annuity settlement – periodic payments of both the principal and interest that continue for the life of the beneficiary終身年金理賠─受益人可以以定期方式，終身的到收入 Note: Life insurance death benefits are income tax-free; however, in some cases state inheritance taxes may apply.注意：人身保險的身故受益人收益是免稅，無論如何，在有些州也可能課徵繼承稅 Prentice Hall Inc.

Types of Life Annuity Settlements終身年金理賠的型態 • Straight life (largest monthly payout)終身年金(最大的每月支付額) • Straight life with period certain annuity終身年金有一定年金收入 • Straight life with refund annuity償還型年金 • Joint life and survivorship annuity結合共享年金 Prentice Hall Inc.

Riders – The Special Provisions附加條件─ㄧ個特殊條款 • Waiver of premium for disability rider殘障的豁免保費 • Accidental death benefit rider or multiple indemnity意外死亡或多重保障的理賠 • Guaranteed insurability rider保險單保附加條款 • Cost-of-living adjustment (COLA) rider死亡撫恤金的附加條款 • Living benefits rider存活利益的附加條款 Prentice Hall Inc.

Buying Life Insurance 購買人身保險 1. Buyer beware – a little knowledge goes a long way.買方注意事項─多少了解一下保險，見微知著 2. Select a high-quality insurance company based on company ratings.透過保險公司評等，選擇高水準的保險公司 3. Select an insurance agent with whom you feel comfortable.選擇一個易於相處暸及解你的保險經紀人 4. Compare costs of competing policies.在多競爭的保單中比較成本 5. Consider alternative approaches: the net or an advisor.考慮替代方案：網路或顧問 Prentice Hall Inc.

1. Buyer Beware – A Little Knowledge Goes a Long Way買方注意事項─了解保險 • Determine your needs.計算你的需求 • Consider your needs relative to the basic products.針對相關基本保險考量你的需求 • Determine what kind of policy you want and buy it.計算何種類型的保險是你需要且想購買的 Prentice Hall Inc.

2. Selecting a High-Quality Company選高水準的保險公司 • Know your state protection.瞭解州的保障協會規定 • Check the ratings for the company’s financial strength and ability to pay off claims:檢視該保險公司財力及理賠的能力的評等 • A.M. Best • Duff and Phelps • Moody’s Investor Service • Standard & Poor’s Prentice Hall Inc.

3. Selecting an Informed Agent選擇一個經紀人 • Get recommendations from friends or professionals.可經由朋友或專家的推薦 • Consider training, designations, and experience.考慮其所受的訓練、證照和經驗 • Interview agents and get quotes on your insurance plan.與經紀人會談並對你的保險計畫做報價 • Select an agent with whom you feel comfortable.選擇一位易於相處、瞭解你想法的人 Prentice Hall Inc.

4. Comparing the Costs of Competing Policies比較成本 • The traditional net cost (TNC) method:傳統淨成本法 • (Premiums - dividends - cash value) / number of years = TNC(保費 –股利 –現金價值) / 年數=傳統淨成本 • Does not consider the time value of money無考慮到現金的時間價值 • The interest-adjusted net cost (IANC) method, or surrender cost index:利息淨成本法，或歸還成本指數法 • Considers the time value of money考慮到貨幣的時間價值 Prentice Hall Inc.

5. Consider Alternative Approaches考慮替代方案 • Consult a premium quote service on the web.在網路報價機構的資料庫上尋求保費報價 • Buy life insurance directly from the company.由保險公司直接購買人身保險 • Buy low-load cash-value life insurance.購買低負擔現金價值的人身保險 • Consult a fee-only insurance advisor.選擇諮詢付費的保險顧問 Prentice Hall Inc.

Major Types of Health Care Coverage健康保險的類型 • Basic health insurance基本的健康保險 • Major medical expense insurance主要醫療費用保險 • Dental and eye insurance牙科和眼科保險 • Dread disease and accident insurance重大疾病和意外保險 Prentice Hall Inc.

Basic Health Insurance基本的健康保險 • Hospital insurance –covers hospitalization expenses including room fees, nursing fees, and drug fees住院保險─包含住院期間所需的成本，例如病房費、護士費與藥品費 • Surgical insurance – covers only the direct costs of surgery including the surgeon’s fees and equipment fees外科手術─外科手術成本，包括外科手續費和設備費用 • Physician expense insurance – covers physicians’ fees including office fees, lab fees, and X-ray fees內科費用保險─手術費以外的費用，包含門診費用、實驗室費用和X光費用 Prentice Hall Inc.

Major Medical Expense Insurance主要醫療費用保險 • Covers medical costs beyond the basic plan保障基本健康保險保障以外的醫療成本 • Normally requires co-payments and deductible payments通常允許保費的支付是共同支付和可減免的 • Stop-loss provision – limits the total out-of-pocket expenses incurred by the insured to a specific dollar amount停損條款─限制了保險人必須負擔的總金額 • Life-time cap – total amount the insurance company will pay over the life of a policy壽命上限─保險公司對該保單幾付的最高限額 Prentice Hall Inc.

Dental and Eye Insurance牙科和眼科保險 • Covers the costs of eye exams, glasses, contact lenses, dental work, and dentures提供眼睛檢查、眼鏡、隱形眼鏡和牙齒假牙的相關費用 • Typically prohibitively expensive unless provided with an employer plan通常價格非常高除非雇主計畫有提供 Prentice Hall Inc.

Dread Disease and Accident Insurance重大疾病和意外保險 • Covers only specific illnesses or accidents是針對重大疾病和意外的保障 • Provides a set dollar amount of reimbursement提供某些特定的理賠金 • Note: Avoid these types of insurance –concentrate on making your health coverage as comprehensive as possible.注意：避免這類型的保險：將注意力集中在你的健康保險，且僅可能的包羅萬象 Prentice Hall Inc.

Private health care plans私人保健保險 Non-group (individual) coverage plans非群體 (個體)保險 Government-sponsored health care plans政府贊助保健保險 Identifying the Various Health Care Providers Prentice Hall Inc.

Private Health Care Plans私人保健保險 • Fee-for-service or traditional indemnity plans傳統的保健保險 • Managed health care:管制型保健保險 • Health maintenance organizations (HMOs)健康保持組織 • Preferred provider organizations (PPOs)優先提供者機構 Prentice Hall Inc.

Fee-for-Service or Traditional Indemnity Plans傳統的保健保險 • Provides greatest flexibility for choosing doctors and hospitals提供最佳自由選擇醫師或醫院 • Coinsurance – defines the percentage of each claim that the policy will cover共同保險─保險條款定義為，保險公司會支付索賠的百分比 • Co-payment or deductible – defines the amount that you must pay before a claim is eligible for reimbursement聯合支付或扣除條款─在保險公司理賠補償你之前，你必須先支付醫療的部份 • Plans are relatively expensive and require more paperwork這類保險較為昂貴，且較多紙上作業 Prentice Hall Inc.

Chapter 9 第九章