THE CHARTERED

INSURANCE INSTITUTE

IF7
Healthcare insurance products
Objective: To provide knowledge and understanding of the fundamental principles and
practices relating to healthcare insurance.

Summary of learning outcomes

1. Healthcare product types;
2. Structure of the UK healthcare insurance market;
3. Healthcare provision in the UK and overseas;
4. Legal and regulatory considerations;
5. Risk assessment, rating and underwriting;
6. Claims.

Important notes
• Method of assessment: 100 multiple choice questions (MCQs). 2 hours are allowed for
this examination.
• This syllabus will be examined from 1 January 2008 until 31 December 2008.
• Candidates will be examined on the basis of English law and practice unless otherwise
stated.
• Candidates should refer to the CII update website www.cii.co.uk/updates for the latest
information on changes to law and practice and when they will be examined.

Published October 2007 1 of 3

© The Chartered Insurance Institute 2007
1. Healthcare product types
On completion, candidates should
1.1 understand the main features of the following
core products:
– private medical insurance;
– health cash plans;
– dental insurance;
1.2 know the main features of the following related products
and services:
– cover for major medical expenses;
– sickness and accident policies, including payment
protection insurance and mortgage payment protection
insurance;
– international medical insurance for expatriates;
– overseas medical expenses;
– travel insurance;
– dental capitation plans;
– employee assistance programmes;
– treatment advice services;
– health screening;
– private GP services;
1.3 understand the main features of the following long-term
protection products:
– long-term care insurance;
– income protection insurance (PHI);
– critical illness insurance;
1.4 understand the circumstances in which each of the
above products would be appropriate.
2. Structure of the UK healthcare
insurance market
On completion, candidates should
2.1 know the organisation and function of:
– provident insurers;
– commercial insurers;
– third party administrators;
– other providers of healthcare insurance;
– health and dental cash funds;
– reassurers and reinsurers of healthcare products;
2.2 understand the basic function and operation of
employee healthcare trusts;
2.3 understand the main distribution channels for
healthcare insurance.
3. Healthcare provision in the UK and
overseas
On completion, candidates should
3.1 know the key features of National Health Service and
private healthcare services provision in the UK;
3.2 know the key features of the systems of healthcare
provision in mainland Europe and the USA.
Published October 2007
© The Chartered Insurance Institute 2007
4. Legal and regulatory considerations
On completion, candidates should
4.1 know the main features of the Financial Services Authority
regulation and dispute resolution relating to healthcare
insurance;
4.2 know the main features of ABI and industry-agreed codes of
practice and non-statutory regulation relating to healthcare;
4.3 understand the effect on healthcare insurance of the:
– Access to Medical Reports Act 1988;
– Access to Health Records Act 1990;
– Disability Discrimination Act 1995;
– Data Protection Act 1998;
4.4 know the personal taxation implications for holders of
healthcare insurance;
4.5 be able to apply the principles defined in learning
outcome 4 to a given set of circumstances.
5. Risk assessment, rating and
underwriting
On completion, candidates should
5.1 understand the main risk considerations and general
underwriting principles of private medical insurance with
specific reference to:
– general exclusions and exceptions;
– medical conditions and procedures;
– acute and chronic conditions;
– hospital banding, postcode rating and restricted
hospital networks;
– excesses and co-payments;
5.2 understand the following styles of underwriting
medical history:
– moratorium;
– full medical underwriting;
– continued personal medical exclusions (CPME);
– medical history disregarded (MHD);
– premium ratings;
5.3 know the rating and underwriting considerations for the
core healthcare products specific to:
– corporate schemes;
– Small and Medium Enterprises schemes (SMEs);
– voluntary schemes;
– individual plans;
5.4 understand the use of customer loyalty mechanisms that
operate in the healthcare market;
5.5 be able to apply the principles defined in learning
outcome 5 to a given set of circumstances.
6. Claims
On completion, candidates should
6.1 know the principles of claims assessment applied to core
healthcare insurance products;
6.2 know the processes involved in a claim under:
– private medical insurance policies;
– other core product policies;
6.3 understand the elements of and the factors that contribute
to healthcare claims costs;
6.4 know the main methods by which claims costs may
be controlled;
6.5 be able to apply the principles defined in learning
outcome 6 to a given set of circumstances.
2 of 3
Reading list
The following list provides details of various publications which
may assist with your studies. The primary text for this syllabus
is shown in bold type. Periodicals and publications listed as
additional reading will be of value in ensuring candidates keep
up to date with developments and in providing a wider coverage
of syllabus topics. Any reference materials cited are authoritative,
detailed works which should be used selectively as and when
required.
Note: The examination will test the syllabus alone. The reading
list is provided for guidance only and is not in itself the subject
of the examination.
CII/Personal Finance Society members can borrow most of these
additional study materials from CII Knowledge Services and may
be able to purchase some at a special discount. For further
information on lending and discounts go to
www.cii.co.uk/knowledge

Primary text
Healthcare insurance products. London: The CII. Coursebook IF7.

Additional reading
Critical illness insurance. Andy Couchman. London: CII
Knowledge Services. Updated as necessary. Available online
(CII/Personal Finance Society members only)
at www.cii.co.uk/knowledge/factfiles
Long-term care insurance. Andy Couchman. London: CII
Knowledge Services. Updated as necessary. Available online
(CII/Personal Finance Society members only)
at www.cii.co.uk/knowledge/factfiles

Reference works
Dictionary of insurance. C Bennett. 2nd ed. London: Pearson
Education, 2004. Also available online (CII/Personal Finance
Society members only) at www.cii.co.uk/knowledge/dictionaries
The Protection Review. Cheltenham, Gloucestershire: Bank
House Communications. Annual.

Periodicals
The Journal. London: The CII. Six issues a year. Also available
online (CII/Personal Finance Society members only)
at www.cii.co.uk/knowledge/journal
Post Magazine. London: Incisive Financial Publishing. Weekly.

Examination guides
You are strongly advised to study these before the examination.
Please visit www.cii.co.uk to buy online or contact CII Customer
Service for further information on +44 (0)20 8989 8464.

Exam technique/study skills

There are many modestly priced guides available in bookshops.
You should choose one which suits your requirements.
You will also find advice at www.cii.co.uk/knowledge/careersupport
(CII/Personal Finance Society members only).
For a more interactive approach, you should consider:
Winning the brain game. London: The CII, 2006. CD-ROM.

Published October 2007 3 of 3

© The Chartered Insurance Institute 2007