Unit Standard 31868 Providing Life Disability and Health Insurance Services Assessment NZQA

Life, Disability & Health Insurance Assessment

Introduction

This Assessment document contains the information you need to demonstrate competency for Life, Disability & Health Insurance for:

Unit Standard 31868 – Demonstrate and apply knowledge of the administrative processes required to provide life, disability, and health insurance services.

This document contains:

• Assessment Guidance
• Assessment Tasks 1-5
• Student Declaration Form
• Assessment Decision and Schedule Form

Assessment Guidance

The Assessment Process

To achieve the unit standard, you must complete and return to Professional IQ the following documents:

• Assessment answers for all questions or tasks
• Student declaration form completed and signed

The assessment is competency based and focuses on the application of learning in the student’s role in their normal working environment. The study guide provided for this unit standard contains the information necessary to develop their knowledge and understanding of the life, disability and health insurance.

The qualified assessor will use their professional judgement and subject-matter expertise to evaluate your assessment ensuring that it is:

• Valid: meets the outcomes and evidence requirements of the unit standard being assessed
• Fair: a fair representation of what you can do and or know against the outcomes of the unit standard
• Authentic: it must be your own work and must not be copied from any course materials or other sources
• Sufficient: answers must be full and complete enough for the assessor to judge competency
• Consistent: answers are consistent with the assessor guidelines and national consistency requirements.

The evidence you submit must comply with any policies & procedures of your organisation, codes of practice of relevant professional bodies or any relevant legislative and regulatory requirements.

Students With Specific Needs

If you have specific learning needs, you should have informed Professional IQ of these at the time of enrolment. This enables the Academic Manager to discuss with you what appropriate support is required to complete your study and assessments.

The Assessor Role

The assessor will consider all written evidence provided by you and decide if it is competent or not yet competent.

The assessor may require you to provide more evidence on one or more questions or tasks, if in their judgement they feel the answer is insufficient or incorrect.

Where there is not enough evidence to make a decision on competency, your assessor will send you a Further Evidence Required request (FER) which means you will need to supply further information. They may contact you to have a professional conversation or to clarify a point in your answer.

The assessor will complete the Assessment Decision Form, including any feedback and return the result to you within 10 working days of receipt.

Please retain a copy of your assessment work and assessment results.

The Appeals Process

An explanation of the appeals process can be found in the Student Handbook located on Professional IQ under Student Resources.

If you disagree with an assessment decision, please follow the guide and complete an Assessment Appeal Form and send it to Student Support at Professional IQ. An independent assessor will be asked to investigate the appeal.

Resources

A copy of the unit standard can be downloaded from NZQA.

It is important you fully understand the outcomes and evidence requirements of the unit standard including any special notes, references and definitions applicable. The study guide is your main resource for this assessment.

You should read the study guide for this unit standard (as part of your course work) to enable you to answer the tasks listed in this assessment document.

References

This list is provided as a guide for students who are seeking further sources of information on this module.

• Consumer Guarantees Act 1993;
• Fair Trading Act 1986;
• Code of Professional Conduct for Financial Advice Services;
• Financial Markets Conduct Act 2013;
• Financial Service Providers (Registration and Dispute Resolution) Act 2008;
• Financial Services Legislation Amendment Act 2019;
• Insurance Intermediaries Act 1994;
• Insurance Law Reform Act 1977;
• Insurance Law Reform Act 1985;
• Life Insurance Act 1908
• Privacy Act 2020;
• Relevant industry codes of conduct;

And all subsequent amendments and replacements

Student Declaration Form

Complete and attach to your assessment answers before submitting for assessment.

The Tasks you submit for assessment must be your own work and cannot be completed by another person.  Initial each item on the list below to show you have read and understood the requirements of the assessment and that the submitted work is your own then sign the declaration.

Your own work means it cannot be copied from course materials or other text. Your answers must be in your own words.

I agree for my information to be shared with Ringa Hora Services Workforce Development Council (RHSWDC), the New Zealand Qualifications Authority (NZQA) and the Ministry of Education (MoE) for the purposes of moderation to ensure consistency and for verifying, recording and management of results.

Signed:  ………………………………………………………………  Date:  ……………………

Assessment Tasks

Answer all the following questions in the blue shaded cells and save your assessment document with a new name – e.g. 31865 John Smith 17 August

Task 1 (US 31868 1.1 & 1.2)

Using the table below, describe each of the steps in the life, disability and health insurance policy issuance and the actions and responsibilities of the parties involved (who will usually be the client, the adviser & the product provider). Your answer for each step should be approximately 80-100 words unless otherwise stated.

Task 2 (US 31868 1.3)

2a In 80-100 words each, describe the following steps in a life or disability insurance claim:

• Notification
• Insurer confirms facts
• Onus of proof
• Insurer decision – claim accepted
• Insurer decision – claim declined
• Effect of a breach of duty of disclosure
• Claim not covered but insurer applies goodwill

 2b. In 80-100 words each, describe the following steps involved in a health insurance claim.

• Pre-approval and claim information
• Information to be supplied
• Claims for day-to-day healthcare costs
• Claim payments
• Insurer decision – claim declined
• Declined because of exclusion or condition, etc.
• Effect of a breach of duty of disclosure
• Claim not covered but insurer applies goodwill.

Task 3 (US 31868 1.4)

Using the table below, describe in 100-200 words in total, the required actions and responsibilities of the parties in each of the key considerations in a life, disability or health claim. If any of the parties do not have a particular action for any of the key considerations, this needs to be stated.

 Task 4 (US 31868 1.5 & 1.6)

Describe in approximately 80-100 words each, the key actions (steps) involved in life, disability and health insurance policy maintenance, cancellation and ending and explain the actions and responsibilities of the parties involved (who will usually be the insurer, the adviser and the insured).

Task 5 (US 31868 2.1 & 2.2)

This task requires you to demonstrate planning the steps, in THREE administrative processes, to meet the client’s needs. For the purposes of this assessment, assume that you are planning the steps as an adviser with your client (this means you must explain the steps that YOU plan to take, not explain the process generically as you did in Tasks 1-4.)  For example, in Task 1, you are asked to describe the steps to be taken in policy issuance, referring to completing the application, underwriting, placement and issue. In Task 5, you must describe the steps YOU would take, and things YOU would discuss with the client.

Using the table below, plan the steps you would take to complete any THREE of the administrative processes. If you are currently in a position where you complete these processes (e.g. as an office support or administrator within a Financial Advice Provider), or you have previously worked in a position where you have completed these processes, you may refer to your current or former organisation’s policies and guidelines in your answer.

Your answer for EACH administrative process must be approximately 150-200 words.

31868 Unit Standard Title: Demonstrate And Apply Knowledge Of Administrative Processes To Provide Life, Disability, And Health Insurance Services

Outcome 1: Demonstrate Knowledge Of The Administrative Processes Required For Life, Disability, And Health Insurance Policies.

• Outline the steps involved in policy application, issue, and underwriting.
• Explain the required actions and responsibilities of the parties involved in policy application, issue, and underwriting.
• Outline the steps involved in facilitating a policy claim.
• Explain the required actions and responsibilities of the parties involved in facilitating a policy claim.

Range: actions and/or responsibilities may arise in respect of but are not limited to – non-disclosure, need for further evidence, contribution of internal and external expertise and support

• Outline the steps involved in policy maintenance, cancellation, and ending.
• Explain the required actions and responsibilities of parties involved in policy maintenance, cancellation, and ending.

Range: actions and/or responsibilities may arise in respect of but are not limited to – arrears and reinstatements, changes to policy terms, changes to client relationships and ownership needs.

Outcome 2: Apply Knowledge Of The Administrative Processes Required For Life, Disability, And Health Insurance Policies.

Range: processes may include – policy application, issue, underwriting, claim, maintenance, cancellation, ending.

2.1 Plan the steps required to meet client needs in accordance with organisational requirements.

2.2 Establish the required actions and responsibilities of the parties involved.

Range: For policy claim, may include but is not limited to – non-disclosure, need for further evidence, contribution of internal and external expertise and support; for policy maintenance, cancellation, or ending, may include but is not limited to – arrears and reinstatements, changes to policy terms, changes to client relationships, changes to ownership.