ICA Education Resource Guide - International Claim Association

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ICA ClaimsEducation ProgramWelcomeThe International Claim Association (ICA) is proud to offer a fun, interactive eLearningprogram to our students. Visit the ICA website, www.claim.org, and with a few clicks ofa button you’ll be able to access all of the tools you need to complete our Associate,Life and Health Claims (ALHC) and Fellow, Life and Health Claims (FLHC) programs.In the following pages, you’ll find a list of required courses, detailed course descriptions,course prices, exam guidelines and other important need-to-know information.Whether you are a seasoned claim veteran, new to the claim industry or seeking acareer change, the ALHC and FLHC programs are for you. ICA is proud to lead the wayin claim excellence and we hope you find our courses both useful and rewarding.Best of luck to you and congratulations on taking the next step in your career future!New in 2011Are you ready to start studying for yourICA exams today? Well now you can!The ICA courses are now available in aneLearning format. This eliminates theuse of a textbook and provides thestudent with a fun, interactive, onlinelearning experience. No more waitingfor your books to be delivered —start learning today!Table of ContentsICA Claims Education Program History & Overview.Introductory Courses.Associate, Life & Health Claims (ALHC) andFellow, Life & Health Claims (FLHC) Overview.Exams.Curriculum Information.Frequently Asked Questions.Important Contacts.124681213The International Claim Association (ICA) is an association of life and health insurance companies whose purpose is to promote efficiency, effectiveness, and highstandards of performance in claim administration, to provide a forum for research,education and the exchange of ideas relating to various aspects of claim administration; and, to devise and give effect to measures for the benefit of policyholdersand beneficiaries in matters relating to claims.The ICA Education Programconsists of a two-tieredcurriculum:1. the Associate, Life and Health Claims(ALHC) Program2. the Fellow, Life and Health Claims(FLHC) Program.The ALHC Program is designed toprovide an introduction to life andhealth insurance and a thoroughunderstanding of claim administrationfor both individual and group coverage.The FLHC Program builds upon the ALHCProgram to offer a more advanced levelof claims education to claim professionals. Its four courses focus on additionalimportant insurance-related functions.HistoryThe ICA Claims Education Programadministered its first examination in1965. The ALHC designation was established in 1985 and has been awarded tomore than 15,000 claim professionals.With the addition of the advanced-levelFLHC Program in 1997, the ICA hasfurthered its tradition of excellence inclaim education. In 2006, the ICAawarded the 1,000th FLHC designation.Program OverviewThe ALHC designation consists of twonon-ICA introductory courses and fourICA courses: C1, C2, C3, and C4. The FLHCdesignation requires four additionalnon-ICA courses. Described in detailfurther ahead, the programs can besummarized as follows:INTROLOMA 280 or LOMA 281andLOMA 290 or LOMA 291orAHIP Part A and AHIP Part BALHCIntro LevelplusC1, C2, C3 and C4FLHCALHCplusACS 100 or ACS 101, UND 382and LOMA 320 or 321plus one elective chosen from:HS 321HS 330HS 331AIRC 420 or 4211

IntroductoryCoursesTo satisfy the introductory course requirements, students musthave successfully completed two required courses offered underone of the following programs:LOMAUnder LOMA’s FLMI Program, studentsmust complete both of the followingcourses:0000000000The Fellow, Life Management Institute (FLMI) Program,administered by LOMA;The Health Insurance Associate (HIA) Program, administered byAmerica’s Health Insurance Plans (AHIP) — HIAA Part Aand Part B;The American College CLU Program and the Advocis’ CanadianProgram, if completed prior to September 30, 1997.The specific courses within each of these programs that can beused to satisfy the ICA introductory course segment are describedbelow. Both required introductory courses must be completedunder the same program.Proof of CompletionStudents are responsible forforwarding proof of completionfor all introductory courses toICA headquarters. A copy of thefollowing will be accepted asproof of course credit:0000TranscriptsGrade ReportLOMA 280 Principles of Insurance orLOMA 281 Meeting Customer Needswith Insurance and AnnuitiesLOMA 290 Insurance CompanyOperations or LOMA 291 Improvingthe Bottom Line: Insurance CompanyOperationsAHIPUnder America’s Health Insurance Plans(AHIP) HIA Program, students mustcomplete both of the following courses:0000Fundamentals of Health Insurance,Part A (Basics of Health Insurance)Fundamentals of Health Insurance,Part B (Basics of Company Operations)HIAAIn 1998, AHIP (formerly the HIAA)removed several courses which the ICAhad previously accepted as satisfyingthe introductory course requirements.These courses were:00000000Individual Health Insurance (Part A)Individual Health Insurance (Part B)Group Life and Health Insurance(Part A)Group Life and Health Insurance(Part B)Because AHIP no longer provides proofof course completion for courses takenprior to 1998, students must submit oneof the following as proof of completion:000000A copy of the student’s transcript, ifavailableA copy of the student’s grade reportfor the coursesA copy of the student’s AHIP/HIAAdiplomaInability to provide proof of coursecompletion will result in the student’shaving to take AHIP’s Fundamentalscourses or other required courses tosatisfy the ICA’s introductory courserequirements.American CollegeThe specified courses in the AmericanCollege’s CLU Program are as follows:EITH ERHS 323 Individual Life Insurance(If taken before September 30, 1997)ORHS 324 Insurance Environmentand Operations(If taken before December 31, 1986)AN DHS 325 Group BenefitsStudents who have completed eitherpair of these courses can use them tosatisfy the ICA’s introductory courserequirements by providing proof ofcompletion to ICA.23

ALHCThe FLHC curriculum, in addition to the introductory courses and four ICAcourses,consists of four courses in total: three required LOMA courses and one electivefrom LOMA or the American College.The courses in the ALHC segment of the ICA Claims EducationProgram are designed to provide the student with a thoroughunderstanding of the administration of life and health insuranceclaims. In addition to the two introductory courses found onpages 2-3 the ALHC courses include:The three required LOMA courses include:00000000 ACS 100 Foundations of Customer Service or ACS101 Customer Service forInsurance Professionals LOMA 320 Life and Health Insurance Marketing or LOMA 321 Marketing inFinancial Services UND 386 Underwriting Life and Health InsuranceC1 Medical Aspects of ClaimsC2 Life and Health Insurance LawC3 Claim AdministrationC4 Management of Claim Operations(LOMA’s former Course 10-SR or UND 385 may be substituted for UND 386.)For the fourth course in the FLHC curriculum, students are required to completeany one of the following electives:For course descriptions for the ALHC courses, see pages 8-9 of thisbrochure. For instructions on how to purchase an ICA courseplease see page 12.LOMA Courses LOMA 307 Business and FinancialConcepts for Insurance Professionals LOMA 308 The Business ofInsurance: Applying Financial Concepts LOMA 335 Operational Excellence inFinancial ServicesFLHCThe Fellow, Life and Health Claims (FLHC) is an advanced-leveldesignation. To earn the FLHC designation, students mustcomplete all ten courses in the ICA Claims Education Program.This includes:000000Two introductory coursesFour ALHC courses (ICA Courses C1 – C4)Four FLHC courses (Three LOMA courses one elective)Students who earned the ALHC designation prior to the Fall 1991introduction of Course C4 —Management of Claim Operations, arerequired to successfully complete C4 in addition to all other FLHCrequirements to earn the FLHC designation. LOMA 371 Managing Solvency andProfitability in Life Insurance Companies(if completed after September 1, 1996) AIRC411The Regulatory Environment forLife Insurance AIRC 421 Regulation of Life InsuranceProducts, Sales and Operations(LOMA's former courses AIRC 410 and 420 maybe substituted for 411 and 421respectively)American College Courses HS331 Planning for Business Owners andProfessionals HS330 Fundamentals of Estate Planning HS331 Planning for Business Owners andProfessioonalsFor both the ALHC and FLHC programs,completion of all required courses does notresult in a student’s earning the appropriatedesignation until all non-ICA courserequirements have been successfully completedand proof of such completion has been providedto the ICA.Although the courses may be taken in any order,the ICA recommends completing the ALHCprogram courses firstsince the FLHC courses build upon theknowledge gained from the ALHC curriculum.2 Introductory Courses ICA C1, C2, C3, and C4ALHC2 Introductory Courses ICA C1, C2, C3, and C4 ACS 100 or ACS 101 LOMA 320 or 321 UND 386 ElectiveFLHC045

ExamsAccess to an ICA exam is given immediately upon purchase ofthe course and can be found on the student’s online dashboard.Please note that even though the exam is available to you on yourhome computer your company may require a proctor. AlthoughICA does not require the exams to be proctored it is best notto proceed until you check with your Company’s EducationRepresentative (Ed Rep) or Human Resources department forany specific corporate guidelines.In addition to the core ICA courses, the ALHC and FLHC designationrequire courses administered by other organizations. Pleaseconsult with LOMA, the American College, and America’s HealthInsurance Plans for exam requirements and costs for coursesadministered by them. See page 13 of this Brochure for ContactInformation.Exam PreparationThe ICA Claims Education Program is designed for independent study. All examquestions are answerable either directly from the online study materials or byapplication of the principles and concepts presented in the online study materials.Exam GradesThe feedback on test results will be immediate. The exams are graded electronically.The minimum passing score for these exams is 70 percent on a 100-point scale.Completion of Designation Requirements, Awards, Recognitionand Other BenefitsAs soon as you receive notification that you have successfully completed all therequirements in either the ALHC or FLHC Program, you may begin using yourdesignation proudly on your business cards, stationery, and nameplates.AwardsOnce all requirements are met for either the ALHC or FLHC designation the studentwill receive a certificate of completion. Please note that students are responsible forforwarding proof of completion for all non-ICA courses to ICA headquarters. A copyof the following will be accepted as proof of course credit:0000TranscriptsGrade ReportICA Headquarters cannot print your certificate until this information is forwarded tous. All ALHC and FLHC certificates will be printed with the month and year thecertificate was earned.67

CurriculumInformationThe following outlines summarize thenature of the general topics covered ineach course. These outlines are notexhaustive; neither are they indicationsof the relative weight assigned to thesubject matter.C2 Life and Health Insurance LawContentCourse C2 provides students with anunderstanding of the life insurance policyas a legal contract and sets forth the legalaspects of life, health, and group claims.Subj ect Outline00000000ICA Courses000000C1 Medical Aspects of ClaimsContentCourse C1 familiarizes students with thefollowing topics: the anatomy, physiology,and disorders of the various body systems.00000000S ubj ect Outline0000000000000000Medical Aspects of ClaimsMedical TerminologyAnatomy and PhysiologyDisorders of the Circulatory, Respiratory,Digestive, Urinary, Reproductive,Endocrine, Nervous, andMusculoskeletal SystemsEyes, Ears, Skin, and PsychiatricDisordersOncology and Radiology &Nuclear Medicine00Insurance Law and GovernmentRegulationPrinciples of Contracts and Agency LawInsurance Products and Policy StructureCreating an Insurance ContractLife and Health Policy Limitationsand ExclusionsDisability and Accident InsuranceGroup InsuranceBeneficiariesWills, Trusts, Guardianships, andCommunity PropertyPremiumsPolicy Contests and IncontestabilityRemedies and DamagesManaged Care and PrivacyFraud and InvestigatingInsurance Fraud0000ContentCourse C3 describes the administrationof insurance claims, including life,medical expense, disability, group, andannuity benefit payments.ContentCourse C4 focuses on the application ofmanagement theory to the operationsof claim departments, including themanagement functions of planning,controlling, organizing, and leading.S ubj ect Outline000000000000000000000000000000Subj ect Outline00000000000000The Claim Decision ProcessDetermining when Coverage Beginsand EndsAnalyzing and Paying Life InsuranceClaims and Supplemental BenefitsHandling Life Insurance ClaimsSettlement Options and TaxesAnalyzing and Paying Medical ExpenseClaims and Supplemental BenefitsAnalyzing and Paying Claims underDisability, Long-Term Care, andEndowment InsuranceAnalyzing and Paying Annuity ClaimsHandling Fraud in Life, Health, andAnnuity ClaimsC4 Management ofClaim OperationsC3 Claim Administration0080000Managing the Claim AreaIntroduction to Claim ManagementTheories of ManagementPlanning and ControllingOrganizing the Claim AreaOrganizational Design and ConflictOrganizational ChangeOrganization DevelopmentManaging Claim StaffOrientation, Training, andDevelopment StaffingMotivatingEvaluatingLeadingManaging Claim OperationsDecision MakingInformation ManagementOperations Management,Productivity, and Quality ControlBudgeting and Financial ManagementRequiredFLHC CoursesACS 100 – Foundations ofCustomer ServiceContentFor the professional seeking to become adistinguished customer service leader,ACS 100 provides a comprehensiveintroduction to customer service in afinancial services environment. Thecourse explores the knowledge and skillsemployees need to understand anddeliver exceptional customer service.Subj ect Outline00000000000000000000000000Introduction to Customer ServiceExceptional Customer ServiceThe People Who Drive CustomerService: Selection, Training, Evaluation,and MotivationUnderstanding Customer Expectations,Perceptions, and BehaviorCustomer Service and CommunicationListening to and UnderstandingCustomersInteracting with CustomersEffective CommunicationThe Customer-Centric OrganizationOrganization and Teamwork inCustomer ServiceCustomer Service Processes andPerformance MeasuresBetter Customer Service ThroughTechnologySucceeding in Customer Servicecontinued next page 9

Required FLHC Courses continuedACS 101 — Customer Service for InsuranceProfessionalsACS 101 is an online course that uses a variety ofmedia to provide a compre-hensive overview ofthe role of customer service in insurance andfinancial services organizations and the skillsservice providers need to deliver excep-tionalcustomer service. The course describes importantcustomer service functions, processes, andtechnologies and offers opportunities for studentsto learn and improve their listening, speaking, andwriting skills so that they can interact effectivelywith customers.LOMA 321 - Marketing in FinancialServicesCONTENTused in the financial services industry toStudents pursuing the FLHC designationare required to selectone of thefollowing courses offered by LOMA orthe American College.create profitable customer relationships. TheLOMA COURSES:interactive exercises so that learners will beLOMA307–BusinessandFinancialConceptsIntroduces industry employees to basicfinancial concepts and terminology and relatesthese concepts to the business of insuranceand company operations and profitability.LOMA 321 is an online course that uses avariety of media to present basic marketingprinciples and show how these principles aresatisfy customers' financial needs and tocourse utilizes extensive examples andable to understand and apply the marketingprinciples in their own work environment.LOMA 320 – Life and Health InsuranceMarketinguND 386 – underwriting Life andCONTENTHealth InsuranceLOMA 320 covers marketing principles and thefunction of marketing as an integral aspect of thelife and health insurance industry.utline0 The Marketing Environment0 Regulation of Insurance Marketing 0How Companies Manage Marketing 0Marketing Information and Research 0Market Segmentation andTarget Marketing0 Basic Product Concepts0 Pricing Insurance Products:A Marketing Perspective0 Product Development0 Customer Behavior and CustomerRelationship Marketing0 Distribution Systems and Strategies 0Promotion Tools0 Marketing Communications:Engaging the CustomerElective supplementalcoverages.SUBjECT OUTLINE0 Principles of Underwriting0 The Underwriting Unit and Staff0 Sources of Underwriting Information 0Medical, Financial, and PersonalUnderwriting Factors0 Legal Aspects of Underwriting0 Underwriting Specialized Policies,Group Policies, and Health Policies0 Underwriting Activities and inancialConcepts Covers marketing principlesand the functions of marketing as an integralaspect of the life and health industry.LOMA335 -OperationalExcellenceinFinancialServices Focuses on the practical techniques toaccomplish the everyday tasks of providingfinancial services as effectively as possible.LOMA351–FinancialServicesEnvironment (creditwill be accepted if the course is completedbetween September 1, 1998, and December 31,2015). Provides an understanding of thefinancial system, financial markets, interestrates, the banking system, financial institutions,and the basics of economic theory.LOMA 371 – Managing for Solvency andProfitability in Life Insurance Companies (ifcompleted after September 1, 1996) Explains themanagement issues surrounding enterprise riskmanagement, capital, product development, andproduct design for life insurance and annuities.AIRC 411 The Regulatory Environment for LifeInsurance Discusses the compliance function ina life insurance company and how the stateand federal governments regulate lifeinsurance companies operating in the UnitedStates. Content is specific to U.S. laws andregulations.(AIRC 411 replaced AIRC 410.)10AIRC 421 - Regulation of Life InsuranceProducts, Sales & Operations Explains thestate and federal regulation of life insuranceand annuity product design. The course alsodescribes the regulation of life companyoperations, including underwriting, claims,reinsurance, market analysis andexaminations. Content is specific to U.S. lawsand regulations. (AIRC 421 replaced AIRC 420.)AMERICAN COLLEGE COURSES:HS321 – Income TaxationExamines the federal income tax system withparticular reference to the taxation ofindividuals. Covers such concepts as grossincome, exclusions from gross income,deductions, tax credits, capital gains and losses,taxation of life insurance and annuities andincome taxation of partners, partnerships,corporations and shareholders.HS330 – Fundamentals of Estate PlanningCovers various aspects of estate and gift taxplanning, including the nature, valuation,transfer, administration and

INTRO LOMA 280 or LOMA 281 and LOMA 290 or LOMA 291 or AHIP Part A and AHIP Part B ALHC Intro Level plus C1, C2, C3 and C4 FLHC ALHC plus ACS 100 or ACS 101, UND 382 and LOMA 320 or 321 plus one elective chosen from: LOMA 335 HS 321 HS 330 HS 331 LOMA 371 LOMA 308 AIRC 410 or 411 AIRC 420 or 421 1

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