Ethical Practices in Health Insurance

Ethical Practices in Ethical Practices in Health InsuranceHealth Insurance

Presented byPresented by

GCAHU Programs CommitteeGCAHU Programs Committee

AgendaAgenda What is Ethics?What is Ethics? Why Study Ethics?Why Study Ethics? Target EthicsTarget Ethics Philosophy of EthicsPhilosophy of Ethics The Golden and Platinum RulesThe Golden and Platinum Rules Your Role as an AgentYour Role as an Agent Agent DutiesAgent Duties Professional and Personal EthicsProfessional and Personal Ethics The Ethics of ReplacementThe Ethics of Replacement ResponsibilitiesResponsibilities Code of EthicsCode of Ethics

Why Important?Why Important? Before it is possible to say Before it is possible to say

who needs ethics in their who needs ethics in their

lives, we must first define lives, we must first define

what ethics are.what ethics are.

Defining ethics PRECISELY Defining ethics PRECISELY

would depend upon many would depend upon many

variables, although some variables, although some

elements are universal.elements are universal.

Why Important?Why Important?

Cultural ethics depend upon:Cultural ethics depend upon: The society one lives inThe society one lives in Religious beliefsReligious beliefs Personal long-range goalsPersonal long-range goals

Ethics are a form of excellence.Ethics are a form of excellence. Many people do not realize that when Many people do not realize that when

they see excellence, they are seeing a they see excellence, they are seeing a form of ethics.form of ethics.


An athlete who wins an An athlete who wins an

Olympic gold medal is Olympic gold medal is

recognized for their recognized for their

performance.performance. Recognizable excellence is Recognizable excellence is

not only seen in athletes, not only seen in athletes,

but also in the business world.but also in the business world.


The individual is dedicated, The individual is dedicated, structured and far-sighted.structured and far-sighted.

Excellence does not happen Excellence does not happen miraculously.miraculously. Come from pace setting levels of Come from pace setting levels of

personal effectiveness and effort.personal effectiveness and effort.

Can not be judged against a rigid set of Can not be judged against a rigid set of criteria.criteria.

Ethical Considerations

WHATWHAT

AREARE

ETHICS?ETHICS?

What is Ethics?What is Ethics?

A branch of study that includes the A branch of study that includes the values of human life, duty, and values of human life, duty, and morality, or rules of conduct. In morality, or rules of conduct. In short, ethics is the study of moral short, ethics is the study of moral principles which govern our principles which govern our behavior. A behavior that is behavior. A behavior that is conscious, although it can be conscious, although it can be developed to the point where it developed to the point where it becomes habitual.becomes habitual.


An ethical decision is based An ethical decision is based on “doing the right thing.”on “doing the right thing.”


It is wrong to lie.It is wrong to lie. Good universal principle.Good universal principle. Particular situations, we may cheat a Particular situations, we may cheat a

bit on our own principles.bit on our own principles.

Why Why Study Study Ethics?Ethics?


Why bother to study ethics?Why bother to study ethics?

Who cares what our professional Who cares what our professional organizations say about ethics? organizations say about ethics?

Why Study Ethics?Why Study Ethics?The answer is surprising:The answer is surprising:

We study ethics to increase, We study ethics to increase, not decrease, our personal not decrease, our personal

freedom.freedom.

Why Study Ethics?Why Study Ethics?

An automatic, unthinking An automatic, unthinking approach to ethics has approach to ethics has

caused some grief in the caused some grief in the insurance professioninsurance profession


Other reasons to study ethics:Other reasons to study ethics: An ethical insurance professional will An ethical insurance professional will

keep long-term clients.keep long-term clients. Get more referrals.Get more referrals. Stay out of trouble with the law.Stay out of trouble with the law. When you act with integrity, the When you act with integrity, the

word gets around.word gets around.

Albert Einstein

To make a goal of comfort To make a goal of comfort or happiness has never or happiness has never appealed to me; a system appealed to me; a system of ethics built on this of ethics built on this basis would be sufficient basis would be sufficient only for a herd of cattleonly for a herd of cattle


Acting ethically involves Acting ethically involves more than making a list of more than making a list of what is “right and wrong.”what is “right and wrong.”

Target Target EthicsEthics

Target EthicsTarget Ethics

Ethical behavior must include legal Ethical behavior must include legal standards for the insurance standards for the insurance profession.profession.

Some books on ethics begin and end Some books on ethics begin and end with legal obligations.with legal obligations.

Familiarity with legislation is a logical Familiarity with legislation is a logical beginning point.beginning point.

OH DOI Mission StatementOH DOI Mission Statement

The Ohio Department of The Ohio Department of Insurance's mission is to provide Insurance's mission is to provide consumer protection through consumer protection through education and fair but vigilant education and fair but vigilant regulation while promoting a regulation while promoting a stable and competitive stable and competitive environment for insurers. To environment for insurers. To accomplish that goal, it is accomplish that goal, it is important that we consistentlyimportant that we consistently regulate Ohio's insurance laws. regulate Ohio's insurance laws.

OH DOI BulletinsOH DOI Bulletins 2010-01Temporary Extension of State Continuation Coverage To Take Temporary Extension of State Continuation Coverage To Take

Advantage of Federal Premium Subsidy2/26/2010Advantage of Federal Premium Subsidy2/26/2010 2009-14 Guidance Regarding Use of the NAIC/NIPR Attachments Warehouse for Guidance Regarding Use of the NAIC/NIPR Attachments Warehouse for

the Electronic Filing of Insurance Producer Licensing Documents10/07/2009the Electronic Filing of Insurance Producer Licensing Documents10/07/2009 2009-13 Guidance Governing the Giving of Promotional or Advertising 2009-13 Guidance Governing the Giving of Promotional or Advertising

Items10/01/2009Items10/01/2009 2009-12Loss of Control of Policyholder Information11/02/20092009-12Loss of Control of Policyholder Information11/02/2009 2009-112009-11Mandatory Use of SERFF for Product Filing Submissions12/31/2009Mandatory Use of SERFF for Product Filing Submissions12/31/2009 2009-10Workers' Compensation Other-States' Coverage 05/27/20092009-10Workers' Compensation Other-States' Coverage 05/27/2009 2009-09The Ohio Annuity Disclosure Pilot Program for Fixed and Indexed 2009-09The Ohio Annuity Disclosure Pilot Program for Fixed and Indexed

Annuities 04/01/2009Annuities 04/01/2009 2009-08Certificates of Insurance 03/12/20092009-08Certificates of Insurance 03/12/2009 2009-07Revision of Bulletin 97-1: Basic Health Services and Infertility 2009-07Revision of Bulletin 97-1: Basic Health Services and Infertility

Services 02/10/2009Services 02/10/2009 2009-06Revision of Bulletin 94-8: Disclosure and Use of Provider 2009-06Revision of Bulletin 94-8: Disclosure and Use of Provider

Discounts 02/10/2009Discounts 02/10/2009 2009-04Calculation of the Amount of Deferred Income Tax Admitted in the 2009-04Calculation of the Amount of Deferred Income Tax Admitted in the

Preparation of Statutory Financial Statements 02/03/2009Preparation of Statutory Financial Statements 02/03/2009 2009-03Calculation of the Reserves for Variable Annuities that provide 2009-03Calculation of the Reserves for Variable Annuities that provide

Guaranteed Living Benefits (VAGLBs) in the Preparation of Statutory Financial Guaranteed Living Benefits (VAGLBs) in the Preparation of Statutory Financial Statements 02/03/2009Statements 02/03/2009

2009-02Interpretation of the Calculation of the Segment Length with respect to 2009-02Interpretation of the Calculation of the Segment Length with respect to the Life Insurance Model Regulation and use of the 2001 CSO Preferred Class the Life Insurance Model Regulation and use of the 2001 CSO Preferred Class Structure Table to Determine Basic and Minimum Reserve Liabilities 02/03/2009Structure Table to Determine Basic and Minimum Reserve Liabilities 02/03/2009

2009-01Reporting of Changes in Health Plan Provider Networks 01/20/20092009-01Reporting of Changes in Health Plan Provider Networks 01/20/2009

Philosophy Philosophy

of of EthicsEthics

PhilosophyPhilosophy of Ethics of Ethics

The study of ethics is The study of ethics is practicalpractical, not , not abstract, because we must make abstract, because we must make value judgments each day.value judgments each day.

By studying ethics, we become By studying ethics, we become aware of the reasons behind our aware of the reasons behind our judgments.judgments.

Philosophy of EthicsPhilosophy of Ethics

The word The word ethicsethics comes comes from two Greek words from two Greek words which mean “moral” andwhich mean “moral” and

“ “character”.character”.

Philosophy of EthicsPhilosophy of EthicsEthics as a branch of study that Ethics as a branch of study that

includes the values of:includes the values of: Human LifeHuman Life DutyDuty MoralityMorality Rules of Rules of

ConductConduct

PhilosophyPhilosophy of Ethics of Ethics

Many focused their intellect on Many focused their intellect on ethical questions – the same ones ethical questions – the same ones which form the background of our which form the background of our own study.own study.

Philosophy of EthicsPhilosophy of Ethics

Ethical behavior is something that is Ethical behavior is something that is conscious.conscious. It can be developed to the point where it It can be developed to the point where it

becomes habitual.becomes habitual. Must understand the underlying Must understand the underlying

principles upon which they are principles upon which they are based.based.

Golden and Platinum RulesGolden and Platinum Rules

Max Weber was an early writer from the Capitalist system and he saw ethics from a slightly different perspective. He thought that ethics was something that was necessary for society in order to hold the capitalist system together. If there isn’t a set of ethics that people adhere to, anarchy would ensue and the whole system would fall apart. So, from a societal point of view, he felt that ethics was critical.

The Golden RuleThe Golden Rule

The Golden Rule:The Golden Rule:

““Act toward others as you Act toward others as you would like them to act would like them to act

toward you.”toward you.”

The Platinum RuleThe Platinum Rule

The Platinum Rule:The Platinum Rule:

““Do unto others as Do unto others as they would have you they would have you

do unto them.”do unto them.”

The Golden & Platinum RulesThe Golden & Platinum Rules

Ward and June, Ward and June, husband & wife, husband & wife, want different things want different things when they are sick. when they are sick. Ward wants to be Ward wants to be left alone. June left alone. June enjoys attention and enjoys attention and nurturing, which she nurturing, which she believes helps her believes helps her heal more quickly.heal more quickly.

The Gold & Platinum RulesThe Gold & Platinum Rules

If Ward follows the Golden Rule when If Ward follows the Golden Rule when his wife is sick, he will leave her his wife is sick, he will leave her alone because that’s what he would alone because that’s what he would prefer.prefer.

Act toward others as Act toward others as

you would like them you would like them

to act toward you.to act toward you.


In this case, the Platinum Rule is better.In this case, the Platinum Rule is better.

Do unto others as they would have you Do unto others as they would have you do unto them.do unto them.

June wants something June wants something

different than Ward. different than Ward.

She wants attention!She wants attention!


The Golden and Platinum Rules invite The Golden and Platinum Rules invite us to use our imaginations:us to use our imaginations: How it feels to be on the receiving end How it feels to be on the receiving end

of our actions.of our actions.

We trigger our own moral sense or We trigger our own moral sense or intuition.intuition.


Personal experience of imagining the Personal experience of imagining the consequences of our actions is one of consequences of our actions is one of the most powerful tools:the most powerful tools: AcknowledgingAcknowledging DevelopingDeveloping AdhereAdhere

To our own ethical codes.To our own ethical codes.


In insurance, we follow the In insurance, we follow the Platinum RulePlatinum Rule.. We listen to the needs of clients.We listen to the needs of clients. Help meet those needs.Help meet those needs.

Current example of the platinum Current example of the platinum rule being carried out…rule being carried out…

Agent RoleAgent Role


According to law, your role According to law, your role as an insurance agent as an insurance agent makes you a fiduciary.makes you a fiduciary.


FiduciaryFiduciary Someone who holds a thing in Someone who holds a thing in

trust for others.trust for others.


Fiduciary:Fiduciary: Valuable because of the Valuable because of the

confidence which is bestowed confidence which is bestowed by others.by others.


““Stands in the shoes of” the Stands in the shoes of” the insurer.insurer.

Power to describe coveragesPower to describe coverages Solicit applicationsSolicit applications Collect premiumsCollect premiums Provide service for the insurerProvide service for the insurer


Agent not only acts with integrity Agent not only acts with integrity because: because: “it’s the right thing to do.”“it’s the right thing to do.”

Accordance with the law.Accordance with the law. Avoid E & O claim.Avoid E & O claim.


Fiduciary ResponsibilitiesFiduciary Responsibilities Three kinds of authorityThree kinds of authority Held in trust by agentsHeld in trust by agents


Express AuthorityExpress Authority Granted by an insurer in writing.Granted by an insurer in writing.

No confusion about this kind of No confusion about this kind of authorityauthority Life and health agents have express Life and health agents have express

authority to solicit applications.authority to solicit applications. Express authority is granted through the Express authority is granted through the

appointment with that carrier.appointment with that carrier.


Implied AuthorityImplied Authority Next logical level of an agent’s power.Next logical level of an agent’s power.

Agents have the implied authority to Agents have the implied authority to explain policy provisions and explain policy provisions and coverages.coverages.


Apparent AuthorityApparent Authority Gets agents into troubleGets agents into trouble

Agent represents the insurerAgent represents the insurer Statements not authorized by the company, carry Statements not authorized by the company, carry

the apparent authority in the eyes of the client.the apparent authority in the eyes of the client. CarrierCarrier

Not bound by every statement made by an agent.Not bound by every statement made by an agent. Generally must stand behind credible statements.Generally must stand behind credible statements.


Full Full

DisclosureDisclosure

Agent RoleAgent Role Disclose all information which may Disclose all information which may

affect the policy owner’s coverageaffect the policy owner’s coverage Important for application and claims Important for application and claims

processing.processing. Complexities of insurance contracts, Complexities of insurance contracts,

certificates and policiescertificates and policies Must understand what you are selling.Must understand what you are selling.

Must maintain a current license.Must maintain a current license. Meet your state’s continuing Meet your state’s continuing

education (CE) requirements.education (CE) requirements.


Deliver your work promptlyDeliver your work promptly Agents have an obligation to submit Agents have an obligation to submit

applications promptly.applications promptly. Deliver policies in a timely manner.Deliver policies in a timely manner. Provide accurate information to both Provide accurate information to both

the insured and insurer.the insured and insurer.


MisrepresentationMisrepresentation An agent who gives written or oral An agent who gives written or oral

statements which do not accurately statements which do not accurately represent terms and conditions of an represent terms and conditions of an insurance policy is guilty of insurance policy is guilty of misrepresentation.misrepresentation.


MisrepresentationMisrepresentation May be unintentionalMay be unintentional

Both the agent and the insurer may be Both the agent and the insurer may be found liable for damages.found liable for damages.


RebatingRebating ““You scratch my back and I’ll scratch You scratch my back and I’ll scratch

yours!”yours!” Occurs when the agent offers to return Occurs when the agent offers to return

money or other valuable inducement to money or other valuable inducement to buy.buy.


RebatingRebating Returning premium.Returning premium. Special advantage for dividends.Special advantage for dividends. Special advantage to issue date/issue Special advantage to issue date/issue

age.age. Contract for services or paid Contract for services or paid

employment.employment. Arranging a loan.Arranging a loan. Giving anything of value.Giving anything of value.


RebatingRebating No insurer or employee or representative thereof No insurer or employee or representative thereof

shall knowingly charge, demand, or receive a shall knowingly charge, demand, or receive a premium for any insurance policy except in premium for any insurance policy except in accordance with the applicable filing on file with accordance with the applicable filing on file with the Commissioner.the Commissioner.

No such insurer, employee, or representative shall No such insurer, employee, or representative shall pay, allow, or give, directly or indirectly, as an pay, allow, or give, directly or indirectly, as an inducement to insurance or after insurance has inducement to insurance or after insurance has been effected, any rebate, discount, abatement, been effected, any rebate, discount, abatement, credit or reduction of premium in the policy.credit or reduction of premium in the policy.


TwistingTwisting Agent persuades a prospect to give Agent persuades a prospect to give

up an existing policy up an existing policy withoutwithout clearly clearly explaining the benefits which will be explaining the benefits which will be lost.lost. Twisting is misrepresentationTwisting is misrepresentation


TwistingTwisting Must show:Must show:

Better off by dropping old policy.Better off by dropping old policy. Better off buying a new one.Better off buying a new one.

MisrepresentationMisrepresentation


Unfair Trade Practices:Unfair Trade Practices: Boycott, Coercion and IntimidationBoycott, Coercion and Intimidation False Financial Statements, Falsifying False Financial Statements, Falsifying

RecordsRecords Unfair discriminationUnfair discrimination

HandicappedHandicapped Sex or Marital StatusSex or Marital Status


False Advertising:False Advertising: Is it true?Is it true? Is it clear?Is it clear? Prohibited advertising statements:Prohibited advertising statements:

Use words that are unclearUse words that are unclear IncompleteIncomplete DeceptiveDeceptive

Agent DutiesAgent Duties

Insurance is a Contract of Insurance is a Contract of AdhesionAdhesion

An insurance contract is not An insurance contract is not negotiated by both parties.negotiated by both parties. Prepared by one of the parties (the Prepared by one of the parties (the

insurer).insurer). Accepted or rejected by the other (the Accepted or rejected by the other (the

insured).insured).


Insurance is a Contract of Insurance is a Contract of AdhesionAdhesion

In legal terms known as:In legal terms known as: Contract of AdhesionContract of Adhesion

Exclusive power to draw up the contractExclusive power to draw up the contract Courts rule in favor of the insured.Courts rule in favor of the insured. Insurer responsible for making things clear.Insurer responsible for making things clear.


Legal Representative of Legal Representative of AnotherAnother

Avoid LiabilityAvoid Liability Field UnderwritingField Underwriting Handling PremiumsHandling Premiums


Expressed PowerExpressed Power Solicit applicationsSolicit applications

Implied AuthorityImplied Authority Explain policy provisionsExplain policy provisions

Apparent AuthorityApparent Authority Represent the insurerRepresent the insurer

Professional and Personal EthicsProfessional and Personal Ethics

Professional & Personal EthicsProfessional & Personal Ethics

The myth that ethical behavior The myth that ethical behavior is different for business than is different for business than for personal life is an old one.for personal life is an old one.


Poker is not “unethical”Poker is not “unethical”

Rules of pokerRules of poker Analogy to businessAnalogy to business Bluffing and sandbaggingBluffing and sandbagging Rules of conductRules of conduct


Poker becomes unethical when one Poker becomes unethical when one player seeks an advantage not player seeks an advantage not available to others.available to others. Stacking the deck.Stacking the deck. Dealing off the bottom.Dealing off the bottom. Retrieving a discard.Retrieving a discard.


ProfessionalsProfessionals LawyersLawyers DoctorsDoctors NursesNurses MinistersMinisters OtherOther

Professional OrganizationsProfessional Organizations Codes of ethicsCodes of ethics

Professional & Personal EthicsProfessional & Personal Ethics The public expects its professionals The public expects its professionals

to abide by specialized to abide by specialized codes of codes of ethics.ethics.

All the time…All the time…


By all these definitions, insurance By all these definitions, insurance salespeople belong to a bona fide salespeople belong to a bona fide profession.profession.

Whether or not you as an individual Whether or not you as an individual are a “professional” largely depends are a “professional” largely depends on whether you subscribe to your on whether you subscribe to your professional organization’s code of professional organization’s code of ethics.ethics.


Interest of our clients above personal Interest of our clients above personal gain.gain.

Understand their needs.Understand their needs. Comply with laws and codes.Comply with laws and codes. Speak honestly.Speak honestly.


This one is simple:This one is simple: Insurance professionals preserve Insurance professionals preserve

confidentiality.confidentiality.


Some examplesSome examples…… Unintentional MisrepresentationUnintentional Misrepresentation

Incorrect statementIncorrect statement

Bait and SwitchBait and Switch Advertising attractive productAdvertising attractive product


Altering ApplicationsAltering Applications ChangesChanges

WindowingWindowing ForgeryForgery


Theft of Premium or ProceedsTheft of Premium or Proceeds Collects premiumCollects premium

Depositing Premiums in a Personal Depositing Premiums in a Personal AccountAccount Personal fundsPersonal funds


Failing to Indicate a Policy was not Failing to Indicate a Policy was not TakenTaken

Free-look PeriodFree-look Period Unlicensed SellingUnlicensed Selling Properly LicensedProperly Licensed

Ethics of ReplacementEthics of Replacement

Policy ReplacementPolicy Replacement Investigation of CircumstancesInvestigation of Circumstances Ethical JudgmentEthical Judgment

Replacement in the Best InterestReplacement in the Best Interest Trouble with the Insurance Trouble with the Insurance

CommissionerCommissioner

Ethics of ReplacementEthics of Replacement

Full DisclosureFull Disclosure Relevant factorsRelevant factors Decrease in coverageDecrease in coverage Other adverse factorsOther adverse factors

Client’s ChoiceClient’s Choice Full and accurate informationFull and accurate information Including pro and con argumentsIncluding pro and con arguments

ResponsibilitiesResponsibilities

StandardsStandards

Gains obtained through unethical Gains obtained through unethical actions are lostactions are lost HonestyHonesty ResponsibilityResponsibility CaringCaring IntegrityIntegrity SelflessnessSelflessness CourageCourage ExcellenceExcellence

ResponsibilityResponsibility

I Believe It To Be My I Believe It To Be My ResponsibilityResponsibility

To hold my profession in high esteem and To hold my profession in high esteem and strive to enhance prestige.strive to enhance prestige.

To fulfill the needs of my clients to the To fulfill the needs of my clients to the best of my ability.best of my ability.

To maintain my clients’ confidence.To maintain my clients’ confidence. To render exemplary service to my clients To render exemplary service to my clients

and their beneficiaries.and their beneficiaries.


To adhere to professional standards of To adhere to professional standards of conduct in helping my clients to protect conduct in helping my clients to protect insurable obligations and attain their insurable obligations and attain their financial security objectives.financial security objectives.

To present accurately and honestly all To present accurately and honestly all facts essential to my clients’ decisions.facts essential to my clients’ decisions.

To perfect my skills and increase my To perfect my skills and increase my knowledge through continuing education.knowledge through continuing education.


To conduct my business in such a way that To conduct my business in such a way that my example might help raise the my example might help raise the professional standards of health insurance.professional standards of health insurance.

To keep informed with respect to To keep informed with respect to applicable laws and regulations and to applicable laws and regulations and to observe them in the practice of my observe them in the practice of my profession.profession.

To cooperate with others whose services To cooperate with others whose services are constructively related to meeting the are constructively related to meeting the needs of my clients.needs of my clients.

Code Code of of

EthicsEthics

NAHU's Code of EthicsNAHU's Code of Ethics To hold the selling, service and administration of health insurance To hold the selling, service and administration of health insurance

and related products and services as a professional and public and related products and services as a professional and public trust and do all in my power to maintain its prestige. trust and do all in my power to maintain its prestige.

To keep paramount the needs of those whom I serve. To keep paramount the needs of those whom I serve. To respect my clients' trust in me, and to never do anything which To respect my clients' trust in me, and to never do anything which

would betray their trust or confidence. would betray their trust or confidence. To give all service possible when service is needed. To give all service possible when service is needed. To present policies factually and accurately, providing all To present policies factually and accurately, providing all

information necessary for the issuance of sound insurance information necessary for the issuance of sound insurance coverage to the public I serve. coverage to the public I serve.

To use no advertising which I know may be false or misleading. To use no advertising which I know may be false or misleading. To consider the sale, service and administration of health To consider the sale, service and administration of health

insurance and related products and services as a career, to know insurance and related products and services as a career, to know and abide by the laws of any jurisdiction Federal and State in and abide by the laws of any jurisdiction Federal and State in which I practice and seek constantly to increase my knowledge which I practice and seek constantly to increase my knowledge and improve my ability to meet the needs of my clients. and improve my ability to meet the needs of my clients.

To be fair and just to my competitors, and to engage in no To be fair and just to my competitors, and to engage in no practices which may reflect unfavorably on myself or my industry. practices which may reflect unfavorably on myself or my industry.

To treat prospects, clients and companies fairly by submitting To treat prospects, clients and companies fairly by submitting applications which reveal all available information pertinent to applications which reveal all available information pertinent to underwriting a policy. underwriting a policy.

To extend honest and professional conduct to my clients, To extend honest and professional conduct to my clients, associates, fellow agents and brokers, and the company or associates, fellow agents and brokers, and the company or companies whose products I represent. companies whose products I represent.

"Johnny," said his teacher, "if coal is selling at $6 a ton and you pay your dealer $24 how many tons will he bring you?"

"A little over three tons, ma'am," said Johnny promptly.

"Why, Johnny, that isn't right," said the teacher.

"No, ma'am, I know it ain't," said Johnny, "but they all do it."

Code of Ethical ConductCode of Ethical Conduct

Place the interest of your customer first.Place the interest of your customer first. Maintain a high degree of personal Maintain a high degree of personal

integrity.integrity. Maintain a professional level of conduct in Maintain a professional level of conduct in

association with peers and other involved association with peers and other involved in the same activities.in the same activities.

Avoid sensational, exaggerated and Avoid sensational, exaggerated and unwarranted statements.unwarranted statements.

Assist in helping the public understand Assist in helping the public understand your mission.your mission.

Code of Ethical ConductCode of Ethical Conduct

Take individual responsibility for knowing Take individual responsibility for knowing the various laws and requirements that the various laws and requirements that regulate your business and observe them regulate your business and observe them not only in letter, but spirit.not only in letter, but spirit.

Improve your professional knowledge, Improve your professional knowledge, skills and competence.skills and competence.

In light of all conditions surrounding those In light of all conditions surrounding those you serve, make every effort to you serve, make every effort to understand the conditions and render understand the conditions and render services you would apply to yourself and services you would apply to yourself and your family.your family.

An Ethics CheckAn Ethics Check

Is it legal?Is it legal? Will I be violating either civil law or company policy?Will I be violating either civil law or company policy?

Is it balanced?Is it balanced? Is it fair to all concerned in the short term, as well as the Is it fair to all concerned in the short term, as well as the

long term?long term? Does it promote a win-win relationship?Does it promote a win-win relationship?

How will it make me feel about myself?How will it make me feel about myself? Will it make me proud?Will it make me proud? How would I feel if the decision was published in the How would I feel if the decision was published in the

newspaper?newspaper? Would I feel good if my family knew about it?Would I feel good if my family knew about it?

Performance PressuresPerformance Pressures

Production ObjectivesProduction Objectives Based on ethical actions.Based on ethical actions.

Agent takes an unethical actionAgent takes an unethical action Missed the production objective.Missed the production objective.


Value includes:Value includes: Best efforts of the agentBest efforts of the agent

Provide valueProvide value ““But no one will ever know…”But no one will ever know…”


Customer’s best interest first.Customer’s best interest first. Career not built on one-time sales to Career not built on one-time sales to

strangers.strangers. Referrals and repeat business.Referrals and repeat business. Trust established between agents Trust established between agents

and clients.and clients.


Referrals are great! It shows you did Referrals are great! It shows you did a great job with the first sale!a great job with the first sale!

People like to do business with People like to do business with people they trust!people they trust!


Three Elements of Good Three Elements of Good CommunicationCommunication

StraightforwardStraightforward ResponsiveResponsive FairFair


Typical Disciplinary ActionsTypical Disciplinary Actions Administrative or Criminal InvestigationAdministrative or Criminal Investigation Formal HearingFormal Hearing Official CensureOfficial Censure Cease and Desist OrderCease and Desist Order Fines, Civil Penalties and other Monetary Fines, Civil Penalties and other Monetary

ForfeituresForfeitures Compensatory and Punitive DamagesCompensatory and Punitive Damages License Suspension or RevocationLicense Suspension or Revocation

Creating ExcellenceCreating Excellence

According to the book According to the book Creating ExcellenceCreating Excellence, , the following skills are part of excellence the following skills are part of excellence as well as a part of a strong code of ethics:as well as a part of a strong code of ethics:

Creative insightCreative insight SensitivitySensitivity VisionVision VersatilityVersatility FocusFocus PatiencePatience

Creating ExcellenceCreating Excellence

As with anything, it has been said,As with anything, it has been said, ““No pain, no gain!”No pain, no gain!”

Agents who want to create Agents who want to create excellence, which is ethics in action, excellence, which is ethics in action, cannot rely on quick fixes or magic cannot rely on quick fixes or magic formulas.formulas.

No Effort, No ResultsNo Effort, No Results

TIME FOR A CASE

STUDY?

Thank you for Thank you for attending today!attending today!

Questions or Questions or comments before we comments before we

adjourn?adjourn?

Ethical Practices in Health Insurance

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