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Accident and health > accident and health > Flashcards

accident and health Flashcards

1
Q

provides periodic income weekly or at least monthly. income not taxable on individual policy

A

Disability income

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2
Q

pays 66 2/3 of gross pay

A

disability income

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3
Q

BOE policy

A

pays overhead, rent utilities

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4
Q

buyout partner who becomes disables

A

Business disability buyout, for permanent disability

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5
Q

principal sum

A

refers to the accidental death or death benefit

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6
Q

capital sum

A

refers to the dismeberment

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7
Q

limited benefits provided for daily hospital charges at a flat rate per day. pays first dollar (no deductible) days are limited

A

basic hospital insurance

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8
Q

pays physician visits in hospital, flat dollar amount per day

A

basic medical insurance

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9
Q

provides benefits for a surgeon in or out of hospital. flat amount for each operation.

A

basic surgical insurance

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10
Q

pays high dollar amounts after the insured pays the deductible.

A

Major medical

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11
Q

allows the insured to carry over expenses paid in 4th quarter of prior year to reduce current year deductible when no claims were paid to the insured

A

carry over provision

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12
Q

% participation (80 20) insured and insurer share the cost after deductible

A

Coinsurance

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13
Q

Limits the insureds liability to a certain dollar amount

A

out of pocket limit or stop loss provision

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14
Q

Amount insured pays on major medical

A

deductible plus 20 percent of bill

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15
Q

when the insured owns both basic and major medical

A

comprehensive, basic pays first then corridor deductible then major pays third

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16
Q

imposed controls on use of health care services, fees charged for those services, providers of healthcare services

A

managed care

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17
Q

health maintenance organization HMO

A

provides prepaid doctor and hospital care, stresses preventative medicine with exams and diagnostic procedures

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18
Q

Requires employers with 25 or more employees ro offer HMO/PPO if there is a health plan or hmo in area

A

HMO act of 1973

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19
Q

allows the insured the freedom of choice in selecting a health care professional non preferred provider

A

PPO

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20
Q

This insurance always has a deductible

A

Major medical

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21
Q

covers routine medical exams and diagnostic prodedures

A

HMO/PPO

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22
Q

stresses preventive medicine

A

HMO/PPO

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23
Q

pays first dollar coverage

A

Basic medical

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24
Q

Small dollar amount that must be paid by this member with treatment

A

HMO/PPO

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25
Q

coinsurance % participation

A

Major medical

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26
Q

provides limited coverage

A

Basic

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27
Q

gatekeeper PCP required

A

HMO/PPO

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28
Q

managed care

A

HMO/PPO

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29
Q

Pays directly to hospital and doctors

A

service organizations BC/BS

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30
Q

pays directly to the insured

A

reimbursement insurer

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31
Q

insured has choice of going in or out of network

A

point of service plan

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32
Q

deduct money placed in a fund to pay medical expenses that were not reimbursed

A

MSA

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33
Q

this account can be used to pay for expenses that are not covered by group health plans

A

Flexible spending account and HRA

34
Q

Must have 30 day free look

A

medicare supplement policies

35
Q

Must cover preexisting conditions after 6 months

A

medicare supplement policies

36
Q

Allows the insured to convert from group to individual without proving insurability (31 days)

A

group conversions

37
Q

provides better benefits at less cost

A

group

38
Q

all employers with 20 or more employees must provide continuation of group health insurance to all former employees and dependents

A

COBRA

39
Q

time allowed to choose cobra

A

60 days

40
Q

must provide coverage for at least 12 consecutive months

A

LTC

41
Q

must cover preexisting after 6 months

A

LTC

42
Q

must be at least guaranteed renewable

A

LTC

43
Q

includes entire contract, riders, endorsements and changes

A

entire contract

44
Q

time limit on certain defenses

A

2 years, except fraud

45
Q

additional time after due date

A

grace period 31 days

46
Q

getting back into force a lapsed policy

A

reinstatement

47
Q

if insurer fails to respond to the reinstatement form after _____ days, automatic reinstatement

A

45

48
Q

waiting period on reinstatement

A

10 days

49
Q

time required to file notice of claim

A

20 days

50
Q

must be sent to insured within 15 days

A

claim forms

51
Q

formal or sworn statement about loss

A

proof of loss

52
Q

time of payment of claims

A

immediately

53
Q

have ____ days to file suit against insurer after proof of loss

A

60

54
Q

this provision limits the time period that the insurer ay deny a claim based on prexisting conditions or misrepresentations

A

time limit for certain defenses

55
Q

provision that deals with the agent making revisions on the policy

A

entire contract - changes

56
Q

provision that states who will receive death benefits

A

payment of claims

57
Q

restricts the time for insured to file suit

A

legal actions

58
Q

provision allows the insurer at its expense to examine the insured when a claim is pending

A

physical exam and autopsy

59
Q

requires the insurer to mail forms within 15 days

A

claim forms

60
Q

companys promise to pay

A

insuring clause

61
Q

period of time after purchase before benefits are paid

A

probationary period (happens once)

62
Q

totally disabled from a covered accident or illness for _____ insurer waives premium

A

3 to 6 months

63
Q

refers to a condition that returns before the insured has been back to work for 6 months following total disability

A

recurrent

64
Q

insurer may cancel at any time

A

cancelable

65
Q

insurer may cancel on anniversary date

A

optionally renewable

66
Q

insurer may cancel based upon the conditions specified in policy

A

conditionally renewable

67
Q

insurer may not cancel but can raise premium on class basis

A

guaranteed renewable

68
Q

insurer may not cancel or raise

A

non cancelable

69
Q

when do you receive your first disability check

A

6 months

70
Q

provides periodic payments when unable to work

A

disability insurance

71
Q

time before benefits are payable after a covered accident or illness occurs is usually found in disability policies

A

elimination period

72
Q

provides funds to pay operating expenses of a business

A

business overhead insurance

73
Q

pays a monthly benefit to a business to cover additional help and pay an essential person while disabled

A

key employee

74
Q

pays the insured for loss of earnings after returning to work in the insured is unable to earn as much as before the total disability

A

residual disability

75
Q

refers to a disability where the insured is expected to recover

A

temporary

76
Q

inability to perform one or more but not all of the duties of the occupation (educated and trained for)

A

partial disability

77
Q

insurer would not require the insured to submit to periodic exams by their physician to prove continued disability

A

presumptive

78
Q

related disability relapse before being back to work for 6 months would be called

A

recurrent

79
Q

unable to work for rest of life

A

permanent

80
Q

inability to perform any of the duties required in occupation

A

total disability

81
Q

buyout of an owners interest if permanent disability occurs

A

key employee disability

82
Q

insurer wold not require the payment of premiums while totally disabled

A

waiver of premium

Accident and health (1 decks)

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