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Insurance Cert > Chapter 17 > Flashcards

Chapter 17 Flashcards

1
Q

What is an Accelerated Death Benefit Rider?

A

This rider pays out a portion of the life insurance policy’s death benefit upon the diagnosis of a terminal illness or other condition.

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2
Q

What are Activities of Daily Living (ADL)?

A

These are the six activities that people perform every day, which are essential to living independently: bathing, dressing, toileting, transferring, continence, and eating.

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3
Q

What is Adult Day Care?

A

This is a type of care designed for individuals who require assistance with various activities of daily living while their primary caregivers are absent.

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4
Q

What is an Assisted Living Facility?

A

This is a residential community that provides some services but is more limited than a nursing home, including housekeeping, meals, social activities, and intermittent nursing care.

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5
Q

What is an Automatic Inflation Rider (AIR)?

A

This rider causes the face amount of a long-term care insurance policy to increase annually, generally at 5% per year for a specified number of years.

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6
Q

What is a Benefit Trigger in long-term care insurance?

A

Benefits are activated by either a person’s loss of the ability to perform two or more activities of daily living or the existence of a cognitive impairment.

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7
Q

What is a Buyer’s Guide for Medigap Insurance?

A

This guide provides information about different Medicare Supplement plans and is titled ‘Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.’

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8
Q

What is the Center for Medicare and Medicaid Services (CMS)?

A

This is the federal agency that administers and regulates the Medicare and Medicaid insurance programs.

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9
Q

What is Cognitive Impairment?

A

This is a deficiency in a person’s memory, orientation to her environment, or ability to reason and make safe judgments.

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10
Q

What is Cold Lead Advertising?

A

This is the illegal practice of using marketing that doesn’t disclose that a sales agent may call when a person responds to a marketing campaign.

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11
Q

What is Continuing Care?

A

This type of care is designed to provide benefits to elderly individuals who live in a continuing care retirement community.

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12
Q

What are Continuing Care Communities?

A

These communities provide a range of living arrangements for residents starting at independent living and progressing to nursing home care.

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13
Q

What are Core Benefits?

A

These are the benefits defined in law and regulation that all Medicare Supplement plans must offer.

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14
Q

What is Custodial Care?

A

This is the level of care given to meet daily personal needs, such as dressing, bathing, and eating, but is not medical care.

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15
Q

What is the Donut Hole in Medicare Part D?

A

This refers to a corridor deductible between a person’s basic coverage and catastrophic coverage.

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16
Q

What is Duplication of Coverage?

A

It’s illegal to sell a second Medigap policy to a person who already has one (other than a replacement).

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17
Q

What is an Elimination Period?

A

This is the period during which a person must wait before benefits begin in long-term care insurance.

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18
Q

What is End-Stage Renal Disease (ESRD)?

A

This refers to the point when dialysis or a kidney transplant is necessary to sustain a person’s life.

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19
Q

What is Formal Care?

A

This is the paid care delivered by professional caregivers, including medical assistance from nurses.

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20
Q

What is a Formulary?

A

This is the list of medications covered by a specific prescription drug plan along with each medication’s designated category.

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21
Q

What is the Guarantee of Insurability Option (Rider)?

A

This rider allows the policyholder to purchase additional coverage at designated future intervals.

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22
Q

What is Guaranteed Issue?

A

This refers to an insurance policy that cannot be declined for coverage due to an insurability issue.

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23
Q

What is Hands-on Assistance?

A

This refers to physical assistance with one of the activities of daily living or related tasks.

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24
Q

What are High-Pressure Tactics?

A

These are actions that use an explicit or implicit threat or excessive pressure to affect the sale of a policy.

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25
Q

What is Home Care?

A

This is assistance with the activities of daily living and necessary household tasks.

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26
Q

What is Home Health Care?

A

This includes both skilled and unskilled care provided in an individual’s home, typically on a part-time basis.

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27
Q

What is Hospice Care?

A

This is comfort care for the dying, delivered in a facility or the patient’s home.

28
Q

What are Hybrid (Asset-based) Long-Term Care Plans?

A

These contracts use an annuity or whole life policy to guarantee long-term care benefits.

29
Q

What is Informal Care?

A

This is personal care received from informal (unpaid) caregivers, such as family members.

30
Q

What is Intermediate Care?

A

This is a defined nursing care level used in long-term care insurance, often referred to as intermittent care.

31
Q

What are Lifetime Reserve Days?

A

This is a hospital benefit used when the insured has used up all allotted days of hospital care.

32
Q

What is Long-Term Care?

A

This refers to a broad range of services designed to assist individuals who have lost their ability to remain independent.

33
Q

What is Long-Term Care Insurance?

A

This describes an insurance contract that pays for the cost of medical and personal services defined as long-term care.

34
Q

What is the Long-Term Care Partnership Program?

A

This program allows individuals who purchase qualified long-term care insurance policies to protect a portion of their assets.

35
Q

What are Long-Term Care Riders?

A

These riders use a portion of the underlying policy’s face amount to pay a monthly benefit for long-term care services.

36
Q

What is Medicare?

A

This is the federally sponsored program that provides hospital and medical expense insurance primarily to those age 65 and older.

37
Q

What is Medicare Advantage?

A

This describes an ‘all in one’ private insurance policy subsidized by the federal government.

38
Q

What is Medicare Part A?

A

This portion provides coverage of hospital and nursing home care services for eligible individuals.

39
Q

What is Medicare Part B?

A

This portion provides coverage for the cost of physicians and other medical services for eligible individuals.

40
Q

What is Medicare Part D?

A

This program offers a prescription drug benefit to help Medicare beneficiaries pay for necessary drugs.

41
Q

What is Medicare Select?

A

This is a type of Medicare supplement plan that requires policyholders to receive services from within a defined network.

42
Q

What is a Medicare Supplement?

A

This is a private health insurance policy that fills various gaps in Medicare coverage.

43
Q

What are Non-Forfeiture (Benefit) Options?

A

These allow the insured to receive some value from past premium payments if the policy lapses.

44
Q

What is a Non-Participating Provider?

A

This is a provider that bills individual Medicare recipients rather than accepting assignment from Medicare.

45
Q

What is a Nursing Home?

A

This is a location primarily designed to provide skilled nursing care around the clock.

46
Q

What is Original Medicare?

A

This consists of the fee-for-service hospital and medical insurance programs administered by the federal government.

47
Q

What are Participating Providers?

A

These are medical professionals authorized to bill Medicare for services and accept payment directly from Medicare.

48
Q

What is Physical Assistance?

A

This refers to hands-on assistance with one of the activities of daily living.

49
Q

What is Plan A?

A

This is the most basic of the available Medicare Supplement plans that contains only the Core Benefits.

50
Q

What is a Pool of Money?

A

This concept describes how long-term care insurance policies define their benefit limits.

51
Q

What is Post-Claims Underwriting?

A

This occurs when an insurer approves all applicants and only underwrites the risk when the insured files a claim.

52
Q

What is a Prescription Drug Plan (PDP)?

A

This is a program that offers a prescription drug benefit to help Medicare beneficiaries pay for their drugs.

53
Q

What is a Primary Insurer?

A

This term applies when more than one insurance contract covers the same loss, with the primary insurer having primary responsibility.

54
Q

What is a Private Fee for Service (PFFS) or Medicare Advantage Plan?

A

This allows an individual to use any participating Medicare provider, with the insurance plan determining reimbursements.

55
Q

What is Respite Care?

A

This is a type of care designed to provide a short rest period for a caregiver.

56
Q

What is a Return of Premium Rider?

A

This rider refunds paid premiums when the insured dies without using the policy benefits.

57
Q

What is a Secondary Insurer?

A

This term applies when more than one insurance contract covers the same loss, with the secondary insurer covering costs not covered by the primary insurer.

58
Q

What is a Shopper’s Guide for Long-Term Care Insurance?

A

This guide explains what LTCI is, what it does, and various LTCI contract features.

59
Q

What is Skilled Nursing Care?

A

This is daily nursing care ordered by a doctor and is medically necessary, performed by skilled medical professionals.

60
Q

What is a Skilled Nursing Facility?

A

This is a residential facility that provides skilled nursing care.

61
Q

What is Stand-By Assistance?

A

This is available assistance that can be readily given in the event a person needs help with activities of daily living.

62
Q

What is Substantial Assistance?

A

This indicates that the individual receiving aid can no longer safely carry out the task independently.

63
Q

What is a Tax-Qualified Long-Term Care Insurance Contract?

A

This is a policy that satisfies specific criteria defined by the Health Insurance Portability and Accountability Act (HIPAA).

64
Q

What is Substantial Assistance?

A

This is a level of service which indicates that the individual receiving the aid can no longer safely carry out the task in question independently. Substantial assistance can either be hands-on assistance or stand-by assistance.

65
Q

What is a Tax-Qualified Long-Term Care Insurance Contract?

A

This is an individual policy or group plan that satisfies specific criteria as defined by the Health Insurance Portability and Accountability Act (HIPAA).

According to HIPAA, qualified LTCI plans have the following characteristics: They do not duplicate Medicare; Their benefits are triggered by the inability to perform at least two ADLs or cognitive impairment based on a diagnosis that the impairment will last 90 days or more; They are guaranteed renewable with a 30-day free look; The insured has a written plan of care; The policy has no cash value.

66
Q

What does Twisting mean in insurance?

A

This represents the use of deception or misrepresentation to induce an individual to replace an existing policy with another contract.

67
Q

What is a Waiver of Premium?

A

This is typically a standard clause in long-term care insurance contracts. This provision suspends premium payments while an insured receives benefits.

Insurance Cert (20 decks)

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