Final Exam Prep Flashcards
What four services do HMO and PPO plans cover that are not covered by Medicare or Medicare Supplement policies?
Prescriptions, eye exams, hearing aids or dental care
Under an extended term nonforfeiture option, the policy cash value is converted to a face amount that is what percentage of the whole life policy?
100%
Are there life contingencies with an annuity certain?
No
A life contingency in an annuity is an option that provides a death benefit if the annuitant dies during the accumulation stage
What is the purpose of a conditional receipt?
To provide coverage on a date prior to the policy issue
What does it mean to legally bind coverage?
It means that an insurance company has confirmed that coverage is in place for a policyholder
As a general rule, are premiums for life insurance tax deductible?
No
The exception would be when an employer buys group term life insurance for his employees since it is considered a business expense
What three conditions must be met for a life insurance policy to begin coverage?
When the agent delivers the policy, collects the initial premium and the applicant completes an acceptable Statement of Good Health
Are physical examination and autopsy mandatory for health insurance policies?
Yes
How soon following the occurrence of a covered loss must the insured submit written proof of the loss to the insurance company?
Within 90 days or as soon as reasonable but not to exceed 1 year
Do HMOs provide financing as well as reimbursement?
They do provide financing, not reimbursement
Do group disability benefits apply to injuries incurred both on and off the job?
No, on the job injuries are covered by Workers Comp
Does coverage for illness start immediately upon the reinstatement of a health insurance policy?
No
Accidental injury is covered immediately but illness is not to protect the insurer against adverse selection. Illness is covered 10 days after reinstatement.
What document describes the insured’s medical history, including diagnoses and treatments?
The APS (Attending Physician’s Statement)
What are the three features of noncancellable policies?
- Insurer cannot cancel the policy
- Premiums cannot be increased for the term of the policy
- Apply only to a certain age, usually 65
If an individual already receives Social Security disability benefits, what do they need to do to qualify for Medicare when they turn 65?
Nothing, they’re already qualified for Medicare Parts A and B once they turn 65
What is the maximum age for qualifying for a catastrophic plan?
30
Which has a higher premium and why: joint life or survivorship life?
Joint because survivorship pays on the last rather than the first death so premiums are spread out over a longer period of time
After the deductible, what percent of covered expenses will Medicare Plan B pay?
80%
In the event a policy lapses due to outstanding premium, within how many days would the policy be automatically reinstated once the outstanding premium is paid?
45
What contract characteristic defines the requirement that both the insured and the insurer must meet certain conditions?
Conditional
Does AD&D insurance cover presumptive disabilities?
Yes
How are accelerated benefits paid to a chronically ill insured taxed?
A portion of the benefit to a certain limit is tax free; the rest is taxable income
What is the waiting period on a Waiver of Premium rider in life insurance policies?
6 months
Who examines the books and records of insurance companies in Florida and how often?
The CFO and the Office of Insurance Regulation every 5 years
What method do insurers use to protect themselves against catastrophic losses?
Reinsurance - a contract between an insurance company, called the cedent, and a reinsurer, where the reinsurer takes on some or all of the risk from the cedent’s insurance policies
Who must sign the Notice Regarding Replacement?
Both the applicant and the agent
Compare the premium of Universal vs Whole or Straight Life
Universal - variable premium
Whole/Straight - fixed premium
Compare the cash value guarantee of Universal vs Whole or Straight Life
Universal - cash value NOT guaranteed because it returns current market rates
Whole/Straight - Guaranteed cash value because it returns a fixed interest rate
Compare the death benefit of Universal vs Whole or Straight Life
Universal - Death benefit amount is not guaranteed because the cash value is not guaranteed
Whole/Straight - Guaranteed death benefit because it’s fixed
Compare the cost of Universal vs Whole or Straight Life
Universal - Less expensive
Whole/Straight - More expensive
What type of death protection does Universal Life offer
Annually renewable term life
Compare the death benefit of Universal Life Option A vs Universal Life Option B
Option A - Level death benefit
Option B - Increasing death benefit
Compare the cash value of Universal Life Option A vs Universal Life Option B
Option A - Cash value is accessible only to the policyowner while they are alive
Option B - Both the face value and cash value are paid to the beneficiary upon the death of the insured
What type of death benefit does Term Life have?
Pure death benefit - only pays out the benefit upon the death of the insured. There is no cash value.
Does Term Life have a cash value?
No
What type of premium does Term Life have?
Level premium for the full term
Compare the types of account and who’s responsible for Variable vs Fixed Annuities
Variable - Separate account; policyholder is fully responsible
Fixed - Insurer’s general account; insurer is fully responsible
Compare face amount vs cash value
Face amount - death benefit
Cash value - savings that can be withdrawn or borrowed against
Is evidence of insurability required when converting Term Life?
No
What is adjustable on an adjustable life insurance policy (x3)?
- Premium
- Death benefit
- Coverage period (sometimes)
When converting Term Life, how is the premium amount determined?
Attained age
How is the pay-out of Pure/Straight Life Annuities structured?
Guaranteed Income for the life of the annuitant
What is the cash value and death benefit of Pure/Straight Life Annuities?
No cash value and no death benefit
What must the policyowner of an Adjustable Life Insurance policy provide to increase the death benefit?
Evidence of insurability
What is another name for interest-sensitive whole life insurance?
Current assumption whole life insurance
What are the two ways the principal is treated in Return of Premium Term Life Insurance?
- It is returned to insured if they outlive the term
- It is returned to beneficiary if insured dies during term
With the Life with Guaranteed Minimum annuity settlement option, what happens to the principal amount if the annuitant dies?
The Guaranteed Minimum provision means the beneficiary is refunded the remainder of the principal
What characteristic makes whole life permanent protection?
Coverage until death or age 100
Which types of policies offer endorsements (riders) for LTC?
Which types don’t?
Life insurance policies DO
Health care insurance policies DON’T
What type of insurance is a children’s rider added to an insured’s permanent life insurance policy?
Term insurance covering all the children which is convertible to permanent insurance once the child reaches the maximum age without evidence of insurability
What type of retirement account does not require distributions to start by a certain age?
Roth IRAs
What happens to the principle in an interest-only settlement option?
It stays with the insurer to generate the interest distributed in the pay-out unless the beneficiary chooses to access it sooner
To comply with the Fair Credit Reporting Act, when must a producer notify the applicant that a credit report may be requested?
At the time of application
COBRA applies to employers with at least how many employees?
20
Which nonforfeiture option has the highest amount of protection?
Extended term
It has the same face amount as the original policy but for a shorter period of time
An insured has chosen the Joint and 2/3 Survivorship settlement option. What does this mean to the beneficiary?
While both annuitants (typically a couple) are alive, they receive a set income payment; however, when one person dies, the surviving person will continue to receive 2/3 of that original payment amount for the rest of their life
Are the benefits from individual LTC plans taxed?
No
Unless they exceed the daily cost of LTC
What must all definitions of total disability include?
A person’s ability to work is significantly reduced or eliminated for the rest of their life
The type of policy that can be changed from one that does not accumulate cash value to one that does is a…
Convertible term policy
At what age do Social Security credits start to accrue and how many must they accrue to claim benefits through age 31?
Accrual starts at 21
They must have accrued a minimum of half-time credits between 21 and the time of injury (i.e. 2 per year)
If the free-look period is 10+ days, when can the Buyer’s Guide be delivered?
With the policy
If the free-look period is less than 10 days, when must the Buyer’s Guide be delivered?
Prior to accepting the first premium
How are key person insurance premiums and benefits taxed?
Premiums are not tax deductible but benefits are tax free
What does a term rider attached to a permanent life insurance policy enable the policyowner to do?
Customize the life insurance policy to their needs (e.g. additional temporary insurance for themselves or family members, etc.)
Most policies will pay accidental death benefits as long as the death was caused by the accident and occurs within how many days?
90
What is required from each state in order to add a provision to a health care policy that is consistent with uniform provisions?
Approval
Hospital indemnity/hospital confinement indemnity will provide payment based on what?
Only on the number of days confined in a hospital
What is an accumulation at interest option?
A feature in certain life insurance policies where dividends paid to the policyholder are reinvested back into the policy and allowed to accumulate interest over time
What is third party ownership of a life insurance policy?
It is when the policy owner is different from the insured person (e.g. group or key person life insurance)
In health insurance, who pays for any amount a doctor charges above what the insurer considers usual, customary and reasonable?
The insured
What type of insurance only covers medical costs related to accidents?
Accident-only
If someone 65+ still has health insurance through their employer, what purpose does Medicare have if any?
Employer’s health coverage is primary, Medicare is secondary
Which type a annuity will generally pay the highest monthly income and why?
Straight Life
It only pays for as long as the annuitant lives with no death benefit and no cash value
What kind of organization is formed to provide insurance benefits for members of an affiliated lodge or religious organization?
Fraternal benefit society
What are insurance companies formed in-state, out of state and out of country called?
Domestic, foreign and alien
What is the minimum age required to obtain a life insurance license?
18
Which replacement regulations are applicable when an employer changes its group life insurance policy to a similar one with a different insurer?
None. Replacement regulations do not apply in this situation.
What is another name for time limit on certain actions?
Statute of limitations
How are taxes on accumulation handled for both qualified and nonqualified retirement plans?
They’re both tax deferred in the accumulation phase
What is Durable Medical Equipment?
Equipment prescribed by a doctor (e.g. oxygen equipment, wheelchairs, etc.)
Compare coinsurance vs copayment
Coinsurance is a percent of cost, copayment is a flat amount
What option enables policyowners to use dividends to pay their next premium?
Reduction of premium
What are nonforfeiture values and are they optional?
They are provisions in life insurance policies that allow policyholders to receive some value from their policy if they can no longer pay premiums. These options can be used if a policy lapses or is canceled.
They are required by Florida state law.
How are group medical expense premiums and benefits taxed?
Premiums are paid with pre-tax business proceeds so they are tax deductible
Benefits are not taxed as income to the employee
What type of policy must maintain a “corridor” or gap between the cash value and the death benefit and why?
Universal Life Option A
Not doing so nullifies the life insurance tax benefits
Both consumer reports and investigative consumer reports provide information from an outside source about a customer’s character and reputation. What is unique about consumer investigative reports?
The customer’s associates, friends, and neighbors provide the report’s data