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Life and Health > Glossary/Terms > Flashcards

Glossary/Terms Flashcards

1
Q

TERM: Accelerated Benefits

A

Riders attached to life insurance policies which allow death benefits to be used to cover nursing or convalescent home expenses.

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2
Q

TERM: Accident

A

An unplanned, unforeseen event which occurs suddenly and at an unspecified place.

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3
Q

TERM: Accident Insurance

A

A type of insurance that protects the insured against loss due to accidental bodily injury.

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4
Q

TERM: Accidental Bodily Injury

A

Unplanned, unforeseen traumatic injury to the body.

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5
Q

TERM: Accidental Death and Dismemberment (AD&D)

A

An insurance policy which pays a specified amount or a specified multiple of the insured’s benefit if the insured dies, loses his/her sight, or loses two limbs due to an accident.

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6
Q

TERM: Accidental Death Benefits

A

A policy rider that states that the cause of death will be analyzed to determine if it complies with the policy description of accidental death.

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7
Q

TERM: Accidental Death Insurance

A

An insurance policy that provides payment if the insured’s death is the result of an accident.

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8
Q

TERM: Accumulation Period

A

The time over which the annuitant makes payments or investments in an annuity, and when those payments earn interest tax deferred.

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9
Q

TERM: Acquired Immunodeficiency Syndrome (AIDS)

A

An infectious and incurable disease caused by the human immunodeficiency virus (HIV).

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10
Q

TERM: Activities of Daily Living (ADLs)

A

Activities individuals must do every day such as moving about, getting dressed, eating, bathing, etc.

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11
Q

TERM: Actual Cash Value (ACV)

A

The required amount to pay damages or for property loss, which is calculated based on the property’s current replacement value minus depreciation.

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12
Q

TERM: Actual Charge

A

The amount a physician or supplier actually bills for a particular service or supply.

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13
Q

TERM: Actuary

A

A person trained in the technical aspects of insurance and related fields, particularly in the mathematics of insurance; a person who, on behalf of the company, determines the mathematical probability of loss.

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14
Q

TERM: Adhesion

A

A contract offered on a “take-it-or-leave-it” basis by an insurer, in which the insured’s only option is to accept or reject the contract. Any ambiguities in the contract will be settled in favor of the insured.

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15
Q

TERM: Adjustable Life

A

Life insurance which permits changes in the face amount, premium amount, period of protection, and the duration of the premium payment period.

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16
Q

TERM: Adjuster

A

A representative of an insurance company who investigates and acts on the behalf of the company to obtain agreements for the amount of the insurance claim.

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17
Q

TERM: Administrator

A

An individual appointed by a court as a fiduciary to settle the financial affairs and estate of a deceased person.

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18
Q

TERM: Admitted (Authorized) Insurer

A

An insurance company authorized and licensed to transact business in a particular state.

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19
Q

TERM: Adult Day Care

A

A program for impaired adults that attempts to meet their health, social, and functional needs in a setting away from their homes.

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20
Q

TERM: Adverse Selection

A

The tendency of risks with higher probability of loss to purchase and maintain insurance more often than the risks who present lower probability.

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21
Q

TERM: Agency

A

An insurance sales office or company.

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22
Q

TERM: Agent

A

An individual who is licensed to sell, negotiate, or effect insurance contracts on behalf of an insurer.

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23
Q

TERM: Agent’s Authority

A

Special powers granted to an agent by his or her agency contract.

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24
Q

TERM: Aleatory

A

A contract in which participating parties exchange unequal amounts. Insurance contracts are aleatory in that the amount the insured will pay in premiums is unequal to the amount the insurer will pay in the event of a loss.

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25
Q

TERM: Alien Insurer

A

An insurance company that is incorporated outside the United States.

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26
Q

TERM: Alzheimer’s Disease

A

A disease that causes the victim to become dysfunctional due to degeneration of brain cells causing severe memory loss.

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27
Q

TERM: Ancillary

A

Additional, miscellaneous services provided by a hospital, such as x-rays, anesthesia, and lab work, but not hospital room and board expenses.

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28
Q

TERM: Annual Statement

A

A detailed financial report that an insurance company must submit every year to the insurance department of state(s) in which it conducts business.

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29
Q

TERM: Annuity

A

A contract that provides income for a specified period of years, or for life.

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30
Q

TERM: Apparent Authority

A

The appearance or the assumption of authority based on the actions, words, or deeds of the principal or because of circumstances the principal created.

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31
Q

TERM: Applicant

A

A person making application for, or offering him/herself or another to be insured under an insurance contract.

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32
Q

TERM: Application

A

A document that provides information for underwriting purposes. After the policy is issued, any unanswered questions are considered waived by the insurer.

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33
Q

TERM: Approved Amount

A

The amount Medicare determines to be reasonable for a service that is covered under part B of Medicare.

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34
Q

TERM: Assignment (Life)

A

The transfer of ownership rights of a life insurance policy from one person to another.

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35
Q

TERM: Assignment (Health)

A

A claim to a provider or medical supplier to receive payments directly from Medicare.

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36
Q

TERM: Attained Age

A

The age of the insured at a determined date.

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37
Q

TERM: Attending Physician’s Statement (APS)

A

A statement usually obtained from the applicant’s doctor.

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38
Q

TERM: Authorized (Admitted) Insurer

A

An insurance company authorized and licensed to transact business in a particular state.

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39
Q

TERM: Avoidance

A

A method of dealing with risk by deliberately keeping away from it (e.g. if a person wanted to avoid the risk of being killed in an airplane crash, he/she might choose never to fly in a plane).

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40
Q

TERM: Back-End Load

A

a fee charged at the time of a sale, transfer or withdrawal from an annuity or a life insurance policy.

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41
Q

TERM: Basic Hospital Expense Insurance

A

Coverage that provides benefits for room, board and miscellaneous hospital expenses for a certain number of days during a hospital stay.

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42
Q

TERM: Basic Illustration

A

A ledger or proposal used in the sale of a life insurance policy that shows both guaranteed and nonguaranteed elements.

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43
Q

TERM: Basic Medical Expense Insurance

A

Coverage for doctor visits, x-rays, lab tests, and emergency room visits; benefits, however, are limited to specified dollar amounts.

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44
Q

TERM: Beneficiary

A

The person who receives the proceeds from the policy when the insured dies.

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45
Q

TERM: Benefit Period

A

The length of time over which the insurance benefits will be paid for each illness, disability or hospital stay.

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46
Q

TERM: Binder (Binding Receipt)

A

A temporary contract that puts an insurance policy into force before the premium has been paid.

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47
Q

TERM: Birthday Rule

A

The method of determining primary coverage for a dependent child, under which the plan of the parent whose birthday occurs first in the calendar year is designated as primary.

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48
Q

TERM: Blanket Medical Insurance

A

A policy that provides benefits for all medical costs, including doctor visits, hospitalization, and drugs.

49
Q

TERM: Boycott

A

An unfair trade practice in which one person refuses to do business with another until he or she agrees to certain conditions.

50
Q

TERM: Broker

A

An individual who represents an insured in the process of purchasing and negotiating a contract of insurance.

51
Q

TERM: Buy-Sell Agreement

A

A legal contract that determines what will be done with a business in the event that an owner dies or becomes disabled.

52
Q

TERM: Buyer’s Guide

A

A booklet that describes insurance policies and concepts, and provides general information to help an applicant make an informed decision.

53
Q

TERM: Cafeteria Plan

A

A selection of health care benefits from which an employee may choose the ones that he/she needs.

54
Q

TERM: Capital Amount

A

A percentage of the principal amount of a policy paid to the insured if he/she suffered the loss of an appendage.

55
Q

TERM: Carriers

A

Organizations that process claims and pay benefits in an insurance policy.

56
Q

TERM: Cash Value

A

The amount to which a policyowner is entitled if the policy is surrendered before maturity.

57
Q

TERM: Cease and Desist Order

A

A demand of a person to stop committing an action that is in violation of a provision.

58
Q

TERM: Certificate

A

A statement (or booklet) that confirms that a policy has been written and that describes the coverage in general.

59
Q

TERM: Certificate of Authority

A

A document that authorizes a company to start conducting business and specifies the kind(s) of insurance a company can transact. It is illegal for an insurance company to transact insurance without this certificate.

60
Q

TERM: Certificate of Insurance

A

A legal document that indicates that an insurance policy has been issued, and that states both the amounts and types of insurance provided.

61
Q

TERM: Claim

A

A request for payment of the benefits provided by an insurance contract.

62
Q

TERM: Coercion

A

An unfair trade practice in which an insurer uses physical or mental force to persuade an applicant to buy insurance.

63
Q

TERM: Coinsurance

A

An agreement between an insurer and insured in which both parties are expected to pay a certain portion of the potential loss and other expenses

64
Q

TERM: Coinsurance Clause

A

A provision that states that the insurer and the insured will share the losses covered by the policy in a proportion agreed upon in advance.

65
Q

TERM: Commingling

A

A practice in which a person in a fiduciary capacity illegally mixes his/her personal funds with funds he/she is holding in trust.

66
Q

TERM: Commission

A

The payment made by insurers to agents or brokers for the sale and service of policies.

67
Q

TERM: Commissioner (Superintendent, Director)

A

The chief executive and administrative officer of a state

insurance department.

68
Q

TERM: Comprehensive Policy

A

A plan that provides a package of health care services, including preventive care, routine physicals, immunization, outpatient services and hospitalization.

69
Q

TERM: Comprehensive Major Medical

A

A combination of basic coverage and major medical coverage that features low deductibles, high maximum benefits, and coinsurance.

70
Q

TERM: Concealment

A

The withholding of known facts which, if material, can void a contract.

71
Q

TERM: Conditional Contract

A

A type of an agreement in which both parties must perform certain duties and follow rules of conduct to make the contract enforceable.

72
Q

TERM: Consideration

A

The binding force in a contract that requires something of value to be exchanged for the transfer of risk. The consideration on the part of the insured is the representations made in the application and the payment of premium; the consideration on the part of the insurer is the promise to pay in the event of loss.

73
Q

TERM: Consideration Clause

A

A part of the insurance contract that states that both parties must give something of value for the transfer of risk, and specifies the conditions of the exchange.

74
Q

TERM: Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986

A

The law that provides for the continuation of group health care benefits for the insured for up to 18 months if he/she terminates employment or is no longer eligible, and for the insured’s dependents for up to 36 months in cases of loss of eligibility due to death of the insured, divorce, or attainment of the limiting age.

75
Q

TERM: Consumer Reports

A

Written and /or oral statements regarding a consumer’s credit, character, reputation, or habits collected by a reporting agency from employment records, credit reports, and other public sources.

76
Q

TERM: Contract

A

An agreement between two or more parties enforceable by law.

77
Q

TERM: Contributory

A

A group insurance plan that requires the employees to pay part of the premium.

78
Q

TERM: Controlled Business

A

An entity that obtains and possesses a license solely for the purpose of writing business on the owner, immediate family, relatives, employer and employees.

79
Q

TERM: Convertible

A

A policy that may be exchanged for another type of policy by contractual provision, at the option of the policyowner, and without evidence of insurability (i.e. term life changed to a form of permanent life).

80
Q

TERM: Coordination of Benefits

A

A provision that helps determine the primary provider in situations where an insured is covered by more than one policy, thus avoiding claims overpayments.

81
Q

TERM: Co-pay

A

An arrangement in which an insured must pay a specified amount for services “up front” and the provider pays the remainder of the cost.

82
Q

TERM: Countersignature

A

The act of signing an insurance policy by a licensed resident agent.

83
Q

TERM: Coverage

A

The inclusion of causes of loss (perils) which are covered within a scope of a policy.

84
Q

TERM: Credit Life Insurance

A

A special type of coverage written to pay off the balance of a loan in the event of the death of the debtor.

85
Q

TERM: CSO Table (The Commissioner’s Standard Ordinary Table)

A

A mortality table used in life insurance that

mathematically predicts the likelihood of death.

86
Q

TERM: Custodial Care

A

Care that is rendered to help an insured complete his/her activities of daily living.

87
Q

TERM: Death Benefit

A

The amount payable upon the death of the person whose life is insured.

88
Q

TERM: Decreasing Term

A

A type of life insurance that features a level premium and a death benefit that decreases each year over the duration of the policy.

89
Q

TERM: Deductible

A

The portion of the loss that is to be paid by the insured before any claim benefits may be paid by the insurer.

90
Q

TERM: Defamation

A

An unfair trade practice in which one agent or insurer makes an injurious statement about another with the intent of harming the person’s or company’s reputation.

91
Q

TERM: Dependent

A

A person who relies on another for support and maintenance.

92
Q

TERM: Director (Commissioner, Superintendent)

A

The head of the state department of insurance.

93
Q

TERM: Disability

A

A physical or mental impairment, either congenital or resulting from an injury or sickness.

94
Q

TERM: Disability Income Insurance

A

Health insurance that provides periodic payments to replace an insured’s income when he/she is injured or ill.

95
Q

TERM: Disclosure

A

An act of identifying the name of the producer, representative or firm, limited insurance representative, or temporary insurance producer on any policy solicitation.

96
Q

TERM: Domestic Insurer

A

An insurance company that conducts business in the state of incorporation.

97
Q

TERM: Domicile of Insurer

A

Insurer’s location of incorporation and the legal ability to write business in a state.

98
Q

TERM: Dread (Specified) Disease Policy

A

A policy with a high maximum limit that covers certain diseases named in the contract (such as polio and meningitis).

99
Q

TERM: Dual Choice

A

A federal requirement that employers who have 25 or more employees, who are within the
service area of a qualified HMO, who pay minimum wage, and offer a health plan, must offer HMO coverage
as well as an indemnity plan.

100
Q

TERM: Earned Premium

A

The amount of the premium for which the policy protection has been given.

101
Q

TERM: Effective Date

A

The date when an insurance policy begins (also known as the inception date).

102
Q

TERM: Eligibility Period

A

The period of time in which an employee may enroll in a group health care plan without
having to provide evidence of insurability.

103
Q

TERM: Elimination Period

A

A waiting period that is imposed on the insured from the onset of disability until
benefit payments begin.

104
Q

TERM: Emergency

A

An injury or disease which occurs suddenly and requires treatment within 24 hours.

105
Q

TERM: Employee Retirement Income Security Act (ERISA)

A

The act that stipulates federal standards for private

pension plans.

106
Q

TERM: Endodontics

A

An area of dentistry that deals with diagnosis, prevention and treatment of the dental pulp
within natural teeth at the root canal.

107
Q

TERM: Endorsement

A

A form changing the provisions of and attached to a life insurance policy (also known as a
rider).

108
Q

TERM: Endow

A

to reach the maturity date or time at which the face amount equals cash values.

109
Q

TERM: Enrollment Period

A

The amount of time an employee has to sign up for a contributory group health plan.

110
Q

TERM: Errors and Omissions Policy (E&O)

A

A professional liability insurance that protects the insurer from claims
by the insured for errors or oversights on the part of the insurer.

111
Q

TERM: Estoppel

A

A legal impediment to denying a fact or restoring a right that has been previously waived.

112
Q

TERM: Excess Charge

A

The difference between the Medicare approved amount for a service or supply and the
actual charge.

113
Q

TERM: Excess Insurance

A

Insurance that pays over and above or in addition to basic policy limits.

114
Q

TERM: Exclusions

A

Causes of loss, exposures, conditions, etc. listed in the policy for which the benefits will not be
paid.

115
Q

TERM: Executory Contract

A

A contract which has not yet been fulfilled by one or both parties that promises action
in the event of a specified future occurrence.

116
Q

TERM: Expiration

A

The date specified in the policy as the date of termination.

117
Q

TERM: Explanation of Benefits (EOB)

A

A statement that outlines what services were rendered, how much the
insurer paid, and how much the insured was billed.

118
Q

TERM: Explanation of Medicare Benefits

A

A statement sent to a Medicare patient indicating how the Medicare
claim will be settled.

119
Q

TERM: Exposure

A

A unit of measure used to determine rates charged for insurance coverage.

Life and Health (18 decks)

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