Health and Accident Insurance Flashcards
What is Accident Insurance?
This form of insurance policy only covers losses that are caused directly by an accident
What is Accidental Bodily Injury?
This is a common method of stating ‘accidental result’. Many states require policies to define a covered accident no more restrictively than an ‘accidental bodily injury’.
What is Accidental Death and Dismemberment Insurance?
This is the purest form of accident insurance. Provides insured with a lump-sum benefit amount if accidental death or dismemberment occurs under accidental circumstances.
What is Accidental Means?
This is a restrictive way of defining an accident. It requires the cause of an accident to be unforeseen, unexpected, and unintended.
What is Accidental Result?
This is the definition of an accident that’s used by most policies. This definition is far less restrictive than the accidental means provision (opposed to accidental bodily injury provision)
What is the Affordable Care Act?
This act imposed new government standards on private major medical insurance and established government-run e-market exchanges to facilitate the sale of insurance to those in the individual and small group markets.
What is Blanket Insurance?
These policies cover situation in which a group’s individual members constantly change, but whose membership is consistently exposed to the same hazards. A school may purchase this type of policy for its students and staff. No certificates of coverage are issued.
What is Capital Sum?
One of the benefits payable under AD&D. Amount that’s payable for the accidental loss of sight or accidental dismemberment. It is a specified amount, which is typically expressed as a percentage of the maximum policy benefit.
What is the Community Rating?
Insurers in the small group market often underwrite risks based on the local community’s claims experience. No medical underwriting. Average claim costs and utilization.
What are Comprehensive Policies?
This form of major medical insurance covers a broad range of losses and only excludes those that are specifically excluded in the policy.
What is Disability (Income) Insurance?
This is a form of insurance that insures the beneficiary’s earned income against the risk that a disability could prevent a work from performing the material and substantial duties of their occupation.
What is Dread Disease Insurance?
This type of policy provides limited benefits for a specific disease, such as cancer or heart disease.
What is an Experience Rating?
In group insurance, underwrites use an experience rating to price group contracts. A group’s experience rating reflects the average level of risk in the group. Underwriters calculate experience rating based on the group’s prior claims experience. (Larger groups)
What is Interim Coverage?
This is a short-term policy that’s purchased on an interim basis, typically when a person is between jobs or waiting for a new policy to start.
What is a Hospital Indemnity Insurance policy?
This insurance pays a flat dollar amount on a daily, weekly, or monthly basis directly to the insured while the insured is confined to a hospital.
What is Long Term Care Insurance?
This insurance covers the cost of caring for individuals who have lost the ability to complete daily tasks associated with living independently.
What is Morbidity?
This is the probability or risk of getting ill or becoming disabled.
What is a key feature of non-scheduled dental plans?
Coverage is divided into categories with varying deductibles and co-insurance.
What is required for Limited Benefit Policies?
A notice to the Insured stating it is this type of policy.
How is sickness defined in insurance terms?
An internal occurrence that becomes manifest
