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11-35 > Life, Accident, & Health > Flashcards

Life, Accident, & Health Flashcards

0
Q

Applicant

A

The party making application to the insurance company for the policy

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1
Q

Annuity

A

1.) and amount of money, payable monthly or yearly, which liquidates a financial asset. 2.) and agreement by an insurer to make periodic payments that continue during the survival of the annuitant or for a specified period. Annuities are also accumulation vehicles that function much like savings accounts

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2
Q

Application

A

A form on which the prospect of insured states the facts requested by the insurer and on the basis of which the insurer decides whether to except the risk, modify the coverage offered, or decline the risk. An application without premium money is a request for an offer. With premium money, it becomes an offer. If attached to the policy at issue, it becomes part of the entire contract

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3
Q

Assignee

A

The person to whom policy rights are assigned in whole or in part by the policy owner

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4
Q

Assignment

A

The transfer of rights in a policy to someone other than the policy owner

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5
Q

Attained age

A

The present age of the insured. This is a factor when a person converts term insurance to whole life insurance or buys added disability under a GIR provision

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6
Q

Attorney in fact

A

A person to whom authorization is given by an individual to exchange insurance with other persons. Always present in a reciprocal insurance company

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7
Q

Authorized company

A

An insurer permitted to sell insurance within a state, evidenced by a certificate of authority from the insurance commissioner, also called admitted

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8
Q

Automatic premium loan

A

A provision in a life policy authorizing the insurance company to use the loan value to pay premiums not paid by the end of the grace period. May be present in whole life or other traditional cash value policy is only, but never in term policies

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9
Q

Beneficiary

A

A person who may become eligible to receive, or is receiving, benefits under and insurance plan, other than as a participant

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10
Q

Blanket insurance contract

A

A contract of health insurance that covers all of a class of persons not individually identified. No certificates are issued and people covered may not be aware that the coverage is in place

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11
Q

Blue plan

A

The generic term for those insurers usually on a service rather than reimbursement basis who are authorized to use the designation Blue Cross or Blue Shield and the insignia of either

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12
Q

Broker

A

One who represents an insured in the solicitation, negotiation, or procurement of contracts of insurance, and who may render services incidental to those functions. This person is also called an independent agent. By law, the broker may also be an agent of the insurer for certain purposes such as delivery of the policy or collection of premium

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13
Q

Business insurance

A

Life or health insurance written to cover business situations, such as key person, so proprietor, partnership, corporation’s etc.

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14
Q

Cancelable

A

A contract of insurance that may be terminated by the insurance company or insured at any time. Virtually every form of insurance is cancelable unless state law prohibits such action except life insurance and those health policies designated as guaranteed renewable, or non-cancelable and guaranteed renewable

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15
Q

Cancellation

A

The termination of a contract of insurance in force by voluntary act of the insurance company or insured, affected in accordance with the provisions in the contract or by mutual agreement

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16
Q

Capital sum

A

The maximum amount payable and one some in the event of accidental dismemberment. It is typically half of the face amount of principal sum

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17
Q

Cash dividend option

A

A dividend option under which the policy owner of a mutual contract receives the dividends and cash. Not subject to tax

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18
Q

Cash surrender value

A

The value reposing and a policy that is the legal property of the policy owner and that may be expected should the policy be surrendered for cash. Synonymous with cash value

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19
Q

Certificate

A

A statement evidencing that a policy has been written and stating the coverage in general. Often used with group coverage

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20
Q

Claim

A

A demand for payment under the insurance policy

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21
Q

Classification

A

The grouping of persons for the purpose of determining an underwriting or reading group into which a particular risk must be placed

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22
Q

Co-Insurance

A

In health insurance, A provision that the insured and insurance company will share covered losses in agreed proportion.

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23
Q

Collateral assignment

A

Assignment of part of the proceeds of an insurance policy to a bank as collateral to settle the loan balance that may exist at the insureds death. The agreement is temporary.

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24
Q

Common disaster provision

A

A provision that can be included in the life contract that provides that the primary beneficiary must outlive the insured by a specified period of time in order to receive the proceeds. If not, the contingent beneficiary receives the proceeds. The provision is designed to protect the rights of the contingent beneficiary in the event of simultaneous death of the insured and the primary beneficiary. The time limit is up to 90 days, depending on state law

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25
Q

Comprehensive health or major medical insurance

A

A form of health insurance that combines the coverage of major medical and basic medical expense contracts into one broad contract that provides coverage for almost all types of medical expense with you internal limits. Usually subject to a corridor deductible for expenses after the first dollar base plan limits are exceeded, and to a coinsurance clause applicable to all or some of the remaining covered expenses

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26
Q

Concealment

A

The withholding of facts by an application for insurance that materially affect and insurance risk or loss

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27
Q

Conditional receipt

A

A provision that, premium settlement accompanies the application, coverage shall be enforced from the date of application whether the policy has been issued or not, provided the insurance company would have issued the coverage on the basis of facts as revealed by the application and other usual sources of underwriting information. A physical does not have to be completed for the company to make this judgment

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28
Q

Conditionally renewable

A

A contract of health insurance that provides that the insured may renew the contract to a stated date or an advanced age, subject to the right of the insurer to decline renewal only under conditions defined in the contract

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29
Q

Conditions

A

The part of an insurance contract setting out the responsibilities of both the insured and insurer

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30
Q

Consideration

A

The exchange of value on which a contract is based. In life and health insurance, the consideration is the premium plus the statements in the application

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31
Q

Consideration clause

A

A clause in a life policy specifying the premium due for the insurance protection and their frequency of payment also called mode

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32
Q

Contingent beneficiary

A

The person or persons named to receive benefits if the primary beneficiary is not alive

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33
Q

Contract

A

A legal agreement between two parties for consideration, such as an insurance policy

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34
Q

Contributory group

A

Group insurance for which the employees pay part of the premium

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35
Q

Control business

A

Life insurance coverage written on the agents on Waze and on the lives of such persons as the agents relatives and business associates, or employees of the company in which an agent has an interest

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36
Q

Convertible term insurance

A

A term policy that can be converted to a permanent type of coverage without proof of insurability

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37
Q

Corridor deductible

A

A deductible used only in comprehensive major medical that applies between benefits paid by the basic plan and the start of the major medical benefits

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38
Q

Credit insurance

A

Insurance on a debtor in favor of a lender, intended to pay off a loan or the balance due if the insured dies or is disabled

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39
Q

Death benefit

A

The policy proceeds to be paid on the death of the insured

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40
Q

Deductible

A

Dollars or percentage of expense that will not be reimbursed by the insurer

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41
Q

Decreasing term insurance

A

Term insurance who’s amount of coverage starts out at the full amount, then gradually decreases until the expiration date of the policy

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42
Q

Deferred annuity

A

An annuity on which payments to the annuitant are delayed until a specified future date

43
Q

Direct writer

A

And insurance company that sells its policies through licensed agents who represent the insurer exclusively, rather than through independent local agents who represents several insurance companies

44
Q

Disability income insurance

A

A form of health insurance that provides periodic payments to replace income, actually or presumptively lost, when the insured is unable to work as a result of sickness or injury

45
Q

Dismemberment benefits

A

Benefits paid for the loss of eyesight or limbs

46
Q

Dividend

A

The return of part of the premium paid for a participating policy

47
Q

Dividend options

A

Waze and insured may receive policy dividends

48
Q

Domestic insurance company

A

An insurance company formed under the laws of the state in which the insurance is written

49
Q

Double indemnity

A

Payment of twice the basic benefit in the event of loss resulting from specified cause or under specific circumstances

50
Q

Dread disease policy

A

A policy, usually offering blanket coverage up to a very high maximum, for certain specified diseases only, such as cancer

51
Q

Earned premium

A

The portion of the premium for which policy protection has already been given during the now expired portion of the policy term

52
Q

Effective date

A

The date on which an insurance policy or bond goes into effect and from which protection is furnished

53
Q

Eligibility period

A

The. Following the probationary period, during which the employee is eligible to obtain non-medical coverage under the group life plan

54
Q

Embedded deductible

A

Embedded deductibles will only cover a family member and a high deductible health insurance plan after that individuals personal deductible has already been met

55
Q

Employer mandate

A

A requirement under the affordable care act that businesses that employ 50 or more people and do not offer health insurance will pay a tax penalty beginning in 2015

56
Q

Endorsement

A

A form attached to an insurance contract changing part of the contract. Sometimes called a rider

57
Q

Essential health benefits (EHB)

A

The minimum coverage requirements for health insurance under the affordable care act. The qualified plans must be guarantee issue with no pre-existing conditions and no lifetime benefit maximums

58
Q

Estoppel

A

Related to waiver. Once a person or company waves a known right, the waiver cannot be reversed

59
Q

Exchange

A

Marketplace of current licensed insurance agents and navigators to offer or sell insurance according to the affordable care act

60
Q

Exclusions

A

Causes, conditions, or property listed in the policy that are not covered and for which no benefits are payable

61
Q

Experience

A

The loss record of an insured, a class of coverage, or an insurance company

62
Q

Extended term option

A

A life insurance nonforfeiture option, under which the insured uses the policies cash value accumulation to purchase single premium term insurance in an amount equal to the original policy face amount

63
Q

Face amount

A

The amount indicated on the face of the policy that will be paid at death or when the policy matures

64
Q

Fee for service plan

A

Reimburses the insured or the provider for the covered services costs and has a limited choice of providers

65
Q

Fiduciary

A

Person who occupies a position of special trust and confidence – for example, in handling or supervising the affairs or funds of another

66
Q

Fixed amount option

A

A settlement option under which the beneficiary receives a fixed amount for an unspecified period of time. Payments to continue until the principal and interest are depleted

67
Q

Foreign company

A

And ensure organized under the laws of the state other than the state in which the insurance is written

68
Q

Fraud

A

And intentional misrepresentation made by a person with intent to take advantage of another

69
Q

General agent GA

A

And individual appointed by and ensure to administer it’s business and a given territory. Responsible for building the agency and service force. Compensation is on a commission basis, although there may be additional expense allowances. Often called a managing general agent MGA

70
Q

Grace period

A

A period of time after the premium due date during which a policy remains in force without penalty, even though the premium due has not been paid

71
Q

Grievance

A

A written or oral complaint involving an urgent care request in which the covered person complained about an adverse determination, or rescission of coverage, during a utilization review, claims payment, handling, or reimbursement, or the contractual relationship with the carrier

72
Q

Group contract

A

A contract of insurance made with an employer or other entity that covers a group of people identified as individuals by reference to their relationship to the entity. A group contract maybe life insurance, health insurance, or an annuity

73
Q

Group life insurance

A

Life insurance that a person is eligible to purchase through membership in a group. The group may not be formed just to buy insurance

74
Q

Guaranty Association

A

A state association that takes control of an insolvent insurance company and provides the funds to pay for claims that the company is unable to pay

75
Q

Guaranteed renewable

A

A contract that gives the insured continued coverage in return for the timely payment of premiums for a substantial period of time. During that period of time, the insurer has no right to make any change in any provision of the contract other than a change in the premium rate for all insureds in the same class

76
Q

Hazard

A

Any factor tending to make a policy owner a less desirable risk for the insurance company. Maybe physical or moral

77
Q

Health insurance

A

Broadly, coverage to provide benefits on the occurrence of disabling sickness or accident, accidental death or dismemberment, or loss of income due to disability

78
Q

Health insurance Association

A

A state fund that provides health insurance to residents who have been denied coverage, and the fund is maintained by assessments of the authorized health insurers in the state

79
Q

Health insuring Corporation (HIC)

A

And organization of health providers; this is the Ohio term for an HMO. Each member pays a premium for which he receives medical care when desired. The emphasis is on preventative medicine

80
Q

High deductible health insurance plan (HDHP)

A

A required type of high deductible health insurance plan for employers who want to provide a health savings account to their employees

81
Q

Health savings accounts (HSA)

A

Anna account established by an employer for employees. Both the employer and employee can make pretax contributions that will cover certain qualified medical expenses and other allowable expenses

82
Q

Hospital expense or income policy

A

Policy that pays stated amount per week or month while the insured is hospitalized, without references to expenses actually incurred. Might be viewed as a disability income policy with disability defined as hospitalization. Policy pays in addition to other policies

83
Q

Individual mandate

A

Requirement that all individuals with a few exceptions are covered by an approved health plan containing at least the essential health benefits provided by the affordable care act

84
Q

Immediate annuity

A

Lump some annuity on which the income payments to the annuitant begin at once

85
Q

In-person assister

A

Any person, other than a navigator, who receives any funding from, or is selected or designated by, an exchange, the state, or the federal government to perform any of the activities and duties identified above as those of an insurance navigator

86
Q

Incontestable clause

A

Provides that, after the policy has been enforced for a certain length of time, the company can no longer contest or void it, except for nonpayment of premiums or the insurer proving fraud. Time period is usually 2 years

87
Q

Indemnify

A

Insurance is designed to restore the policy owner to the same financial condition enjoyed prior to a loss. The intent is to cover the amount of the actual loss only; the insured should not profit from a loss situation

88
Q

Individual contract

A

A contract of life or health insurance made with an individual that covers him, and in certain instances, specified members of the household

89
Q

Industrial life

A

Life insurance generally with the face amount of less than $1000, with premiums collected monthly or more frequently by the agent in person. The grace period for this type of insurance is 28 days. Premiums were traditionally collected at the factory or workplace

90
Q

Inpatient

A

A patient admitted to a hospital as a resident patient

91
Q

Insurability

A

The acceptability of an applicant to the insurance company for insurance

92
Q

Insurable interest

A

An interest in the case of an individual owning a policy on the life of another by which there will be a lost at the insured dies. The interest maybe based on either a family relationship or economic factor. Insurable interest must exist at the time of application, but not at the time of loss

93
Q

Insurance

A

A contract or device for the transfer of pure risk to an insurer, who agrees, for a consideration, to indemnify or pay a specified amount for losses suffered by the insured

94
Q

Insurance age

A

And H upon which current premium rates may be established. It is commonly based on age at last birthday, agent next birthday, or age at nearest birthday

95
Q

Insurance director

A

The common title for the head of the state department of insurance

96
Q

Insurance navigator

A

A person or entity selected to perform certain duties identified in the affordable care act and is performing these functions under a grant

97
Q

Insurance policy

A

A contract or legal document that establishes the terms of agreement between the insurer and insured

98
Q

Insured

A

Party to and insurance agreement to him or on behalf of of the insurance company agrees to indemnify for losses, provide benefits, or render service. And prepaid hospital service plans, the insured is called the subscriber

99
Q

Insurer

A

The insurance company assuming risk and agreeing to pay claims or provide services

100
Q

Insuring clause

A

Clause in a policy that specifies the contracts intent and benefits

101
Q

Interest option

A

Settlement option under which the insurer keeps the insurance proceeds and invest them on behalf of the beneficiary. Beneficiary receives the interest from the investment. Proceed to remain the property of the beneficiary. Proceeds are not taxable but the interest is

102
Q

Irrevocable beneficiary

A

Cannot be changed without the name beneficiaries consent, and the irrevocable beneficiary takes over owner like rights to the policy

103
Q

Joint and survivorship life annuity

A

Payments are made to two annuitants, with the survivor continuing to receive payments after the first annuitant dies

104
Q

Joint life annuity

A

Payments continue to two annuitants for as long as both live. On the death of either one payments stop

105
Q

Jumping juvenile

A

Juvenile insurance on which the face amount increases by a multiple, usually five, of the original facing out when insured reaches 21

106
Q

Key person insurance

A

Life or health insurance on the important employees whose death or disability would cause the employer financial loss. The insurance is usually owned by or payable to the employer

11-35 (1 decks)

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