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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
Common disaster provision
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
25
Comprehensive health or major medical insurance
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
26
Concealment
The withholding of facts by an application for insurance that materially affect and insurance risk or loss
27
Conditional receipt
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
28
Conditionally renewable
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
29
Conditions
The part of an insurance contract setting out the responsibilities of both the insured and insurer
30
Consideration
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
31
Consideration clause
A clause in a life policy specifying the premium due for the insurance protection and their frequency of payment also called mode
32
Contingent beneficiary
The person or persons named to receive benefits if the primary beneficiary is not alive
33
Contract
A legal agreement between two parties for consideration, such as an insurance policy
34
Contributory group
Group insurance for which the employees pay part of the premium
35
Control business
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
36
Convertible term insurance
A term policy that can be converted to a permanent type of coverage without proof of insurability
37
Corridor deductible
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
38
Credit insurance
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
39
Death benefit
The policy proceeds to be paid on the death of the insured
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Deductible
Dollars or percentage of expense that will not be reimbursed by the insurer
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Decreasing term insurance
Term insurance who's amount of coverage starts out at the full amount, then gradually decreases until the expiration date of the policy
42
Deferred annuity
An annuity on which payments to the annuitant are delayed until a specified future date
43
Direct writer
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
Disability income insurance
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
Dismemberment benefits
Benefits paid for the loss of eyesight or limbs
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Dividend
The return of part of the premium paid for a participating policy
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Dividend options
Waze and insured may receive policy dividends
48
Domestic insurance company
An insurance company formed under the laws of the state in which the insurance is written
49
Double indemnity
Payment of twice the basic benefit in the event of loss resulting from specified cause or under specific circumstances
50
Dread disease policy
A policy, usually offering blanket coverage up to a very high maximum, for certain specified diseases only, such as cancer
51
Earned premium
The portion of the premium for which policy protection has already been given during the now expired portion of the policy term
52
Effective date
The date on which an insurance policy or bond goes into effect and from which protection is furnished
53
Eligibility period
The. Following the probationary period, during which the employee is eligible to obtain non-medical coverage under the group life plan
54
Embedded deductible
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
Employer mandate
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
Endorsement
A form attached to an insurance contract changing part of the contract. Sometimes called a rider
57
Essential health benefits (EHB)
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
Estoppel
Related to waiver. Once a person or company waves a known right, the waiver cannot be reversed
59
Exchange
Marketplace of current licensed insurance agents and navigators to offer or sell insurance according to the affordable care act
60
Exclusions
Causes, conditions, or property listed in the policy that are not covered and for which no benefits are payable
61
Experience
The loss record of an insured, a class of coverage, or an insurance company
62
Extended term option
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
Face amount
The amount indicated on the face of the policy that will be paid at death or when the policy matures
64
Fee for service plan
Reimburses the insured or the provider for the covered services costs and has a limited choice of providers
65
Fiduciary
Person who occupies a position of special trust and confidence – for example, in handling or supervising the affairs or funds of another
66
Fixed amount option
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
Foreign company
And ensure organized under the laws of the state other than the state in which the insurance is written
68
Fraud
And intentional misrepresentation made by a person with intent to take advantage of another
69
General agent GA
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
Grace period
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
Grievance
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
Group contract
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
Group life insurance
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
Guaranty Association
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
Guaranteed renewable
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
Hazard
Any factor tending to make a policy owner a less desirable risk for the insurance company. Maybe physical or moral
77
Health insurance
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
Health insurance Association
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
Health insuring Corporation (HIC)
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
High deductible health insurance plan (HDHP)
A required type of high deductible health insurance plan for employers who want to provide a health savings account to their employees
81
Health savings accounts (HSA)
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
Hospital expense or income policy
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
Individual mandate
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
Immediate annuity
Lump some annuity on which the income payments to the annuitant begin at once
85
In-person assister
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
Incontestable clause
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
Indemnify
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
Individual contract
A contract of life or health insurance made with an individual that covers him, and in certain instances, specified members of the household
89
Industrial life
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
Inpatient
A patient admitted to a hospital as a resident patient
91
Insurability
The acceptability of an applicant to the insurance company for insurance
92
Insurable interest
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
Insurance
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
Insurance age
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
Insurance director
The common title for the head of the state department of insurance
96
Insurance navigator
A person or entity selected to perform certain duties identified in the affordable care act and is performing these functions under a grant
97
Insurance policy
A contract or legal document that establishes the terms of agreement between the insurer and insured
98
Insured
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
Insurer
The insurance company assuming risk and agreeing to pay claims or provide services
100
Insuring clause
Clause in a policy that specifies the contracts intent and benefits
101
Interest option
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
Irrevocable beneficiary
Cannot be changed without the name beneficiaries consent, and the irrevocable beneficiary takes over owner like rights to the policy
103
Joint and survivorship life annuity
Payments are made to two annuitants, with the survivor continuing to receive payments after the first annuitant dies
104
Joint life annuity
Payments continue to two annuitants for as long as both live. On the death of either one payments stop
105
Jumping juvenile
Juvenile insurance on which the face amount increases by a multiple, usually five, of the original facing out when insured reaches 21
106
Key person insurance
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

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