Pre-Class Glossary Flashcards
Producer
Another name for a licensed agent (that’s soon to be you!). An agent “produces” new business for an insurance company that a customer “consumes.”
Resident Producer
An agent who holds an insurance license in the state in which they live. (You will get your licensed for the state of PA!)
Non-Resident Producer
An agent who is licensed in another state besides the state they live in known as their resident state.
Annual Enrollment or Election Period (AEP)
the time of year that individuals across the country can sign up for, change, or disenroll from an insurance plan. The AEP runs from October 15 to December 7 each year
Insurer
Any insurance company (EXs: Optum, United Healthcare)
Insured
The person covered by an insurance policy. (Tip: the ending has an “ED” like the name of a person is “Ed.”)
Deductible
The amount the insured pays for covered health care services before your insurance plan starts to pay. After you meet your deductible, you usually pay only a copayment or coinsurance.
Coinsurance
The amount an insured must pay at all times to satisfy a claim after the insurance has paid.
Beneficiary
The receiver of insurance policy benefits. In other words, the person who would receive the “pay out/benefits” from the insurance company. (EX: if a parent were to pass away, typically the child- “beneficiary”- receives life insurance money because the parent had a life insurance policy.)
Assignment of Benefits
Tells insurance company what they must pay the doctor/hospital. What your insurance company will cover on a medical bill.
Benefit Period
the time during which insured is receiving benefits.
Premium Mode
How often an insured pays their premium, can be weekly, monthly, quarterly, etc.
Appointments
When an insurance company aligns with an agent to sell their products. Appointments are filed with the State Department of Insurance.
Right to Examine (Free Look)
The period of time a new insured has to return the policy for a full refund.
Grace Period
The period of time an insured has to make a premium payment past their due date
Coordination of Benefits
When 2 or more insurance coverages work together to ensure they do not duplicate benefits.
Contributory
You pay part of the premiums.
Non-Contributory
You pay none of the premium.
Fully Contributory
You pay all the premium.
Pre-Existing Conditions
An illness or disease you may have had prior to applying for new insurance coverage.
Pre-Existing Condition Exclusion
When a pre-existing condition is not covered for a certain period of time on new insurance coverage.
Adverse Selection
When an insurance company covers someone who has a lot of risk or pre-existing conditions.
Health Maintenance Organization (HMO)
Health care plan stressing preventive health care. Persons generally enroll voluntarily by paying a fixed fee periodically. (EX preventative care is a yearly physical that comes as a standard part of your insurance plan but you must go to a doctor that is within your network).
Preferred Provider Organizations (PPO)
A collection of providers that offer services at prearranged discount prices. You pay for each service, rather than the service being apart of your plan like an HMO. (EX a yearly physical at a set rate is not included in this plan but you are not required to get a physical.)
