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Life/health State Exam > Terms > Flashcards

Terms Flashcards

1
Q

Guaranteed Issue

A

Permits a person to enroll regardless if health status, age, gender or other factors

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2
Q

HMO

A

Health Maintenance Organization

  • limits coverage to in-network doctors (except in emergencies)
  • Focus on prevention and wellness
  • Enrollee pays a fixed fee in exchange for medical services
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3
Q

HSA

A

Health Savings Account

  • Contributions are tax free
  • They accumulate interest
  • Used to pay medical expenses
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4
Q

HDHP

A

High deductible health plan

  • can be paired with an HSA
  • Pays for out of pocket medical expenses on a pre-tax basis
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5
Q

LTC

A

Long Term Care

  • Includes medical and non-medical care for people who are unable to perform basic daily activities (includes nursing and assisted living)
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6
Q

Major Dental Care

A

Includes root canals, dentures, crowns and other major dental work outside of x-rays and cleanings

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7
Q

Medical Underwriting

A

Used to figure out health status to make policy and figure out premiums

(Comes after application is submitted and first premium is submitted)

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8
Q

Outpatient

A

Medical services at a doctors office (not overnight hospital stay)

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9
Q

POS

A

Point of Service

  • requires referrals from your primary care physician to see other specialists
  • Pay less if you use doctors, hospital and health care providers in plans network
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10
Q

Pre-Existing Condition

A

Condition or disability that exists prior to insurance policies effective date

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11
Q

PPO

A

Preferred Provider Organization

  • Can use doctors outside of network at additional costs
  • They partner with hospitals and doctors to creat network
  • You pay bill and PPO will reimburse you
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12
Q

Rider

A

An amendment to an insurance policy that adds or excludes coverage for specific benefits

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13
Q

Waiting Period

A

A time when you may not be covered for specific benefits of your plan

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14
Q

Annuity

A

A contract providing income for a specified period of time

  • Annuitant is person receiving payments
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15
Q

Beneficiary

A

Person who may become eligible from a life insurance policy

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16
Q

Coinsurance

A

Percentage of each claim insured will pay

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17
Q

Comprehensive hospital and medical

A

Includes hospital, surgical and major medical coverages

  • does not include medicare supplements
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18
Q

Comprehensive/major meeical

A

Fully insured Indemnity, HMO, PPO, or fee for service for hospital, medical and surgical

Does not include short term medical insurance

19
Q

Conditions

A

Requirements specified in insurance contract

20
Q

Aleatory

A

Refers to the fact that an unequal exchange may occur in an insurance contract

21
Q

Adhesion

A

Accepted or rejected in full

22
Q

Unilateral

A

Insurance contracts are one sided

Only the insurance company is legally bound to the promises made

23
Q

Deductible

A

Portion of the insured loss paid by the policy holder

Ceiling price that is paid before coverage starts

24
Q

Deferred annuity

A

Annuity payment to he made as a single payment or series of installments to begin at some future date

25
Q

Demutualization

A

Conversion of a Mutual insurance company to a capital stock company

26
Q

Dividend

A

A refund of a portion of the premium paid by the insured from insurers surplus

27
Q

ERISA

A

Governing standards for private pension plans

28
Q

Hazard

A

Circumstances that increase the probability or severity of loss

29
Q

Health stop loss

A

Insure against the risk that any one claim will exceed a specific dollar amount

30
Q

Hospital Indemnity Coverage

A

Provides a pre-determined, fixed benefit

31
Q

Incontestability Provision

A

Limiting the time within the insurer has the legal right ti void the contract on grounds of material misrepresentation

32
Q

Index Annuity

A

An interest hearing fixed annuity tied to an equity index

33
Q

Key Persons Insurance

A

Insures the life of an important person so business operations can continue

34
Q

Joint-life Annuity

A

Annuity contract that ceases upon the death of the first of two or more annuitants

35
Q

Lapse

A

Termination of policy due to failure to pay premiums

36
Q

Living benefit rider

A

Provides long term care to the terminally ill

37
Q

Medigap

A

Supplementary private health insurance products to Medicare Insurance Benefits

38
Q

Moral vs. Morale Hazard

A

Moral: Personality characteristics (drugs)

Morale: negligence or disregard (speeding)

39
Q

Policy dividend

A

Refund of part of the premium on a participating life insurance policy

40
Q

Renewable Term Insurance

A

Renewable for a limited number of successive terms regardless of insurability

41
Q

Universal Life Insurance

A

Premiums and coverage are adjustable

42
Q

Variable Life Insurance

A

Face value depends on investments success

43
Q

Variable Universal Life

A

Flexible premiums plus investment options

44
Q

Whole life insurance

A

Level premiums and level benefit value

Builds cash value though

Life/health State Exam (2 decks)

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