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Health Insurance Exam > Glossary Terms A - D > Flashcards

Glossary Terms A - D Flashcards

1
Q

Accident

A

Unplanned, unforeseen event which occurs suddenly and at an unspecified place.

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2
Q

Accident Insurance

A

A type of insurance that protects the insured against loss due to accidental bodily injury.

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3
Q

Accidental bodily injury

A

Unplanned, unforeseen traumatic injury to the body.

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4
Q

Accidental death and dismemberment

A

An insurance policy which pays a specific amount or a specified multiple of the insurance benefit if the insured dies, loses his or her sight, or loses two limbs due to an accident.

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5
Q

Acquired immunodeficiency syndrome

AIDS

A

An infectious and incurable disease caused by the human immunodeficiency virus (HIV)

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6
Q

Accidental death benefits

A

A policy rider that states that the cause of death will be analyzed to determine if it complies with the policy description of accidental death.

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7
Q

Activities of daily living

A

Activities individuals must do every day such as moving about, getting dressed, eating, bathing, etc.

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8
Q

Actual charge

A

The amount a physician or supplier actually bills for a particular service or supply.

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9
Q

Adhesion

A

A contract offered on a “take it or leave it” bases by the insurer, in which the insured‘s only option is to except or reject the contract. Any ambiguities in the contract will be settled in favor of the insured.

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10
Q

Admitted (authorized) insurer

A

An insurance company authorized and licensed to transact insurance in a particular state.

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11
Q

Adult day care

A

A program for impaired adults that attempts to meet their health, social, and functional needs in a setting away from their homes.

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12
Q

Adverse selection

A

A tendency of risks with higher probability of loss to purchase and maintain insurance more often than the risks who present lower probability.

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13
Q

Agent

A

An individual who is licensed to sell, negotiate, or effect insurance contracts on behalf of an insurer.

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14
Q

Aleatory

A

A contract in which participating parties exchange unequal amounts. Insurance contracts are aleatory in that the amount the insured will pay in premiums is unequal to the amount the insurer will pay in the event of a loss.

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15
Q

Alien insurer

A

An insurance company that is incorporated outside the United States.

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16
Q

Apparent authority

A

The appearance or the assumption of authority based on the actions, words, or deeds of the principle or because of circumstances the principal created.

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17
Q

Alzheimer’s disease

A

A disease that causes the victim to become dysfunctional due to degeneration of brain cells and severe memory loss.

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18
Q

Approved amount

A

The amount Medicare determines to be reasonable for a service that is covered under part B of Medicare.

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19
Q

Assignment

A

A claim to a provider or medical supplier to receive payments directly from Medicare.

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20
Q

Attained age

A

The age of the insured at a determined date.

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21
Q

Attending physician’s statement (APS)

A

A statement usually obtained from the applicant’s doctor.

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22
Q

Avoidance

A

A method of dealing with risk (for example if a person wanted to avoid the risk of being killed in an airplane crash, he or she might she was never to fly in a plane.)

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23
Q

Basic hospital expense insurance

A

Coverage that provides benefits for room, board and miscellaneous hospital expenses for a certain number of days during the hospital stay.

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24
Q

Basic medical expense insurance

A

Coverage for doctors visits, x-rays, lab tests, and emergency room visits; benefits, however, are limited to specified dollar amounts.

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25
Q

Beneficiary

A

The person who receives the proceeds from the policy when the insured dies.

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26
Q

Benefit Period

A

The length of time over which the insurance benefits will be paid for each illness, disability or hospital stay.

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27
Q

Birthday rule

A

The method of determining primary coverage for a dependent child, under which the plan of the parent whose birthday occurs first in the calendar year, is designated as primary.

28
Q

Blanket medical insurance

A

A policy that provides benefits for all medical costs, including doctor visits, hospitalization, and drugs.

29
Q

Boycott

A

An unfair trade practice in which one person refuses to do business with another until he or she agrees to certain conditions.

30
Q

Buyers guide

A

A booklet that describes insurance policies and concepts, and provides general information to help an applicant make an informed decision.

31
Q

Cafeteria plan

A

A selection of healthcare benefits from which an employee may choose the options that he or she needs.

32
Q

Capital amount

A

A percentage of the principal amount of a policy paid to the insured if he or she suffered the loss of an appendage.

33
Q

Carriers

A

Organizations that process claims and pay benefits in an insurance policy.

34
Q

Cease and desist order

A

A demand of a person to stop committing an action that is in violation of a provision.

35
Q

Certificate of authority

A

A document that authorizes a company to start conducting business and specifies the kinds of insurance the company can transact. It is illegal for an insurance company to transact insurance without this certificate.

36
Q

Certificate of insurance

A

A written document that indicates that an insurance policy has been issued, and that states both the amounts and types of insurance provided.

37
Q

Claim

A

A request for payment of the benefits provided by an insurance contract.

38
Q

Coercion

A

And unfair trade practices in which an insurer uses physical or mental force to persuade an applicant to buy insurance.

39
Q

Coinsurance

A

An agreement between an insurer and insured in which both parties are expected to pay a certain portion of the potential loss and other expenses.

40
Q

Coinsurance clause

A

A provision that states that the insurer and the insured will share the losses covered by the policy in a proportion agreed-upon in advance.

41
Q

Commissioner

A

The chief executive and administrative officer of the insurance department.

42
Q

Comprehensive policy

A

A plan that provides a package of healthcare services, including preventative care, routine physicals, immunization, outpatient services and hospitalization.

43
Q

Comprehensive major medical

A

A combination of basic coverage and major medical coverage that features low deductibles, high maximum benefits, and coinsurance.

44
Q

Concealment

A

The withholding of known facts which, if material, can void the contract.

45
Q

Conditional contract

A

A type of an agreement in which both parties must perform certain duties and follow rules of conduct to make the contract enforceable.

46
Q

Consideration

A

The binding force in a contract that requires something of value to be exchanged for the transfer of risk. The consideration on the part of the insured is the representations made in the application and the payment of a premium; the consideration on the part of the insurer is the promise to pay in the event of a loss.

47
Q

Consideration clause

A

A part of the insurance contract that states that both parties must give something of value for the transfer of risk, and specifies the conditions of the exchange.

48
Q

Consolidated Omnibus budget reconciliation act (cobra)of 1985

A

The law that provides for the continuation of group healthcare benefits for the insured for up to 18 months if he or she terminates employment or is no longer eligible, and for the insured’s dependents for up to 36 months in cases of loss of eligibility due to death of the insured, divorce, or attainment of the limiting age.

49
Q

Consumer report

A

A written and or oral statement regarding a consumers credit, character, reputation, or habits collected by a reporting agency from employment records, credit records and other public sources.

50
Q

Contract

A

An agreement between two or more parties enforceable by law.

51
Q

Contributory

A

A group insurance plan that requires the employees to pay part of the premium.

52
Q

Coordination of benefits

A

A provision that helps determine the primary provider in situations where an insured is covered by more than one policy, thus avoiding claims over payments.

53
Q

CoPayment

A

An arrangement in which an insured must pay a specified amount for services “upfront” and the provider pays the remainder of the cost.

54
Q

Custodial care

A

Care that is rendered to help an insured complete his or her activities of daily living.

55
Q

Death benefit

A

The amount payable upon the death of a person whose life is insured.

56
Q

Deductible

A

The portion of the loss that is to be paid by the insured before any claim may be paid by the insurer.

57
Q

Defamation

A

An unfair trade practice in which one agent or insurer makes an injurious statement about another with the intent of harming the persons or company’s reputation.

58
Q

Director

A

The chief executive and administrative officer of the insurance department.

59
Q

Disability

A

A physical or mental impairment either congenital or resulting from an injury or sickness.

60
Q

Disability income insurance

A

Health insurance that provides periodic payments to replace an insured‘s income when he or she is injured or ill.

61
Q

Disclosure

A

An act of identifying the name of the producer, representative or firm, limited insurance representative, or temporary insurance producer on any policy solicitation.

62
Q

Domestic insurer

A

An insurance company that is incorporated in the state.

63
Q

Domicile of insurer

A

Insurer’s location of incorporation and the legal ability to write business in the state.

64
Q

Dread (specified) disease policy

A

A policy with a high maximum limit that covers certain diseases named in the contract (such as polio and meningitis).

65
Q

Dual choice

A

A federal requirement that employers who have 25 or more employees, who are within the service area of a qualified HMO, who pay minimum wage, and offer a health plan, must offer HMO coverage as well as an indemnity plan.

Health Insurance Exam (5 decks)

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