Health And Accident

Question 1

A general way of describing insurance against loss through sickness or accidental bodily injury

Answer 1

Health insurance

Question 2

A form of insurance that ensures, the beneficiaries earned income against the risk that a disability creates a barrier for a worker to complete the core functions of their work

Answer 2

Disability (income) insurance

Question 3

Insurance which pays benefits for non-surgical doctors fees commonly rendered in a hospital; sometimes pays for home and office calls

Answer 3

Medical expense insurance

Question 4

A short term policy is purchased on an interim basis, typically in between jobs or waiting for a new policy to start

Answer 4

Interim coverage

Question 5

The purest form of accident insurance. It provides the insured with a lump sum benefit amount in the event of accidental death, or dismemberment under accidental circumstances.

Answer 5

Accidental death and dismemberment insurance

Question 6

Insurance, under which the insured is not entitled to share the divisible surplus of the company

Answer 6

Non-participating plan

Question 7

A plan under which the policy owner receives shares (commonly called the dividends) of the divisible surplus of the company

Answer 7

Participating plan of insurance

Question 8

Healthy act designed to increase health insurance, quality and affordability, lower the uninsured rate by expanding insurance, coverages and reduce the cost of healthcare.

Answer 8

The Patient Protection and Affordable Care Act

Question 9

Insurance that provides coverage for a group of persons, usually employees of a company, under one master contract

Answer 9

Group health insurance

Question 10

Are provisions that define the rights of the insurer to cancel the policy a different points during the life of the policy

Answer 10

Renewability provisions

Question 11

Allows the insurer to cancel, or terminate the policy at any time. This type of renewability is prohibited in most states.

Answer 11

Cancelable policies

Question 12

Policies which gives the insurer in the option to terminate the policy on a date specified in the contract

Answer 12

Optional renewable policies

Question 13

A policy that gives the insurer the option to terminate the policy only in the event of one or more conditions stated in the contract

Answer 13

Conditional renewability

Question 14

Policies which specify that the policy must be renewed, (usually until the insured reaches a specified age)

Answer 14

Guaranteed renewable policies

Question 15

State the policy cannot be cancelled nor can its premium rates be increased under any circumstances. Disability policies are the most common noncancellable (noncan) policies

Answer 15

Noncancellable Policies

Question 16

Policies that are for a predetermined terms of a year or less (typically short term health insurance) and are considered temporary

Answer 16

Non-renewable policies

Question 17

Benefit arrangements in which employees can pick and choose from a menu of benefits, thus tailoring the benefits package to their specific needs

Answer 17

Cafeteria plans

Question 18

Cafeteria plans are also referred to as what?

Answer 18

A Section 125 plan

Question 19

Plans which provide a way to health Athens nurse continue in the event and owner or key employee, dies or in the event of a disabling sickness or injury

Answer 19

Business continuation plans

Question 20

A form of disability income insurance designed to pay necessary business, overhead expenses, such as rent, should the insured business owner become disabled

Answer 20

Business overhead expense insurance

Question 21

Agreements between business co-owners that provides that share, owned by anyone of them who becomes disabled, and shall be sold two and purchased by the other co-owners, or by the business using funds from disability income insurance

Answer 21

Disability buy/sell plans

Question 22

The protection of a business against financial loss caused by the death or disablement of a vital member of the company, usually individuals possessing special managerial, or technical skill or expertise

Answer 22

Key person disability insurance

Question 23

An employee benefit plan under which the employer bares the forecast of the employees benefits; in most states, the plan must ensure 100% of eligible employees

Answer 23

Non-contributory

Question 24

Benefits designed to prevent duplication of group insurance benefits. Limits benefits from multiple group health insurance policies in a particular case to a percentage of the expenses, covered and designates the order in which the multiple carriers are to pay benefits

Answer 24

Coordination of benefits

Question 25

The limited period of time during which all members may sign up for a group plan. This period typically happens once a year for a set number of days.

Answer 25

Enrollment period

Question 26

Must be completed and signed by a new employee during the open enrollment period to enroll in group insurance.

Answer 26

Enrollment card

Question 27

A period of time (often 12 months) beginning with your effective date during which your health insurance plan does not provide benefits of pre-existing conditions. This period may be reduced or waived based on any prior healthcare coverage you had before applying for your new health insurance plan.

Answer 27

Waiting period

Question 28

A specified number of days after insurance policies, issue dates during which coverage is afforded for sickness

Answer 28

Probationary period

Question 29

The act which provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs

Answer 29

Health Insurance Portability and Accountability Act (HIPAA)

Question 30

Allows the policy owner, before an original insurance policy expires, to elect to have a new policy issued that will continue with the insurance coverage

Answer 30

Conversion privilege

Question 31

An illness or medical condition that existed before a policy is effective date

Answer 31

Pre-existing conditions

Question 32

Previous coverage under another insurance plan when there has not been a break in coverage of 63 days

Answer 32

Creditable coverage

Question 33

Federal legislation, which extends group health coverage to terminated employees, and or their families at the individuals, expense, for up to 18 months

Answer 33

COBRA - Consolidated Omnibus Budget, Reconciliation Act of 1985

Question 34

Policies issued to cover a group who may be exposed to the same risks, but the composition of the group are constantly changing

Answer 34

Blanket health policies

Question 35

Plans that provide health insurance coverage to members of an association or professional society

Answer 35

Franchise health plans (wholesale plans)

Question 36

Policies designed to help the insured pay off a loan in the event they are disabled due to an accident or sickness, or in the event they die

Answer 36

Credit policies

Question 37

Coverage provided by a disability income policy that does not provide benefits for losses occurring as the result of the injured’s employment

Answer 37

Non-occupational coverage

Question 38

A tax advantage to medical savings account available to taxpayers in the United States, who are enrolled in a high deductible health plan

Answer 38

Health savings accounts

Question 39

The unforeseen, unexpected, unintended cause of an accident. The cause of the mishap must be accidental for any accident face policy claim to be payable.

Answer 39

Accidental means

Question 40

Policies that use the accidental bodily insurance provision required that the result of the injury has to be unexpected and accidental. This is far less restrictive than the accidental means provision.

Answer 40

Accidental results

Question 41

The amount payable as a death benefit. It is the amount of insurance purchased. It is the max amount the policy will pay.

Answer 41

The principal, some under and AD&D policy

Question 42

A form of payment available under AD&D. It is a specified amount, usually expressed as a percentage of the principal sum, which fairies, according to the severity of the injury.

Answer 42

Capital sum

Question 43

Provides coverage for specific kinds of accidents or illnesses, such as injuries received as a result of travel, accidents, or medical expenses stemming from a specified disease

Answer 43

Limited risk policies

Question 44

A policy which covers unusual hazards, not normally covered under ordinary accident and health insurance

Answer 44

Special risk policy

Question 45

The person or entity designated in the policy to receive the death proceeds

Answer 45

The beneficiary of an accidental death and dismemberment policy

Question 46

The first in line to receive death benefit proceeds

Answer 46

Primary beneficiary

Question 47

The second in line to receive death benefit proceeds

Answer 47

Secondary (contingent) beneficiary

Question 48

The third in line to see if death benefit proceeds. If no one is named death benefit will go to the Insurance Estate

Answer 48

Tertiary beneficiary

Question 49

A beneficiary that the policy owner may change at any time without notifying or getting permission from the beneficiary

Answer 49

Revocable beneficiary

Question 50

A beneficiary that may not be changed without the written consent of the beneficiary

Answer 50

An irrevocable beneficiary

Question 51

In the event that a beneficiary dies before the insured, benefits from the policy will be paid to the beneficiaries heirs

Answer 51

Per stirpes (by the bloodline)

Question 52

Evenly distribute its benefits among all named living beneficiaries

Answer 52

Per capita (by the head)

Question 53

The act which states that if the insured and the primary beneficiary die at approximately the same time for a common accident, with no clear evidence as to who died first, the law will assume that the primary died first, this allows the death benefit proceeds to be paid to the contingent beneficiaries

Answer 53

Simultaneous death act

Question 54

A provision which ensures a policy owner, if both of the insured and the primary beneficiary die within a short period of time, the death benefits will be paid to the contingent beneficiary

Answer 54

Common disaster provision

Question 55

A Clause which prevents a beneficiary from recklessly spending benefits by requiring the benefits to be paid and fixed amounts or installments over a certain period of time

Answer 55

A spendthrift clause

Question 56

Entities which offer benefits to subscribers in return for the payment of premium. Benefits are in the form of services provided by hospitals and physicians in the plan.

Answer 56

Service providers

Question 57

With the dominant health insurers of the United States

Answer 57

Blue Cross and blue shield

Question 58

Another type of organization offering comprehensive, prepaid healthcare services to it, subscribing members

Answer 58

A health and maintenance organization (HMO)

Question 59

A collection of healthcare providers, such as physicians, hospitals, and clinics, who offer their services to certain groups at prearranged discount prices

Answer 59

A preferred provider organization (PPO)

Question 60

A program created to provide hospital and medical expense insurance protection to those aged 65 and older

Answer 60

The federal administered Medicare program

Question 61

In addition to Medicare, the federal government also provides disability related benefits, through what program?

Answer 61

Social Security OASDI program

Question 62

Title XIX of the social Security act, added to the Social Security program in 1965

Answer 62

Medicaid

Question 63

The program with the purpose to provide matching federal funds to states for their medical public assistance, plans to help needy persons, regardless of age

Answer 63

Medicaid

Question 64

Laws in programs and acted to provide mandatory benefits to employees for work, related injuries, illness, or death

Answer 64

Worker’s Compensation

Question 65

A method of marketing group benefits, to employers who have a small number of employees

Answer 65

Multiple employer trusts

Question 66

A type of MET (Multiple employer trust) which consists of small employers, who have joined to provide health benefits to their employees, often on a self insured basis

Answer 66

Multiple employer welfare arrangement (MEWA)

Question 67

A federal government, accident, and health plan, which provides accident and health coverage to military service members and their families

Answer 67

Tricare

Question 68

Helps pay for inpatient hospital, care, and patient care and a skilled nursing facility, home healthcare, and hospice care

Answer 68

Medicare part A

Question 69

Pays for Dr. services and a variety of other medical services and supplies that are not covered by hospital insurance

Answer 69

Medicare part B

Question 70

Medicare provided by an approved health, maintenance organization, or preferred provider organization. Known as Medicare choice or Medicare advantage.

Answer 70

Medicare part C

Question 71

Optional coverage that provides access to private prescription drug plans, that contract with Medicare

Answer 71

Medicare part D

Question 72

Total disability that requires that for disability income benefits, to be payable, the insured must be unable to perform any job for which the insured is “reasonably suited by reason of education, training, or experience”

Answer 72

Any occupation

Question 73

Total disability that requires that in order to receive disability income benefits, the insured must be unable to work at the insured’s own occupation

Answer 73

Own occupation

Question 74

Coverage provided by a disability income policy that does not provide benefits for a loss is occurring as the result of the insured’s employment

Answer 74

Non-occupational

Question 75

A disability income policy benefit that provides that if an insured experiences, a specified disability, such as blindness, the insured is presumed to be totally disabled, and entitled to the full amount, payable under the policy, whether or not the insured is able to work

Answer 75

Presumptive disability

Question 76

An illness or injury preventing the insured from performing at least one or more, but not all of the insurance, occupational duties, or the inability to work at that job on a full-time basis, either of which result in a decrease in income

Answer 76

Partial disability

Question 77

A disability income payment based on the proportion of income the insured has actually lost, taking into account, the fact that the insured is able to earn some income

Answer 77

Residual amount benefit

Question 78

The unforeseen, unexpected, unintended cause of an accident. The cause of the mishap must be accidental for any accident best policy claim to be payable.

Answer 78

Accidental means

Question 79

Policies that use the accidental, bodily injury provision (sometimes called the results of provision) required that the result of the entry has to be unexpected, an accidental. This is far less restrictive than the accidental means provision.

Answer 79

Accidental results

Question 80

A specified number of days after an insurance policy is issued date, during which coverage is not afforded for sickness.

Answer 80

Probationary Period

Question 81

A duration of time between the beginning of an insured’s disability, and the commencement of the period for which benefits are payable

Answer 81

Elimination period

Question 82

The maximum length of time, during which a benefit is paid. The longer the benefit period the higher the cost of the policy.

Answer 82

Benefit period

Question 83

A disability income policy provision that allows a certain amount of time after an accident for disability to result, and the insured remains eligible for benefits

Answer 83

Delayed disability provision

Question 84

A disability income policy provision that specifies the period of time during which the reoccurrence of a disability is considered a continuation of a prior disability

Answer 84

Recurrent disability provision

Question 85

Provides for the payment of additional income when the insured is eligible for social insurance benefits, but those benefits have not yet begun, have been denied, or has begun in an amount less than the benefit amount of the rider

Answer 85

The Social Security rider

Question 86

A rider available with some policies that provides for an automatic increase in benefits (typically tied to the consumer price index) offsetting the effects of inflation

Answer 86

Cost of living adjustment rider

Question 87

And arrangements usually provided by a Rider whereby additional insurance may be purchased at various times, without evidence of insurability

Answer 87

Guaranteed insurability rider

Question 88

Facilitates vocational training to prepare insured for a new occupation.

Answer 88

Rehabilitation benefit

Question 89

Determines the benefit of using a percentage of the insured’s pre-disability earnings, and take some to account other sources of disability income

Answer 89

The percent of earnings approach

Question 90

Specifies a flat income benefit amount that will be paid if the insured becomes totally disabled

Answer 90

Flat amount approach

Question 91

Allows the insurer to reduce the maximum benefit, payable under the policy. If the insured switches to a more hazardous occupation, or to reduce the premium rate, changed, if the insured changes to a less hazardous occupation

Answer 91

Change of occupation, provision

Question 92

Injuries that may have resulted from an accident, but are not necessarily a disability

Answer 92

Non-disabling injuries

Question 93

May be selected by the insured when applying for a disability policy. These are typically for short term, disability income policies, and provide for an optional lump sum payment for certain named injuries.

Answer 93

Elective, indemnity options

Question 94

Allows the policy owner to waive premium payments during a disability and keeps the policy in force. It does not provide cash payments to the policy owner. The disability must be total and permanent.

Answer 94

The waiver of premium rider

Question 95

A health insurance policy that provides “first dollars” benefits for specified and limited healthcare, such as hospitalization, surgery, or physician services. Characterized by limited benefit periods and relatively low coverage limits.

Answer 95

Basic medical expense insurance

Question 96

A health insurance policy that provides broad coverage and high benefits for hospitalization, surgery, and physician services. Characterized by deductibles and coinsurance cost sharing.

Answer 96

A major medical expense policy

Question 97

An amount of expense or a loss to be paid by the insured before a health insurance policy starts paying benefits

Answer 97

Deductible

Question 98

A deductible that is a State a dollar amount that applies to a covered loss. This deductible is applied per occurrence, per insured individual. Sometimes referred to as an “initial deductible”

Answer 98

Flat deductible

Question 99

A deductible which comes into play when a major medical policy is supplementing basic coverage that contains no deductible.

Answer 99

A corridor deductible

Question 100

A deductible used when a major medical plan is supplementing basic coverages

Answer 100

An integrated deductible

Question 101

With this kind of deductible, the insured must satisfy a deductible for each accident or illness

Answer 101

Per cause deductible

Question 102

With this kind of deductible, if the insured only has to meet the deductible amount once during the benefit period

Answer 102

All cause deductible

Question 103

The provision which allows an insured to defer current health charges to the following year’s deductible instead of the current years deductible. Usually applies to expenses incurred during the last three months of the plan year.

Answer 103

Carryover provision

Question 104

The principal, under which the company insures only part of the potential loss, the policy owners of paying the other part

Answer 104

Coinsurance

Question 105

Designed to stop the companies loss at a given points, as an aggregate, payable, under a policy, a maximum payable, for anyone, disability, or the like

Answer 105

A stop loss

Question 106

An illness or medical condition that existed before policies, effective date; usually excluded from coverage through the policies, standard provisions, or by waiver

Answer 106

Pre-existing conditions

Question 107

Tax advantaged medical savings accounts available to taxpayers in the United States, who are enrolled in a high deductible health plan. Funds contributed are not subject to federal income tax at the time of deposit.

Answer 107

Health savings accounts (HSA)

Question 108

Employer funded an employer established, tax-advantaged health benefit plans that reimburse employees for out-of-pocket medical expenses and individual health insurance premiums.

Answer 108

Health reimbursement arrangements

Question 109

Accounts created to help employees of small employers, as well as self-employed individuals, pay their medical care expenses

Answer 109

Medical savings accounts (MSAs)

Question 110

Text advantaged accounts that can be set up through a cafeteria plan of an employer. It allows an employee to set aside a portion of earnings to pay for qualified medical expenses as established in the cafeteria plan.

Answer 110

Flexible savings accounts or flexible spending accounts

Question 111

Forms of health insurance, providing a stipulated daily, weekly, or monthly indemnity during hospital confinement

Answer 111

Hospital indemnity policy is

Question 112

Restricted benefits to specified accidents or diseases, such as travel policies, dreaded disease policies, ticket policies, and so forth

Answer 112

Limited benefit policies

Question 113

A policy which provides a variety of benefits for a specific disease, such as cancer or heart disease. Benefits are usually paid as a scheduled fixed dollar amount for specified perils or medical procedures, such as hospital, confinement or chemotherapy.

Answer 113

Limited risk (dread disease) policy

Question 114

And insurance product in which the insurer is contracted to typically make a lump sum cash payment if the policyholder is diagnosed with one of the specific illnesses on a predetermined list as part of an insurance policy

Answer 114

Critical illness policies

Question 115

Policies which cover, hospital room and board, miscellaneous hospital, expenses, such as lab and x-ray charges, medicines, use of operating room, and supplies.

Answer 115

Hospital expense policies

Question 116

A policy where expenses are covered while the insured is confined in a hospital. There is no deductible, and the limits on room and board are set at a specified a dollar amount per day up to a maximum number of days.

Answer 116

Hospital expense policies

Question 117

Benefits which cover expenses for occupancy of the room in bed, general, nursing care, food, and beverages, and personal hygiene items. These limits may not provide for the full amount of hospital room and board of charges incurred by the insured.

Answer 117

Hospital room and board benefits

Question 118

Policies commonly written in conjunction with Hospital expense policies. These policies pay for the cost of surgeons services whether the surgery is performed in or out of the hospital.

Answer 118

Surgical expense policies

Question 119

Under this approach, every surgical procedure is assigned a dollar amount by the insurer

Answer 119

Surgical schedule approach

Question 120

An approach similar to the surgical schedule method. The difference is that instead of a flat dollar amount being assigned to every surgical procedure, a specified set of units is assigned.

Answer 120

The relative value approach

Question 121

An approach where the surgical expense is compared to what is deemed a reasonable and customary for the geographical part of the country where the surgery was performed.

Answer 121

The usual, customary, and reasonable approach (UCR)

Question 122

This combines the features of basic expense coverage and major medical coverage, sold as one policy. Cover practically all medical expenses, hospital, physicians, surgical, nursing, drugs, laboratory, test, etc..

Answer 122

Comprehensive major medical

Question 123

Health insurance that provides coverage to fill the gaps in Medicare coverage

Answer 123

Medicare, supplements

Question 124

A type of Medicare supplement plan sold in some states that can be any of the standardized Medigap plans (A-N) but which requires policyholder to receive services from within a defined network of hospitals, and in some cases doctors in order to be eligible for full benefits

Answer 124

Medicare select

Question 125

A program that offers a prescription drug benefit to health, Medicare beneficiaries pay for the drugs they need. This benefit is optional

Answer 125

Medicare part D

Question 126

Insurance which refers to the broad range of medical and professional services for individuals, often the elderly, who need assistance with daily activities for an extended period of time

Answer 126

Long-term care insurance

Question 127

Daily nursing care ordered by a doctor; often medically necessary. It can only be performed by or under the supervision of skilled medical professionals, and is available hours a day.

Answer 127

Skilled nursing care

Question 128

The level of health or medical care, given to meet daily personal needs, such as dressing, bathing and getting out of bed. Though it does not require medical training, it must be administered under a physicians order.

Answer 128

Custodial care

Question 129

Skilled or unskilled care, provided in an individuals home, usually on a part-time basis

Answer 129

Home health care

Question 130

A type of care (usually custodial) designed for individuals who require assistance with various activities of daily living, while their primary caregivers are absent. Offered in care centers.

Answer 130

Adult daycare

Question 131

A type of health or medical care designed to provide a short rest. For a caregiver. Characterized by its temporary status.

Answer 131

Respite care

Question 132

All Medicare supplement plans, cover coinsurance on hospital cost, up to an additional 365 days after Medicare part A hospital benefits run out

Answer 132

Core benefits

Question 133

Programs which are federally, supported, state operated initiative that allows individuals who purchase a qualifying, long term, care, insurance, policy, or coverage to protect a portion of their assets that they were typically need to spend down prior to qualifying for Medicaid coverage

Answer 133

Long-term care partnership programs

Question 134

Designed to provide a benefit for elderly individuals who live in a continuing care retirement community

Answer 134

Continuing care

Question 135

States the insurance policy itself, any riders and endorsements/amendments, and the application comprise the entire contract between all parties. Insurance producers cannot make changes to a policy.

Answer 135

The entire contract

Question 136

States the policy is incontestable after it has been in force a certain period of time, usually two years. This is similar to the incontestable clause.

Answer 136

The time limit on certain defenses

Question 137

A period after the due date of a premium, during which the policy it remains in force without penalty

Answer 137

Grace Period

Question 138

Putting elapsed policy back-and-forth by producing satisfactory evidence of insurability and paying any past due premiums required

Answer 138

Reinstatement

Question 139

A policy provision that describes the policy owners obligation to provide notification of a claim to the insurer within a reasonable period of time

Answer 139

Notice of claim

Question 140

Specifies the formal request to an insurance company asking for a payment based on the terms of the insurance policy

Answer 140

The claim forms provision

Question 141

A mandatory health insurance provision, stating that the insured must provide a completed claim form to the insurer within days of the date of loss

Answer 141

Proof of loss

Question 142

A provision that requires claims be paid immediately or within a stated number of days.

Answer 142

Time of payment of claims

Question 143

In an insurance contract, specifies, how and to whom claim payments are made

Answer 143

The payment of claims provision

Question 144

A standard health insurance policy provision, allowing the insurer to examine the insured. When I claim is pending, and in the event of death perform an autopsy, where not prohibited by law.

Answer 144

The physical exam and autopsy provisions

Question 145

A provision which states the insured cannot take legal action against the company and a claim dispute, until after 60 days from the time the insured submits proof of loss.

Answer 145

The legal actions provisions

Question 146

A provision that permits, the insured to change the beneficiary as often as he, or she wishes, except in policies where the beneficiary is irrevocable

Answer 146

Change of beneficiary

Question 147

The provision which allows the insurer to reduce the maximum benefit, payable under the policy if the insured switches to a more hazardous occupation, order to reduce the premium rate, charged if the insured changes to a less hazardous occupation

Answer 147

Change of occupation provision

Question 148

The provision which allows the insurer to adjust the policy benefit if the insured’s age or sex is misstated on the policy application

Answer 148

The misstatement of age or sex provision

Question 149

The provision which states that the total amount of coverage to be under written by a company for one person, is restricted to a specified maximum amount, regardless of the number of policies issued

Answer 149

The other insurance in this insurer provision

Question 150

The provision which states that benefits payable for expenses incurred, will be prorated in cases where the company excepted the risk without being notified of other existing coverage for the same risk

Answer 150

The insurance with other insurers provision

Question 151

The provision which outlines that if disability income benefits from all disability income policy is for the same law succeed, the insured’s monthly earnings at the time of disability. This provision states that the insurer is liable only for that proportionate amount of benefits as the insured’s earnings bear to the total benefits under all such coverage

Answer 151

The relation of earnings provision

Question 152

The provision which states if there is an unpaid premium at the time of claim, becomes payable, the amount of the premium is to be deducted from the sum, payable to the insured or beneficiary. It’s a provision that permits unpaid premiums to be taken from claim payments.

Answer 152

The unpaid premiums provision

Question 153

The provision which simply states that any provision of this policy that is in conflict with state statutes in the state, where the insured lives at the time the policy is issued is automatically amended to conform with the minimum statutory requirements

Answer 153

Conformity with state statutes provision

Question 154

A clause that states the insured is not covered for losses that arise if he or she tries to commit a felony. Coverage is also voided if the insured is working at an illegal occupation.

Answer 154

The illegal occupation clause

Question 155

A provision that states the policy is not liable for losses that occur as a result of the policyholder, being intoxicated, or taking a narcotic without a physician, supervision and recommendation

Answer 155

The intoxicants and narcotics provision

Question 156

Insurance contracts that may be terminated by the company or that is renewable at its option

Answer 156

Cancelable policies

Question 157

Provisions found in whole life policies and some long-term care policies. These policies must begin to build cash value after certain number of years. In most states this is three years.

Answer 157

Policy loan or cash value provisions

Question 158

The provision which allows the insurer to automatically use the cash policy value to pay an overdue premium. There is no cost for this provision.

Answer 158

Automatic premium loans

Question 159

Features of an insurance policy, stating that the policy will not cover certain risks.

Answer 159

Exclusions

Question 160

The clause that states the policy will be voided and no benefit will be paid if the insured commits suicide within two years from policy issuance

Answer 160

Suicide clause

Question 161

The options you have for your cash value if you terminate a policy that has cash value.

Answer 161

Nonforfeiture options

Question 162

The option which permits the policy owner to use the policies, cash value to buy level, extended term insurance for a specified period.

Answer 162

Extended term option

Question 163

The option where the policy owner pays no more premiums, but the face amount is decreased

Answer 163

Reduced paid up option

Question 164

The options a policy owner has when receiving dividend payments from an insurance policy

Answer 164

Dividend options

Question 165

A rider which allows the policy owner to waive premium payments during a disability, and keeps the policy in force. It does not provide cash payments to the policy owner. The disability must be total and permanent, and have sustained through the waiting period

Answer 165

The waiver of premium rider

Question 166

The writer which ensures that premiums will be waived, if the individual paying the premiums on a juvenile life policy, becomes disabled or dies

Answer 166

The payor rider (or Payor Clause)

Question 167

The rider which allows the insured to receive a portion of the death benefit prior to death if the insured has a terminal illness, and is expected to die within one to two years

Answer 167

Accelerated benefit rider

Question 168

The rider which permits the policy owner to buy additional permanent license Sherance coverage at specific points of time in the future, without submitting proof of insurability. Usually the benefit is allowed every three years.

Answer 168

The guaranteed insurability rider

Question 169

The rider which pays the total amount of premiums paid into the policy, in addition to the face value as long as the insured dies within a certain time period specified in the policy

Answer 169

The return of premium rider

Question 170

The rider which provides for the payments of additional income, when the insured is eligible for social insurance benefits, but those benefits have not yet begun, have been denied, or have begun in an amount less than the benefit amount of the rider

Answer 170

The Social Security rider

Question 171

This is built into the most commercial health policies, and let’s owners assigned benefit payments from the insurer directly to the healthcare provider, thus relieving the policy owner of first, having to pay the medical care provider

Answer 171

The right of assignment

Question 172

The clause which prohibits the insurer from questioning the validity of the contract after a certain period of time has elapsed

Answer 172

Incontestable clause

Question 173

The right to transfer a policy rights to another person or entity

Answer 173

The assignment clause

Question 174

When they assign, he receives full control of the policy and rights to the policy benefits from the current policy owner

Answer 174

Absolute assignment

Question 175

The partial and temporary transfer of rights to another person or entity. These assignments are usually intended for securing a loan with a creditor.

Answer 175

Collateral assignment

Question 176

States the policy owner is permitted a certain number of days once the policy is delivered to look over the policy and return it for a refund of all premiums paid

Answer 176

The free look

Question 177

The clause, which is the insurer’s basic promise to pay specified benefits to a designated person, in the event of a covered loss. States the scope and limits of coverage “we insure you for…”

Answer 177

The insuring clause / insuring agreement

Question 178

The clause which states a policy owner, must pay a premium in exchange for the insurers promise to pay benefits. A policy owners consideration consists of completing the application and paying the initial premium.

Answer 178

The consideration clause

Question 179

The 12 mandatory provisions that are required to be part of all health insurance contracts

Answer 179

• Entire contract
• Time limit on certain defenses (incontestable)
• Grace period
• Reinstatement
• Notice of claim
• Claim forms
• Proof of loss
• Time payment of claims
• payment of claims
• Physical examination and autopsy
• legal actions
• Change of beneficiary

Question 180

The 11 optional health provisions that may be part of a health insurance contract

Answer 180

• change of occupation
• Misstatement of age
• Conformity with state statutes
• Other insurance in this insurer
• Insurance with other insurer
• Insurance with the other insurers
• Relation of earnings to insurance
• Unpaid premiums
• Cancellation
• Illegal occupation
• Intoxicants and narcotics

Question 181

The tendency of a disproportionate number of poor risks to seek or buy insurance or maintain existing insurance in force.

Answer 181

Adverse selection

Question 182

Hobbies or non-occupational activities

Answer 182

Avocation

Question 183

One of the types of receipts, given by an insurance company upon the completion of an insurance application, when the applicant pays the initial premium with the application

Answer 183

Binding receipt / unconditional receipt

Question 184

A pamphlet that describes an compares various forms of life or health insurance

Answer 184

Buyers guide

Question 185

An insured‘s history of claims or rate of loss.

Answer 185

Claims experience

Question 186

Insurance carriers generally base this on their overall claim experience and healthcare costs in a geographical area

Answer 186

Community rating

Question 187

Insurers issue this kind of receipts when agents collect the initial premium with an application

Answer 187

Conditional receipt

Question 188

This occurs when an insurance carrier gives up all control of a policy and releases at four unconditional delivery to someone acting for the policyholder, including the company’s own agent

Answer 188

Constructive delivery

Question 189

A detailed background investigation them include an interview with coworkers, friends, commas, and neighbors about an applicant character, reputation, lifestyle, etc.

Answer 189

Consumer report

Question 190

The legal description of what happens when an insurer declines a paid application for insurance with a standard rate classification, but is willing to offer a “rated” or substandard policy that will require a higher premium

Answer 190

Counter offer

Question 191

A summary of an insurance applicant credit history made by an independent organization that has investigated an applicants credit standing

Answer 191

Credit report

Question 192

Usually can designate the start of the policies free look period

Answer 192

Delivery receipt

Question 193

A prorated amount of paid in advance premiums allocated to the proportion of the policy term that has already elapsed

Answer 193

Earned premium

Question 194

A receipt which documents the temporary release of a new policy to the perspective policy owner without payment. It allows the prospective insured to review the contract before actually buying it.

Answer 194

Inspection receipt

Question 195

A report that contains general information regarding the health habits, finances and reputation of an applicant. This report is developed by affirm that specializes in rendering this type of service.

Answer 195

Inspection report

Question 196

Describes the financial or emotional relationship between two or more parties. Exist in health insurance. If the applicant is in a position to suffer a loss show to the insured and Curt medical expenses, or be unable to work due to a disability.

Answer 196

Insurable interest

Question 197

The dates, the insurance company finishes underwriting, a risk exposure and generates the insurance contract

Answer 197

Issue date

Question 198

Hey service organization that collects medical data on life and health insurance applicants for member insurance companies

Answer 198

Medical information bureau

Question 199

Describes the basic benefits, conditions, and other terms of an insurance policy, without using industry jargon

Answer 199

Outline of coverage

Question 200

The person responsible for paying the policy

Answer 200

Payor

Question 201

Funds set aside to pay future claims. Some state statutes require them.

Answer 201

Reserves

Question 202

Describes the underwriting category into which a risk exposure is placed, depending upon the applicants susceptibility to injury, illness, or death

Answer 202

Risk classification

Question 203

Describes an applicant who cannot qualify for a standard policy. They secure one with a rider waiving the payment for a loss involving certain existing health impairments.

Answer 203

Special class

Question 204

An application submitted without the initial premium

Answer 204

Trial application

Question 205

A prorated amount of paid in advance premiums that have not been “and” by the insurer

Answer 205

Unearned premium