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Crash Review > Crash Review > Flashcards

Crash Review Flashcards

1
Q

California Insurance Code

A

Insurance law that is underwritten by state legislature

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2
Q

CCR

A

Insurance rules (written. I the commissioner, who can change/withdraw regulations

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3
Q

Direct system also known as

A

Direct writer

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4
Q

Broker represents

A

The consumer (PC only)

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5
Q

Insurance agent represents?

A

The insurance (PC only)

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6
Q

McCarran Ferguson Act

A

Have stayed the right to regulate majority of the insurance industry at the state level

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7
Q

What’s express authority?

A

An authority that’s written in the contract (in writing)

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8
Q

What’s implied authority?

A

Authority that you have that’s nit specifically written in the contract nut is reasonable for the public to assume you have

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9
Q

What’s apparent authority?

A

Authority of an agent that is created when the agent oversteps actual authority, and when inaction by the insurer does nothing to counter the public impression that such authority exists.

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10
Q

Domestic

A

Within CA

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11
Q

Foreign

A

Out of state

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12
Q

Alien

A

Outside the US

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13
Q

Stock company

A

Non participating policies
Stockholders
Dividends to stockholders are taxable

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14
Q

Mutual company

A

Participating policies

Policyholder gets dividends and are not taxable

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15
Q

Reciprocal insurers are managed by

A

An attorney in fact

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16
Q

Admitted

A

Licensed by the state of California

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17
Q

Solvency requirements

A

Money to cover liabilities, reinsurance, assets equal to paid in capital

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18
Q

Insolvency

A

Failure to meet solvency requirements

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19
Q

Notice to seizure

A

Issued by court, gives commissioner right to seize books/assets/records. Failure to comply can result in $1,000 fine and prison up to a year

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20
Q

Non admitted

A

Not licensed by the state of California to transact, not a member of California guarantee association

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21
Q

California life and health insurance guarantee association (CLHIGA)

A

For life health and annuity companies (admitted companies only)

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22
Q

California insurance guarantee association (CIGA)

A

For p&C companies (admitted companies only)

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23
Q

Purpose of guarantee associations

A

To protect policy holders and insured when member insurers become insolvent (subject to certain limitations)

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24
Q

Code section 770

A

The longest one

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25
Q

Representation

A

Statement to the best knowledge and belief of the party making the contract (implied contract)

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26
Q

Max limit benefits % for workers compensation

A

66 2/3%

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27
Q

Compulsory means

A

Required by law

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28
Q

Any changes to the application

A

Attached to the policy in writing and signed by auth officer of the company

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29
Q

Assignment

A

Policyowner must notify the insurer in writing if they are going to assign/transfer a policy

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30
Q

Collateral assignment

A

Used when a policy is assigned to a creditor to secure a debt

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31
Q

Misstatement of age formula

A

Rate for stated age / rate for correct age * death benefit

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32
Q

Automatic premium loan provision

A

Allows insurer to withdraw amount from cash value to pay for premium

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33
Q

Waiver of premium rider

A

If insured becomes disabled. Insurer will waive premiums on policy

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34
Q

Payor rider

A

Used on juvenile policy, allows for waiver of premium if payor dies or becomes disabled

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35
Q

Guaranteed insurability rider

A

Guaranteed that insured may buy more insurance in the future without proof of insurability

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36
Q

Accidental death

A

Policy will pay additional amount above face value of death is caused by an accident

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37
Q

Cost of living rider

A

Allows insured to increase amount of insurance according to CPI inflation

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38
Q

Universal life insurance

A

Adjustable benefit, accumulates cash value and has flexible premiums. Three elements: investment earnings, cost of protection, and company expenses

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39
Q

Variable life insurance

A

Securities based permanent insurance, seperate account

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40
Q

Modified whole life

A

Lower premium in the first years, then it gets higher for the life of the contract

41
Q

Limited payment whole life

A

Allows premium to be paid over a shorter period of time

42
Q

Decreasing term/credit

A

Death benefit decreases, premium remains constant/level

43
Q

Joint life policy

A

Covers 2 or more lives on one policy

44
Q

Family protection policy

A

Whole life on head of household and term on spouse and children.

45
Q

What is a non forfeiture option?

A

Ways cash values can be paid out or used by the policy owner if policy is cancelled: cash surrender, reduced paid up, and extended term

46
Q

What’s reduced paid up?

A

When you use cash value of your policy as a single premium to buy insurance of the same plan as current policy that is paid up in full.

47
Q

What’s extended term?

A

Use cash value to buy term policy with the same face value as original policy

48
Q

What are the four settlement options other than lump sum

A

Fixed period
Fixed amount
Interest only
Life income

49
Q

Life annuity straight life

A

Paid annuitant for their lifetime

50
Q

Life with period certain

A

Pays annuitant for life, but guarantees a min period of payments

51
Q

Fixed annuity

A

Pays a guaranteed fixed benefit to the annuitant

52
Q

Variable annuity

A

Offers a variety of investment funding options. Invests payments in insurers separate account.

53
Q

A retirement account that is established by anyone under age of 70.5, grows tax deferred.

A

IRA

54
Q

In an IRA, withdrawals before age what age, are subject to 10% penalty.

A

59.5

55
Q

Retirement account where contributions are not tax deductible in year the contribution was made

A

Roth IRA

56
Q

ERISA

A

Establishes rules and regulations to govern private pension plans

57
Q

The entitlement of a pension plan partcipang to receive benefits from a retirement plan

A

Vesting

58
Q

The percentage of ownership an employee has in the employers contributions to the retirement plan

A

Vesting schedule

59
Q

Provide plans to cover medical services such as physician or hospital costs (in general)

A

Health insurance providers

60
Q

Commercial health insurance provider

A

Stock and mutual companies. Offers medical expense and disability insurance. Usually provide coverage on an indemnity basis (indemnity health plans)

61
Q

Service health insurance provider

A

Provide health care plans where benefits are provided instead of monetary reimbursement for health care expenses (service provider makes payments directly to the medical provider)

62
Q

HMO objectives to contain medical costs by:

A
  • stressing preventive care through physical exams
  • reduce excessive hospital visits
  • reduce average number of days per hospital visit
  • reduce duplication of benefits
63
Q

Group practice model (medical group model)

A

HMO teams up with a medical group and pays medical group a capitation fee (fixed fee)

64
Q

Open group practice models

A

Provides services to HMO members only

65
Q

Open group practice models

A

Provides services to HMO and non-HMO members

66
Q

Basic medical

A

Referred to as first dollar coverage, insurer pays from first dollar of expenses incurred without requiring a deductible

67
Q

Comprehension major medical

A

Covers essentially all medical expenses under one policy (required deductible and coinsurance)

68
Q

Supplemental major medical

A

Supplements a basic medical policy. Deductible must be paid after benefits of basic medical policy have been exhausted and before supplemental major medical policy will apply

69
Q

Per cause deductible

A

Deductible must be satisfied for every separate claim

70
Q

Calendar year deductible

A

One deductible needs to be satisfied for the year

71
Q

Family deductible

A

Two or three family members can satisfy the deductible for all family members

72
Q

Corridor deductible

A

Must be paid after the basic medical benefits are exhausted and before supplemental major medical benefits will apply

73
Q

Hospital confinement policy

A

Pays a specified dollar amount for each day the insured is in the hospital

74
Q

Dread disease/specified disease policy

A

Covers a specific disease such as. Cancer or heart disease (only provides coverage/benefits for diseases specifically listed on the policy)

75
Q

Disability - own occupation

A

Defined total disability as the insured’s inability to perform any/all of the duties of their own occupation as a result of sickness or accident.

76
Q

Disability - Any occupation

A

Defined total disability as the insured’s inability to perform the duties of any occupation for which the insured is reasonably qualified by education, training, or experience

77
Q

Occupational policy

A

Covers losses due to work related or non work related injuries

78
Q

Non-occupational policies

A

Will cover the insured only while not working

79
Q

Contract between insurer and organization, covers multiple people under one policy

A

Group insurance

80
Q

Minimum of 10 people is a

A

True group

81
Q

In California, a group is how many people?

A

2 or more memberships

82
Q

Covers group of individuals exposed to the same risks (not named individually on policy)

A

Blanket insurance

83
Q

Sponsor or group policy, responsible for applying coverage and providing information to insurer about the group, and making premium payment

A

Master policyowner

84
Q

Individuals covered by group plan

A

Group memberships

85
Q

Group formed for reasons other than purchasing insurance

A

Natural group

86
Q

Employer and employee contribute to premium payment

A

Contributory

87
Q

Non-contributory

A

Employer pays entire premium

88
Q

MET

A

Provides benefits to employees of two or more financially unrelated companies

89
Q

Employee does not have to report the employer paid premium for life insurance as long as the coverage is ______ or less.

A

$50,000

90
Q

To be fully insured, a worker needs 40 work credits. In 2016, a worker will earn one credit every —– in earnings up to a max of four per year.

A

$1,260

91
Q

To be fully insured in social security, a worker needs at least _ quarters of coverage earned during a ___ quarter period

A

6, 13

92
Q

In social security, disability has a very difficult definition. To be able to have gainful work is equal to making

A

At least $1,130

93
Q

Program that’s administered by the Health Care Financing Administration (HCFA) a division of

A

The department of health and human services

94
Q

In Medicare, the initial enrollment period is

A

7 months that begins 3 months before turning 65 and ends 3 months after the individual’s 65th Birthday.

95
Q

Medicare part A pays for:

A

Impatient care:
Hospital
Home health care
Hospice

96
Q

Medicare part b:

A

Medical insurance that helps pay for doctors services, outpatient hospital care and other medical service
- doctor visits

97
Q

Medicare part C

A

Allows private health plans such as HMOs and PPOs to provide Medicare benefits (Medicare advantage plans)

98
Q

Medicare part D

A

Outpatient prescription drug insurance. Only contracted through private insurance companies that have contracts with the government, never from the government directly (unlike original Medicare)

Crash Review (1 decks)

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