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Flashcards in Health Insurance - Basics Deck (16):

Health Insurance

Broadly covers may risks, such as loss of income because of disability; the costs of medical care and treatment; and the costs of care not covered by government plans.


The common perils which health insurance insures against:

1.) Accidental Injury;
2.) Illness


Types of health insurance

1.) Disability Income Insurance;
2.) Medical Expense Insurance;
3.) Accidental Death and Dismemberment (AD&D);
4.) Medicare Supplement
5.) Long-Term Care;
6.) Limited Benefit policies (e.g., visions, dental, prescription, etc.)


Providers of health insurance

1.) Commercial insurance companies;
2.) Health and managed care service providers;
3.) Governmental insurance providers.



The owners of a group health insurance policy (i.e., the employer or association).


Certificate of Insurance

Document received by participating members of a group health insurance policy specifying the terms of coverage.


Producer's Role in the Health Insurance Sale

1.) Asking for insurance applications;
2.) Providing advice;
3.) Completing, Accepting and Submitting Applications;
4.) Scheduling the medical exam (if applicable);
5.) Collecting Premium payments;
6.) Issuing receipts
7.) Delivering the Policy


Field Underwriting

The activities that a producer performs when seeking applications for insurance, including requesting information about prospective insureds and helping people fill out applications of coverage.


Agent's Report

Section of a health insurance application documenting a producer's notes regarding information about an applicant that will be helpful for underwriting.


Providing a policy receipt when premiums are paid.

When the applicant submits an initial premium with his or her application, the producer must give the applicant a policy receipt. The receipt indicates the insurer's liability and its responsibility during the underwriting period before the policy is actually issued.


Binding Receipt (Temporary Insurance Agreement)

Guarantees coverage from the time the applicant completes the application (or the medical exam) during the underwriting process.


Conditional Receipt

Provides conditional coverage beginning on the date of the application or medical exam so long as the insurer determines the applicant is insurable.


Policy of
Information Practices

Informs the applicant of the insurer’s right to collect information from sources other than the application. In addition, it states how the insurer can share that information with third parties.


Buyer's Guide

Explains the applicant's rights and responsibilities with regard to the type of insurance coverage being applied for.


Policy Summary

Outlines the coverages and benefits of the specific policy being applied for.


State Insurance Guaranty Fund

Most states maintain a life and health insurance guaranty fund that provides limited financial relief to policyholders in the event their insurer becomes insolvent. In virtually every state with such a fund, producers are prohibited from mentioning it during their marketing and sales activities. The purpose for this requirement is to prevent producers from enhancing a product’s appearance by implying that it is guaranteed by the government.