Insurance Flashcards

(53 cards)

1
Q

What is the elimination period for SS disability?

A

5 months

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2
Q

If the employer pays for disability insurance for the employee, are the benefits taxable?

A

Yes

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3
Q

If the employee pays for disability insurance via payroll deduction, are the benefits taxable?

A

No

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4
Q

If disability insurance premiums are paid with pre-tax dollars, are the benefits taxable?

A

Yes

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5
Q

What should be covered by disability insurance?

A

Sickness and Accidents (Illness and Injury)

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6
Q

Disability benefit should be in what range?

A

60-70% of gross income

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7
Q

Best way to determine how long you want the elimination period of a disability policy to be?

A

determined by the amount of time that can be covered by the emergency fund

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8
Q

What are the four common methods of paying for LTC services?

A

Medicare, Medicaid, Personal assets & savings, LTC insurance

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9
Q

What are ADLs?

A

Activities of Daily Living (Eating, Bathing, Dressing, Transferring, Toileting, Continence)

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10
Q

What are the four categories of risk?

A
  1. Pure & Speculative, 2. Subjective & Objective, 3. Fundamental & Particular, 4. Non-financial & Financial
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11
Q

Pure Risk

A

Either loss or no loss, no chance of gain (insurable, ex premature death, illness or injury, disability, damage to property by natural forces like wind)

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12
Q

Speculative Risk

A

Profit, loss, or no loss (not insurable. ex investments or starting a business)

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13
Q

Subjective Risk

A

Risk that an individual perceives based on prior experience. Differs based on individual perception. Not measurable and not insurable.

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14
Q

Objective Risk

A

Does not depend on an individual’s perception, the difference between the expected and actual losses. Varies indirectly with the number of loss exposures in an insured pool. As the pool of insureds increased, objective risk is reduced because actual results will more likely approximate expected claims. Measurable and insurable.

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15
Q

Fundamental Risk

A

A risk that can impact a lot of people at once like a war or earthquake. These are difficult to insure by the insurer and can sometime be covered by a separate policy. Some are uninsurable. (flood damage, flood insurance is backed by the government)

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16
Q

Particular Risk

A

A risk that has the likelihood of only affecting a small number of people or a particular individual like death or disability. This is an insurable risk.

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17
Q

Nonfinancial Risk

A

Results in a loss that is not a financial loss. Ex. emotional distress

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18
Q

Financial Risk

A

Loss of financial value.

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19
Q

3 Categories of Insurance Products

A

Personal, Property, Liability

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20
Q

Most Important types of risk coverage for individuals

A

Life, Health, Disability, Property, LTC, Personal Liability

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21
Q

Law of Large Numbers

A

“Pooling Effect”, the more exposures, the more likely the probable results will equal actual results, helps reduce objective risk.

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22
Q

Risk Management Process

A
  1. Determine Objectives; (protect assets, protect earing capacity, human life value, health, peace of mind, family relationships)
  2. Identify Pure Risks or exposures; (3 categories: loss of income, loss of property, liability causing financial loss) lifecycle position plays a role in what is needed. (review income statement, and statement of financial position to help identify potential exposures)
  3. Evaluate the identified risks for probability and severity; (determine how often the event is likely to occur and how much it would cost)
  4. Determine alternatives for managing risks; (reduction, transfer (high severity, low frequency), avoidance (high severity, high frequency), retention)
  5. Select most appropriate alternative for each exposure;
  6. Implement plan;
  7. Periodically Evaluate.
23
Q

How much cash in the home will typical HO policy cover? Limits on other valuables?

A

$200 cash
$1500 Jewelry, Furs, Watches
$2500 Firearms
Silverware/Goldware $2500

24
Q

What is a peril?

A

immediate cause and reason for a loss occurring (accidental death, disability, property loss caused by fire, storm, burglary, etc

25
What is a hazard?
a specific condition that increases the likelihood of a loss
26
What are the 3 types of hazards?
Moral (false claims), Morale (indifference to risk, carelessness), Physical (physical condition such as wet floor, icy road)
27
How much should a client spend on insurance?
Rule of thumb is that all premiums should be around 10-12% of income
28
What are the elements of a valid insurance contract?
1. Mutual Consent 2. Offer & Acceptance 3. Performance or Delivery 4. Lawful Purpose (what is insured must be legal) 5. Legal competency of all parties (minor, lacking sound mind)
29
Principle of Indemnity
"making whole", insured can't make money
30
Subrogation Clause
A person can't file a claim and be paid and then sue the person responsible for the loss. The insurer can seek a claim, but not the insured if the claim was paid.
31
Representation
Statement made by applicant during the application process regarding age, gender, occupation, marital status, and family medical history, etc.
32
Warranty
A promise made by the insured that is part of the contract. could be a promise to do something or not to do something
33
Concealment
Insured in intentionally silent regarding a material fact during the application process.
34
Adhesion
Take it or leave, no change to negotiate terms
35
Aleatory
money exchanged may be unequal, small premium may receive large benefit
36
Unilateral
Only one promise made by insurer, to pay in the event of a loss
37
conditional
Insured must pay premium to receive promise to pay
38
Personal
a contract between the insurer and the insured, contract can't be assigned to someone else
39
Express Authority
Agent has a an agreement with the insurer that expressly outlines his duties, responsibilities, and scope of authority, agent can bind the carrier (general agent, independent agent)
40
Apparent Authority
When the public believes an agent has authority, but there is no contract in place with the carrier, based on how the agent represents himself. The carrier is still bound by the claim.
41
Estoppel
Where a person is denied a right he might otherwise be entitled to under the law. Applies when one party relies on information from another party and that information causes harm to the party who relied on the information.
42
Stock Insurer
issues stock and is owned by shareholders with the intent of making a profit. Dividends paid are taxable.
43
Mutual Company Insurer
owned by policy holders, not shareholders. Dividends paid are not taxable but treated as a return of premium.
44
Agent
legal representative of the insurer, acts on behalf of the insurer, only sells policies issued by their company, duty of loyalty to the carrier
45
Broker
legal representative of the insured, acts on behalf of the insured, may sell policies from a number of companies, broker can not bind the carrier
46
Reinsurace
when a carrier transfers some or all of its risks to another carrier as a form of diversification to reduce exposer to a certain risk
47
Parts of an insurance contract
1. Definitions 2. Declarations - summary of policy data (who, what, how much, terms, etc) 3. Descriptions 4. Perils covered 5. Exclusions 6. Conditions
48
Rider vs. Endorsement
Endorsement is a modification or change to property policy, rider is a modification or change to a life or heath policy
49
Deductible
first dollars in a loss, purpose is to reduce small claims, a way to retain risk
50
Copayment
paid in addition to deductible, loss-sharing arrangement
51
Coinsurance
cost sharing, defines percentage of responsibility each party is responsible for for property: $$$ of policy/$$$ insurance required X Covered Loss - Deductible = Payout The greater of the formula above and the ACV of the loss will be paid. purpose is to ensure a minimum amount of coverage is maintained for health insurance: amount after deductible is paid, but before the out-of-pocket max
52
Actual Cash Value
replacement cost - depreciation
53
Who regulates the insurance industry?
state