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52 Cards in this Set
- Front
- Back
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In insurance, what term is used for cause of loss? |
Peril |
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What is the capital sum in Accidental Death and Dismemberment (AD&D) coverage? |
A percentage of the principal sum |
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Under a credit disability policy, payments to the creditor will be made for the insurer until what point in time? |
Until the period of disability ends or the debt is repaid |
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What do limited health policies cover? |
A specified accident or disease |
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During the application process for health insurance, a producer is trying to obtain creditable information about the applicant that would help underwriters determine if the risk is insurable. In what role is the producer acting? |
Field underwriter |
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What type of hospital policy pays a fixed amount each day that the insured is in the hospital? |
Indemnity |
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What are the two types of expenses that are covered by health insurance? |
Expenses related to health care, and expenses that compensate for loss of income |
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At what age do individuals qualify for Medicare? |
65 |
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What is adverse selection? |
People who are more likely to submit insurance claims are seeking insurance more often than preferred risks. |
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What is the term used for a written request for an insurer to issue an insurance contract based on the provided information? |
Application |
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When should agent obtain a Statement of Good Health from the insured? |
When the premium was paid upon policy delivery and not at the time of application |
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Health insurance contracts are unilateral. What does that mean? |
Only one party makes a legally enforceable promise |
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How is the information obtained for an investigative consumer report? |
Through interviews with the applicant's associates, friends and neighbors (i.e. pretext interviews) |
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What is the term used for a condition for which the insured has received diagnosis, care or treatment during a specified period of time prior to the health policy issue? |
Pre-existing condition |
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What type of group health insurance is used to prove accident coverage on a group of persons that are participating in a particular activity, when the individual insureds are unknown, and are covered automatically? |
Blanket |
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In medical expense contracts, what is the term that describes the payment method when the insured is responsible for paying the medical expenses, and then the insurer pays directly to the insured? |
Reimbursement |
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Most health policies will pay the accidental death benefits if the death is caused by an accident and occurs within how many days? |
90 days |
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What characteristics would qualify an applicant for health insurance as a substandard risk? |
Poor health history or a dangerous occupation or avocation (high risk) |
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When must the Outline of Coverage be provided to the insured? |
No later than policy delivery |
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In forming an insurance contract, when does an acceptance usually occur? |
When the insurer approves a prepaid application |
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Who must sign a health insurance application? |
The policyowner, the insured(if different), and the agent |
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What is the purpose of the Outline of Coverage in health insurance? |
To provide the insured full and fair disclosure about the policy issued |
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What information are the members of the MIB required to report? |
Adverse medical info about the applicants or insured |
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Who is a field underwriter |
Agent/producer |
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What are the three types of risk rating classification in health insurance? |
Standard, substandard, and preferred |
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During which stage in the insurance process do insurers evaluate information that identifies adverse selection risks? |
Underwriting |
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What are the four elements of an insurance contract? |
Agreement (offer & acceptance), consideration, competent parties, and legal purpose |
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In health insurance, the policy itself and the insurance application form what? |
The entire contract |
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Who is responsible for paying the cost of a medical examination required in the process of underwriting? |
Insurer |
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How can health insurance policies be delivered to the insured? |
Personally delivered by the agent or mailed |
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If an underwriter required extensive information about the applicant's medical history, what report will best serve this purpose? |
Attending Physician's Statement (APS) |
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What report is used to assess risk associated with a health insurance applicant's lifestyle and character? |
Investigative Consumer Report |
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In health insurance, what is considered a sickness? |
An illness that first arises while the policy is in force |
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Health contracts are prepared by insurers and must be accepted by the insured on an 'as is' basis. This describes what aspect of a health contract? |
Contract of adhesion |
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In health insurance contracts, the insured is not legally bound to any particular action; however, The insurer is obligated to pay for losses covered by the policy. What contract element does this describe? |
Unilateral |
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what is warranty in an insurance contract? |
An absolutely true statement upon which validity of the insurance contract is based |
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What type of health insurance plans cover all accidents and sicknesses that are not specified in the policy? |
Comprehensive plans |
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What are the common exclusions in most health insurance policies? |
War, self-inflicted juries, pre-existing conditions, elective cosmetic surgeries, injuries caused by participating in illegal activities, and workers compensation benefits. |
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What risk classification would qualify for lower premiums? |
Preferred risk |
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If an agent fails to pay state income tax, what can happen? |
It would be grounds for a person's license suspension, revocation, or refusal to renew |
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What earnings are factors taken in account when calculating residual disability benefits? |
Present earnings and earnings prior to disability |
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What does the provision regarding illness in a health insurance policy say? |
Losses resulting from sickness are covered only if the sickness occurs at least 10 days after the reinstatement date |
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What is the name of a limited accident and health insurance policy? |
A dread disease policy |
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What earnings are factors taken in account when calculating residual disability benefits? |
Present earnings and earnings prior to disability |
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An insurance institution or agent that discloses information in violation of the information privacy and disclosure statue of North Carolina will be liable for? |
Damages sustained by the individual to whom the information relates |
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What is the First-dollar-coverage principle in basic medical insurance? |
The insured is not required to at a deductible. Apart of the three basic types of coverage. |
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A sole business proprietor with a medical expense plan can deduct what percentage of the cost? |
100% |
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Who can legally bind coverage? |
The insurer |
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Does the Patient Protection and Affordable Care Act include a tax deduction provision or a tax credit? |
Tax credit |
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The relation of earnings to insurance provision allows the insurance company to limit the insured's benefits to his/her average income over how many months? |
The last 24 months |
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Which entity protects policyowners, insureds, and beneficiaries, under insurance contracts when insurers fail to perform contractual obligations due to financial impairment? |
The Insurance Guaranty Association |
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Which renew ability provision allows an insurer to terminate a policy, for any reason, and to increase the premiums for any class of insured? |
Optionally renewable policy. |
