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148 Cards in this Set
- Front
- Back
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Adhesion
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" A contract offered on a ""take-it-or-leave-it"" basis by an insurer
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Adverse Selection
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The tendency of risks with higher probability of loss to purchase and maintain insurance more often than the risks who present lower probability.
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Birthday Rule
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" The method of determining primary coverage for a dependent child
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Blanket Medical Insurance
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" A policy that provides benefits for all medical costs
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Certificate of Authority
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A documents that authorizes a company to start conducting business and specifies the kind(s) of insurance a company can transact. It is illegal for an insurance company to transact insurance without this certificate.
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Coercion
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An unfair trade practice in which an insurer uses physical or mental force to persuade an applicant to buy insurance.
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Coinsurance
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An agreement between an insurer and insured in which both parties are expected to pay a certain portion of the potential loss and other expenses.
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Comprehensive Major Medical
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" A combination of basic coverage and major medical coverage that features low deductibles
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Consideration
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The binding force in a contract that requires something of value to be exchanged for the transfer of risk. The consideration on the part of the insured is the representations made in the application and the payment of premium; the consideration on the part of the insurer is the promise to pay in the event of loss.
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Co-payment
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" An arrangement in which an insured must pay a specified amount for services ""up front"" and the provider pays the remainder of the cost"
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Dread (Specified) Disease Policy
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A policy with a high maximum limit that covers certain diseases named in the contract (such as polio and meningitis).
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Dual Choice
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" A federal requirement that employers who have 25 or more employees
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Elimination Period
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A waiting period that is imposed on the insured from the onset of disability until benefit payments begin.
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Free Look
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" A period of time
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Gatekeeper Model
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A model of HMO and PPO organizations that uses the insured’s primary care physician (the gatekeeper) as the initial contact for the patient for medical care and for referrals.
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Grace Period
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" Period of time after the premium due date in which premiums may still be paid
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"Hazard
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Moral "
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Health Maintenance Organization (HMO)
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A prepaid medical service plan in which specified medical service providers contract with the HMO to provide services. The focus of the HMO is preventive medicine.
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Health Reimbursement Accounts (HRAs)
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Plans that allow employers to set aside funds for reimbursing employees for qualified medical expenses.
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Health Savings Accounts (HSAs)
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Plans designed to help individuals save for qualified health expenses.
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Indemnify
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To restore the insured to the same condition as prior to loss with no intent of loss or gain.
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Intermediate Care
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A level of care that is one step down from skilled nursing care; provided under the supervision of physicians or registered nurses.
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Investigative Consumer Report
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" A report similar to consumer report
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Legal Reserve
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The accounting measurement of an insurer’s future obligations to pay claims to policyowners.
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Long-Term Disability Insurance
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A type of individual or group insurance that provides coverage for illness until the insured reaches age 65 and for life in the case of an accident.
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Medical Information Bureau (MIB)
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An information database that stores the health histories of individuals who have applied for insurance in the past. Most insurance companies subscribe to this database for underwriting purposes.
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Medical Savings Account
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An employer-funded account linked to a high deductible medical insurance plan.
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Noncancelable
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An insurance contract that the insured has a right to continue in force by payment of premiums that remain the same for a substantial period of time.
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Nonrenewal
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A termination of a policy by an insurer on the anniversary or renewal date.
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Partial Disability
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" Ability to perform some
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Peril
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The cause of a possible loss.
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Permanent Disability
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Disability from which the insured does not recover.
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Preferred Provider Organization (PPO)
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An organization of medical professionals and hospitals who provide services to an insurance company’s clients for a set fee.
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Presumptive Disability
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A provision that is found in most disability income policies which specifies the conditions that will automatically qualify the insured for full disability benefits.
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Pro Rata Cancellation
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" Termination of an insurance policy
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Probationary Period
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The period of time between the effective date of a health insurance policy and the date coverage for all or certain conditions begins.
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Reciprocity
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" A situation in which two parties provide the same help or advantages to each other (for example
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Recurrent Disability
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A policy provision that specifies the period of time during which the recurrence of an injury or illness will be considered a continuation of a prior period of disability.
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Renewability Clause
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A clause that defines the insurance company's and the insured’s right to cancel or renew coverage.
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Reserve
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An amount representing actual or potential liabilities kept by an insurer in a separate account to cover debts to policyholders.
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Residual Disability
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" Type of disability income policy that provides benefits for loss of income when a person returns to work after a total disability
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Respite Care
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A type of temporary health or medical care provided either by paid workers who come to the home or by a nursing facility where a patient stays to give a caregiver a short rest.
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Risk Retention Group
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" A liability insurance company owned by its members
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"Risk
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Pure "
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"Risk
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Speculative "
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"Risk
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Standard"
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"Risk
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Substandard"
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Service Plans
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Insurance plans where the health care services rendered are the benefits instead of monetary benefits.
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Standard Risk
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" An applicant or insured who is considered to have an average probability of a loss based on health
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Subrogation
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The legal process by which an insurance company seeks recovery of the amount paid to the insured from a third party who may have caused the loss.
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2 years
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License renewal period
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30 days
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"Before renewal date
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2 years
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After license lapse license cannot be renewed
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12 months
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Maximum period of license suspension
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30 days
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A certificate of authority must be returned to the Director after suspension or revocation
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24 hours
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Continuing education requirement
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2 years
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To complete continuing education (license period)
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90 days
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Extension to complete continuing education
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30 days
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For insurer to appoint a producer after a written agency contract is executed
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15 days
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For insurer to notify a producer a notice of termination of appointment
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30 days
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The appointee may file written comments after receiving notice of termination
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5 years
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Records of all insurance transactions must be kept for examination by the Director
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10 years
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Records of all reinsurance transactions must be kept for examination by the Director
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10 working days
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Licensees must reply in writing to a records inquiry by the Director
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30 days
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In premium financial agreement for licensee to give notice of cancellation if borrower defaults
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50%
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Maximum legal amount of premiums/commissions earned by transacting controlled business during 1 year
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15 days-1 year
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To pay civil penalties
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"$2
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500 "
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"$10
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000 "
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"$25
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000 "
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"$300
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000 "
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"$500
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000 "
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"$100
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000 "
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$5 million
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Maximum that Guaranty Association will pay for any one contract holder in unallocated annuity contracts
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Adhesion
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" A contract offered on a ""take-it-or-leave-it"" basis by an insurer, in which the insured's only option is to accept or reject the contract. Any ambiguities in the contract will be settled in favor of the insured."
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Adverse Selection
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The tendency of risks with higher probability of loss to purchase and maintain insurance more often than the risks who present lower probability.
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Birthday Rule
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" The method of determining primary coverage for a dependent child, under which the plan of the parent whose birthday occurs first in the calendar year, is designated as primary."
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Blanket Medical Insurance
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" A policy that provides benefits for all medical costs, including doctor visits, hospitalization, and drugs."
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Certificate of Authority
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A documents that authorizes a company to start conducting business and specifies the kind(s) of insurance a company can transact. It is illegal for an insurance company to transact insurance without this certificate.
|
|
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Coercion
|
An unfair trade practice in which an insurer uses physical or mental force to persuade an applicant to buy insurance.
|
|
|
Coinsurance
|
An agreement between an insurer and insured in which both parties are expected to pay a certain portion of the potential loss and other expenses.
|
|
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Comprehensive Major Medical
|
" A combination of basic coverage and major medical coverage that features low deductibles, high maximum benefits, and coinsurance."
|
|
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Consideration
|
The binding force in a contract that requires something of value to be exchanged for the transfer of risk. The consideration on the part of the insured is the representations made in the application and the payment of premium; the consideration on the part of the insurer is the promise to pay in the event of loss.
|
|
|
Co-payment
|
" An arrangement in which an insured must pay a specified amount for services ""up front"" and the provider pays the remainder of the cost"
|
|
|
Dread (Specified) Disease Policy
|
A policy with a high maximum limit that covers certain diseases named in the contract (such as polio and meningitis).
|
|
|
Dual Choice
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" A federal requirement that employers who have 25 or more employees, who are within the service area of a qualified HMO, who pay minimum wage, and offer a health plan, must offer HMO coverage as well as an indemnity plan."
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Elimination Period
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A waiting period that is imposed on the insured from the onset of disability until benefit payments begin.
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Free Look
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" A period of time, usually required by law, during which a policyowner may inspect a newly issued individual life or health insurance policy for a stated number of days and surrender it in exchange for a full refund of premium if not satisfied for any reason."
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Gatekeeper Model
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A model of HMO and PPO organizations that uses the insured’s primary care physician (the gatekeeper) as the initial contact for the patient for medical care and for referrals.
|
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Grace Period
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" Period of time after the premium due date in which premiums may still be paid, and the policy and its riders remain in force."
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"Hazard, Moral "
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" The effect of a person’s reputation, character, living habits, etc. on his/her insurability."
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Health Maintenance Organization (HMO)
|
A prepaid medical service plan in which specified medical service providers contract with the HMO to provide services. The focus of the HMO is preventive medicine.
|
|
|
Health Reimbursement Accounts (HRAs)
|
Plans that allow employers to set aside funds for reimbursing employees for qualified medical expenses.
|
|
|
Health Savings Accounts (HSAs)
|
Plans designed to help individuals save for qualified health expenses.
|
|
|
Indemnify
|
To restore the insured to the same condition as prior to loss with no intent of loss or gain.
|
|
|
Intermediate Care
|
A level of care that is one step down from skilled nursing care; provided under the supervision of physicians or registered nurses.
|
|
|
Investigative Consumer Report
|
" A report similar to consumer report, but one that also provides information on the consumer’s character, reputation and habits."
|
|
|
Legal Reserve
|
The accounting measurement of an insurer’s future obligations to pay claims to policyowners.
|
|
|
Long-Term Disability Insurance
|
A type of individual or group insurance that provides coverage for illness until the insured reaches age 65 and for life in the case of an accident.
|
|
|
Medical Information Bureau (MIB)
|
An information database that stores the health histories of individuals who have applied for insurance in the past. Most insurance companies subscribe to this database for underwriting purposes.
|
|
|
Medical Savings Account
|
An employer-funded account linked to a high deductible medical insurance plan.
|
|
|
Noncancelable
|
An insurance contract that the insured has a right to continue in force by payment of premiums that remain the same for a substantial period of time.
|
|
|
Nonrenewal
|
A termination of a policy by an insurer on the anniversary or renewal date.
|
|
|
Partial Disability
|
" Ability to perform some, but not all, of the duties of the insured's occupation as a result of injury or sickness."
|
|
|
Peril
|
The cause of a possible loss.
|
|
|
Permanent Disability
|
Disability from which the insured does not recover.
|
|
|
Preferred Provider Organization (PPO)
|
An organization of medical professionals and hospitals who provide services to an insurance company’s clients for a set fee.
|
|
|
Presumptive Disability
|
A provision that is found in most disability income policies which specifies the conditions that will automatically qualify the insured for full disability benefits.
|
|
|
Pro Rata Cancellation
|
" Termination of an insurance policy, with an adjustment of the premium charge in proportion to the exact coverage that has been in force."
|
|
|
Probationary Period
|
The period of time between the effective date of a health insurance policy and the date coverage for all or certain conditions begins.
|
|
|
Reciprocity
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" A situation in which two parties provide the same help or advantages to each other (for example, Producer A living in State A can transact business as a nonresident in State B if State B's resident producers can transact business in State A)."
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Recurrent Disability
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A policy provision that specifies the period of time during which the recurrence of an injury or illness will be considered a continuation of a prior period of disability.
|
|
|
Renewability Clause
|
A clause that defines the insurance company's and the insured’s right to cancel or renew coverage.
|
|
|
Reserve
|
An amount representing actual or potential liabilities kept by an insurer in a separate account to cover debts to policyholders.
|
|
|
Residual Disability
|
" Type of disability income policy that provides benefits for loss of income when a person returns to work after a total disability, but is still not able to perform at the same level as before becoming disabled."
|
|
|
Respite Care
|
A type of temporary health or medical care provided either by paid workers who come to the home or by a nursing facility where a patient stays to give a caregiver a short rest.
|
|
|
Risk Retention Group
|
" A liability insurance company owned by its members, which are exposed to similar liability risks by virtue of being in the same business or industry."
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"Risk, Pure "
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The uncertainty or chance of a loss occurring in a situation that can only result in a loss or no change.
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"Risk, Speculative "
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The uncertainty or chance of a loss occurring in a situation that involves the opportunity for either loss or gain.
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"Risk, Standard"
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"An applicant or insured who is considered to have an average probability of a loss based on health, vocation and lifestyle."
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"Risk, Substandard"
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"An applicant or insured who has a higher than normal probability of loss, and who may be subject to an increased premium."
|
|
|
Service Plans
|
Insurance plans where the health care services rendered are the benefits instead of monetary benefits.
|
|
|
Standard Risk
|
" An applicant or insured who is considered to have an average probability of a loss based on health, vocation and lifestyle."
|
|
|
Subrogation
|
The legal process by which an insurance company seeks recovery of the amount paid to the insured from a third party who may have caused the loss.
|
|
|
2 years
|
License renewal period
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30 days
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"Before renewal date, renewal notice is sent"
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|
2 years
|
After license lapse license cannot be renewed
|
|
|
12 months
|
Maximum period of license suspension
|
|
|
30 days
|
A certificate of authority must be returned to the Director after suspension or revocation
|
|
|
24 hours
|
Continuing education requirement
|
|
|
2 years
|
To complete continuing education (license period)
|
|
|
90 days
|
Extension to complete continuing education
|
|
|
30 days
|
For insurer to appoint a producer after a written agency contract is executed
|
|
|
15 days
|
For insurer to notify a producer a notice of termination of appointment
|
|
|
30 days
|
The appointee may file written comments after receiving notice of termination
|
|
|
5 years
|
Records of all insurance transactions must be kept for examination by the Director
|
|
|
10 years
|
Records of all reinsurance transactions must be kept for examination by the Director
|
|
|
10 working days
|
Licensees must reply in writing to a records inquiry by the Director
|
|
|
30 days
|
In premium financial agreement for licensee to give notice of cancellation if borrower defaults
|
|
|
50%
|
Maximum legal amount of premiums/commissions earned by transacting controlled business during 1 year
|
|
|
15 days-1 year
|
To pay civil penalties
|
|
|
"$2,500 "
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Civil penalty for insurer that transacts through an improperly licensed producer
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"$10,000 "
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Civil penalty for each violation of the Insurance Code
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"$25,000 "
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Civil penalty for each willful violation of the Insurance Code
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"$300,000 "
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Maximum that Guaranty Association will pay for Life or Disability Policies
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"$500,000 "
|
Maximum that Guaranty Association will pay for some medical policies
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"$100,000 "
|
Maximum that Guaranty Association will pay for annuities
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$5 million
|
Maximum that Guaranty Association will pay for any one contract holder in unallocated annuity contracts
|
