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235 Cards in this Set

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Accelerated Benefits Model Regulation
An NAIC model regulation that is designed to regulate accelerated death benefit provisions and to impose disclosure standards on insurers that provide accelerated death benefits
accelerated death benefit provision
a life ins policy provision that gives the policyowner the right to receive a portion - usually between 50 and 80 % - of the policy benefit during the insured's lifetime when the insured is terminally ill as defined in the policy
acceptable alternative mechanism
for the purpose of HIPAA, a state approved plan that provides health ins coverage to all eligible individuals without imposing pre-existing conditions exclusions and gives eligible individuals a choice of health ins coverage
Accident and Sickness Insurance Minimum Standards Model Act
An NAIC model law that establishes certain standards for all individual health policies other than Medicare supplement policies
accident only coverage
a type of health ins coverage that provides coverage for death, dismemberment, disability, and/or hospital and medical care caused by accident
accredited reinsurer
in states that have enacted laws based on the Credit for Reinsurance Model Law, a reinsurer that is not licensed in the ceding company's domicilary state but meets specified financial and reporting requirements of that state and is licensed to transact ins or reinsurance in at least one other state
actual net debt
for purposes of determining the benefit payable under a consumer credit ins policy, the lump-sum amount needed on any given date to pay off the debt, excluding unearned interest and any other unearned finance charges
adjusted community rate
a health ins premium rate that reflects the medical and hospital costs to all insureds in a particular community
binding premium receipt
a type of premium receipt that provides temporary ins coverage from the time the applicant receives the receipt
Buyer's Guide
a brochure designed to educate consumers about life ins and enable them to get the most for their money when shopping for life ins
Buyer's Guide to Equity-Indexed Annuities
an NAIC publication that describes specific features of equity-indexed annuities and explains ways in which equity indexed annuities differ from other annuities
Buyer's Guide to Fixed Deferred Annuities
an NAIC publication that describes the various types of annuities and some of the annuity features that prospects should consider before purchasing an annuity
ceding company
in a reinsurance transaction, the ins co that transfers risk to another insurer
certificate of authority
a document issued by a state ins dept granting an insurer the right to conduct an ins business in the state
certificate of coverage provision
a group life and health ins policy provision that states that the insurer will issue a certificate to the policyholder for delivery to each insured
change of beneficiary provision
an individual health ins policy provision which states that, unless a policyowner makes an irrevocable beneficiary designation, the policyowner has the right to change a beneficiary designation and to surrender or assign the policy without the beneficiary's consent
change of occupation provision
an individual health ins policy provisiong that specifies how benefits or premiums will be adjusted if the insured changes to a more or less hazardous occupation
Civil Rights Act of 1964
a federal antidiscrimination law that applies to employeers that are engaged in interstate commerce and that have 15 or more employees. Title VII of the Act prohibits employment discrimination on the basis of race, color, sex, religion, or national origin
Civilian Health and Medical Program of the Uniformed Services
a federal program that provides health ins coverage to the families of military personnel, including military retirees, military spouses, and dependents of military personnel
claim forms provision
an individual health ins policy provision which states that the insurer will furnish the claimant with forms for filing proofs of loss when it receives notice of a claim
closed contract
a contract for which only those terms and conditions printed in or attached to the contract are considered to be part of the contractual agreement
closed-end credit transaction
a transaction in which a lender extends to the debtor a specified amount of credit that will be repaid at a specified interest rate in a series of equal payments over a specified time
COBRA continuation coverage
group health ins coverage provided to an individual who elected to continue group health coverage under COBRA
coinsurance
a specified amount or percentage of eligible medical expenses for which the insured - rather than the insurer - is responsible for paying
compensation
for the purposes of the Consumer Credit Insurance Model Act, any form of renumeration resulting directly from the sale of consumer credit ins, including commissions, dividends, retrospective rate credits, service fees, expense allowances or reimbursements, gifts, or the furnishing of equipment, facilities, goods, or services
complaint
for purposes of the Unfair Trade Practices Act, any written communication primarily expressing a grievance
conditional premium receipt
a type of premium receipt that specifies certain conditions that must be met before the temporary ins coverage provided by the receipt becomes effective
conformity with state statutes provisions
an individual health ins policy provision which states that any policy provision that is in conflict with the laws of the state which the insured resides is amended to conform to the minimum requirements of such laws
Consolidated Omnibus Budget Reconciliation Act
a federal law that imposes requirements on group medical expense ins plans sponsored by employers with 20 or more employees
consumer credit insurance
credit ins that is subject to the requirements of the Consumer Credit Insurance Model Act, including credit life ins, credit accident and health ins, and credit unemployement ins
Consumer Credit Insurance Model Act
an NAIC model law designed to regulate consumer credit ins issued or sold in connection with loans or other credit transactions for personal, family, or household purposes
consumer Credit Insurance Model Regulation
an NAIC model regulation that provides standards for the sale of consumer credit ins
conversion provision
a group life ins policy provision that gives insureds the right to obtain an individual life ins policy if their group coverage terminates because of specified reasons
coordination of benefits (COB) provisions
a group medical expense policy provision that is designed to prevent a group member who is insured under more than one group ins policy from receiving benefit amounts greater than her actual incurred medical expenses
copayment
a specified dollar amount that an insured pays for the cost of certain medical services, such as physician office visits or emergency room care
cost of benefits
for the purpose of premium calculations, the total amount that an insurer is expected to pay out in contractually required benefits for the given ins product
credit accident and health insurance
credit ins that insures a debtor to provide funds for the payment of amounts due under a specific credit transaction while the debtor is disabled as defined in the ins policy
Credit for Reinsurance Model Law
an NAIC model law that specifies the situations in which a ceding insurer is entitled to reinsurance reserve credits
Credit for Reinsurance Model Regulation
an NAIC model regulation that supplements the Credit for Reinsurance Model Law's requirements concerning the situations in which a ceding insurer is entitled to reinsurance reserve credits
credit life insurance
credit ins that insures a debtor to provide funds for the payment of all or part of a specific debt owed under a credit transaction upon the debtor's death
credit unemployment insurance
credit ins that insures a debtor to provide funds for the payment of amounts due under a specific credit transaction while the debtor is involuntarily unemployed as defined in the ins policy
creditable coverage
for purposes of HIPAA, health ins coverage under any of a number of specified types of health plans without a lapse of 63 days or more
deductible
a specified dollar amount of eligible expenses that an insured must pay under a medical expense ins policy before the insurer begins to pay any benefits
defined benefit plan
a retirement plan that defines the amount of the benefit each plan participant will receive at retirement
defined contribution plan
a retirement plan that describes the annual contribution the employer will deposit into the plan on behalf of each plan participant
determination letter
a letter issued by the IRS in response to a party's request that the IRS evaluate a specific product and determine whether the product meets federal tax law requirements
determination period
for purposes of HIPAA, a period of time used to calculate an individual's creditable coverage under the alternative method...ordinarily it is the individual's most recent period of creditable coverage up to a max of 365 days; the max period for late enrollees is 546 days (18 months)
direct response marketing
a marketing method that uses one or more media to elicit an immediate and measurable action - such as an inquiry or purchase - from a customer
disability income protection coverage
a type of health insurance coverage that provides periodic payments, either weekly or monthly, for a specified period during the continuance of disability
disclosure document
a document that the Annuity Disclosure Model Regulation requires insurers to provide to prospective purchasers of certain types of deferred annuities; the document identifies and describes the specific annuity the customer is considering purchasing
disclosure statement
a written statement that an insurer must provide to a customer considering the purchase of an individual retirement annuity and that provides non-technical explantions of the operation of an individual retirement annuity
fronting company
the primary insurer in a fronting arrangement
generic name
a short title that describes the premium and benefit patterns of a policy or rider
grace period provision
a life ins, health ins, and annuity policy provision that gives the policyowner a specified period following a premium due date within which to pay a renewal premium
gross debt
for purposes of determining the benefit payable under a credit disability ins policy, the total of the remaining scheduled payments on a given date
gross premium
the amount an insurer charges a policyowner for a specific life or health ins product...consists of two elements: the net premium and the loading
Group Coordination of Benefits Model Regulation
An NAIC model regulation that permits group health ins plans to include a coordination of benefits provision and imposes requirements on COB provisions
Group Health Insurance Definition and Group Health Insurance Standard Provisions Model Act
an NAIC model law that defines the types of groups that are eligible for group life ins and specifies standard provisions that group life ins policies must include
Group Health Insurance Mandatory Conversion Privilege Model Act
an NAIC model law that requires specified types of group health ins policies to give insureds in specified situations the right to obtain individual health ins without providing evidence of insurability
guaranteed renewable policy
a health ins policy that gives the polichyowner the right to continue coverage until the insured reaches age 65 or becomes eligible for Medicare and that gives the insurer that right to change the premium rate charged for the policy if it does so for the class of policies
gross premium
the amount an insurer charges a policyowner for a specific life or health ins product...consists of two elements: the net premium and the loading
Group Coordination of Benefits Model Regulation
An NAIC model regulation that permits group health ins plans to include a coordination of benefits provision and imposes requirements on COB provisions
Group Health Insurance Definition and Group Health Insurance Statndard Provisions Model Act
an NAIC model law that defines the types of groups that are eligible for group life ins and specifies standard provisions that group life ins policies must include
Group Health Insurance Mandatory Conversion Privilege Model Act
an NAIC model law that requires specified types of group health ins policies to give insureds in specified situations the right to obtain individual health ins without providing evidence of insurability
guaranteed renewable policy
a health ins policy that gives the policyowner the right to continue coverage until the insured reaches age 65 or becomes eligible for Medicare and that gives the insurer that right to change the premium rate charged for the policy if it doenes so for the class of policies
Guide to Health Insurance for People with Medicare
a document that was developed by the NAIC and the federal Centers for Medicare and Medicaid Services (CMS) to provide consumers who are eligible for Medicare with information to help them make informed health insurance purchase decisions
Health Care Professional Credentialing Verification Model Act
An NAIC model law that requires a managed care plan to establish a credential verification program that serves to verify the credentials of all participating health care professionals who participate in the plan
Health Carrier Grievance Procedure Model Act
An NAIC model law that is designed to ensure that covered individuals have an opportunity to resove their grievances concerning health care decisions rendered by managed care plans
Health Insurance Portability and Accountability Act
a federal law that imposes a number of requirements on employer-sponsored group health ins plans, health ins companies, and health maintenance organizations
Health Insurance Reserves Model Regulation
an NAIC model law that establishes minimum reserve standards for all types of individual and group health ins products except Medicare supplement and long-term care policies
health maintenance organization
a person, partnership, association, trust or corporation that undertakes to provide or arrange for the delivery of basic health care services to enrollees on a prepaid basis, but tht leaves enrollees responsible for paying copayments and deductibles
Health Maintenance Organization Act of 1973
a federal law that encouraged the growth of HMOs during the late 1970s and 1980s by providing funds to HMOs that met specified requirements and requiring empolyers in certain situations to provide employees with the option of participating in either a federally qualified HMO or the employers' traditional group medical expense Ins plans
Healther Maintenance Organization Model Act
an NAIC model law designed to regulate all aspects of the organization and operation of HMOs conducting business in a state that has enacted such a law
hospital confinement indemnity coverage
a type of health ins coverage that provides a daily benefit of at leatst $40 a day for a period of at least 31 days during any hospital confinement
HR 10 plan
a type of qualified retirement savings plan that may be established by self-empolyed individuals and partnerships as an individual retirement account or individual retirement annuity that operated much like a regular IRA but with higher maximum contribution limits than a regular IRA (AKA Keogh)
illegal occupation provision
an individual health ins policy provision which states that the insurer will not be liable for any loss that results from the insured's committing or attempting to commit a felony or from the insured's engaging in an illegal occupation
illustration
a presentation or depiction that includes nonguaranteed values of a life ins policy. When used in the sale of a life ins policy, it may be either basic or supplemental
illustration actuary
an actuary specially qualified in the actuarial standards of practice relating to a life insurance sales illustration
incontestability provision
an individual life ins and annuity policy provision that limits the time during which the insurer may contest the validity of the ins contract on the ground of a material misrepresentation in the application for ins
indemnity plan
a medical expense ins plan that reimburses insureds for the covered medical expenses they incur and allows insureds to select their own medical care providers
indemnity reinsurance
a type of reinsurance used to effect, in most cases a partial transfer of business and to form a basis for sharing the risks of the insurance business
Individual Health Insurance Portability Model Act
an NAIC model law designed to increase access to individual health ins coverage
individual retirement account
an individual retirement arrangement that consists of a trust account created in the US for the exclusive benefit of an individual and her beneficiaries and that meets requirements specified in the federal tax laws, including a requirement that the trustee of the trust must be a bank, investment company, or similar organization
individual retirement annuity
an individual deferred annuity that qualifies for the favorable federal income tax treatment as an individual retirement arrangement because it meets requirements specified in the federal tax laws
individual retirement arrangement (IRA)
an individual retirement account or individual retirement annuity that meets requirements specified in the federal tax laws and thus receives favorable federal income tax treatment
industrial life insurance
life ins that is paid for by weekly or monthly premiums which are collected by an agent of the insurer (AKA home service ins or debit ins)
Industrial Life Insurance Model Bill
an NAIC model law that establishes standards for the sale of industrial life ins
institutional advertisement
an advertisement that is designed to promote the consumer's interest in the concept of ins or the insurer as a seller of ins
insurablity premium receipt
a type of conditional premium receipt which specifies that the temporary coverage provided by the receipt becomes effective when the receipt is issued if the insurer finds the proposed insured to be insurable
insurer's illustrated scale
according to the Life Insurance Illustrations Model Regulation, a schedule of non guaranteed elements calculated based on the insurer's recent experience
insuring clause
an individual life ins policy provision that contains the insurer's contractual promise to pay the policy benefits in accordance with the provisions contained in the policy
interest-indexed policy
a universal life ins policy that provides for the interest credits to be linked to an external standard, such as the Standard & Poor's 500 index
Internal Revenue Code
a comprehensive collection of laws that codifies the federal tax laws
intoxicants and narcotics provision
an individual health insurance policy provision which states that an insurer will not be liable for any loss resulting from the insured's being under the influence of alcohol or any narcotic unless taken on the advice of a physicial
invitation to contract
any ins advertisement other than an institutional advertisement or an invitation to inquire
invitation to inquire
an advertisement that is designed to induce the audience to inquire further about a specified policy and that contains only a brief description of the coverage being advertised
material misrepresentation
a statement made in an application for ins that is not substantially true and that is relevant to the insurer's evaluation of the proposed insured
medical savings account (MSA)
an interest-bearing account created for the purpose of paying the account owner's qualified medical expenses that are not otherwise covered by ins
Medicare
a federal program that provides hospital and medical expense coverage for persons age 65 and older, disabled individuals, and specified others
Medicare Supplement insurance Minimum Standards Model Act
an NAIC model law that imposes specified minimum standards on Medicare supplement policies and group certificates and requires state ins departments to adopt regulations that impose additional standards
Medicare supplement insurance policy
a policy advertised, marketed, or designed primarily to cover the gap between the amount of hospital, medical, and surgical expenses incurred by an individual eligible for Medicare and the amount of those expenses that Medicare covers (AKA Medigap policy)
Mental Health Parity Act (MHPA)
a federal law that requires group health plans, health ins companies, and HMOs that offer mental health benefits to impose the same annual and lifetime maximum amounts for mental health benefits as are imposed for medical and surgical benefits
misstatement of age provision
a life ins, health ins, and annuity policy provision that describes how policy benefits will be paid if the age of the insured has been misstated
Model Health Plan for Uninsurable Individuals Act
an NAIC model law that provides for the establishment of a state health ins plan that would offer health ins coverage to uninsurable individuals who meet certain criteria
Model Newborn Children Bill
an NAIC model law that requires that health ins policies that provide coverage for a family member of the insured must provide coverage for a newly born child of the insured from the moment of birth
Model Policy Loan Interest Rate Bill
an NAIC model law that places a maximum limit on the interest rate that insurers may charge on policy loans and requires insurers to state the applicable interest rate in their policies
Model Regulation to Implement the Accident and Sickness Insurance Minimum Standars Model Act
an NAIC model regulation designed to standardize and simplify the terms of individual health policies, to facilitate public understanding of health policies, and to provide full disclosure in the sale of such policies
Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act
an NAIC model regulation that contains extensive requirements designed to standardize the coverages provided by individual and group Medicare supplement policies, to facilitate public understanding of such policies, and to ensure full disclosure in the sale of such policies
Model Variable Annuity Regulation
an NAIC model regulation that establishes qualifications an insurer must meet in order to market variable annuities and specifies requirements that variable annuities must meet
modified guaranteed annuity
according to the Modified Guaranteed Annuity Regulation, a deferred annuity for which the underlying assets are held in a separate accout but for which the contract values are guaranteed if held for a specifed time
Modified Guaranteed Annuity Regulation
an NAIC model regulation that imposes requirements on insurance producers and insurers that market modified guaranteed annuities
NAIC
National Association of Insurance Commissioners
NAIC Model Rules Governing Advertisements of Medicare Supplement Insurance
NAIC model rules that regulate the advertising of Medicare supplement ins by imposing requirements similar to those imposed on health ins advertising by the Advertisements of Accident and Sickness Insurance Model Regulation
net amount at risk
the difference between the amount of the death benefit promised by a life ins policy and the amount of the policy reserve
net premium
the amount included in the gross premium for life or health ins product to cover the product's expected cost of benefits
net worth
according to the Health Maintenance Organizations Model Act, an HMO's total admitted assets minus its total liabilities
network plan
a health care plan that provides health care through a network of preferred health care providers
new business strain
the decrease in an insurer's capital and surplus caused by high first-year costs and the reserve requirements associated with issuing new policies (AKA surplus strain)
Newborns' and Mothers' Health Protection Act of 1996(NMHPA)
a federal law that prohibits specified health plans and health ins carriers from restricting benefits for a hopsital stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarian section
noncancellable policy
a health ins policy that gives the policyowner the right to continue coverage until the insured reaches age 65 or becomes eligible for Medicare
nonduplication of benefits provision
a type of COB provision that more stictly limits the benefits payable when an insured is covered by more than one group ins policy
non forfeiture provision
a provision that is included in permanent life ins policies that builds a cash value and in deferred annuity policies and that specifies the nonforfeiture benefit options available to a policy owner who elects to stop paying required premiums
nonpreferred provider
a health care provider who has not contracted with a health care insurer
notice of claim provision
an individual health ins policy provision which states that written notice of a claim must be given to the insurer within 20 days after the occurance or commencement of a covered loss or as soon there after as is resonably possible
notice of transfer
a document that an insurer must mail to its affected policyowners before the insurer transfers their policies to another insurer as part of an assumption reinsurance transaction. The document provides policyowners with information about the transfer and their rights to consent to or reject the transfer of their policies
open contract
a contract that identifies the documents that constitute the contract between the parties, but the enumerated documents are not all attached to the contract
open-end credit transaction
a transaction in which credit is extended under an agreement in which (1) the creditor reasonably expects repeated transations;(2) the creditor imposes a periodic finance charge on an outstanding unpaid balance; and (3) the amount of credit that may be extended to the debtor during the term of the agreement-up to any limit set by the creditor-generally is made available to the extent that any outstanding balance is repaid
outline of coverage
according to the Model Regulation to Implement the Accident and Sickness Insurance Minimimum Standards Model Act, a brief descritpion of the coverage provided by an individual helath insurance policy that an insurer must deliver to the policyowner when the policy is delivered or to the applicant when the application is completed
overinsurance provision
an individual health insurance policy provision that defines an insurer's liabililty to pay policy benefits for covered losses that are insured by more than one policy regardless of whether the same insurer issued all fo those policies
payment of claims provision
an individual health ins policy provision which states that claims for loss of life will be payable to the named beneficiary, and all other claims will be payable to the insured
Pension Benefit Guaranty Corporation (PBGC)
a federal corporation that is responsible for guaranteeing the payment of retirement benefits for participants in defined benefit retirement plans when those plans become financially unable to pay benefits
pension plan
for the purposes of ERISA, a plan, fund, or program that is establised or maintained by an employer or by an employee organization and that provides retirement income to employees or results in a dererral of income by employer for periods extending to the termination of employment or beyond
permanent life insurance
life ins that provides coverage throughout the insured's lifetime as long as premiums are paid when due and also usually provides a savings element that builds up cash value
personal selling
a marketing method that uses commissioned or salaried sales personnel to sell products through oral presentations made to prospective purchasers
physical examinations and autopsy provision
an individual health ins policy provision that gives an insurer the right to conduct a medical examination of the insured at the insurer's expense when reasonably necessary when a claim is pending
nonduplication of benefits provision
a type of COB provision that more stictly limits the benefits payable when an insured is covered by more than one group ins policy
non forfeiture provision
a provision that is included in permanent life ins policies that builds a cash value and in deferred annuity policies and that specifies the nonforfeiture benefit options available to a policy owner who elects to stop paying required premiums
nonpreferred provider
a health care provider who has not contracted with a health care insurer
notice of claim provision
an individual health ins policy provision which states that written notice of a claim must be given to the insurer withing 20 days after the occurance or commencement of a covered loss or as soon there after as is reasonalbly possible
notice of transfer
a document that an insurer must mail to its affected policyowners before the insurer transfers their policies to another insurer as part of an assumption reinsurance transaction. The document provides policyowners with information about the transfer and their rights to consent to or reject the transfer of their policies
plan administrator
the party who is responsible for handling the administrative aspects of a group ins plan or a group retirement plan and ensuring that the plan complies with aplicable regulatory requirements
plan participant
an employee or union member who is covered by a group retirement plan
plan sponsor
an employer or union that establishes a group retirement plan
policy loan provision
a provision that is included in permanent life ins policies that build a cash value and that specifies the terms on which the polcyowner may obtain a policy loan
policy reserve
a liability that identifies the amount that the insurer expects to need in order to pay future policy benefits for a given life or health ins product
policy rider
an ins policy amendment that becomes a part of the insurance contract and either expands or limits the benefits payable under the contract
policy summary
a written statement that describes specific guaranteed elements of a life ins policy that a prospect is cosidering for purchase
preexisting condition
for purposes of the Model Regulation to Implement the Accident and Sickness Insurance Minimum Standards Model Act, the existence of symptoms which would cause an ordinarily preduent person to see diagnosis, care, or treatment within a five-year period preceding the effective date of the insured's coverage or a condition for which medical advice or treatment was recommended by a physician or received from a physician withing a five-year period preceding the effective date of the insured's coverage. OR for the purpose of HIPAA, a physical or mental condition for which medical advice, diagnosis, care, or tretment was recommended or received within the six-month period preceding the date of an individual's enrollment in a group medical expense ins plan
preexisting conditons policy provision
a health ins policy provision that excludes preexisting condition from coverage for a specified period following the effictive date of coverage
preferred provider
a health care provider who enters into a preferred provider arrangement with a health care insurer
preferred provider arrangement (PPA)
a contract between a health care insurer and a health care provider or group of providers who agree to provide specified covered services to insureds
Preferred Provider Arrangements Model Act
an NAIC model law that establishes minimum standards for preferred provider arrangements and the health benefit plans that include such arrangements
preferred provider organization (PPO)
a specific type of health benefit plan that includes a preferred provider arrangement
Pregnancy Discrimination Act
a federal law that was enacted as an ammendment to the Civil Rights Act of 1964 and that requires employers to treat pregnancy, childbirth, and related medical conditions the same as any other medical condition
Premium Rates and Renewability of Coverage for Health Insurance Sold to Small Groups
an NAIC model law that regulates small group medical expense plans by imposing restrictions relating to premiums rates and renewability of coverage. The model also imposes disclose requirements on insurers that market health insurance to small groups
premium receipt
a receipt that is provided in exchange for the payment of an initial life ins policy premium and that provides the proposed insured with some type of temporary ins coverage while the application for ins is being underwritten
premiums
the amounts that ins companies charge for ins products
pre-need funeral contract
an agreement by or on behalf of an individual before her death relating to the purchase of funeral or cemetery merchandise or services
prima facie premium rates
the maximum premium rates that most state ins departments permit insurers to charge for specific types of comsumer credit ins
probationary period
a period following a health ins policy's effective date during which no benefits are payable (AKA waiting period)
proofs of loss provision
an individual health ins policy provision that specifies the time limits within which claimants must provide the insurer with proof of a covered loss
Public Health Service Act
a federal law that establised the authority to award grants for research and for the construction of hospitals and laboratories
qualified beneficiaries
for the purposes of COBRA, specified individuals who have the right to continue their group health ins coverage following a qualifying event without providing evidence of insurability
qualified long-term care insurance policy
a long-term care ins policy that meets requirement specified in the federal tax code and, thus qualifies for favorable federal income tax treatment
qualified plan
a group retirement savings plan that meets specified requirements imposed by ERISA and federal tax laws and, as a result is subject to favorable federal income tax treatment
qualifying events
for the purposes of COBRA, events that would otherwise result in the termination of an individual's group health coverage and that entitle the individual to continue that group coverage for a specified period of time
Quality Assessment and Improvement Model Act
an NAIC model law that requires a managed care plan to develop a quality assessment program
quality assessment program
a program established by a managed care plan to measure and evaluate the quality of health care services rendered by health care professionals who participate in the plan
quality assurance program
a program that establishes procedures to ensure that health care services provided to enrollees of a health maintenance organization are rendered under reasonable standards of quality of care consistent with prevailing professionally recongnized standards of medical practice
quality rating
a letter grade or score on a numerical scale representing a rating agency's opinion of an insurer's financial condition
rating agencies
organizations, owned independently of any insurer or government body, that evaluate the financial condition of of insurers and provide information to potential customers of and investors in ins companies
rebating
a prohibited sales practice in which an ins producer or insurer offers a prospect an inducement to purchase an ins policy from the producer or insurer and the inducement is not offered to all applicants in similar situations and is not stated in the policy itself
recapture provision
a provision that is sometimes included in indemnity reinsurance agreements and the specifies a procedure by which the ceding company may end the reinsurance arrangement on a given block of reinsurance business
recurrent disability
a disability that results from the same cause as an original disability and that reappears after the original disability ends and after the insured returns to work
reduction
a health ins policy provision that reduces the amount of the benefit payable when specified conditions are met
reinstatement provision
an individual life ins, health ins, and annuity policy provision that gives the owner of a policy that has lapsed for nonpayment of premium the right to reinstate the policy by meeting specified requirements. The provision also gives the owner of an individual life ins policy that has been continued under the extended term or reduced paid-up nonforfeiture options the right to reinstate the policy by meeting specified requirements
reinsurance
ins that an insurer buys to transfer some or all of its own risk on ins policies
reinsurance intermediary
a third party that acts as a go-between for an insurer and a reinsurer in effecting a reinsurance transaction
reinsurance intermediary-broker (RB)
according to the Reinsurance Intermediary Model Act, any person, firm, or corporation that solicites, negotiates, or places reinsurance cessions or retrocessions on behalf of a ceding insurer but that is not authorized to enter into a binding reinsurance contract on behalf of the ceding insurer
reinsurance intermediary-manager (RM)
according to the Reinsuranc Intermediary Model Act, any third party that acts as an agent of the reinsurer and either has authority to bind the reinsurer to a reinsurance contract or manges all or part of the reinsurer's assumed business
Reinsurance Intermediary Model Act
an NAIC model law that is designed to regulate the activities of reinsurance intermediaries and of insurers and reinsurers that use the services of reinsurance intermediaries
reinsurer
in a reinsurance transaction, the ins company that accepts risks from another insurer
renewal provision
a term life ins policy provision that gives the policyowner the right, within specified limits, to renew the insurance coverage at the end of the specified term without submitting evidence of insurability. An individual health insurance policy provision that describes the conditions under which the insurer has the right to cancel or refuse to renew the coverage and describes the insurer's right to increase the policy's premium rate at the time of renewal
representation
a statment made by a party to a contract that will invalidate the contract if the statement is not substantially true
reserve credit
the accounting treatment by which a ceding ins company records the transfer of reserves to a reinsurer as a result of an indemnity reinsurance transaction
reserves
liabilities that represent amounts that an insurer expects to pay to meet its future business obligations
Roth IRA
a type of IRA that has been available to eligible individuals since 1998 and that has the same contribution limits as traditional IRAs. They have the following features:(1)a taxpayer may contribute if his adjusted gross income is (a) less than $160,000 if he is married and filing a joint return, (b) less than $110,00 if he is filing a single or head-of-household return, or (c) less than $10,000 if he is married and filing a separate return; (2)no tax deduction is allowed for contributions made to the IRA; (3)qualified withdrawals that the taxpayer has held for at least five years are not subject to income taxation; (4) no tax penalty exists if distributions begin after age 70 1/2
savings incentive match plan for employees (SIMPLE)
a type of qualified savings plan that may be established by small employers and self-employed individuals and that qualifies for favorable federal tax treatment if it meets specified requirements
scheduled net debt
for purposes of determining the benefit payable under a consumer credit ins policy, the lump-sum amount needed to pay off the debt on a given date according to the credit agreement's repayment schedule
scheduled premium variable life policy
according to the Variable Life Insurance Model Regulation, an individual variable life policy for which the insurer fixes both the time and amount of premium payments
settlement options provision
a deferred annuity contract provision that describes the contractholder's right to select the terms on which the insurer will pay periodic annuity benefits
Shopper's Guide to Long-Term Care Insurance
a publication developed by the NAIC to provide consumers with information about the long-term care ins coverages that are available and to help consumers make informed purchase decisions
significant break in coverage
a period of 63 consecutive days during which an individual does not have creditable health ins coverage
simplified employee pension (SEP) plan
a type of qualified retirement savings plan that may be established by self-employed individuals and partnerships as an individual retirement account or individual retirement annuity that is owned by the employee and is funded by employer contributions
small employer
for purposes of HIPAA, an employer that had an average of at least 2 but not more than 50 employees during the preceding calendar year and had at least 2 employees on the first day of the group plan year
Small Employer and Individual Health Insurance Availability Model Act
an NAIC model law designed to increase the availability of health ins coverage to small employers and to individulals who are not covered by or eligible for group health ins or other state-required health benefits
Small Employer Health Insurance Availability Model Act
an NAIC model law thet regulates the renewablity of and the premium rates charged for small group mddical expense plans and that impose requirements on carriers that provide small group health benefit coverages
specified accident coverage
a type of health ins coverage that provides benefits for death or dismemberment resulting from a specifically identified type of accident
specified disease coverage
a type of health ins coverage that pays benefits for the diagnosis and treatment of a specifically named disease or diseases (AKA dread disease coverage)
spokesperson
according to the NAIC Advertisements of Accident and Sickness Insurance Model Regulation, a spokesperson may include (1) a person who makes a testimonial or endorsement and who has a financial interest in an insurer, (2) a person who is in a policy-making position and is affiliated with an insurer, (3) a person who is in any way directly or indirectly compensated for making a testimonial or endorsement, or (4) a person who speaks on behalf of an entity formed or controlled by an insurer
standard health benefit plan
for the purposes of the Small
Employer and Individual Health Insurance Acailability Model Act, a more expensive health benefit plan that may contain more extensive benefits than a basic health benefit plan
Standard Nonforfeiture Law for Individual Deferred Annuities
an NAIC model law that requires individual deferred annuities to provide specified minimum nonforfeiture values
Standard Nonforfeiture Law for Life Insurance
an NAIC model law that specifies how a life ins policy's minimum cash surrender value is calculated
Standard Valuation Law
an NAIC model law that establishes minimum requirements for the reserve liabilities that insurers must establish for life ins and annuity policies
structured settlement annuity
an immediate annuity issued to a person who is entitled to receive a specified sum of money from a third party; the terms of the annuity contract are tailored to carry out the terms of the agreement between the annuitant and the third party
suicide exclusion provision
a life ins policy provision which states that policy proceeds will not be paid if the insured dies as the result of suicide within a specified period follwoing the date of the policy issue
suitability requirement
a regulatory requirement that imposes a duty on insurance producers and/or insurers to have resonable grounds on which to decide that a specific product is suitable for a customer's needs
supplemental illustration
a life ins policy illustration that is provided along with a basic illustration and that presents the information in a different format than that used in the basic illustration
Taft-Hartley Act
a federal law that regulates labor-management relationships and that prohibits an employer from paying anything of value to a labor union (AKA Labor Management Relations ACT)
term life insurance
ins that provides a death benefit if the insured dies during a specified period
time limit on certain defenses provision
an individual health ins policy provision that limits the time during which an insurer may contest the validity of an ins contract on the ground of misrepresentation or may reduce or deny a claim on the ground it results from a preexisting condition
time of payment of claims provision
an individual health ins policy provision which states that after receiving written proof of loss for which the policy provides periodic benefit payments, the insurer will pay those benefits as described in the policy
top-heavy plan
a retirement plan under which, for a given plan year, the present value of accrued benefits for key employees exceeds a specified percentage of the present value of accrued benefits for all employees
traditional IRA
an IRA available to eligible individuals since 1974 for which (1) anyone who is less than age 70 1/2 and who has taxable income can contribute up to a specified amount of earned income each year; (2) some or all contributions are tax-deductible, but taxation of interest earnings is deferred until funds are withdrawn; (3) with specified exceptions, tax penalties are imposed on withdrawals made before the taxpayer attaines age 59 1/2; (4)taxpayers must begin making annual withdrawals of at least a specified minimum amount by age 70 1/2
trust
a fiduciary relationship in which a person, known as the trustee, holds legal title to property for the benefit of another person, known as the trust beneficiary
trust beneficiary
a person for whose benefit another person holds legal title to trust property
trust property
property that is held in trust
trustee
a person who holds legal title to trust property for the benefit of another person, known as the trust beneficiary
unauthorized reinsurer
a reinsurer that does not meet requirements specified in state ins laws based on the Credit for Reinsurance Model Law
uncovered expenditures
the cost to an HMO for health care services that are the obligation of the HMO and for which an enrollee may also be liable if the HMO is insolvent
uncovered expenditures insolvency deposit
a deposit that an HMO may be required to may and that is held in trust to be used by the state ins commissioner to pay claims for uncovered expenditures if the HMO becomes insolvent
underwriting guidelines
general rules that an insurer's underwriting staff use in assigning applicants to different risk classifications
underwriting philosophy
a body of standards and goals for guiding all of the insurer's risk selection and risk classification procedures
Unfair Trade Practices Act
an NAIC model law that identifies a number of general practices that are prohibited as unfair trade practices in the business of ins
Uniform Individual Accident and Sickness Policy Provision Law (UPPL)
an NAIC model law that specifies the provisions that individual health ins policies must contain
unisurable individual
an individual who represents a risk of loss that is too great for an insurer to cover at all or at standard risk rates
unit of coverage
a basic amount of coverage that insurers use when calculating premium rates for their products. For life ins, this is usually $1,000 of coverage
Universal Life Insurance Model Regulation
an NAIC model regulation that is intended to provide states with a means to supplement their ins laws and regulations to accommodate the issuance of universal life ins
universal life insurance policy
a life ins policy for which the insurer periodically makes separately identified (1) interest credit, other than credits for dividend accumulations, premium deposit funds, or other supplementary accounts; (2)mortality charges; and (3) expense charges
unpaid premiums provision
an individual health ins policy provision which states that when a claim is paid, any premium due and unpaid may be deducted from the claim payment
Variable Life Insurance Model Regulation
an NAIC model regulation that establishes qualifications an insurer must meet in order to market variable life ins within a state and specified requirements variable life ins policies must meet
variable life insurance policy
for purposes of the Variable Life Insurance Model Regulation, an individual policy that provides life ind coverage which varies in amount or duration according to the experience of one or more separate accounts established and maintained by an insurer
vested
the status of a retirement plan participant who has met requirement giving her the right to receive partial or full benefits under the plan even if she terminates her employment prior to retirment
warranty
a statement made by a party to a contract that will invalidate the contract if the statement is not literally true
Women's Health and Cancer Rights Act of 1998 (WHCRA)
a federal law that requires health ins plans that cover mastectomies to provide specified benefits for patients who choose to have breast reconstruction following a mastectomy