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325 Cards in this Set
- Front
- Back
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• be 18 or older • be of good moral character •Not have been convicted of a felony • either require licensing fee and pass the state examination |
Minimum requirements to qualify for license |
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• South Carolina Department of insurance application confirmation page •SLED criminal background check • Sam status report which indicated you pass the examination with a minimum score |
documentations requested |
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He or she must be appointed by an authorized representative of the insurance company (insurer) Who will verify character, background and record of the producer to be sure they are of good moral character, trustworthy and qualified to hold themselves up as a legal representative of the insurer. |
producer appointment |
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must send a copy of the FINRA CRD screen to verify |
Variable |
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types of licenses |
•producer •nonresident •temporary |
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Hass to be licensed to do the following • selling soliciting or negotiating insurance for an insurer •Taking an inurance application or delivering an insurance Application or policies • receiving or delivering insurance policies performing any other acts involved in making an insurance contract for or with an insurer * has to be renewed biennially by the last day of the birth month
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producer |
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may be licensed if.. • the person is a licensed producer in a good standing in his or her home state • The person applies for licensure and pays the required fees at NIPR.com • The person provides the director with an original uniform application The person’s home state grants nonresident producer licenses to South Carolina residents on the same basis this is know as a “reciprocal agreement” *must file with the director a change of address within 30 days of move
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Nonresident |
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A person cannot train a ______ insurance producers license that is valid for up to 180 days can be granted to • The spouse or court appointed personal representative of a licensed producer who dies or is mentally or physically disabled in order to sell the producers insurance business or allow enough time for the producer to recover and return to the business or allow enough time to train people to run the producers business • A member or employee of an agency that is licensed as an insurance producer • A person designated by a licensed producer who is entering active service in the US Armed Forces or other circumstances deems necessary by the DOI •A temporary license will not be issued for the purpose of continuing Education *the director may limit the lines of authority for a temporary license for the purpose of protecting the public
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Temporary |
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Is an individual licensed by the director or his designee to represent the citizens of the state in placing their insurance
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Broker |
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• A fine up to $2500 or $5000 if the act is willful •License suspension or evection •both a fine and license suspension or reaction |
file with director of a change in a name or address |
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every insurance producer license is required to complete 24 hours of continuing insurance education every two years in order to renew his or her license
following • a minimum of (8) hours in each licensed line •a minimum of (3) hours in ethics • and the remaining hours in any approved category ( LA&H (P&C Ethics)
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continuing education |
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Producer whose license lapses for failure to satisfy the continuing education requirements may reinstate the license within six months if he or she fulfills the continuing education requirement and pays the fees for reinstatement |
reinstatement |
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committing an unfair deceptive act or practice is entitled to a _____before the director of the person was notified in writing of the time in the place of the hearing person cited to appear at any charges or offensive charged at least 30 days in advance of the hearing
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Hearing |
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after 10 days notice or refused to issue or re-issue a license when it appears that a producer has been…
• convicted of a crime involving moral turpitude • has violated insurance law or any regulation of the department • has Willfully deceived or dealt unjustly with the citizens of the state
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probation |
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• Appointed by the governor •With advice and consent of the senate •As full-time paid position • with no set term • and services at the governors pleasure • with the power of a circuit court judge • The state pays a $50,000 surety bond |
Director Appointment |
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As a producer you have a relationship that requires you to perform certainly responsibilities on behalf of the applicant or the insured. This relationship has developed because of the trust the other individual places in you as their representative. This is known as a fiduciary relationship |
misappropriation of funds |
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A producers ______ is to transfer money on behalf of an insured or applicant for insurance to the appropriate place as required by the agency agreement. |
fiduciary responsibility |
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A producer cannot sign a blank application, contract, or insurance policy or encourage the applicant to do so |
blank forms |
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an insurer or a producer may pay a commission, fee, or other consideration to a person for selling, soliciting, or negotiating an insurance contract in South carolina if the person has a license to transact insurance in the same licensed line of authority. *a licensed insurance producer may _______ for automobile insurance premiums with the insured |
sharing commissions |
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anyone who makes false statements about the insurers financial statements with the intent to deceive the public or a public official is guilty of |
False financial statement |
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• detecting insurance fraud • encouraging reporting with immunity • Setting up penalties for insurance fraud • requiring full restitution for victims of insurance fraud • requires investigation of SLED • establishes the insurance fraud division in the attorney generals office |
Adressing Insurance fraud act |
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cannot be offered or provided as an inducement for the purchase or sale of real estate or personal property or services connected to them |
Free Insurance |
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when acting in good faith, a person who reports insurance fraud is immune from any liability for providing information to or cooperating with the law-enforcement agencies unless a person who does so with malice or in bad faith |
immunity from liability |
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When collecting or using non-public personal financial or health information , insurer or producer is required to
• notify individuals about the insurers or producers privacy policies or practices • describe conditions under which an insurer or producer may disclose this information to affiliated companies in nonaffiliated third parties • provide methods for individual to prevent an insurer or producer from disclosing this information (OPT OUT) • notice must be riding, but can provide electronically if the customer agrees • providing the notice over the phone or orally explaining the notice is not adequate • cannot provide policy numbers to nonaffiliated third parties for telemarketing direct mail or other marketing through electronic-mail to consumer |
initial notice |
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The federal fair credit reporting act |
notice of right to opt out required |
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• supervise and regulate the rates and services of every insurers as well as set reasonable standards and practices for insurers to follow when doing business in the state • enforce the insurance law • issue regulations to administer the insurance law • Report criminal violations concerning the insurance business to the state attorney general or law-enforcement officials • Institute of civil or a ministration action necessary to carry out the directors duties, either through his office or the attorney generals office, but only relative to the business of insurance |
Directors general duties and powers |
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In general, an insurer or producer is not required to notify customers of their right to opt out when the non-public personal financial information will be disclosed to non-affiliated third parties to perform services for the insurer or producer. however, the insurer or producer must give the initial notice about its privacy policies and practices, and prohibits the third-party from disclosing or using the information for other purposes. |
exception to requirement for opt-out notice |
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(FCRA) of 1970 is an important consumer protection law that allows issuers to use credit reports and determining whether an applicant is eligible for insurance. |
fair credit reporting act |
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provides information about the consumers credit, character, habits collected by reporting agency employment records, financial institutions and other public sources |
consumer report |
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provides the same information as the consumer report but provides additional information about the habits, hobbies character, reputation through an investigator of an interview process with interviews with neighbors, friends and associates. |
investigative consumer report |
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A customer whose insurance application has been declined based on a credit report has a legal right to know what is in the.... |
consumer report |
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chance of loss *refers to the person, property, or activity that is insured |
Risk |
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can result in loss or gain * generally uninsurable |
Speculative Risk |
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involves only the chance of a loss, gain is not possible • possibility of loss of a home as a result of a fire • The possible death of a person *generally insurable |
pure risk |
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A condition that increases the probability of a loss or the likely severity of a loss |
Hazard |
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characteristics that increase the chance of loss . they exist due to the presence of some physical condition |
Physical hazard |
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(A) The insurer is duly qualified to transact business (B) paid all taxes in the state (C) adequate reserves for the protection of policyholders (D) adequate reinsurance arrangements (E) The directors and officers that have not been convicted of a crime in any jurisdiction involving fraud and, dishonesty, or violated any insurance statute of any jurisdiction (F) The operations will not be hazardous to the public or to its policyholders |
certificate of authority |
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dishonest tendencies or traits of an individual that increases the chance of a loss. And insured who files a fraudulent claim is a ..... |
moral hazard |
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Are an individuals care less tendencies. these arise from a state of mind, attitude or indifference to loss. * not getting a flu shot when a nasty flu season is raging is it an example |
morale hazard |
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which are legal or regulatory environment characteristics that affect and insurers ability to provide insurance at a premium that is consistent with the it lost experience. * example a court decision might interpret insurance policy language In a way that causes insurers to pay more claims then they expected, or insurance regulators might impose restriction on insurers ability to cancel insurance policies |
legal hazard |
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• is not financially solvent • has violated the law • poses as a hazard to the public or it’s policyholder • refuses to submit to examination by the director or has not obeyed a lawful order of the director |
Solvency |
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The director reviews the premium ____ said by insurance and establish standards and practices insurers to just follow when setting these ____ |
Rates |
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The director can _____ the books and records of any insurer domiciled in South Carolina as often as necessary but at least once every five years |
Examination of books & records |
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before a licensed producer can represent an authorized insurer South Carolina they must be approved and designated as an agent to act on behalf of the insurer |
Appointment |
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when an insurer terminates a producers appointment the insurer must notify the department within 30 days of the termination |
termination of appointment for business reasons |
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Insured must notify the director within 15 days of termination. The notification of termination is to be made to the producer by certified mail, return receipt requested, postage prepared or by overnight delivery using a nationally recognized carrier to the last known address. |
termination of an appointment for criminal reasons |
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producers must keep records of every insurance transaction for at least five years from the last date of contact, showing the number, date, term, amount insured, premiums and the person to whom and issued of every policy or certificate of renewal. these records are open to inspection by the director , who may request them at any time |
Records maintenance |
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Cause of loss Examples • Premature death •high cost of medical care due to accident •loss of income |
Peril |
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are owned by their policy owners *A ____ has no stockholders |
mutual insurance companies |
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unwelcomed & unplanned reduction to value |
loss |
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not only buying insurance but ... •Share it •Tranfer it •Avoid it •Reducing it •Retaining it |
Methods of handling risk |
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groups with a common exposure to loss will form a risk sharing group with the intention that each member will share the financial burden of a loss suffered by any member of the group |
Sharing |
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an individual or business transfers the risk of financial loss to another party. by buying insurance a person or business transfer a certain risks to an insurance company in return for the payment of a premium |
Transfer |
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Individuals can avoid some risks by never having them in the first place |
Avoidance |
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risk prevention measures reduce the likelihood that loss will accuse risk _____ measures reduce the severity of any loss that does occur |
Reduction |
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is sometimes referred to as the “do nothing “ option rather thank avoiding, controlling , sharing & transferring risk, a person or business may simply use its own funds to pay for any losses that occur |
Retention |
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this Consult recognizes that, as the number of independent events increases, The likelihood that actual results will be close to the expected results also increases. Applying the _______ To insurance, this means that the larger the number of the units independently exposed to a loss, the greater the probability that actual loss experience will equal expected loss experience. *as the numbers of units of exposure increase, prediction becomes more accurate. this is the basic principle underlying _____
*the larger the group, the more certain will be the prediction of loss |
Law of Large Numbers |
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Like many other companies, ___ are owned by stockholders who purchase shares of stock as an investment |
Stock insurance companies |
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not an insurance company , rather, it is an association of individuals and companies that provide insurance. * it offers a forum for large companies and brokers to find insurers |
Lloyd’s of London |
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owned by a parent company that uses the captive insurer to insure risks of the parent company or affiliated companies at rates lower than those of other insurers (1) obtain a certificate of authority (2) would at least one board of directors meeting each year in the state (3) maintain its principal place of business in the state (4) appoint a registered agent to act on his behalf |
Captive insurance companies |
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•private & government • admitted and not admitted insurers • domestic, foreign, and alien insurers |
Classes of insurers |
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• independent agency system • exclusive agency system •Managerial System • Direct response marketingz |
marketing (Distribution) System |
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•Agreement -Officer -Acceptance •Consideration •Competent Party •Legal Purpose |
Element of a legal contract |
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an agent (or producer) will always be deemed to represent the insuerer, not the insured, but has a first duty to insured what relationship is this ? |
producer / insurer relationship |
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•Express Authority •Implied Authority •Apparent Authority |
Authority & power products of producers |
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•the offer •the acceptance •the agreement |
agreement equals an offer and acceptance |
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two things that have to be proven in order to purchase life insurance on another adult |
insurable interest receive the proposed insured’s written permission |
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Provide chronically and terminally ill insured A sum of money to pay medical expenses |
vital Settlement |
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does not require an illness, most common reason is the owner no longer needs it or it’s too expensive |
Life settlement |
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property and casualty policies are |
contracts of adhesion |
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involved in exchange of an equal amounts, specifically un equal transfer of value between the parties |
Aleatory contracts |
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only one party makes an enforceable promise, with an insurance policy. only the insurer makes a promise that can be enforced |
unilateral contract |
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When a party intentionally relinquishes there rights |
waiver |
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exist when a party cannot restart or regain a right of privileges that it has voluntarily waived or given it up by its past conduct |
Estoppel |
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The main purpose is to pay a death benefit to a beneficiaries when the insured person dies |
life insurance |
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is the party who purchases the contract and who has all the rights and responsibilities also known as policy____ |
owner |
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Is the party on who’s life the contract is based. When the owner and ___ are different parties the owner must prove insurable interest |
Insured |
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is the party who benefits and receives the death benefit from the insurance policy when the insured dies |
beneficiary |
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based on the economic value of _____ this involves estimating A person’s net future earnings (after taxes & living expenses) each year to retirement, and then discounting that some to a present lump sum value using a reasonable interest rate |
Human life value approach |
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mutual insurance companies, the policy owner is eligible for policy dividends declared by the insurance company Insurance and charges a premium higher than necessary in order to have a margin for extraordinary operating expenses or mortality costs, and justified by the fact that if the excess premium is not needed it will be returned to the owner and the form of a dividend. |
participating life insurance |
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if you buy stock insurance companies, there are no policy dividends paid as owner grants no rights to profits |
non-participating life insurance (non par) |
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examines personal and family income, liabilities, and assets to calculate the appropriate amount of life insurance which would be needed by your family to allow them to meet the expenses & financial obligations upon your death. It is the most common method used today information collected totally includes •Current Income •Accumulated Assets & liabilities • Financial goals and objectives • current (& expected ) expenses • risk profile |
Needs approach |
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is one in which a person, group of people, or entity agrees to buy a business owner’s interest in the business upon the owner’s death or permanent disability * The intent is to enable the business to continue to operate after an owners death or total disability * it creates an obligation for the sale and purchase of a deceased owner’s share of the business, it does not provide the funding. * when life insurance is bought or provide the funds to support a _______ , the arrangement is called an _____. |
insured buy-sell agreement |
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in this agreement, the partners or shareholders agreed to buy the interest of the others in the event the individual dies or withdrawls from the business |
cross-purchase buy-sell agreements |
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In contrast to cross purchase plan, ____ is one in which the business itself is a party to the agreement * and this plan the business past the deceased partners or shareholders interest in the business |
entity buy-sell agreement |
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• Group vs. individual insurance • permanent vs. term (temporary) Insurance • participating vs. non-participating Life insurance • fixed vs. variable life insurance |
classes of life insurance policies |
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One master policy covers multiple people -from my few as 10 - 100s or more. The policy is issued to & owned by the organization (most commonly an employer) That represent And sponsors the coverage * coverage is the evidence by the individual certifates of coverage each participant receives from the plan sponsor. •employers •labor unions •trade & professional association groups |
Group insurance |
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people who buy life insurance for personal protection typically do so with _______ policies |
individual insurance |
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Commonly issued by mutual insurance companies, the policy owner is eligible for policy dividends declared by the insurance company Insurer charges a premium higher than necessary in order to have a margin for extraordinary operating expenses or mortality costs, and justified by the fact that if the excess premium is not needed it will be returned to the owner and the form of a dividend. |
participating life insurance (par) |
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coverage is temporary, applying only for a limited time. at the end of that time, the policy expires The policy pay the death benefit only if the insured dies during the term. no cash value so at the end of the term the insured owes no payment or refund to the policy owner |
term life insurance |
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With a fixed policy, the insurer guarantees a fixed death benefit and a minimum rate of return on the policies cash value. * premiums are invested in the companies general account |
fixed life insurance |
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applicant who presents a high risk of loss to the insurer is classified as a _____ Application received this rating for a number reasons, including poor health, bad habits, a dangerous job, engaging in hazardous pastimes or a history of early major illnesses in the family. * applicants with this risk rating pay a higher premiums for the amount of coverage issued. |
substandard risk classification |
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applicants with very high substandard risk rating are decline coverage altogether. Generally only about 2% of life insurance applicants are rejected |
uninsurable (declined) risk classification |
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•term life insurance •whole life insurance •flexible premium polices •specialized polices •group life |
type of life insurance polices |
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temporary protection |
term life insurance |
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coverage for your whole life, features more guarantees or any other form of permanent life insurance available today * guaranteed death benefit |
whole life insurance |
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premiums are invested in the investment sub accounts managed by the insurer. The insurer guarantees minimum death benefits, usually the face amount of the policy at issue. *The insured does not guarantee a rate of return on the cash value invested. Instead, the policy owner as soon as all the risks for the performance of the policies investments over time. |
variable life insurance |
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Premium payment mode |
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a |
documents that must be provided to an applicant during replacement |
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• lapsed, forfeited, surrender to any extent, assigned to the replacing insurer, or otherwise terminated • converted to reduce paid up insurance, continued as extended term insurance, or otherwise reduced in value through the use of nonforfeiture benefits • subjected to a loan to purchase the new policy • changed it to reduce the benefits or the term or which covers remains in force or benefits are to be paid • re-issued with a reduced cash value |
replacement |
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• properly soliciting the sale of policies • filling out applications for coverage, asking The underwriting questions and writing down the answers • disclose information about the insurers underwriting any policy issue practices • obtaining the appropriate signature • collecting the initial premium and issuing the receipt • delivering the policy |
Field underwriting responsibilities |
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•names , sex, & ages of all to be covered by the policy • past medical histories of all to be covered by the policy •if other health insurance coverage exists •whether the applicant was ever declined issue of health insurance coverage •the requested mode of premium payment ( monthly , quarterly, annually ) |
application procedures |
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provides for conditional coverage that begins on the date of application on the date of a medical exam, if require, which ever is late. |
conditional receipt |
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rating that is one who meets the insurers that guidelines as an acceptable risk * applicants rated as a _____ pay standard premium rates |
Standard risk classification |
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an applicant who presents a very low risk of loss to the insurer is classified as a _____ • enjoys excellent health • does not have risky habits •Works in a low risk job • has no family history of heart disease or cancer at an early age (applicants with this risk rating pay lower than standard premiums) |
Preferred risk classification |
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•Mortality •interest •expenses |
Premium factors |
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applicant who presents a high risk of loss to the insurer is classified as a _____ Application received this rating for a number reasons, including poor health, bad habits, a dangerous job, engaging in hazardous pastimes or a history of early major illnesses in the family. * applicants with this risk rating pay a higher premiums for the amount of coverage issued. |
substandard risk classification |
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applicants with very high substandard risk rating or decline coverage altogether. Generally only about 2% of life insurance applicants are rejected |
uninsurable (declined) risk classification |
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•term life insurance •whole life insurance •flexible premium polices •specialized polices •group life |
type of life insurance polices |
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temporary protection plan policy terminates without value unless it is renewed or converted to permanent coverage * it is pure insurance with no cash value |
term life insurance |
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coverage for your whole life, features more guarantees or any other form of permanent life insurance available today * guaranteed death benefit * guaranteed cash value |
whole life insurance |
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premiums are invested in the investment sub accounts managed by the insurer. The insurer guarantees minimum death benefits, usually the face amount of the policy at issue. *The insured does not guarantee a rate of return on the cash value invested. Instead, the policy owner as soon as all the risks for the performance of the policies investments over time. |
variable life insurance |
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Policy owner can, within certain limits, increased premiums, reduce premiums, or pay no premiums |
Universal life insurance (UL) |
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• lapsed, forfeited, surrender to any extent, assigned to the replacing insurer, or otherwise terminated • converted to reduce paid up insurance, continued as extended term insurance, or otherwise reduced in value through the use of nonforfeiture benefits • subjected to a loan to purchase the new policy • changed it to reduce the benefits or the term or which covers remains in force or benefits are to be paid • re-issued with a reduced cash value |
replacement |
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• properly soliciting the sale of policies • filling out applications for coverage, asking The underwriting questions and writing down the answers • disclose information about the insurers underwriting any policy issue practices • obtaining the appropriate signature • collecting the initial premium and issuing the receipt • delivering the policy |
Field underwriting responsibilities |
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an applicant who presents a very low risk of loss to the insurer is classified as a _____ • enjoys excellent health • does not have risky habits •Works in a low risk job • has no family history of heart disease or cancer at an early age (applicants with this risk rating pay lower than standard premiums) |
Preferred risk classification |
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Provide periodic income payment if the insured becomes disabled during the period of policies coverage * Disability income policy benefits are payable only if the insured meets the policies definition of disability |
Disability income Insurance (DI) |
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disability income policy benefits are payable only if the insurance is the policy’s definition of disability |
qualifying for benefits |
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definition of total disability is more expensive & also more generous . Under the owner of ____ policy benefits are payable if the insured cannot perform the duties of his or her own particular occupation due to injury or sickness |
own occupation definition |
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This definition of total disability is more stricter for the insured and therefore less costly |
any occupation definition |
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This contract does not guarantee a specific dollar amount of coverage, but promises to replace a percentage of the insured’s or lost income due to disability. Before doing so the company will consider all sources of income before determining the actual loss of income, “pure loss” |
income replacement |
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do you sure automatically qualify for the policies for benefits if he or she suffers a specified loss That, by definition, is deemed totally and permanently disable playin that, by definition, and from which it is presumed recovery is not possible • loss of sight • loss of hearing • loss of speech • loss of any to Limbs |
presumptive total disability |
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disable ensures that may find themselves living off the disability income benefits for many years. for this reason, some may want the buying Power of this income payment to keep pace with inflation |
Cost of living adjustment (COLA) |
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unlike life insurance (which could be written for any amount the owner chooses ) DR policy benefits are strictly limited to something less in the ensure his income of earnings. The goal is to help the insured survivor income loss while motivating him or her to recover and return to work |
benefits tied to income |
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this disability policy may have a _____ added for additional premium. if the rider amount is $100,000 & the insured dies , the full face amount - called the principal sum is paid to the beneficiary |
AD& D Accidental death and dismemberment rider |
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and I will be insured to get back part of his or her premium payment if he or she has no or low claim against the DI policy. *For example , After 10 years, the owner could receive 80% of the total DI premium payment, reduced by the amount of any benefits paid during that term |
return of premium (refund ) rider |
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read page |
186 |
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Provide group insurance to its members if it is a natural group and meet certain specific criteria 100 members * Elimina, professional, others |
association group |
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The most common type of a group insurance is the credit or debtor or group for providing credit disability insurance * depositors, creditor debtor, other |
customer groups |
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• A business or industry in which the group is engaged • age and gender of participant • Number of people in the company specific job classification • groups prior claims history • which employees are eligible and whether there is a waiting period for coverage to start • turnover of employees, with new low risk people replacing high-risk retirees • groups are minimum participation levels |
insurer underwriting criteria |
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is one in which the employer pays the full premium hundred percent of eligible full-time employees must be covered in the plan |
noncontributory plans |
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The employee must pay part time with premium at least 75% of the small employers eligible employees must participate |
contributory plans |
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1. the primary plan pays its full benefits first ( yourself ) 2 secondary plan . ( spouse plans ) |
order of benefit payment |
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1. ( hospital insurance) institutional medical care , patient hospital care, skilled nursing home care, post hospital home healthcare, and hospice care. * paid for by workers payroll taxes 2. Part B ( medical insurance) physicians services & preventive services 3. Part C caught a Medicare advantage, is a managed care plan alternative to originally Medicare 4. Part D add prescription drug coverage |
nature financing & administration |
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• our age 65 and older and have our in 40 quarters of coverage under SS • our age 65 in their spouses at least 62 and is fully insured under SS • have been receiving SS disability checks for at least two years at any age • I have an stage renal disease (ESRD, which is can you disease requiring a transplant or dialysis) • have amyotrophic lateral sclerosis (ALS, Lou gehrig’s disease) |
Part A eligibility |
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those who apply for SS retirement benefits at age 65 may become enrolled in Medicare part a and B . new enrollees do not want part B coverage must contact the CMS to opt out * A person who wants to enroll in Medicare at age 65 but chooses to differ SS retirement should still consider enrolling in part a and as the worker has paid for it and it may become secondary coverage to his existing group insurance |
medicare enrollment |
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Brings into the program managed care providers such as HMO’s & PPO’s by enrolling in of the Medicare program a person chooses to receive his or her healthcare for Medicare approved HMO or PPO. |
medicare Part C |
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which operates as a Medicare for private insurance plan |
private fee for service (PFFS) |
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cannot be defined strictly a condition for which medical advice was given or treatment was recommended by a receipt from a medical doctor within six months of for the affective date of coverage in general and in sure can I glued it benefits during the first six months of coverage on the basis of a pre-existing condition for which the insured receive treatment or was diagnosed during a six month before the effective date of coverage |
open enrollment |
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provides healthcare coverage and health related services to people with low income and other needy individuals . is jointly funded by the federal and state government, but it is administrated by the state * those who are blind or disabled or age 65 and older eligible ,if they meet income and financial resource requirements * it is especially important service for elderly people even those with modest financial resources |
medicaid |
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medicare only covers the first hundred days of care and In a skilled nursing facility and requires that a persons first to be hospitalized * medicare’s 100 day benefit period . *Medicaid “provider of last choice “ Just cover extended nursing call me cost. However, to qualify for these benefits, a person must spend down personal assets are near poverty level. |
need for LTC insurance (long term care) |
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LTC policy provides benefits after the insured meets a benefit trigger as defined in the policy • The insurers are inability to perform two or more activities of daily living • The insured’s loss of cognitive ability such that it limits his or her ability to care for himself or herself or without help or supervision • medical necessity |
eligibility for benefits (ADL) |
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•dressing •eating • transferring ( moving from bed to chair ) • bathing • toileting • continence (The ability to control urinary & bowel function ) |
long-term care insurance recognize the six basic activities of daily living (ADL’s) |
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if a person has been a resident of the state for at least 30 days is eligible for coverage under the south Carolina health insurance. If he or she is uninsurable for medical reasons |
respite care |
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once it insured has met the benefit triggers LTC benefit payment begins after satisfy the policy elimination period . * as with disability income elimination period The deductible is not a dollar amount but rather a statement of how long the insured must use his own resources before benefit begin •benefit amount •benefit period |
benefit period & benefit amount |
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A person who has been a resident of the state for at least 30 days , if he or she is unsurable about for medical reasons |
eligibility |
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premiums that individuals are not tax-deductible. And return the benefits the policy pay for receipt entirely tax free in group Insurance plans with employer pays the premium The business can deduct the premiums and the premium payments are not considered taxable income to the employee. |
taxation of disability income insurance |
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with group DI, whatever percentage of the premium the employer pays is the percentage of plan benefits of which the employee is taxed |
taxation of Group DI benefits |
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considered a discretionary expense and premiums are not tax-deductible. On the other hand policy benefits are received tax free |
disability buy sell policy |
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since the policy benefits are paid to the business, premiums are not tax-deductible. However benefits are also income tax free |
key person disability income policy |
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BOE insurance provides funds necessary to continue business operations if the insured owner or partner becomes disabled. Premiums are deductible as an ordinary business expenses, and benefits are received by the business as taxable |
Business overhead expense insurance |
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the provision must be on the first page of the policy & State that the policyholder is permitted to return the policy within a period of not less than 10 days of his delivery to the policyholder |
right it examine (free look) |
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excludes death as a result of operating , riding , or descending from an air craft unless the insureds is a passenger. * flying your own plane is excluded |
aviation exclusion |
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Exclude a death benefit if the insured dies as a result of his or her occupation or hobby. Some policies allow coverage of these Risks |
hazardous hobbies & occupations |
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death benefits proceeds are shared equally by a class or group of individuals. & if one of them predeceases the insured , then his or her share passes down to his or her children (if any ) * branch of the family becomes the class member , it only passes down by blood |
per stirpes (by branch) |
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under the extended term insurance option, the insurer apply’s the cash value of the surrender policy to buy a term insurance policy. The term insurance is bought in an amount equal to the face amount of the lapsed policy term coverage last for whatever period cash value buys |
extended term insurance option |
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are payable only with participating life insurance policies. A participating policy is one that participates in the insurer surplus |
dividend basic |
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dividend buys additional paid up insurance of the same type as the base policy (premium rate for the paid up additions is based on the attained age of the insured when he or she buys edition this will be chosen by the insurer if the owner neglects to choose one of the dividend option |
buy paid up addiction |
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this is one of the most common and popular riders added to my life insurance policy. Under this rider of the policy premiums are waived if the insured becomes totally disabled. Stated in the rider. Most waiver of premium rider’s require that the insured be totally disabled for six months before the waiver begins. This is called the “waiting period “ *Premiums are payable during the “waiting period” |
Waiver of premium rider |
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works only when the policy premium is a fixed amount payable on a scheduled basis. A disability waiver would generally only waive the cost of insurance and expense deducted From the policies cash each month which is why it’s generally called __ |
waiver of cost of Insurance (UL) |
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all the previous riders require the disability of the insured as a trigger * if the payor becomes totally disabled or dies then the waiver usually stays in effect until the payor recovers or the child reaches of age (18-21) |
payor benefit (juvenile insurance) |
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allows a payout of some portion of the policy’s death benefit while the insured is still living. most of these riders pay less than the full face value as an _____ the typical provision allows up to 50 percent of the death benefits to be available *to qualify for this benefit, the insured must prove that he or she either has a terminal illness or a catastrophic accident or illiness that results in permanent disability requiring long term care |
accelerated benefit riders |
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this rider provide financial support for the cost of medical care , nursing home care, & assisted living care for extended duration |
long term care rider |
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A temporary assignment that uses some of the policy cash value for a loan or for some other transaction between the policy owner and the assignee |
assignment |
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this occurs when the policy owner permanently transfers all rights in the policy to an assignee. The sign he becomes a policy owner. He or she assumes all rights of the previous owner when it is complete. *example of this would be a viatical settlement |
absolute assignment |
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that uses of some of the policy cash value for a loan or for some other transaction between the policy owner and the assignee * The sign he has post claim on the policy for the amount of the |
collateral assignment |
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three parties to any annuity contract |
• owner • annuitant •beneficiary |
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serves Only to distribute income I person who buys this exchange is a lump sum amount of money for series of monthly quarterly semiannual your annual income payment |
immediate annuities (SPIA) |
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popular financial products used to distribute a sum of money over an extended period of time. *The purpose is to accumulate and eventually liquidate funds over a certain Period |
Annuities |
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1. provides protection in the form of guaranteed death benefits 2. can provide a lifelong stream of income if the product is annuitized |
insurance aspect of annuities |
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*benefits are usually 3 to 6 months/13 to 26 weeks * employers in for a stated % of earnings * no medicals for participants |
group short term disability |
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Settlement options with out life contingency |
Health insurance portability and accountability act (HIPAA) |
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•single (straight ) life income •life income with period certain • joint & survivor life income • joint live w/ term certain |
settlement options with life contingency |
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•lump sum cash payment •payments for fixed period •payment of a fixed amount •entrust only payment |
settlement options without life contingency |
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* more likely to be an individual policy * benefits can run for five years or to age 65 |
Long term disability |
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The insurer apply the cash value of the surrendered policy to buy the policy it is bought in and the amount equal to the face amount of the lapsed policy. The coverage last for whatever. The cash value buys. |
Extended term insurance option |
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As developed in the original BCBC formate were (first dollar ) plans which has no out of pocket cost to the insured |
Basic medical expenses (indemnity) policies |
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death benefits proceeds are shared equally by a or group if one of the predeceased The insured they are no longer a class member and their share is divided equally among the surviving class members. No shares are passed down to the shared children. |
Per capita (Per head) |
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The policies proceeds are converted into an income stream that last the beneficiaries entire life. Payment ceases at the beneficiaries death. |
Single (straight) life income option |
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•annual and/or lifetime max benefits • examination and cleanings typically every six months |
Limitations |
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• Losses due to war • pre-existing condition • if Worker’s Compensation benefits are payable • cosmetic dentistry, unless due to an accident • if benefits are available under other insurance such as VA or Medicare |
Exclusions |
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is voluntary and available to anyone who qualifies for Medicare part A |
Medicare part B |
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Prescription drug plan is available for anyone covered under the original Medicare plan |
Medicare part D eligibility |
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Available to those who are covered under part A, provides coverage for Medicare |
Medicare part a hospital insurance |
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After the deductible is paid, Medicare pays fully for the benefit for the first 60 days of hospitalization. |
Medicare part a deductible and co-payments |
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Available to those who are covered under part A, provides coverage for medical care beyond hospitalization. Part B is not all inclusive |
Medicare part B medical insurance |
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The policy is surrendered and the insured or simply pays the cash value to the policy owner in a lump sum.pre |
Cash surrender option two pencils |
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Group |
Cash surrender option |
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Prevent the lost of cash value & applying when the policy is surrendered or lapses |
Standard non forfeiture option |
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Group health insurers plans included in order to avoid duplication of benefits when an individual is covered under multiple plans |
Coordination of benefits (COB) |
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Is a person upon whose life the annuity payment amounts and duration is based on |
Annuitant |
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Serves only to distribute income A person who buys this exchanges a lump sum of money for a series of monthly, quarterly, semi annually & anual income payments |
Immediate annuities (SPIA) |
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Is a contact under which annuitization is delayed or deferred until future date |
Deferred annuities |
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•fixed annuities •variable annuities •equity -indexed annuities •market -value adjusted annuities |
Annuity products |
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All values are guaranteed Guarantees both the annuity principal and a specific rate of interest to be credited to the contract |
Fixed annuities |
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Used by employers on a group basis , has the same features as an individual annuityac |
Group annuities |
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is a corporation that delivers healthcare services on a prepaid basis, financed by members premiums. |
HMO health maintenance organization |
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Access to network specialist is controlled by this who is also one of the HMO network physician there roll is to coordinate and direct members health care treatment and for that reason they are sometimes known as a “gate keeper” |
Primary Care Physician (PCP) |
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They after a vast network of physicians and facilities to choose from yet provide practice independently. They permit members to seek care outside the network. They also do not require members to use a (pcp). |
Preferred Provider Organization (PPO) |
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To be considered for group coverage a group can not be formed for the soul purpose of purchasing insurance. The group must be a “Natural Group “ To which the insurence is a side benefit. But not it’s purpose. |
Eligible Group |
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These policies do not contain the 3 standard options. This is due largely Bc the policies enforce as long as there cash value allows the insurer to make a monthly deduction to cover the policies insurance and operational cost. |
Nonforeiture option and UL insurance |
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Up to 50 people |
Small Employers |
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• diagnostic and preventative care • restorative treatment • oral surgery • endodontics •periodontics • orthodontics • prosthodontics |
Types dental treatment |
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All employees who regularly schedule to work 30 hours a week or more must be covered in the small group health plan |
Eligibility of employees |
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S.C. Mandates that all small groups insurer must offer 2 plans which all pay same benefits |
Benefits plan offered |
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Is an optional provision that an life insurance applicant can elect at the time the policy is purchased. |
Automatic Premium Loan Provision (APL) |
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are not cash value distribution but are loans from the insurer • if the policy is later surrendered , then unpaid loan balances are paid off using the cash value •if the policy is designated as as a modified endowed contract (or MEC ) |
Policy Loans |
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• when a policy owner withdraws the policy cash value while the insured is alive & the policy is in force . the amount that exceeds is premiums paid is taxable as ordinary income |
policy surrender |
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the receive the favorable tax benefits of life insurance , a policy must meet the definition of life insurance *a life insurance policy that is _____ loses the benefit of tax free cash value * this is not a unique type of life insurance when life insurance contracts become ___ subject to less favorable income tax treatment if it fails to meet the 7 pay test |
modified endowment contract (MECs) |
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applies to the premiums paid into a contract during its first seven years . |
7 pay test |
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1. accumulation stage 2. payout (annuitization ) stage |
taxation of annuities |
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includes a provision to pay a death benefit if the owner dies before the contract annuitizes tackle to the beneficiary |
annuity death benefits |
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certificates of deposit , securities , annuities , & some forms of real estate are allowed to fund ... people can contribute any amount they want . deductions 1. whether they are covered by an employer- sponsored retirement plan 2. what the owners income level is if covered under an employer - sponsored retirement plan |
traditional IRA |
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provides “ back end “ tax benefits . meaning that the contributions to an account are paid with after - tax dollars & cannot be deducted . |
Roth IRA |
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• an annuity for an annuity as long as the annuitants are the same • a life insurance policy for an annuity as long as the insured and the annuitant are the same •a life insurance policy for another life insurance policy as long as the insureds are the same |
allowable 1035 |
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available for : •employers for the benefits of their employees •individual •self employed people |
qualified retirement plans |
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Require all medical plans cover certain services w/o cost sharing kept at a percentage of gross income |
Preventive care (PPACA) |
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It states that insurance policies and a complete signed application makes it up. The application is normally attached and made part of the policy. |
Entire contract |
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Capped that had a percentage of gross income, search as 65- 70% in order to equal a persons net income after taxes and expenses |
Income benefits (Monthly indemnity) |
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Most group insurance today is offered on a group basis through employment related insurance employers will cover all full-time employees |
Employment related groups |
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• The plan must be in writing and communicated to employees • The employer must set up the plan for the sole benefit of the employees • The employer, the employees, or both must make contributions consistently to the plan • The plane cannot discriminate in cover that is , the employer cannot set up the plan mainly for the benefit of key employees or the business owners ) • The benefits also must not be geared exclusively to the above mentioned prohibited group • The plan must meet minimum funding levels • there is also an extensive set of annual reporting rules |
General plan qualification requirements |
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it’s a form of defined contribution plan funded only with the employer dollar |
simplified employee pension plan (SEP) |
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one of the most popular types of qualified plan is____ named for the section of internal revenue code where they are described, is yet another form of defined contribution plan, it allows employer and employees to contribute to the plan |
401(k) plans |
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this plan is a non-qualified retirement plan available only two employees of state and local government units • eligible employees are allowed to make elective salary deferral‘s into plan on a pre-tax basis |
457 plan |
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•accidental injury • sickness |
definition of peril |
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commonly known as “dread disease insurance” this insurance covers • heart attack • strokes •Coronary disease requiring surgery • end stage renal disease(kidney failure ) • major organ transplant • paralysis • multiple sclerosis |
critical illness insurance |
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is an accident only policy issued to an organization to protect a group of individuals engage in a specific group activity |
blanket health insurance |
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•eye exams (usually once per year ) • vision correction Material (eyeglasses contact lenses) every few years as stated • specific eye diseases |
vision insurance |
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• disability income •medical expense •accidental death & dismemberment (AD&D) • medicare supplement • long - term care policies • limit benefits • dental insurance |
categories of health insurance |
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|
certain health coverage are available through the federal and state government. These were established for social purposes to benefit people who may otherwise not be able to get medical coverage. Medicare was established originally to provide coverage for people who are retired and did not have access to health coverage for the private market because the high risk of the aging group |
private versus government |
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•such as a hospital income insurance or prescription drug coverage, pays only for the exact risk in the policy • such as Blue Cross or HMO plan covers whatever illness or accident may be falled the insured |
Limited versus comprehensive |
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noted to protect the buyer for misunderstanding what one of these limited calyces covers South Carolina insurance laws require that in bold print on the first page of the policy is this statement “THIS IS A LIMITED POLICY” followed by definitions of what this particular plan will cover |
required notice to insured |
|
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• accidental death and dismemberment insurance (AD&D) • hospital indemnity insurance • critical illness insurance (Dread disease ) • blanket health insurance • prescription drug insurance • vision insurance • dental insurance |
types of limited policies |
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The oldest living at risk policy insurance is available as an individual policy, through a group insurance policy, or as a rider to do some other form of insurance |
accident only with south carolina minimum standard (AD&D) |
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• dies -then the benefit is paid to the beneficiary • loses one or more Limbs (benefit to insured) • lose eyesight or hearing(total deafness) (benefit to insured) pays benefits only if the loss is accidental |
purpose of AD&D |
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|
helps provide extra cash to cover personal expenses not covered by insurance during hospitalization |
hospital indemnity insurance |
|
|
this insurance covers the risk of a loan customer becoming disabled ( unable to pay off loan) and pays a monthly benefit equal to the loan payment amount |
Credit disability insurance |
|
|
•accidental injury • sickness |
definition of peril |
|
|
commonly known as “dread disease insurance” this insurance covers • heart attack • strokes •Coronary disease requiring surgery • end stage renal disease(kidney failure ) • major organ transplant • paralysis • multiple sclerosis |
critical illness insurance |
|
|
is an accident only policy issued to an organization to protect a group of individuals engage in a specific group activity |
blanket health insurance |
|
|
•eye exams (usually once per year ) • vision correction Material (eyeglasses contact lenses) every few years as stated • specific eye diseases |
vision insurance |
|
|
•self inflicted injuries •war & military actions •sickness or injury while on active duty in the armed forces • elective cosmetic surgery (not due to an accident or birth defect ) •infertility treatment •non commercial airline travel •injuries or sickness for which workers comp benefits are payable •treatment in a government hospital •losses incurred while involved in committing a felony or other illegal act |
common policy exclusions |
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|
•medical advice or treatment was recommended by or received from a physician •symptoms existed that would cause a carful person to seek diagnosis, care, or treatment. |
preexisting condition |
|
|
the state regulates the content & delivery of health insurance ____ ensure they are accurate & truthful. |
advertising |
|
|
•the type of coverage provided •a description of the benefits •a description of exceptions & limitations •the conditions for a renewal, including any reservation by the insurer of its right to change the premium • a statement that the outline summarized the policy and that the policyholder should refer to the policy off the governing provisions |
Outline of coverage |
|
|
the producer expected to guide an applicant through the application process & assure that all application questions are fully answered . as an agent of the insurer , the producer is also expected to serve a field under writing role the agent , who is the eyes & ears of the insurer is also referred to as a |
field under writer (underwriting) |
|
|
• disability income •medical expense •accidental death & dismemberment (AD&D) • medicare supplement • long - term care policies • limit benefits • dental insurance |
categories of health insurance |
|
|
certain health coverage are available through the federal and state government. These were established for social purposes to benefit people who may otherwise not be able to get medical coverage. Medicare was established originally to provide coverage for people who are retired and did not have access to health coverage for the private market because the high risk of the aging group |
private versus government |
|
|
•such as a hospital income insurance or prescription drug coverage, pays only for the exact risk in the policy • such as Blue Cross or HMO plan covers whatever illness or accident may be falled the insured |
Limited versus comprehensive |
|
|
noted to protect the buyer for misunderstanding what one of these limited calyces covers South Carolina insurance laws require that in bold print on the first page of the policy is this statement “THIS IS A LIMITED POLICY” followed by definitions of what this particular plan will cover |
required notice to insured |
|
|
• accidental death and dismemberment insurance (AD&D) • hospital indemnity insurance • critical illness insurance (Dread disease ) • blanket health insurance • prescription drug insurance • vision insurance • dental insurance |
types of limited policies |
|
|
The oldest living at risk policy insurance is available as an individual policy, through a group insurance policy, or as a rider to do some other form of insurance |
accident only with south carolina minimum standard (AD&D) |
|
|
• dies -then the benefit is paid to the beneficiary • loses one or more Limbs (benefit to insured) • lose eyesight or hearing(total deafness) (benefit to insured) pays benefits only if the loss is accidental |
purpose of AD&D |
|
|
helps provide extra cash to cover personal expenses not covered by insurance during hospitalization |
hospital indemnity insurance |
|
|
this insurance covers the risk of a loan customer becoming disabled ( unable to pay off loan) and pays a monthly benefit equal to the loan payment amount |
Credit disability insurance |
|
|
•accidental injury • sickness |
definition of peril |
|
|
commonly known as “dread disease insurance” this insurance covers • heart attack • strokes •Coronary disease requiring surgery • end stage renal disease(kidney failure ) • major organ transplant • paralysis • multiple sclerosis |
critical illness insurance |
|
|
is an accident only policy issued to an organization to protect a group of individuals engage in a specific group activity |
blanket health insurance |
|
|
•eye exams (usually once per year ) • vision correction Material (eyeglasses contact lenses) every few years as stated • specific eye diseases |
vision insurance |
|
|
•self inflicted injuries •war & military actions •sickness or injury while on active duty in the armed forces • elective cosmetic surgery (not due to an accident or birth defect ) •infertility treatment •non commercial airline travel •injuries or sickness for which workers comp benefits are payable •treatment in a government hospital •losses incurred while involved in committing a felony or other illegal act |
common policy exclusions |
|
|
•medical advice or treatment was recommended by or received from a physician •symptoms existed that would cause a carful person to seek diagnosis, care, or treatment. |
preexisting condition |
|
|
the state regulates the content & delivery of health insurance ____ ensure they are accurate & truthful. |
advertising |
|
|
•the type of coverage provided •a description of the benefits •a description of exceptions & limitations •the conditions for a renewal, including any reservation by the insurer of its right to change the premium • a statement that the outline summarized the policy and that the policyholder should refer to the policy off the governing provisions |
Outline of coverage |
|
|
the producer expected to guide an applicant through the application process & assure that all application questions are fully answered . as an agent of the insurer , the producer is also expected to serve a field under writing role the agent , who is the eyes & ears of the insurer is also referred to as a |
field under writer (underwriting) |
|
|
•age & sex • occupation & activities outside of work •current physical condition & past medical history • habits or lifestyle |
underwriting criteria |
|
|
• disability income •medical expense •accidental death & dismemberment (AD&D) • medicare supplement • long - term care policies • limit benefits • dental insurance |
categories of health insurance |
|
|
certain health coverage are available through the federal and state government. These were established for social purposes to benefit people who may otherwise not be able to get medical coverage. Medicare was established originally to provide coverage for people who are retired and did not have access to health coverage for the private market because the high risk of the aging group |
private versus government |
|
|
•such as a hospital income insurance or prescription drug coverage, pays only for the exact risk in the policy • such as Blue Cross or HMO plan covers whatever illness or accident may be falled the insured |
Limited versus comprehensive |
|
|
noted to protect the buyer for misunderstanding what one of these limited calyces covers South Carolina insurance laws require that in bold print on the first page of the policy is this statement “THIS IS A LIMITED POLICY” followed by definitions of what this particular plan will cover |
required notice to insured |
|
|
• accidental death and dismemberment insurance (AD&D) • hospital indemnity insurance • critical illness insurance (Dread disease ) • blanket health insurance • prescription drug insurance • vision insurance • dental insurance |
types of limited policies |
|
|
The oldest living at risk policy insurance is available as an individual policy, through a group insurance policy, or as a rider to do some other form of insurance |
accident only with south carolina minimum standard (AD&D) |
|
|
• dies -then the benefit is paid to the beneficiary • loses one or more Limbs (benefit to insured) • lose eyesight or hearing(total deafness) (benefit to insured) pays benefits only if the loss is accidental |
purpose of AD&D |
|
|
helps provide extra cash to cover personal expenses not covered by insurance during hospitalization |
hospital indemnity insurance |
|
|
this insurance covers the risk of a loan customer becoming disabled ( unable to pay off loan) and pays a monthly benefit equal to the loan payment amount |
Credit disability insurance |
|
|
•application •agents (producers ) report • attending physician statement (APS) • investigative consumer reports • MIB group, inc • medical exams and lab test •HIV testing |
sources of underwriting information |
|
|
1. preferred 2 Standard 3. substandard 4. declined |
underwriting classification |
|
|
• existing coverage is being terminated • pre-existing health conditions may not be covered under the new policy • A new policy may impose they waiting periods in deductible • The applicant has been advised to contact the existing insured to make sure the _____ is in his or her interest • failure to include all material medical information on any application may provide a basis for the insurer to deny any future claims and to refund the premium as though the policy had never been in for. |
replacement |
|
|
insured producers covered for the cost of damage, real or allegedly. He or she will also be defended by the insurer in any food that may be brought against the producer it is intended to cover honest mistake by the producer so it does not cover well for fraud, intentional misrepresentation, or other criminal actions |
Producer liability for error & omission (E&O) |
|
|
states that the policy , copy of the application , attatched rider & endorsement make it up |
entire contract |
|
|
provision requires that the insured notify the insurer within 20 days after he or she has covered loss |
Time limit on certain defenses ( incontestability) |
|
|
•7 - day grace period for premium paid weekly •10 - day grace person for premiums paid monthly (including monthly bank draft) •31- day grace period for all other payment modes * The mode of premium payment, which can be weekly, monthly, quarterly, semi annually, or annually the sets the |
grace period |
|
|
provision requires that the insured notify the insured with and 20 days after he or she has a covered loss |
notice of claim |
|
|
Provide a dollar amount for up to 1 year approximately the benefits that SS disability would pay. After that the benefits cease as the insurer is assumed to have qualified for SSD benefits. |
Additional Monthly Benefit Rider (AMB) |
|
|
The laps policy cash value is applied as a single premium to buy the policy of the save type as the lapse policy but with reduced face amount. This option requires no further premium. Does not retain a cash value The cash value will continue to grow through out the life of the policy |
Reduced Payed Up Insurence Option (RPU) |
|
|
Paying the death benefit including paying the death benefit to the death resulted in war, declared war on declared any act or hazard of such a war |
War exclusion |
|
|
1. |
Suicide provision |
|
|
This is the time that must pass after their policy is issued before illness related disabilities will be covered typically 15 to 30 days accidents are covered in directly after issued with no waiting period. |
Probationary period provision |
|
|
1. I had deductible insurance plan HD HP that covers medical expenses there and exceed the high deductible that is sold by the insurer. 2. A tax favored savings account that can be used to find expenses subject to the high deductible health insurance plan deductible provided by the savings institutionIf the insured has failed to pay a premium that is due when I claim is made during the grace period, the insurer will pay the claim, but also will deduct the amount of the unpaid premium |
The Basic HSA concept Health Savings account |
|
|
It protects those who are no longer covered by an employer’s health insurance plan or benefits applied to groups 25 or more
The employer has the right to charge an additional 22% of the cost to cover its administrative expenses. |
COBRA |
|
|
If the insured has failed to pay a premium that is due when I claim is made during the grace period, the insurer will pay the claim, but also will deduct the amount of the unpaid premium from the total settlement |
Unpaid premiums |
|
|
under this provision, the insurer must receive written ____,with the 90 days of the loss |
proof of loss |
|
|
the insured may sign an “assignment of benefits “authorization which permits the healthcare provider to submit claims directly to the insured to provide timely benefit payments |
time of payment of claim |
|
|
The law states that the insured must give the insured 60 days in which to make a claim settlement offer |
legal actions |
|
|
In the event that the insured is found to have multiple policies with different insurance, and the companies had not been informed of the duplication of coverage, the issuers will collaborate and share proportionately and payment of the one single claim |
expensive incurred benefits |
|
|
do you sure can exclude any loss that arises from the insured‘s participation in a felony crime or other illegal occupation |
illegal occupation |
|
|
under this provision, the insurer must receive written ____,with the 90 days of the loss |
proof of loss |
|
|
this policy is purchased to fill a gap in medical coverage, such as a person light off who needs short term coverage or a person who is leaving an old job for a new one and wants a cheaper alternative to the more costly COBR a coverage until benefits commence at the new job |
cancelable health term policies |
|
|
the insured may sign an “assignment of benefits “authorization which permits the healthcare provider to submit claims directly to the insured to provide timely benefit payments |
time of payment of claim |
|
|
The law states that the insured must give the insured 60 days in which to make a claim settlement offer |
legal actions |
|
|
In the event that the insured is found to have multiple policies with different insurance, and the companies had not been informed of the duplication of coverage, the issuers will collaborate and share proportionately and payment of the one single claim |
expensive incurred benefits |
|
|
do you sure can exclude any loss that arises from the insured‘s participation in a felony crime or other illegal occupation |
illegal occupation |
|
|
insures can exclude any laws that arises from the insurance being intoxicated or under the influence of any prescription drugs that were not prescribed by physician |
intoxicants & narcotic |
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•agents delivers new policy : 10 day free look •policy sold by mass/direct marketing : 31 days •nature market policies - medicare supplement & long term care : 30 days |
right to examine (free look) |
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as a contract, a health insurance policy requires three things: offer acceptance and consideration. |
consideration clause |
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during this policy the insurer guarantees that during this period It will neither cancel the policy nor increase the premium |
non-cancelable |
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what a step down from my non-cancelable policy is one that is guaranteed renewable. The insured guarantees that during the guaranteed minute. It will not cancel or non-renew the policy, though it does have the right to increase premiums • however, the insurer cannot raise the premium on an individual; it may only increase the premiums provided it does not so for our policies in homogeneous class |
guaranteed renewable |
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The benefits purchased is based on the insurance attain age |
Buy one year term insurance |
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Provide a dollar amount for up to 1 year approximately the benefits that SS disability would pay. After that the benefits cease as the insurer is assumed to have qualified for SSD benefits. |
Additional Monthly Benefit Rider (AMB) |
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Many DI policies include a return to work for provision or rehabilitation provision. Insured pays the OT and training |
Rehabilitation pro vision |
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All changes to A life insurance contract must be made into writing and an insurance company officer must endorse the changes document before it becomes effective. Producer does not have the right to modify a policy in anyway |
Contract modification |
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The insurer must pay an annual deductible ($166- 2016) after paying the deductible they pay 80% Medicare approved healthcare charges, are based on usual and customary charges that prevail in community. There is no max on 20% coinsurance benefits must pay during the year |
Part B premiums and deductible |
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Provides an additional monthly benefit rated to win SSD benefits might begin. Benefits forSSD are very difficult to qualify for |
Social insurance supplement rider (SIS) |
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Allow life-insurance applicants to customize policy to their specific needs. They had an additional level or protection in some form and they usually come and in modest cost. |
Policy rider for disability protection |
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Similar to the return of premium rider this extra cost writer provides for a lump sum refund for a percentage of DI premium minus claims paid at the termination of the contract |
Cash surrender value rider |
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The laps policy cash value is applied as a single premium to buy the policy of the save type as the lapse policy but with reduced face amount. This option requires no further premium. Does not retain a cash value The cash value will continue to grow through out the life of the policy |
Reduced Payed Up Insurence Option (RPU) |
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Paying the death benefit including paying the death benefit to the death resulted in war, declared war on declared any act or hazard of such a war |
War exclusion |
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1. |
Suicide provision |
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This is the time that must pass after their policy is issued before illness related disabilities will be covered typically 15 to 30 days accidents are covered in directly after issued with no waiting period. |
Probationary period provision |
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1. I had deductible insurance plan HD HP that covers medical expenses there and exceed the high deductible that is sold by the insurer. 2. A tax favored savings account that can be used to find expenses subject to the high deductible health insurance plan deductible provided by the savings institutionIf the insured has failed to pay a premium that is due when I claim is made during the grace period, the insurer will pay the claim, but also will deduct the amount of the unpaid premium |
The Basic HSA concept Health Savings account |
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It protects those who are no longer covered by an employer’s health insurance plan or benefits applied to groups 25 or more
The employer has the right to charge an additional 22% of the cost to cover its administrative expenses. |
COBRA |
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If the insured has failed to pay a premium that is due when I claim is made during the grace period, the insurer will pay the claim, but also will deduct the amount of the unpaid premium from the total settlement |
Unpaid premiums |
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A dependent loses coverage if the parents lose coverage. The child is no longer considered independent. The parents stop paying the premium on the master contract terminate |
Terminate coverage |
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Allows the insured to buy extra coverage under the policy without providing evidence of insurability) (also called a guaranteed insurability rider) |
Future increase option rider |
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The policy owner simply elects to receive the dividend in cash * not income taxable |
receive the dividend in cash |
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* based on individual underwriting of applicant *Benefits runs from six months to two years |
Individual short term disability |
