Accident & Health flashcards
Accident & Health · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- McCarran-Ferguson Act
- A federal law that reserves regulation of insurance to the states and exempts the business of insurance from most federal antitrust laws.
- Producer appointment
- The authorization by an insurer for a licensed producer to act as its agent; the appointment must be filed with the state insurance department.
- Continuing education requirement
- A state-mandated number of credit hours (commonly 24 every two years) that a licensed producer must complete to renew a license.
- Insurable interest
- A financial interest in the life or health of another person such that a loss would cause financial hardship; required at the time of application.
- Utmost good faith
- A principle requiring both insurer and insured to disclose all material facts; concealment or misrepresentation can void the contract.
- Adhesion contract
- A contract drafted by one party (the insurer) and accepted or rejected by the other; ambiguities are construed against the drafter.
- Aleatory contract
- A contract in which the amounts exchanged by the parties are unequal and depend on chance, as in insurance.
- Conditional receipt
- A receipt that provides temporary coverage beginning on the date of application or medical exam, provided the applicant is insurable.
- Free-look period
- A period (typically 10–30 days) after policy delivery during which the insured may return the policy for a full premium refund.
- Entire contract clause
- A provision stating that the policy and the application (plus any attached riders) constitute the entire agreement between the parties.
- Incontestability clause
- A provision that prevents the insurer from contesting the policy after it has been in force for two years, except for nonpayment of premium.
- Grace period
- The time after the premium due date during which coverage remains in force; commonly 7 days for weekly, 10 for monthly, and 31 for other modes.
- Reinstatement provision
- A clause allowing a lapsed policy to be restored upon proof of insurability and payment of overdue premiums, often with a new contestable period.
- Waiver of premium rider
- A rider that waives premium payments during a total disability after a specified waiting period, keeping the policy in force.
- Elimination period
- The waiting period after a disability begins before benefits are payable; longer elimination periods reduce the premium.
- Own-occupation definition
- A disability definition that pays benefits if the insured cannot perform the duties of their own occupation, even if they could work elsewhere.
- Residual disability benefit
- A partial benefit paid when the insured returns to work at reduced income or hours due to disability.
- Coinsurance clause
- A cost-sharing provision splitting covered expenses between insurer and insured, commonly 80% insurer and 20% insured.
- Out-of-pocket maximum
- The limit on the insured's total cost sharing; after reaching it, the insurer pays 100% of covered expenses.
- Health maintenance organization
- A managed care plan that requires members to use network providers and a primary care physician for referrals; providers are often capitated.
- Preferred provider organization
- A managed care plan allowing members to use in-network or out-of-network providers, with higher costs for out-of-network care.
- COBRA
- A federal law requiring employers with 20 or more employees to offer continued group health coverage for up to 18 months after a qualifying event.
- Master policy
- The single group insurance contract issued to an employer or association; individual members receive certificates of coverage.
- Experience rating
- A method of setting group premiums based on the group's past claims experience and demographic characteristics.
- Medicare Part A
- The hospital insurance component of Medicare covering inpatient care, skilled nursing facility, hospice, and some home health services.
- Medicare Part B
- The medical insurance component of Medicare covering outpatient care, physician services, preventive services, and durable medical equipment.
- Medigap
- A private Medicare supplement policy that helps pay costs not covered by Original Medicare, such as deductibles and coinsurance.
- Medicaid
- A joint federal-state program providing health coverage to low-income individuals and families, with eligibility varying by state.
- Annuity
- A contract that pays a series of income payments in exchange for a premium, typically used to provide retirement income.
- Surrender charge
- A fee imposed for withdrawing funds from an annuity during the surrender period, which is typically several years.
- Exclusion ratio
- The formula used to determine the portion of each annuity payment that is a tax-free return of principal for nonqualified annuities.
- Twisting
- The unethical practice of inducing a policyholder to lapse or surrender a policy to buy another through misrepresentation.