KS Life & Health flashcards
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32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Insurable Interest
- A financial or emotional loss the beneficiary would suffer if the insured died; it must exist when the policy is applied for, or the contract is void.
- Entire Contract Clause
- Provision stating the policy and the attached application form the complete agreement; no outside documents or oral promises can change its terms.
- Incontestability Clause
- After the policy has been in force two years, the insurer cannot contest the contract or deny a claim because of misrepresentation on the application.
- Grace Period (Life)
- The 30 days after a premium due date during which coverage remains in force; if death occurs, the unpaid premium is deducted from the benefit.
- Suicide Clause
- A two-year exclusion under which the insurer returns premiums paid rather than paying the face amount if the insured dies by suicide.
- Automatic Premium Loan
- A provision that uses available cash value to pay an overdue premium at the end of the grace period, preventing the policy from lapsing.
- Reduced Paid-Up Option
- A nonforfeiture choice that uses the cash value to buy a smaller face amount of permanent coverage with no further premiums due.
- Extended Term Option
- A nonforfeiture choice that uses cash value to purchase term insurance equal to the original face amount for a limited period.
- Cash Surrender Option
- A nonforfeiture choice in which the owner surrenders the policy and receives its net cash value; all insurance protection ends.
- Policy Loan
- Money borrowed from the insurer using cash value as collateral; unpaid loan and interest reduce the death benefit or surrender value.
- Paid-Up Additions
- A dividend option that uses each dividend to buy a small amount of additional permanent coverage; the additions have their own cash value.
- Fixed Period Settlement
- A settlement option paying the death benefit in equal installments for a chosen number of years, with interest included in each payment.
- Misstatement of Age Provision
- If the insured's age was misstated, the death benefit is adjusted to the amount the premium paid would have purchased at the correct age.
- 1035 Exchange
- A tax-free transfer of a life insurance policy into another life policy or an annuity; transfers from an annuity to life insurance are taxable.
- Kansas Guaranty Association
- A state program that pays claims of insolvent insurers, up to $300,000 in death benefits and $100,000 in cash surrender value per insured.
- Irrevocable Beneficiary
- A beneficiary whose rights cannot be changed without written consent; the owner cannot change the designation, borrow, or surrender without permission.
- Deductible
- The amount the insured pays for covered services each year before the insurer begins paying benefits, except for services exempted from the deductible.
- Coinsurance
- The percentage of covered costs the insured pays after the deductible; for example, 20% of an allowed charge.
- Out-of-Pocket Maximum
- The yearly limit on deductibles, coinsurance, and copays; once reached, the insurer pays 100% of covered in-network services.
- COBRA Continuation
- Federal law letting employees and dependents keep group coverage after a qualifying event for up to 18 months by paying up to 102% of the premium.
- HIPAA Special Enrollment
- A 60-day window after marriage, birth, adoption, or loss of other coverage to enroll in a group health plan outside open enrollment.
- Medicare Part A
- Hospital insurance covering inpatient hospital stays, skilled nursing facility care, hospice, and some home health; premium-free with 40 work quarters.
- Medicare Part B
- Medical insurance covering physician services, outpatient care, durable medical equipment, and lab work; it requires a monthly premium.
- Medicare Part D
- Optional outpatient prescription drug coverage delivered through private stand-alone plans or Medicare Advantage plans; late enrollment can trigger a penalty.
- Medicare Advantage
- Part C; a private plan that provides Part A and B benefits, usually with drug coverage, and often uses networks and prior authorization.
- Guaranteed Renewable
- The insurer must renew the policy as long as premiums are paid, but it may raise rates for an entire class of policyholders.
- Noncancellable Policy
- The insurer cannot cancel the policy or increase premiums before a stated age, as long as the insured pays premiums on time.
- Coordination of Benefits
- Rules determining which health plan pays first when a person has two plans; for children, the birthday rule usually applies.
- Elimination Period
- The waiting period after a disability begins before disability income benefits become payable; it acts like a time deductible.
- Own Occupation Definition
- A disability definition that pays benefits when the insured cannot perform the duties of their own specific occupation, even if able to work elsewhere.
- Medical Loss Ratio
- The share of premium dollars spent on claims and quality improvement; ACA requires 80% individual/small group and 85% large group, with rebates otherwise.
- KanCare
- Kansas's Medicaid managed care program, delivering medical, behavioral health, and long-term services through contracted managed care organizations.