OR Life & Health flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Oregon Insurance Division

Oregon's insurance regulator, a division of the Department of Consumer and Business Services; its administrator, the Insurance Commissioner, enforces state insurance laws, licenses producers, and examines insurers.

Oregon producer continuing education

Oregon requires 24 continuing education credit hours every two years, including at least 3 hours of ethics, to renew a resident life or health license.

Rebating

Giving cash or anything of value not stated in the policy to induce a purchase; an unfair trade practice that can lead to license suspension or a fine.

Utmost good faith

Contract principle requiring both parties to deal honestly and disclose material facts; concealment, fraud, or material misrepresentation can void the policy.

Contract of adhesion

A policy drafted by the insurer and offered on a take-it-or-leave-it basis; because the insured has no bargaining power, ambiguities are construed against the insurer.

Aleatory contract

An agreement in which the amounts exchanged are unequal and depend on chance, such as a large death benefit paid after only a few premiums.

Insurable interest

A financial or love-and-affection relationship between the owner and the insured that must exist when the policy is issued; without it the contract is void.

Three premium factors

Mortality, interest, and expense. Mortality and expense increase the premium, while the interest assumption reduces the amount the insurer must charge.

Level term insurance

Pure death protection for a specified number of years with a constant face amount and no cash value; the premium typically stays level during the term.

Universal life Option A

A level death benefit option where the death benefit remains constant while cash value grows inside it, so the pure insurance amount gradually shrinks.

Variable life insurance

Permanent coverage whose cash value is invested in separate-account subaccounts; selling it requires a securities registration and delivery of a prospectus.

Incontestability clause

After a policy has been in force for two years, the insurer generally cannot contest it based on misstatements in the application, except for nonpayment of premium.

Extended term option

A nonforfeiture option that uses the cash value as a single premium to buy term coverage for the full face amount for whatever period that money will purchase.

Waiver of premium rider

Waives premium payments after the insured has been totally disabled for a specified waiting period, keeping the policy and its values in force.

Exclusion ratio

The portion of each annuity payment that is a tax-free return of basis, calculated as investment in the contract divided by the expected return; the remainder is taxable.

Deferred annuity

An annuity whose accumulation phase precedes payout, allowing interest to grow tax-deferred; early withdrawals may trigger surrender charges and a federal tax penalty before age 59½.

Annuitization payout options

Choices for receiving annuity income, including life only, life with a period certain, joint and survivor, fixed period, and fixed amount.

Modified endowment contract

A life policy that fails the 7-pay test; loans and withdrawals are taxed income-first and may incur a 10% penalty before age 59½.

Transfer for value rule

When a life policy is sold for consideration, the death benefit becomes income taxable to the buyer unless an exception applies, such as a transfer to the insured or a business partner.

Coordination of benefits

Rules that establish which plan pays first and which pays second when a person has coverage under more than one health plan, preventing duplicate payment.

Guaranteed renewable policy

The insurer must renew the policy as long as premiums are paid, but it may increase premiums for an entire class of insureds, not for one individual.

Own occupation definition

A disability definition that pays benefits when the insured cannot perform the duties of their own specific occupation, which is more favorable than any-occupation wording.

Principal sum and capital sum

In accidental death and dismemberment insurance, the principal sum pays for accidental death or double loss, while the capital sum pays a percentage for a single loss.

HMO capitation

A payment model where providers receive a fixed monthly fee per member; HMO members must use network providers and a primary care gatekeeper for specialist referrals.

Essential health benefits

Ten ACA-required benefit categories, including hospitalization, emergency care, maternity, mental health, and prescription drugs, that non-grandfathered individual and small-group plans must cover.

COBRA continuation coverage

Federal law requiring employers with 20 or more employees to offer continued group health coverage for 18, 29, or 36 months at up to 102% of the premium.

Actively at work provision

Group eligibility rule stating coverage begins only when the employee is physically able to perform job duties; it substitutes for individual evidence of insurability.

Medigap open enrollment

A six-month period beginning the month the person is 65 and enrolled in Medicare Part B, during which insurers must sell a Medigap policy regardless of health.

Medicare Part C

Medicare Advantage plans offered by private insurers that provide Part A and Part B benefits, often drug coverage, and may use provider networks with an annual out-of-pocket limit.

Disability benefit taxation

Disability income is taxable when the employer paid the premiums; it is received tax-free when the employee paid premiums with after-tax dollars.

Workers compensation coverage

A state-regulated, no-fault benefit system that pays medical expenses and partial wage replacement for employees injured or made ill by their work.

Social Security disability

Benefits require a disability expected to last at least 12 months or result in death, with a five-month waiting period before payments begin.