WA Life & Health flashcards

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

Washington Insurance Commissioner

Statewide elected official who heads the Office of the Insurance Commissioner, licenses insurers and producers, enforces Title 48 RCW, and adopts insurance regulations.

Producer appointment filing

An insurer must notify the Washington OIC of a producer appointment within 30 days of executing the contract, and report termination within 30 days as well.

Washington producer continuing education

Licensed producers must complete 24 credit hours every two-year license term, at least 3 of which must be ethics, before the license can be renewed.

State guaranty association limits

The Washington life and disability guaranty association pays covered claims up to limits such as $300,000 for life death benefits, $100,000 for cash surrender value, and $250,000 for annuity present value.

Insurable risk characteristics

The loss must be accidental, definite and measurable, shared among many similar exposure units, and incapable of producing catastrophic losses to the insurer.

Elements of a valid contract

Offer and acceptance, consideration, competent parties, and legal purpose. Insurance also requires insurable interest and is a contract of utmost good faith.

Contract of adhesion

An insurance policy is drafted by the insurer with little or no negotiation by the insured, so ambiguous language is interpreted in favor of the insured.

Aleatory contract

A contract in which the values exchanged are unequal and depend on chance, because the insured may receive benefits far exceeding or far below premiums paid.

Human life value approach

A method of sizing life insurance that calculates the present value of the insured's expected future earnings and contributions to others.

Modified endowment contract

A life policy that fails the 7-pay test, causing loans and withdrawals to be taxed income-first with a possible 10% penalty before age 59½.

Policyowner rights

The owner controls beneficiary designation, policy loans, surrender, assignment, and dividend elections, even when the owner is not the insured person.

Term life insurance

Temporary death protection purchased for a stated period with no cash value accumulation, often renewable or convertible at the insured's option.

Universal life insurance

Permanent coverage with flexible premium payments, an adjustable death benefit, and cash value credited current interest less cost-of-insurance charges.

Variable life insurance

Permanent coverage whose cash value is invested in separate-account subaccounts; the owner bears investment risk and sales require a securities registration plus a life license.

Incontestability clause

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

Grace period

The time after a premium due date, commonly 31 days for life insurance, during which the policy remains in force before it lapses.

Nonforfeiture options

Choices available when a cash-value policy is surrendered or lapses: cash surrender, reduced paid-up insurance, or extended term insurance.

Waiver of premium rider

A rider that cancels premium payments while the insured is totally disabled beyond the waiting period, keeping the policy and its values intact.

Exclusion ratio

A calculation that divides the investment in the annuity contract by the expected return to determine the tax-free portion of each annuity payment.

Joint and survivor annuity

A payout option that continues income as long as either of two annuitants is alive, ending at the second death, often at a reduced amount after the first death.

Coinsurance

The percentage of covered medical expenses the insured pays after the deductible is satisfied, for example 20%, with the insurer paying the balance.

ACA metal tiers

Bronze, Silver, Gold, and Platinum plans cover roughly 60%, 70%, 80%, and 90% of expected costs, and only Silver plans support cost-sharing reductions.

Special enrollment period

A window, generally 60 days, that allows health plan enrollment outside open enrollment after events such as marriage, birth, or loss of other coverage.

Time limit on certain defenses

A uniform health provision stating that after two years the insurer cannot deny a claim based on application statements, except for fraudulent misstatements.

Proof of loss requirement

The insured must furnish written proof of loss within 90 days after the loss, unless it was not reasonably possible to do so.

Coordination of benefits

Rules that determine the order of payment when a person is covered by two health plans, with the primary plan paying as if no other coverage existed.

Own occupation disability

A disability definition that pays benefits when the insured cannot perform the duties of their own specific occupation, a broader standard for the insured.

Long-term care benefit triggers

Long-term care benefits become payable when the insured cannot perform two of six activities of daily living or suffers a severe cognitive impairment.

Elimination period

The waiting period that begins with a disability or long-term care claim and must pass before benefits are paid, functioning like a time deductible.

COBRA continuation coverage

Applies to group health plans with 20 or more employees, allowing 18, 29, or 36 months of continued coverage at up to 102% of the group premium.

Medicare Part B

Covers physician services, outpatient care, and preventive services, requiring a monthly premium and generally 20% coinsurance after the annual deductible.

Medicare Part D late penalty

A permanent addition to the drug plan premium equal to 1% of the national base beneficiary premium for each month of delayed Part D enrollment.