WY Life & Health flashcards

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

Wyoming Insurance Commissioner

Appointed by the Governor to head the Wyoming Department of Insurance; enforces the state insurance code, issues producer licenses, and investigates unfair trade practices.

Twisting

An illegal practice in which a producer persuades a policyholder to drop an existing policy through misleading or incomplete comparisons, usually to sell a replacement policy.

Rebating

Giving or offering any part of a premium, commission, or other inducement not specified in the policy to persuade a person to buy insurance; an unfair trade practice in Wyoming.

Life free-look period

A right giving the owner at least 10 days after policy delivery to return an individual life policy for a full refund of premium, without giving a reason.

Guaranty association coverage

A state safety net funded by member insurers that pays limited benefits, commonly up to $300,000 in death benefits and $100,000 in net cash surrender value, when an insurer fails.

Wyoming CE requirement

Producers must complete 24 continuing education credit hours every two years, including at least 3 hours of ethics, to renew a Wyoming insurance license.

Insurable interest

A relationship in which the policy owner would suffer a financial loss if the insured died; it must exist when the application is signed, not at death.

Premium rating factors

Mortality (expected death claims), interest (earnings assumed on reserves), and expenses (operating costs) determine gross premium, which is net premium plus expense loading.

Modified endowment contract

A life policy that fails the 7-pay test, so loans and withdrawals are taxed as income first and may face a 10% penalty before age 59 1/2.

Death benefit tax treatment

Proceeds paid to a beneficiary because the insured died are generally exempt from federal income tax, including amounts paid out under installment settlement options.

Conditional receipt

Provides coverage from the application or medical exam date if the proposed insured proves insurable; otherwise the insurer refunds the premium and no coverage began.

Variable life insurance

Permanent coverage whose cash value is held in a separate account and invested in subaccounts; it is a security requiring both insurance and securities registration.

Owner versus annuitant

The owner controls an annuity contract and names the beneficiary, while the annuitant's lifespan measures the payout; one person may fill both roles.

Entire contract clause

States that the policy plus the attached application form the whole agreement, and that only an authorized officer of the insurer can change its terms.

Nonforfeiture options

Ways to use accumulated whole life cash value: cash surrender, reduced paid-up insurance with a smaller face and no more premiums, or extended term coverage.

Automatic premium loan

A provision letting the insurer borrow from a policy's cash value to pay an overdue premium, preventing unintentional lapse when sufficient cash value exists.

Reinstatement provision

Allows restoring a lapsed policy within about 3 years by proving insurability and paying overdue premiums with interest; a new contestable period may apply.

Waiver of premium rider

After total disability lasting a waiting period, commonly 6 months, the insurer waives premiums and keeps the policy in force, sometimes refunding premiums paid during the wait.

Misstatement of age provision

If the insured's age was misstated, the insurer recalculates the death benefit to the amount the premium actually paid would have purchased at the correct age.

Settlement options

Choices for how beneficiaries receive proceeds: lump sum, interest only, fixed period, fixed amount, or life income such as straight life or joint and survivor.

Coinsurance

The share of covered expenses the insured pays after the deductible, commonly 20%, while the insurer pays the remainder until the out-of-pocket maximum is reached.

Deductible

The amount an insured must pay out of pocket for covered services each year before the health plan begins paying its share of covered costs.

Guaranteed renewable policy

The insured may renew coverage to a stated age without proving insurability, but the insurer can raise premiums for the entire class of policyholders.

Coordination of benefits

Rules that determine which plan pays first when a person is covered by two health plans, so combined payments never exceed the actual covered expenses.

Rescission

Voiding a health policy back to its issue date for fraud or intentional misrepresentation, with at least 30 days' advance written notice to the insured.

Usual, reasonable, customary

The prevailing fee benchmark for a medical service in a geographic area; charges above it may be only partly covered, leaving the insured responsible for the balance.

Own-occupation definition

A disability income standard that pays when the insured cannot perform the duties of their own occupation, even if they are able to work in another field.

Residual disability benefit

A partial benefit paid when the insured returns to work but earns less because of the disability, usually calculated as a percentage of lost income.

Medicare Part A

Hospital insurance covering inpatient stays, skilled nursing facility care after a hospital stay, hospice, and some home health; premium-free with 40 quarters of work.

Social Security disability waiting period

Payments start after five full months of disability and Medicare begins after 24 months of benefits; the insured must be unable to perform substantial gainful activity.

HMO gatekeeper model

An HMO member selects a primary care physician who coordinates care and authorizes specialist referrals within a closed network of contracted providers.

Long-term care benefit trigger

Benefits begin when the insured cannot perform at least 2 of 6 activities of daily living for 90 days or has a severe cognitive impairment.