health insurance part 1

What provision Makes the insurer pay a claim immediately after proof of loss?

Time of Payment of Claims

The time limit on certain defenses provision in a health insurance policy is like which provision in a life insurance policy?

incontestable clause

A cancellable policy allows the insurer to:

increase premium

An indemnity policy

pays the expsense of a loss

Which will make an insurer liable for a claim arising from the insured's use of an intoxicant or narcotic?

A physician prescribed the narcotic or intoxicant for the insured.

What is intended to reduce the number of uninsured Americans and the cost of medical care. Through mandates, subsidies, and tax credits to employers and individuals, requires all persons to participate in the program also imposes tax penalties for noncompliance -requires all persons to join the pool.

ACA

what policies pay a benefit if the insured dies or is dismembered from an accident.

Accidental death and dismemberment (AD&D) policies

The application contains a section called the where the producer explains the relationship within the applicant, how they met the applicant and the purpsoe for the coverage

Agent's Report

what is it called when Increases benefits by a specified amount to keep pace with inflation.

Automatic Increase Option

what is it called when Insured names a beneficiary to receive claims payments that would otherwise be paid to the insured, in case the insured dies before the claim is paid.

Beneficiary Benefits

what is it called when they integrates an insurer's benefits w/ similar benefits insured gets from other sources to prevent overinsurance & minimize premiums.

Benefit Integration

What plans are available to persons who are younger than 30 years and cannot afford any other health insurance, or who want minimal coverage in exchange for a high deductible and a low premium. These persons are usually single, low-income individuals whose employers do not offer group health insurance.

Catastrophic plans

What provision Lets the insured change the beneficiary for a death benefit. (Irrevocable beneficiary must consent.)

Change of Beneficiary

what Reduces benefits if insured takes a more dangerous occupation. Reduces the premium if the insured takes a less dangerous occupation?

Change of Occupation

when Any non-compliant provisions automatically conform to the minimum requirements of the insured's state whats it called?

Conformity w/ State Statutes

what is it called when it Specifies what the parties exchange to form the insurance contract.

Consideration Clause

what is it called when Each time a loss occurs, sets the time that must pass before benefits begin.

Elimination Period

What covers injuries and damages that arise from services a producer gives or failed to give. The typical policy covers: -placement of policies w/ insurers that are not licensed or authorized to conduct business in a state -negligence (such as failure to deliver required documents) -failure to perform due diligence and other duties of a producer

Errors and Omissions (or E&O) insurance

what is it called when Insured can return the policy within 10 (sometimes 20, or 30) days of delivery for a full refund of premium and fees.

Free Look (Right to Examine)

What equires insurers to renew an insured's health coverage under most circumstances.

HIPAA

whis is called ______ when the insurer can deny a claim for loss incurred from the insured's illegal activity?

Illegal Occupation

What insurer can prorate its benefit for a loss if another insurer covers same loss

Insurance w/ Other Insurer

what is it called when Insurer promises to pay a benefit if a certain event occurs, describes the type and scope of coverage defines terms used in the policy states the conditions under which the policy will pay a benefit?

Insuring Clause

What is it called when an Insurer can deny a claim for loss incurred from the insured's intoxication or illegal use of narcotic drugs?

Intoxicants & Narcotics

What polcies cover specific conditions or provide benefits for specific health services?

Limited benefits (or voluntary benefit) policies c

What is a tate public assistance program (with some federal support) that provides health care benefits for the poor of any age?

Medicaid

What is a standard that insurers follow to ensure that they spend premiums primarily on health care coverage, and not on business expenses?

Medical Loss Ratio

what is a federal government program that provides hospital and medical insurance to people age 65 and older?

Medicare

what policies provide private coverage to supplement Medicare coverage.

Medicare supplement policies

What Adjusts benefits for what the premium would buy at the insured's correct age and sex when age or sex was misstated in application?

Misstatement of Age or Sex

What provision Makes the insured notify the insurer of a loss within 20 days, or as soon as possible.

Notice of Claim

What Limits total coverage from a single insurer when insured has two or more related policies with the same insurer?

Other Insurance in This Insurer

what is; When more than one insurer covers a loss, allocates each insurer's share of the total benefit due?

Other Insurance w/ Other Insurers

What provision Tells the insurer to whom it must pay a claim.

Payment of Claims

What provision Lets the insurer order a physical exam or autopsy of the insured following a claim.

Physical Examination & Autopsy

Under the Patient Protection and Affordable Care Act, how must group medical plans handle new insureds with pre-existing medical conditions?

Pre-existing condition exclusions are prohibited in all group medical plans that begin on or after January 1, 2014.

what is, In individual policy, sets time that must pass between policy's effective date & time when losses are covered. In group policy, sets time that must pass between a person's hire date & time when losses are covered?

Probationary Period

What provision Entitles the insurer to write proof of loss w/I 90 days of loss.

Proof of loss

what Reduces the disability income policy's income benefit amount if it exceeds the insured's wages?

Relation of Earnings to Insurance

what is it called when States the insurer's rights to increase premiums or cancel coverage, and the insured's right to renew coverage.

Renewability

What provides benefits to workers who become sick or injured because of a job-related event?

State workers' compensation

What explains the applicant's rights and responsibilities.

The Buyer's Guide

tells the applicant about the insurer's right to collect information from sources beyond the application. It states how the insurer can share that information with third parties.

The Notice of Information Practices

What outlines the policy's coverages and benefits.

The Policy Summary

Under the other insurance with other insurer provision, what happens to any premiums the insured paid in excess of those needed for coverage?

The insurer returns them

what is it called when Insurer pays for organ transplants.

Transplant Coverage

What reciept gives the applicant coverage from the date of the medical exam (if required) or the signed application—whichever is later? Not liable for cliams

a conditional receipt

Which is a penalty for failing to comply with the Patient Protection and Affordable Care Act?

annual fine

What gives the applicant coverage during the underwriting period. Coverage takes effect when the application is signed -strictly controled, liable for claims

binding receipt

when the insurer can cancel the policy with 45 days' advance notice, or with 10 days' notice if premium was not paid what is it called?

cancellation

policies replace income when disability keeps the insured from working are?

disability income

What provides disability income to people under age 65 who become totally disabled?

disability program under Social Security

What provision Specifies that a policy, riders, and endorsements make up the contract between the insurer and insured.

entire contract

Which provision lets a policyowner return the policy to the insurer for a refund of the premium?

free look

What provision Gives the insured more time—7, 10, or 31 days—after a premium is due to pay it and keep a policy from lapsing.

grace period

The other insurance with other insurers provision often applies when the insured:

has coverage from a state's workers' compensation program

What provision Permits the insured to sue the insurer no earlier than 60 days and no later than 3 years after a loss.

legal action

This fund (all states have it) offers some financial relief to policyowners when their insurer becomes insolvent and cannot pay claims.

life and health insurance guaranty fund

what polcies cover the cost of long-term care in a nursing home, at home, or at extended health care agencies or facilities.

long term care policies

what policies cover the cost of medical care and services

medical expense

An insured is injured and files a claim under his disability income insurance policy. When does the elimination period begin?

on the date of injury

Which optional provision applies when an insured has coverage for the same expenses with another insurer but has not notified this insurer of other existing coverage?

other insurance with other insurer

After buying a health insurance policy, the insured takes a job that increases the risk of injury. What will the insurer do to accommodate the increased risk?

reduce benefits

After buying a health insurance policy, the insured takes a job that increases the risk of injury. What will the insurer do to accommodate the increased risk? reduce benefits

reduce benefits

What must an insurer do under a cancelable policy?

refund any advance premiums before canceling the policy

What provision Lets the insured put a policy back in force after it lapses, usually within 3 years of lapse.

reinstatement

Which standard provision allows a lapsed policy to take effect again?

reinstatement provision

Which optional provision is used in policies that provide income payments if the insured becomes disabled?

relation of earnings to insurance

Which provision gives the insurer the right to cancel coverage?

renewability provision

What is the primary document that insurance underwriters use to determine the applicant's risk?

the application

What provision revents the insurer from voiding a policy after 2 or 3 years from issue due to a misrepresentation.

time limit on certain defense

How much time do most states allow for the time limit on certain defenses provision?

two to three years

What Deducts an unpaid premium from the claim payment?

unpaid premium

An insured's health insurance policy pays a flat rate of $200 a month if she becomes disabled, regardless of her actual income. What kind of policy does she have?

valued policy

The federal government does NOT provide health care coverage through

workers compensation