Insurance
Written Instrument in which a contract is set forth
- Policy 58% :(
How many parts does Medicare have
4 A-D
Contracts prepared by one for a take-it-or-leave-it
CONTRACTS OF ADHESION
Moral
Conceal Health information on a contract
What groups make up MIB (medical information bureau) -
Insurers
Insurance Protects against
LOSS
Property being insured
Statement of insurable interest Etc
Organization company designed to return profits
Stock Company
In forming an insurance contract, when does an acceptance usually occur?
When the insurer approves a prepaid application
Pure Risk -
loss or stays the same
Adverse Selection
poor risks
Reciprocal -
when insurance is obtained through a reciprocal insurer, the insureds are sharing the risk of loss with other subscribers of that reciprocal
When does acceptance occur? -
when insurer's underwriter approves coverage
When must policy summary for a life insurancee o policy be be delivered
- at the time of policy delivery
What condition may a policy owner transfer their personal insurance policy to another
-written consent of the insurer -life you must provide notice of the transfer
3 Types of Hazards
1. Physical 2. Moral 3. And Morale
4 Elements of an Insruance Contract
1Agreement 2Consideration3Competent Parties 4Legal Purpose
What are the three Types Agent Authority
1Express 2Implied 3Apparent
Adverse Selection Prevention
1Restriction of Coverage 2Refusal to accept risk 3Accept risk at higher rate
First-year commission on a medicare supplement policy may not exceed
200% of the 2nd year commission on the same policy
Misrepresentation violation can include
25k, imprisonment in county jail for a pierod no longer than 1 year, or both, also suspension of license for 3 years
Elimination period -
30 days not eligible for benefits
Elimination period for SS -
5 months
An employee will be taxed on the cost of group life if exceeds
50k
How many spice rate requirements should an insurance policy have?
6
Affordable Care Act, specially enrollment period allows individual to enroll in qualified plan how man days
60
Graace period durrations
7 days if paid weekly, 10 days if monthly and 31 all other models
Accidental death ben if happens in -
90 days
OFFER IS USUALLY MADE WHEN
AN APPLICANT SUBMITS AN APPLICATION TO THE INSURER
Principal is represented by
Agent or Producer
Examples of risk retention are
Copayments Self-insurance Deductibles
NOT fundable by annuities
Death Ben
Moral Hazard -
Dishonesty
Five characteristics of an ideally insurable risk?
Due to chance Definite and measurable Statistically predictable Not Catastrophic Coverage cannot be mandatory
What kind of policy does not typically require proof of insurability?
Group Insurance,
Legal Hazard -
Individuals file lawsuit and claim tremendous amounts for alleged damages
Medicare Part A will pay for what type of services?
Inpatient hospital care, skilled ursing facility care, home health care and hospice
Pure Risk
Insurable
What two elements are necessary for a life insurance e contract to have a legal purpose
Insurance interest and consent
When is misrepresentation fraud
Intentional and material
Insurance company looking to return profits -
Mtual Company
Paid out one year and not the next, what type of company
Mutual
what part medicare will cover lab services
Part B
what part of midecare is medical insurance
Part B
Who is offered part B medicare
Part B is optional to everyone in part A
Profitable Distribuition of Exposures -
Poor risks are balanced with preferred risks, and average risks are in the middle
When does insurance policy go into effect
When teh policy is delivered and the premium is paid
In insurance when is the offer usually made on a contract?
When the insurnace application is submitted
An insurer is accepted an permitted to work -
admitted or authorized
no-loss/no-gain provision allowed and not allowed -
allowed; insurance with other insurers, payment of claims, free look/right of rescission. NOT ALLOWED; pre-existing conditions
Warrant -
an absolutely true statement upon which teh validity of the insurance contract is based
Employer contributions made to a qualified plan -
are subject to vesting requirements
How is the amount of SS disability benefits calculated
based upon the worker's Primary Insruance Amount (PIA), calculated from their Average Indexed Montly Earnings over their highest 35 years
PPACA metal levels of classification
bronze level benefit 60%, silver 70% gold 80% plat 90%
how is part B medicare funded
by monthly premiums and frm the general rev of the fed gov
Insured receives an annual life insurance dividend check, what term best describes this arrangement
cash option
Peril -
cause of loss insured against in an insurance policy, causing the loss ie tornado
Reduction -
change in lifestyle and habit would likely reduce the chances of helath problems
Hazard
conditions or situations that increase probability of an insured loss occurring
Hazards -
conditions such as lifestyle and existing health, activities such as scuba diving
A hospital indemnity policy will pay
confinement indemnity policies pay specific amounts that depend on the amount of time the insured is confined to the hospital
Aleatory contract -
contact which unequal amounts or value are exchanged
NOT legitimate use of annuities by business —
creating tax shelter
True about credit life insurance -
creditor is policyowner \
"First-dollar coverage" -
do not require the insured to pa a deductible
Certificate of Authority -
doc required for an insurance company to transact insurance?
Fact about Debtor
doesn't have insurable interest on the creditor
Double Indemnity
double the face amount of insurance policy due to death
Moral Hazard -
driving recklessly, arise from state of mind that causes indifference to loss, such as carelessness
What are the beenfits part C
expanded benefits for a fee through private insurnace programs such as HMO's or PPOs
Medicare supplement plan must have at least
guaranteed renewable
Skilled care -
in an institutional setting, under direction of physician
Policyowner must have an insurable interest
in the insured
If a Medicare insured uses a non-participating in Medicare physician, he or she may be asked to sign a private contract; these things will happen
insured will have to pay watever the provider charges for the services, medicare limiting charges will not apply, no claims submitted to medicare, and medicare will not pay if one is submitted
Back injury, disabled for a year, insurance carries diability income benefit rider, which of the following best fits will he receive -
monthly premium waiver and monthly income; Disability Income Benefit rider waives the policy premiums, just like the waiver of premium rider. Unlike the waiver of premium rider, it also allows the insured to receive a weekly or monthly income during the disability period
CONVERTIBILITY OPTION UNDER TERM LIFE INSURANCE POLICY -
most term policies contain a convertiblity option, upon conversion, the premium for the permanent policy will be based upon attained age, evidence of insurability is not required
Morale Hazard -
not locking doors
Business continuation plan -
one business partner becomes disabled or die, other purchase interst of deceased or disabled \
what is another name for meidcare advantage plan
part C
What do HMO's provide
pateint care, financing, services
Who must have insurable interest in the insured? -
policy Owner
Indemnity -
principle stipulates that the insured can only collect for the amount of the loss even if the policy is written with greater benefit limits Allow for greater compensation than the financial loss incurred
The price of insurance for each exposure unit is known as —
rate
What is not covered/insured
replacement
Variable annuities -
require SEC and securities license
In case of a loss, indemnity provision
restores an insured person to the same financial state as before the loss; indemnity aka reimbursement
Legal hazard -
set of legal or regulatory conditions that affect an insurere's ability to collect premiums commensurate with the level of risk incurred
Is considered risk
sharing arrangement
STOLI
stanger-originated life insurance, people who have no relationship with the insured with the intention of selling them for life settlements
When a client replaces an existing LTC or Medicare Supplement insurance policy wit another from the same company CA law requires that
the agent must advise the client about HICAP and its services
When must insurable interest exist in a life insurance policy?
time of app