2-15 questions
smaller face value polices: ordinary limited-pay and single-premium industrial group
industrial
sold by home service insurers and the face value of these policies is usually smaller than most and provide modest benefits and a relatively short benefit period, premiums are collected in person by the agent at the policyholder's home weekly or monthly: ordinary limited-pay and single-premium industrial group
industrial life
type of policy does not share in the surplus earnings of the insurer and therefor does not allow insured to receive any policy dividends
nonparticipating (nonpar)
how long is grace period for life insurance policies
one month but no less than 30 days
in life insurance policies which the premiums are paid monthly, the grace period is how long?
one month, but no les than 30 days
The most common category of life insurance: ordinary limited-pay and single-premium industrial group
ordinary
includes several variations of temporary (term) and permanent insurance plans, including while life, endowment, universal life, variable universal life, and other interest-sensitive cash value plans: ordinary limited-pay and single-premium industrial group
ordinary life insurance
type of policy is one in which the policyowner receives policy dividends as a return of premium based on the insurer's financial success *higher premiums *option to receive dividend payment in cash, accumulate interest, purchase paid-up additions, or use to purchase one-year term additions
participating life insurance policy (par)
employers are required to provide their employees and their employees' family member a continuation of their group health coverage, at a cost not to exceed what percent?
115
how long must free look periods be? *life insurance*
14 days
free look provision provides the applicant how much time to examine new policies with no obligation? and when is this process started? (life insurance)
14 days from policy delivery
in a health policy, how many days before a claim form must be submitted? 5 15 20 25
15
cobra or mini-cobra guarantees the consumer's right to purchase group health insurance for generally up to how many months?
18 months
coverage for any newborn child of a person covered under a health insurance policy must be provided immediately after birth for how long?
18 months
if the insurer stops offering all policies, they must provide how many days notice? *furthermore, it cannot write health insurance coverage in Florida for 5 years after last nonrenewal date)
180 days
In a health policy, how many days is notice of claim? 10 20 30
20
In a health policy, how many days is the grace period for a policy with weekly premiums? 7 10 31
7
in a health policy, how many days to submit proof of loss? 30 60 90 120
90
if the insurer stops offering a particular policy, coverage can only be discontinued with at least how many days notice? *insurer must offer the purchase of any other plan currently offered in the state*
90 days
failure to appear for subpoena or an order of the chief financial officer can result in a fine of what amount?
$1,000
In a health policy, how many days is the grace period for a policy with monthly premiums? 7 10 31
10
rebate cannot exceed what percent of paid premiums
10
agent exhibiting fraudulent conduct in committing the practices of twisting or churning can be charged with a first degree misdemeanor if displaying fraudulent conduct and may be subject to a fine of what amount (nonwillful and willful)
$5,000 $75,000
willfully submitting fraudulent signatures on an application or policy-related document is a third-degree felony and is subject to what about in fines (nonwillful and willful)
$5,000 $75,000
violation of a cease and desist order can carry a fine up to:
$50,000
how long must free look periods be? *health insurance*
10 days
lapse of notice must be provided within how many days?
21 days
lapse of notice must be provided within how many days? *if the grace period is more than 51 days*
21 days
most common age range in which guaranteed insurability is available is from
25 to 40
how long must insurance agents keep records on file if a transaction involves premium payment?
3 years
the time limit for the reinstatement period is
3 years
florida law requires an agent to report in writing to the department within how many days? (if he has pled guilt or nolo contendere or been convicted or found guilty of, a felony or crime punishable by imprisonment of one year or more under ant state law, federal law, or law of any other country)
30 days
how long must free look periods be? *medicare supplements*
30 days
In a health policy, how many days is the grace period for a policy with weekly premiums? 7 10 31
31
conversion must take place within how many days
31 days
in a health policy in Florida, what is the time of payment claims after first received? 15 30 45 60
45
how often must domestic insurers be examined by the OIR?
5 years
insurance code that spells out the terms that allow domestic insurers the right to invest a certain percentage of their total assets in loans or certain other investments
Leeway or "Basket" Provision
committing practices of churning and twisting can be charged a first degree misdemeanor
True
how often does the office of insurance regulation conduct examinations of insurance company financial and operational situations?
at least every 3 years
enables the insurer to withdraw funds from the policy if any cash value has accumulated within the contract - to pay for any premiums that may not be paid by the policyowner
automatic premium loan provision
policyowner wants to relinquish the value of the policy in exchange for cash
cash surrender value
what type of vesting means that the employee must have a designated amount of years of service before becoming fully vested?
cliff vesting
can be used for groups of 10 or more and averages the cost for all employees, charging the same for each, regardless of the nature variances of age and sex
composite rating
defined as the child or spouse of the employee eligible for coverage as specified in health benefit plan
dependent
works at least 25 hours weekly and meets all waiting period provisions of the act. part-time, provisional, or substitute employees are not eligible employees
employee that eligible employee
means to furnish with an income
endow
the type of policy that is paid to either the beneficiary or the policyholder, stipulates a certain time in which the policy matures and if the policyholder is still alive, they are entitled to receive the policy benefits
endowment policies
offer policy holders accumulation values tied to a stock market index
equity-index universal life
differs from reduced paid-up insurance option as it does not allow the policy to continue to earn interest
extended term insurance
should the policyowner get into a situation in which he cannot continue to make the required premium payments, this option can be utilized
nonforfeiture options
whole life + decreasing term, covering a select period of years. family income plans involve adding decreasing term insurance to a basic whole life contract. upon death, policy pays the beneficiary monthly income for the balance of the family income coverage period: family income policies family maintenance policies family plan policies multiple protection policies
family income policies
whole life + level term, covering a select period of years. family maintenance plans use level term insurance, which is added to a basic whole life contract. at death of the insured, the policy will pay the beneficiary a monthly income for a preselected number of years: family income policies family maintenance policies family plan policies multiple protection policies
family maintenance policies
all family members are covered under one plan, will usually have both term and whole life coverage included. Newborns are covered automatically at no extra premium: family income policies family maintenance policies family plan policies multiple protection policies
family plan policies
created as a nonprofit legal entity to contract with preferred provider organizations and health maintenance organizations to provide high-risk people the most cost-effective quality health care, at rates up to 250%
florida comprehensive health association (FCHA)
allows small businesses to provide group health insurance coverage for their employees in a guarantee-issue basis regardless of health circumstances, preexisting conditions, or claims experience/history
florida employee health care access act
20% increase each years beginning after two years of service until 100% vested after six years of service
graded vesting
includes coverage provided by a group health plan, or a group or individual health insurance issuer, in which an individual was enrolled on (or before) March 23, 2010, and such coverage has covered at least one person continuously since then
grandfathered health plans
coverage for specific groups: ordinary limited-pay and single-premium industrial group
group
coverage for specific groups: ordinary limited-pay and single-premium industrial group
group insurance (study in detail lesson 6, there were a lot of group related questions)
allows the policyholder to renew the policy without the insured having to go through medical underwriting (providing evidence of insurability): guaranteed renewability option to convert
guaranteed renewability
insurance policy that must be offered to an employer, employee, or depends of employee irrespective of preexisting conditions, current health, or claims history *in effect as of 1/1/1993, law in florida *carriers must provide all employees with 2 to 50 employees a health benefit plan
guaranteed-issue basis
covers two or more people, using permanent insurance, it pays the death benefit when one of the insureds dies. the survivor then has the option of purchasing a single individual: family income policies joint life policies family plan policies multiple protection policies
joint life policies
provides when a child reaches age 21, coverage increases to five times the face amount, premiums remain the same: juvenile insurance jumping juvenile policy
jumping juvenile policy
permanent insurance written on underage children (usually from one day to age 14 or 15 years) juvenile insurance jumping juvenile policy
juvenile insurance
covers two lives; benefit is paid upon the death of the last surviving: family income policies joint life last survivor policy multiple protection policies
last survivor policy
certain amount of money set aside to fulfill future claims
legal reserve
require premium payments for a limited amount of time, and offer lifetime protection: ordinary limited-pay and single-premium industrial group
limited-pay
alternative premium payment options: ordinary limited-pay and single-premium industrial group
limited-pay and single-premium
policies that offer an alternative way to pay premiums for life insurance, and offer different benefits to policy holders: ordinary limited-pay and single-premium industrial group
limited-pay and single-premium
nonprofit organization whose main purpose is to be reliable source of medical information for their more than 700 member insurance companies
medical information bureau (MIB)
allows for insurance rate differences to be based on demographic information, such as gender, age, and geographic location, subject to office review and approval
modified community ratings
how is legal reserve calculated?
morality tables and interest rates
pays a benefit of double or triple the face amount if death occurs during a specified period family income policies family maintenance policies family plan policies multiple protection policies
multiple protection policies
what are the three most important risk factors for health insurance? and additional risk factor?
physical condition, moral hazards, occupation age sex medical history high-risk hobbies
permanent life insurance policy may be borrowed against, using the policy's cash value as collateral
policy loan provision
policyowner request that cash value of the policy be used to pay for the policy itself
reduced paid-up insurance
requires a single payment of a large premium, after which point, the policy is paid-up and the holder is insured for life: ordinary limited-pay and single-premium industrial group
single-premium
defined by the act as one who employs at least 1 but no more than 50 employees and identifies a full-time employee as one who works at least 25 hours per week
small employer
carrier that provides health benefit plans covering employees of one of more small employers
small employer carrier
small employers may use a stop-loss insurance policy, which refers to a policy that covers the employer's obligation for the excess cost of medical care on an equivalent basis per employee provided under a self-insured health benefit plan
stop-loss insurance
places a time limit (usually two years) in which the insurer can dispute a policy based on the validity of statements made of the original application
the incontestable clause
the policy is incontestable after it has been in force a certain period of time, usually two years (fraudulent statements is grounds for content at any time) incontestable clause time limit on certain defense
time limit on certain defenses *life policies would not contest (incontestable clause)
these life insurance policies are very flexible
universal life insurance
funds invested in higher risk separate accounts
variable life
life insurance policy where the face value of whole life insurance stays the same throughout the life of the policy, which lessens purchasing power, was developed in an attempt to keep in step with inflation due to the underlying investments
variable life insurance
premium flexibility, cash value investment control, death benefit flexibility. separate accounts are composed of common stock, bond, money market, and other securities investment options
variable universal life
