WEBCE Prep Exam Health Insurance|A+ Graded
Health insurance
broadly covers many risks, such as the loss of income because of disability, the costs of medical care
and treatment, and the costs of care not covered by government plans.
Long term care
A broad term that includes a wide range of assistance, services, or devices provided over an extended
period. It is designed to medical, personal, social needs in a variety of settings and locations to enable
a person to live as independently as possible.
Managed care providers
provide their insured with health care directly through a network of health care providers
Government plans
In relation to health insurance, a third health insurance option after commercial insurers and
managed care plans. include Medicare, Medicaid, Social Security disability, and workers'
compensation.
Medicare
a federal government program that provides hospital and medical insurance to people age 65 and
older.
Medicaid
a state public assistance program (with some federal support) that provides health care benefits for
the poor of any age.
State workers' compensation
provides benefits to workers who become sick or injured because of a job-related event.
Catastrophic 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.
Agent's Report
Includes information about the client that would be useful to the underwriter
Binding Receipt
Guarantees coverage from the time the applicant completes the application (or the insured completes
the medical exam).
Conditional Receipt
The coverage begins on the date of application or the date of a medical exam if required, whichever is
later. The receipt is made on the condition that underwriting determines the insured is insurable.
, Buyer's Guide
A type of disclosure to an insurance applicant that explains the applicant's rights and responsibilities
with regard to the insurance coverage.
Policy Summary
outlines the policy's coverages and benefits.
entire contract provision
A life and health policy provision that states that if any guarantees, promises, exclusions, or anything
else are not included in the policy (or in the application, if made a part of the policy), then they are
not part of the contract
time limit on certain defenses provision
One of the 12 required provisions in a health insurance policy. Largely the same as the incontestable
clause in life insurance. It limits the time an insurer can void a contract or deny a claim for material
misrepresentations on the application. Usually 2 or 3 years.
incontestability provision
A provision in an insurance policy that states that after a policy has been in force for a set period, the
insurer cannot contest a claim for any reason except for non-payment of premiums. Under most
policies, that period is two years.
Grace Period Provision
Coverage remains in effect for 31 days past premium due date; benefits paid during would be
deducted from sum.
Reinstatement Provision
A provision that lets the policyowner place a lapsed policy back in force within a certain period. This
period is typically three years.
physical examination and autopsy provision
One of the 12 required provisions in a health insurance policy. Allows the insurer to require the
insured to take a physical exam during the claims investigation process. (The insurer must pay for the
exam.) If the claim is because of the death of the insured, this provision also allows the insurer to
order an autopsy to determine the cause of death. Again, the insurer must pay for the autopsy
legal actions provision
One of the 12 required provisions in a health insurance policy. Defines the periods during which the
insured can take against the insurer because it didn't pay a claim.
irrevocable beneficiary
A beneficiary designation in a life insurance policy that the policyowner cannot change without the
beneficiary's written consent.
Notice of Claim provision
the insured must give written notice to the insurer within 20 days after a covered loss occurs
Health insurance
broadly covers many risks, such as the loss of income because of disability, the costs of medical care
and treatment, and the costs of care not covered by government plans.
Long term care
A broad term that includes a wide range of assistance, services, or devices provided over an extended
period. It is designed to medical, personal, social needs in a variety of settings and locations to enable
a person to live as independently as possible.
Managed care providers
provide their insured with health care directly through a network of health care providers
Government plans
In relation to health insurance, a third health insurance option after commercial insurers and
managed care plans. include Medicare, Medicaid, Social Security disability, and workers'
compensation.
Medicare
a federal government program that provides hospital and medical insurance to people age 65 and
older.
Medicaid
a state public assistance program (with some federal support) that provides health care benefits for
the poor of any age.
State workers' compensation
provides benefits to workers who become sick or injured because of a job-related event.
Catastrophic 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.
Agent's Report
Includes information about the client that would be useful to the underwriter
Binding Receipt
Guarantees coverage from the time the applicant completes the application (or the insured completes
the medical exam).
Conditional Receipt
The coverage begins on the date of application or the date of a medical exam if required, whichever is
later. The receipt is made on the condition that underwriting determines the insured is insurable.
, Buyer's Guide
A type of disclosure to an insurance applicant that explains the applicant's rights and responsibilities
with regard to the insurance coverage.
Policy Summary
outlines the policy's coverages and benefits.
entire contract provision
A life and health policy provision that states that if any guarantees, promises, exclusions, or anything
else are not included in the policy (or in the application, if made a part of the policy), then they are
not part of the contract
time limit on certain defenses provision
One of the 12 required provisions in a health insurance policy. Largely the same as the incontestable
clause in life insurance. It limits the time an insurer can void a contract or deny a claim for material
misrepresentations on the application. Usually 2 or 3 years.
incontestability provision
A provision in an insurance policy that states that after a policy has been in force for a set period, the
insurer cannot contest a claim for any reason except for non-payment of premiums. Under most
policies, that period is two years.
Grace Period Provision
Coverage remains in effect for 31 days past premium due date; benefits paid during would be
deducted from sum.
Reinstatement Provision
A provision that lets the policyowner place a lapsed policy back in force within a certain period. This
period is typically three years.
physical examination and autopsy provision
One of the 12 required provisions in a health insurance policy. Allows the insurer to require the
insured to take a physical exam during the claims investigation process. (The insurer must pay for the
exam.) If the claim is because of the death of the insured, this provision also allows the insurer to
order an autopsy to determine the cause of death. Again, the insurer must pay for the autopsy
legal actions provision
One of the 12 required provisions in a health insurance policy. Defines the periods during which the
insured can take against the insurer because it didn't pay a claim.
irrevocable beneficiary
A beneficiary designation in a life insurance policy that the policyowner cannot change without the
beneficiary's written consent.
Notice of Claim provision
the insured must give written notice to the insurer within 20 days after a covered loss occurs
