Life & Health Insurance Exam With Complete
Solutions Graded A+
Insurance
- Is a contract that transfers the risk of financial loss from an individual or business to an insurer. In
return, the insurer agrees to cover the individual or business for certain losses if they occur.
- state run
Peril
What more so directly caused the loss, for example: fire, wind, theft, and water.
Hazard
Something that can increase the chance of a loss occurring. There remains three types of hazards:
morale hazard (carelessness), moral hazard (morality of the individual). and physical hazard (wet
floor).
Underwriting
A process used by insurance companies to try to figure out your health status when you're applying
for health insurance coverage to determine whether to offer you coverage, at what price, and with
what exclusions or limits.
Grandfathered Health Plans
An individual health insurance policy purchased on or before March 23, 2010.
Subsidies
Health coverage available at reduced or no cost for people with incomes below certain levels.
Written Proof of Loss
A legal document that explains what's been damaged or stolen and how much money you're claiming
Beneficiary
The person or entity that you legally designate to receive the benefits from your financial products.
Claim
A formal request by a policyholder to an insurance company for coverage or compensation for a
covered loss or policy event.
Indemnity
A type of insurance compensation paid for damage or loss. When the term is used in the legal sense,
it also may refer to an exemption from liability for damage.
Deductible
The amount you pay for covered health care services before your insurance plan starts to pay.
Blanket Disability
, Any policy or contract which insures a group of persons conforming to the requirements of one of the
following subdivisions (3), (5), (6) or (7) against total or partial disability, excluding such disability from
accident or from accidental means, shall be deemed a blanket health insurance policy.
Preferred Provider Organization (PPO)
- A type of medical plan in which coverage is provided to participants through a network of selected
healthcare providers, such as hospitals and physicians. Enrollees may seek care outside the network
but pay a greater percentage of the cost of coverage than within the network.
- No primary care physician is necessary.
- No referral is necessary.
- Fee-for-service basis.
Health Maintenance Organization (HMO)
- A type of health insurance plan that usually limits coverage to care from doctors who work for or
contract with the HMO.
- Highly stresses preventative care.
- Requires a primary care physician.
- Requires a referral.
- Prepaid basis.
- service based plan > operated on a capitated basis (per person)
- the surmise of an hmo is to keep costs low
Elimination Period (Waiting Period)
An elimination period is the length of time between when an injury or illness begins and receiving
benefit payments from an insurer.
Benefit Period
The length of time during which an insurance policyholder or their dependents may file and receive
payment for a covered event
Long-Term Care Policies
- Needs to provide coverage at a minimum of 12 months.
- Excess money is at the possibility of taxation.
- 30 day elimination period.
- Skilled nursing, intermediate care nursing, adult day care, respite care, and custodial care are all on a
dollar-per-day basis.
- Needs a designated emergency contact.
Inflation Coverage Protection
- Imperative to notify the insured about Insurance Coverage Protection.
- Increases your coverage limits annually so you don't end up underinsured due to rising costs
Nonforfeiture
An insurance policy clause stipulating that an insured party can receive full or partial benefits or a
partial refund of premiums after a lapse due to nonpayment
Primary Insurance Amount (PIA)
- The amount of Social Security benefits paid to a retiree at full retirement age.
- Is equal to the fully insured worker's disability benefits.
Solutions Graded A+
Insurance
- Is a contract that transfers the risk of financial loss from an individual or business to an insurer. In
return, the insurer agrees to cover the individual or business for certain losses if they occur.
- state run
Peril
What more so directly caused the loss, for example: fire, wind, theft, and water.
Hazard
Something that can increase the chance of a loss occurring. There remains three types of hazards:
morale hazard (carelessness), moral hazard (morality of the individual). and physical hazard (wet
floor).
Underwriting
A process used by insurance companies to try to figure out your health status when you're applying
for health insurance coverage to determine whether to offer you coverage, at what price, and with
what exclusions or limits.
Grandfathered Health Plans
An individual health insurance policy purchased on or before March 23, 2010.
Subsidies
Health coverage available at reduced or no cost for people with incomes below certain levels.
Written Proof of Loss
A legal document that explains what's been damaged or stolen and how much money you're claiming
Beneficiary
The person or entity that you legally designate to receive the benefits from your financial products.
Claim
A formal request by a policyholder to an insurance company for coverage or compensation for a
covered loss or policy event.
Indemnity
A type of insurance compensation paid for damage or loss. When the term is used in the legal sense,
it also may refer to an exemption from liability for damage.
Deductible
The amount you pay for covered health care services before your insurance plan starts to pay.
Blanket Disability
, Any policy or contract which insures a group of persons conforming to the requirements of one of the
following subdivisions (3), (5), (6) or (7) against total or partial disability, excluding such disability from
accident or from accidental means, shall be deemed a blanket health insurance policy.
Preferred Provider Organization (PPO)
- A type of medical plan in which coverage is provided to participants through a network of selected
healthcare providers, such as hospitals and physicians. Enrollees may seek care outside the network
but pay a greater percentage of the cost of coverage than within the network.
- No primary care physician is necessary.
- No referral is necessary.
- Fee-for-service basis.
Health Maintenance Organization (HMO)
- A type of health insurance plan that usually limits coverage to care from doctors who work for or
contract with the HMO.
- Highly stresses preventative care.
- Requires a primary care physician.
- Requires a referral.
- Prepaid basis.
- service based plan > operated on a capitated basis (per person)
- the surmise of an hmo is to keep costs low
Elimination Period (Waiting Period)
An elimination period is the length of time between when an injury or illness begins and receiving
benefit payments from an insurer.
Benefit Period
The length of time during which an insurance policyholder or their dependents may file and receive
payment for a covered event
Long-Term Care Policies
- Needs to provide coverage at a minimum of 12 months.
- Excess money is at the possibility of taxation.
- 30 day elimination period.
- Skilled nursing, intermediate care nursing, adult day care, respite care, and custodial care are all on a
dollar-per-day basis.
- Needs a designated emergency contact.
Inflation Coverage Protection
- Imperative to notify the insured about Insurance Coverage Protection.
- Increases your coverage limits annually so you don't end up underinsured due to rising costs
Nonforfeiture
An insurance policy clause stipulating that an insured party can receive full or partial benefits or a
partial refund of premiums after a lapse due to nonpayment
Primary Insurance Amount (PIA)
- The amount of Social Security benefits paid to a retiree at full retirement age.
- Is equal to the fully insured worker's disability benefits.
