New Hampshire Accident and Health
Insurance Exam
Aleatory✔️✔️An insurance policy can be described as this because one party may
recover more in value than he or she has parted with based upon a possible future
event. A contract characterized by an unequal payment or consideration.
Blue Cross/Blue Shield✔️✔️Community or service organizations that provide health
care to subscribers. This covers hospital charges on a UCR basis. They function on
either a for-profit or nonprofit basis depending upon State legislation in a particular
locale. They receive favorable tax treatment as well since many states exempt them
from premium and income taxation.
CHAMPUS✔️✔️Civilian Health and Medical Program of the Uniformed Services. A
government organization that provides health care benefits for the families of members
of the armed services.
Ahesion✔️✔️An insurance policy is described as this because it is drafted by the
insurer and accepted by the applicant. In other words, the insurer "draws up" all the
contract language and the applicant must act according to the language of the
agreement.
Conditional✔️✔️An insurance policy may be described as this since it depends upon
the performance of the parties arriving at an agreement.
Competent Parties✔️✔️The parties arriving at an agreement must possess the
capacity to enter into that contract. In other words, the parties involved in the agreement
must be competent to enter into that agreement.
Consideration✔️✔️In order for an insurance agreement to be binding, both parties
must provide each other with something of value. The premiums paid and the
representations made on the application. The promise to pay legitimate claims for
coverage provided during the policy period.
Contract Law✔️✔️States that elements that must be present in order for any contract
to be legal and enforceable in a court of law include: (1) Offer and Acceptance; (2)
Consideration; (3) Competent Parties; and (4) legal purpose.
Employer Plans✔️✔️These plans provide coverage for employees and their
dependents. Employers administer and manage their health related exposures by using
, commercial insurers or other entities which provide health care services such as an
HMO or PPO. May be self-funded or self-insured.
Errors and Omissions✔️✔️When a producer makes an unintentional error or honest
mistake. Insurer can purchase this type of insurance to cover the malpractice or
negligence of producers.
Estoppel✔️✔️A legal principle involving a broken promise. It prohibits an insurer from
denying a claim due to specific actions by the insurer or its representatives or due to
inaction by the insurer
Exclusions✔️✔️Provision in an insurance policy eliminating coverage for certain risks
or limiting coverage
HMO✔️✔️A type of managed care plan that does not provide coverage for treatment
outside of the managed care network since they required subscribers to utilize the
services of pre-approved providers. They combine health care delivery with prepaid
financing.
Legal Purpose✔️✔️A contract must be in existence with the public interest in mind.
Legal Capacity✔️✔️Requirement that a party to a contract be of legal age and have
requisite mental capacity to enter into contract.
MET/MEWA✔️✔️These plans provide a mechanism for the employees of small
businesses to band together to purchase more affordable group health insurance.
No Loss / No Gain Provisions✔️✔️These are state laws that supposedly prevent a
policy owner from profiting from the purchase of insurance. They state that the purpose
of insurance policies are primarily to indemnify a person for a loss.
Offer and Acceptance✔️✔️Also known as an agreement. A valid offer and
unconditional acceptance must be present in order for the contract to be enforceable.
Genuine Assent must exist.
Open Panel Plans✔️✔️HMOs that function on an individual practice association basis.
these plans offer more flexibility with regard to subscribers selecting physicians.
PPO✔️✔️An organization , generally administered by a third-party administrator, which
enters into a contractual arrangement with doctors or hospitals in order to secure
medical coverage for its insureds. It is not a traditional comprehensive health care
provider. The provider is the physician or hospital "providing" medical services. The
objective is to channel patients to providers that discount their medical services.
Insurance Exam
Aleatory✔️✔️An insurance policy can be described as this because one party may
recover more in value than he or she has parted with based upon a possible future
event. A contract characterized by an unequal payment or consideration.
Blue Cross/Blue Shield✔️✔️Community or service organizations that provide health
care to subscribers. This covers hospital charges on a UCR basis. They function on
either a for-profit or nonprofit basis depending upon State legislation in a particular
locale. They receive favorable tax treatment as well since many states exempt them
from premium and income taxation.
CHAMPUS✔️✔️Civilian Health and Medical Program of the Uniformed Services. A
government organization that provides health care benefits for the families of members
of the armed services.
Ahesion✔️✔️An insurance policy is described as this because it is drafted by the
insurer and accepted by the applicant. In other words, the insurer "draws up" all the
contract language and the applicant must act according to the language of the
agreement.
Conditional✔️✔️An insurance policy may be described as this since it depends upon
the performance of the parties arriving at an agreement.
Competent Parties✔️✔️The parties arriving at an agreement must possess the
capacity to enter into that contract. In other words, the parties involved in the agreement
must be competent to enter into that agreement.
Consideration✔️✔️In order for an insurance agreement to be binding, both parties
must provide each other with something of value. The premiums paid and the
representations made on the application. The promise to pay legitimate claims for
coverage provided during the policy period.
Contract Law✔️✔️States that elements that must be present in order for any contract
to be legal and enforceable in a court of law include: (1) Offer and Acceptance; (2)
Consideration; (3) Competent Parties; and (4) legal purpose.
Employer Plans✔️✔️These plans provide coverage for employees and their
dependents. Employers administer and manage their health related exposures by using
, commercial insurers or other entities which provide health care services such as an
HMO or PPO. May be self-funded or self-insured.
Errors and Omissions✔️✔️When a producer makes an unintentional error or honest
mistake. Insurer can purchase this type of insurance to cover the malpractice or
negligence of producers.
Estoppel✔️✔️A legal principle involving a broken promise. It prohibits an insurer from
denying a claim due to specific actions by the insurer or its representatives or due to
inaction by the insurer
Exclusions✔️✔️Provision in an insurance policy eliminating coverage for certain risks
or limiting coverage
HMO✔️✔️A type of managed care plan that does not provide coverage for treatment
outside of the managed care network since they required subscribers to utilize the
services of pre-approved providers. They combine health care delivery with prepaid
financing.
Legal Purpose✔️✔️A contract must be in existence with the public interest in mind.
Legal Capacity✔️✔️Requirement that a party to a contract be of legal age and have
requisite mental capacity to enter into contract.
MET/MEWA✔️✔️These plans provide a mechanism for the employees of small
businesses to band together to purchase more affordable group health insurance.
No Loss / No Gain Provisions✔️✔️These are state laws that supposedly prevent a
policy owner from profiting from the purchase of insurance. They state that the purpose
of insurance policies are primarily to indemnify a person for a loss.
Offer and Acceptance✔️✔️Also known as an agreement. A valid offer and
unconditional acceptance must be present in order for the contract to be enforceable.
Genuine Assent must exist.
Open Panel Plans✔️✔️HMOs that function on an individual practice association basis.
these plans offer more flexibility with regard to subscribers selecting physicians.
PPO✔️✔️An organization , generally administered by a third-party administrator, which
enters into a contractual arrangement with doctors or hospitals in order to secure
medical coverage for its insureds. It is not a traditional comprehensive health care
provider. The provider is the physician or hospital "providing" medical services. The
objective is to channel patients to providers that discount their medical services.
