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PA Life & Health

PA Life, Health & Accident Insurance

Question	Answer
Uncertainty or chance of loss is called	Risk
When you buy insurance you do what with the risk	Transfer
Not buying insurance means you are	Self insured
Without insurance you are doing what with risk	Risk retention
when companies share risk between one another this is known as	Reinsurance
when partners share risk this is called	Risk sharing
Insurance is based on the	Law of Numbers or Averages
As the number of insured units increases what improves	predictability
actuaries place individuals into groups to study the risk factor known as	Morbidity units
Actuaries never study	individuals
to buy a policy you must have an	insurable interest
what is a legal purpose or reason to purchase insurance called	insurable interest
If someone's sickness or death causes you financial loss this then the risk would be	ascertainable
facing risk of financial loss due to loss of life or property creates an	insurable interest
the principle of insurance or indemnity is that the insured should be ______ to the same financial condition prior to suffering the loss	restored
to sell insurance in PA you must be both ______ and ______ by the insurance dept	approved and admitted
an insurer organized and chartered in PA is known as	domestic
an insurer organized and chartered in another state with an office in PA is known as	foreign
an insurer organized and chartered in any other country with an office in PA is known as	alien
NAIC, national association of insurance commissioners objective is to protect	policy owners
NAIC national association of insurance commissioners are to encourage ______ in state laws and regulations	uniformity
stock companies are owned by	stock holders or share holders
mutual companies are owned by	policy holders
which one issues participating policies: stock company or mutual company	mutual company
which one gives dividends: stock company or mutual company	mutual company
participating policies pay	dividends
fraternal organizations are	tax exempt
fraternal organizations only sell policies to	their members
do fraternal organizations issue participating policies	no
which companies elect board of directors	stock and mutual companies
when a group of individuals band together and self insure each other this is known as a	reciprocal company
reciprocal company is managed by an	attorney of fact
lloyds of london is a self funded	syndicated group
insurers are audited by the insurance department how many times	once every five years
can the insurance department examine insurers more than 1x/5 years	yes
anything unpaid would be considered a	liability
policy reserves are considered a	liability
AM Best and Standard & Poor's _____ and _____ insurers based on financial stability	rates and grades
independent producers can represent ____ _____ _____ company	more than one
captive producers represent _____	insurer
do captive producers own their book of business or renewals	no
Captive producers are ______	by the insurer
who does not use producers and instead goes direct to the public through mass media	direct writers
producers represent the _____	insurer that has them appointed
non appointed producers represent _______ or their ______	themselves clients
Non appointed producers only represent the company at ____ and _____	issue and delivery
producers have ______ authority through their agency agreement	expressed
expressed authority must be ____ _______	in writing
a producer who has company forms, business cards and sample policies would have _____ authority	apparent
is implied authority in writing	no
Implied authority is ______ authority but not in writing	expressed
a producer's deeds and actions would be _____ authority	apparent
when producer is trusted to collect premiums for insurer this is called ____ responsibility	fiduciary
when a producer deposits funds from a client for an insurer they must be in a _____ _____ _____	separate trust account
producers do not receive _____ _____	premiums
producers must keep records of complaints, which ones	written
who notifies the insurer of a death claim	the producer asap
what do producers purchase to protect them from being sued by their clients for liability	errors and omission policy
who can bind the company to a risk	underwriters
who choses the effective date of a policy	underwriters
who gives the final premium on a polciy	underwriters
underwriters job is to determine _____ risks	acceptable
the most important source of information for an underwriter is the	application
when an application is submitted when should the under writing process begin	immediately
underwriters can pull inspection, medical and credit reports but they cannot pull	federal tax returns
is the condition of your residence a factor in rating	yes
considering geographic location as a rating factor is called _____ and is	redlining illegal
if underwriter or insurer makes unreasonable demands on applicant this is	boycotting
when is a producer a field underwriter	face to face contact
field underwriting is to avoid _____ _____	needless costs
insurance is a ___ ____ contract	two party
there are ___ elements to a legal contract	four
agreement is the	offer and acceptance
agreement is also known as	mutual consent mutual assent
application with premium is the	offer
application without premium is the	invitation
policy issuance or delivery is the	acceptance
coverage is effective at the ___ ___ ____ if the premium is paid	time of application
if premium is not paid at time of application the client must sign a	statement of continuing good health
money exchanging hands is called	consideration
you must have a paid premium to have a ____ _____	valid contract
what must exchange hands to have a valid contract	money or consideration
when both parties are of sound legal mind this is called	mental competent
the person buying insurance must stand to incur a financial loss s called ___ ____	insurable interest
having an insurable interest is also called a ____ ____ purpose	valid legal
only one party must live up to terms of the contract once initial premium is paid. this is why insurance is a _______ contract	unilateral
the party that must live up to the contract once initial premium is paid is the	insurance company
insurance contracts are contract of	adhesion
insurance contracts are non	negotiable
insurance contracts have a free look period lasting	10 days
policy replacement is ____ days	20 days
LTC and medigap policies have ____ days free look	30
there will be an _____ exchange of consideration. one party receives more money than they give	unequal
insurance contracts are ____. there is an unequal exchange of consideration	aleatory
insurance contracts are also ______. the company must pay claims under condition client pays premium and lives up to their terms of contract	conditional
statements made by insured or applicant are considerd	representations
statements made by insurance company are considered	promises or warranties
a producer can make a change by getting the insured to ____ each change	initial
when a producer has the insured initial changes this is called the ____ used in case a dispute arises	procedure
statements by the insurer are _____ to be true	guaranteed
the insurance statements can only be changed by the	officer of the insurer
insurance statements can only be changed by the officer of the insurer and must be	in writing
if a warranty is in writing it is an _____ warranty	expressed
application and policy =	contract
contract consists of the _____ and _____	application and policy
A rider	adds on
A waiver	takes away
once you surrender your rights they cannot be enforced at a later date. this is known as	estoppel
signed application and paid premium =	consideration clause
what contains the promises of the company	insuring clause
which clause identifies the owner, insured, beneficairy, company, benefits and initial premium	insuring clause
the promise of the company is in the	insuring clause
which provision states who the owner is and describes their rights	ownership provision
what can't the owner do	change grace period or insured
owner is allowed to choose	policy options
who pays the premium	the owner
if the policy has an ______ beneficiary the owner needs their permission to change the beneficiary or cancel the policy	irrevocable
the premium the company charges is the	gross premium
the net premium is the gross	minus expenses
three types of risk are	preferred standard substandard declined
medical information bureau is a non profit owned by	insurers
the MIB produces a report with	medical information
the MIB report is used to _____	assess risk
the Fair credit reporting act is to protect the	consumer
company must notify applicant in ___ business days if report was ordered	three
reporting agency has ___ days to correct any errors. no legal action is required	thirty
licensing producers is to prove they are competent, trustworthy and	qualified
if you solicit, negotiate or place risk you are required to be	licensed
name 2 that do not need to take a license test. both begin with 'C"	CLUs and CPUs
attorneys applying for a _____ ____ license or a _____ license do not need to test	title insurance temporary
a temporary license is valid for _____ days	180
can you write new contracts with a temporary license	no
can you service existing contracts with a temporary license	yes
a deceased producer's ____ or _____ or ______ can apply for a temporary license	spouse executor administrator
to receive commission a producer must be ____ with an insurer	appointed
what is needed between an insurer and producer to be appointed	written agreement
penalty for transacting insurance without a license is	$1,000
how many CE credits can you carry over	24
renewing your producer license is _______ responsibility	your
who enforces insurance laws	insurance commissioner
who writes the laws	legislators
crimes involving interstate commerce have 10 year jail sentence under what code	18 us code 1033
if interstate commerce crime causes insolvency or physical harm you are jailed for	15 years
risk managers and those who predict risk	do not need a license
when one insurance line is suspended or terminated what happens	all are suspended or terminated
producers have a primary obligation to the	insurer that appoints them
producers obligation to clients is called	utmost good faith
things not to do while selling a policy are called	unfair trade practices
offering a discount to your client is called	rebating
guaranteeing dividends or offering part of your commission is called	illegal inducement
failing to disclose important material facts is called	concealment
causing duress or selling by threat is called	coersion
giving untrue or false information intentionally is called	misrepresentation
inducing insured to lapse, forfeit or surrender their policy is	twisting
making incomplete comparisons just to replace a policy is called	twisting
inducing client to terminate policy only to write a new one is	churning
the insurer may deny, delay or refuse a policy as long as they provide _____ and in _____	reasons writing
if insurer denies, delays or refuses a policy with no reason or explanation this is called	unfair claim settlement
if the state insurance department wants to hold a hearing it must give the producer ____ days notice	10
name changes, address changes must be given to SID within ___ days	30
a non resident has ____ days to apply for a residence license once they move to this state	90
maximum civil penalty for violating insurance law or regulation is	$5,000
if producer charged with a felony or convicted they must notify the SID within ____ days	30
the fine for acting as a producer without a valid license is	$1,000
who is responsible for all advertising regardless of author	insurer
insurers must give dept ___ copies of advertising and remain filed for ___ years	3 4
testimonials in advertising must provide	specific details
when you consider highest income and multiply by career span this is called what approach	human life value
when you consider what the insurance money will be used to fund in the future (future needs) this is called what approach	needs approach
most companies will adjust the amount payable equal to what the premium would have been if purchased at the correct age. this is when an insured	misstates their age or gender
time allowed after the due date to pay premiums without penalties is called	grace period
are you covered during the grace period	yes
used to prevent unintentional lapses of a policy is called	grace period
if the insured dies during the grace period the company would deduct the ____ _____ from the ____ _____	unpaid premium death benefits
company will refund only the premiums paid if the insured commits ____ in the first ____ years	suicide 2
the company cannot challenge statements on the application after ____ years	2
application + policy + attached papers + riders + waivers =	entire contract
entire contract provision states it can only be changed by the	officer of the company
to see intent in court they look at the	entire contract
when insured requests a portion of their cash values this is called a	policy loan
you can never borrow ____ ____ ___ only the loan value	full cash values
the cash value - interest =	loan value
you must repay your ____ loan including _____	entire interest
a company can defer making policy loans for up to	6 months
is a policy loan taxable	no
is a withdrawal taxable	yes
when you transfer, convey or assign your rights and entitlement under policy to another party (like a bank) this is called a	policy assignment
when you transfer you entire policy or rights to the third party and they become the policy owner this is called	absolute assignment
automatic premium loan provision is also know as	premium default
automatic premium loan provision (premium default) allows the insurer to withdraw from ___ ____ ____ to pay your policy ____ on last day of grace period	your cash values premium
you must select the premium default provision at the time of	application
under what provision does the company borrow from the cash values to pay unpaid premiums	premium default
to reinstate your cash value account you must pay the	borrowed premiums plus interest
non forfeiture options can only be used with policies that have	cash value
non forfeiture options give you three choices when you cannot pay your premiums. the three options are	extended term reduced paid up cash surrender
extended term option gives you the ____ protection for the _____ time period	most shortest
which non forfeiture option gives the insured a term policy with face value equal to face value of the original whole life policy	extended term
reduced paid up option gives you ____ protection for the _____ time period	less longest
which non forfeiture option gives the insured another whole life policy with a face amount less than the original policy for one lump sum premium payment. Note the face amount is always reduced for less then the face amount of the original policy	reduced paid up
which non forfeiture option gives you cash values but with no life insurance protection. If the amount you receive exceeds what you paid in, the excess is taxable unless taken out for nursing home or rest of your life	cash surrender
if you do not choose a non forfeiture option the company will chose which option if you are a standard risk	extended term option
if you do not choose a non forfeiture option the company will chose which option if you are a substandard risk	reduced paid up
the following are what type of options: cash, premium reduction, paid up additions, accumulate interest, accelerated endowment, paid up option	dividend options
participating policies pay	dividends
a dividend is a ____ of the paid premium	portion
dividends are never	guaranteed
dividends are _____ based on current experience	projected
dividends are not used to determine the	premium
policy loans have nothing to do with	dividends
are dividend payments taxable	no
are dividend interest earned taxable	yes
when you receive a dividend check this is the ____ dividend option	cash
when you accumulate dividends until a future date then use to reduce your future premiums this is the _____ _____ dividend option	premium reduction
accumulated dividends are used to purchase more insurance of the same type using a single net premium. additional insurance can be surrendered any time for cash values. this dividend option is not offered with term insurance and is called the __ ___ ___	paid up additions
if you leave the money with the company and earn interest, getting an 1099 each year declaring your interest as income this is which dividend option	accumulate interest
when dividends are used to buy a one year term policy this is the dividend option called	one year term
individuals who purchased an endowment can use dividends to accelerate the endowment. Dividends can shorten the endowment period allowing policy to mature faster. this dividend option is called the ____ _____	accelerated endowment
what dividend option allows the policy owner to pay it off early, using dividends to pay the premium over the course of the policy	paid up option
the following would be considered what: cash option, interest only option, interest only with right of withdrawal, life income, fixed period settlement option, fixed amount settlement option, retained asset account	settlement options
when the insured lives up to the contract and dies the company must	settle up
which settlement option does the beneficiary receive full face amount of the policy in one lump sum minus outstanding premiums and loans. Proceeds are tax free until paid to estate. Can also set up a trust for the payouts instead	cash settlement option
when the beneficiary leaves the money with the company to earn interest. company pays only the interest annually to the beneficiary. what settlement option is this	interest only
beneficiary leaves money with company to earn interest. interest paid annually to beneficiary but also has right to withdrawn all or part of the money at any time. this settlement option is	interest only with right of withdrawal
when the beneficiary received income for remainder of their life, benefits stop when beneficiary dies this settlement option is	life income
beneficiary receives face amount + interest over certain period of time. this settlement option is called	fixed period settlement option
beneficiary received face amount + interest until exhausted. Minimum is $1000 per month. this settlement option is called	fixed amount settlement option
insurance company deposits policy proceeds into interest bearing account. must disclose how rate is determined and how credited. Beneficiary can use as they wish. this settlement option is	retained asset account
in life insurance policy a waiver of premium rider must be selected	at time of application
for a waiver of premium rider the disability must be _____ and ____	permanent total
waiver of premium rider has a waiting period of ____ ____ and premiums __ ___ ___	6 months must be paid
benefits are never paid during	waiting periods
will a life insurance policy continue to build cash values with a waiver of premium rider if total permanent disability	yes
you still have _____ rights and you can still get ___ ____ with a waiver of premium rider	non forfeiture policy loans
if you die the life insurance with a waiver of premium rider must pay the	full face amount
under the life insurance waiver of premium rider the company waves the ____ and cannot get them back. this is called	premiums estopple
a waiver of disability pays a monthly income benefit of ___ per ____ face amount to the insured	$10 per $1000
waiver of disability is not available with what insurance	term
a rider for a parent buying life insurance for their children is called	payor rider
a rider that waives the premium if the parent dies or becomes disabled before a child reaches 18yrs is called a	payor rider
a rider that guaranteed your right to purchase additional insurance at certain specified ages without proof of insurability (up to 40) is called	guaranteed insurability rider
a guaranteed insurability rider is also called an ___ ____ option	additional purchase
in a guaranteed insurability rider the total amount that may be purchased is stated at the time of	application
a guaranteed insurability rider is not available with what insurance	term
if you want the beneficiary to receive full face amount of the policy and get back all premiums paid or accumulated cash values you would use which rider(s)	increasing cash value rider or return of premium rider
the increasing cash value rider adds to the original policy an ___ ___ policy	increasing term
under the increasing cash value rider or return of premium rider the term coverage increases to match the ____ value or _____ paid	cash premiums
you get a combination of yours and theirs from whole life and current face amount of second policy upon death benefit. what rider(s) do this	increasing cash value or return of premium
to receive the full face amount plus cash values you use which rider	return of cash values
which rider pays twice the face amount if the insured's death is an accident. pays twice indemnity	accidental death rider
which rider automatically increases face amount without proof of insurability due to inflation. Tied to CPI	cost of living adjustment COLA
what clause is commonly used provision in life policies regarding death from infrequent flights, paying full face amount	aviation clause
in the aviation clause covered individuals are _____ and ____	passengers and crew members
commercial airline pilots, military pilots, student pilots and test pilots are all exclusions under the aviation clause as _____ forms of air travel	hazardous
which clause is added to policies(endorsement on rider) during times of or impending war	war clause
under war clause status excludes coverage during wartime regardless of	circumstances
under the war clause under the status type insurer pays a ____ of ____ or an amount equal to the cash value, whichever is greater	refund premiums
when an individual needs a major operation, is expected to die in 12 months or entering nursing home for rest of life, you can get an advance of death benefit with this	accelerated death benefits or living needs
accelerated death benefits are also called	living needs
accelerated death benefits advantage is they could receive tax free percentage of face amount 25-99% while	still alive
can you use the accelerated death benefit for anything without penalty	yes
upon death, amount received is ____ from face amount under accelerated death benefit	deducted
the minimum to take out on an accelerated death benefit is usually what percent	25%
can insurer charge you a service fee to take advantage of the accelerated death benefit	yes
term riders are used to purchase insurance on ____ _____ of the insured	family members
all whole life mature or endow at age	120
mature also means to ______ a policy	endow
matured or endowed policy means the cash values equal the	face amount
whole life policies ___ ____ keep pace with inflation	do not
a whole life policy requiring life time premiums continuous. premiums and cash value are level. cash values must be illustrated	straight whole life
the most common whole life premium is	continuous premium
whole life policy where entire premium paid in one lump sum. also the cheapest form of whole life insurance	single premium
whole life policy where premiums met over number of years not whole lifetime. still matures at 120. covered after premium payments end	limited pay
whole life policy allows changes to face amount and premiums or conversion to whole life to term and back. used for bad economic times. No need of insurability	adjustable life
guaranteed death benefit through life insurance or variable annuity, whichever is greater.	variable life
when your premium payment is invested in an ____ also referred to as an underlying or separate account, the value fluctuates with the stock market	annuity
to sell variable life policy you must be licensed with ____ and have a series _ and __ license plus life insurance license	FINRA 6 63
this life policy the face amount starts level but goes up and down with the CPI. Always a fixed minimum so never below initial face amount	index based variable life
US Congress does what	writes security laws
SEC does what	enforces security laws
FINRA does what	oversees registered representatives
One policy covers 2 lives. based on least life expectancy. pays to 2nd insured when 1st dies. called	joint life policy
policy covers 2 lives. pays after 2nd dies. also called last to die policy	survivorship life policy
policy taken out by parent on child's life. child becomes owner at age 21. level premium level death benefit. Juvenile does not sign.	juvenile life policy
a policy that is a combination of permanent and term insurance. covers whole family under one package plan. based on age of individual with the whole life policy. policy is called	family policy
how many children can you add to a family policy once issued, without premium increases	as many as you like
children can convert a ____ policy to permanent with a ____ rider with no medical and premium based on their attained age	family term
on a family policy the _____ insured has cash, loan and _____ values	primary non forfeiture
you can change a family policy to a family maintenance income plan using a	rider
family maintenance plan is a combination of whole life and _____ term	decreasing
family maintenance death benefit begins when	you die
family income policy the decreasing term beings when	policy is issued
family term policy helps cover extra ___ ____	child expenses
this plan is tied to the CPI. using a policy rider the face amount goes up automatically with CPI as well as premium. if dont pay new premiums you cannot have future increases in death protection	indexed based whole life
associates are allowed to use life insurance to purchase a business as a business use of life insurance. this is known as __ and ___	buy sell
business life insurance when each partner buys a policy on the other naming himself as the beneficiary	cross purchase plan
business life insurance when partnership is the owner, beneficiary and premium payer on all partners lives is called	entity purchase plan
the difference between cross purchase plan and entity purchase plan is the ____ of the plan	buyer
all policies that earn cash values or surrender values must include this, showing the values and growth with inception and expiration date	policy illustrations
when a business owner takes a life insurance policy on a employee this is what policy	key person
a company needs ___ ____ from the key employee to purchase insurance on them	written permission
a key person life policy has level death protection, level premium whole life or term. may also have a ___ ___ _____ provision if employee quits or is terminated	change of insured
when an employer gives an employee a raise to pay his life policy it is called ____ policy	executive
is the raise in an executive policy taxed	yes as a bonus
for individual life policies is the premium deductibe	no
are benefits from an individual life policy tax free	yes
for individual life policies the principal or death protection is ____ ____ and the interest earned is ____	tax free taxed
if a policy uses a cash surrender and surrenders it prior to maturity the excess over what was paid (interest earned) is	taxed as ordinary income
if you use a cash surrender of a policy but you are entering a nurse home for rest of life the entire amount is	tax free
dividends are paid ___ ___. interest earned is ___	tax free taxed
under section 1035 of the IRS Code you cannot exchange a ____ policy for a ____ _____ policy	annuity life insurance
can you exchange an annuity for a life insurance policy	no
benefits paid under a life insurance policy to terminally or chronically ill	accelerated benefits
accelerated benefits are received income ____ _____	tax free
accelerated benefits to chronically ill have a limit of	$175 per day
this life insurance is written as annually renewable	term
which life insurance requires 10+ participants	group life
group life is a policy between the ____ and ____	insurer and employer
on a group life policy the employees get	certificates
a group plan can be converted to a _____ plan when the employee leaves employment	whole life
who holds the contract on a group life policy	employer
when can an employee who leaves a company change his group life plan to whole life, during the ____ period with no proof of insurability within ____ days	conversion 30
can you convert your group life plan to whole life while employed for specific reasons	no
group life has two types contributory and non contributory. which one requires 100% participation	non contributory
a group life contributory plan requires ____ participation	75%
for a group life plan employees serve a _____ period. during this time they are not eligible for insurance. usually 1-3 months	probationary
on group like plan once complete probationary period you can enroll without a medical exam during the _____ period	eligibility
do you need a medical exam to enroll in a group life plan during the eligibility plan	no
a baby group has less than 10 participants. each has their own policy, subject to medical exams and can differ. this is called a ____ group policy	franchise
how many participants are in a franchise group	less than 10
when several employers band together forming a trust to get insurance under one plan, all similar nature companies this is called a	multiple employer trust
when can you use an annuity to fund a group insurance	never
does the insurance commissioner regulate group rates	no
do employees rely on their group policy for covering end of life expenses	no
policy written to protect consumer loans is a	credit life policy
a credit life policy is purchased by the ____ naming the ____ as beneficiary and is a ____ term insurance	borrower creditor decreasing
on a credit life policy the insurable interest is the ____ amount of the ____. there are ______ amounts to borrow and time periods	dollar loan maximums
a credit life policy is a _____ term policy	decreasing
you can never have ___ ____ than the loan on a credit life policy	more insurance
on a credit life policy if the loan is pre-paid the insurance is	terminated
with credit life insurance is the borrower defaults the insurance is ___ and the creditor can ____ collateral	terminated repossess
if a credit life loan policy is delinquent the insurance is	terminated
universal life is usually written as	term insurance
universal life is term insurance on a __________ basis and does not pay ______	non participating dividends
universal life insurance is _____ insurance protection and a ____ value account	pure cash
the cash value of a universal life cannot ____ the face amount of the insurance	exceed
the amount of interest can be ______ to reflect policy _____	adjusted loans
do premiums need to be paid every month for universal life	no
if you dont pay universal life premiums each month what must be true	you have money in the cash value account
this life insurance was created to address low interest rates on whole life policies in high inflation	universal life
universal life comes in two forms. they are	part A and B
universal life part a beneficiaries receive	only the face amount
universal life part b beneficiaries receive	face amount plus accumulated cash values
if the company deducts a percent of universal life for expense is this legal	yes
universal life mostly guarantees what percentage interest on surrender values	5%
for universal live the insurers must send the policy holder	annual statements
universal life can be used for life time protection but as you age the _____ charges increase	mortality
can you make partial withdrawals from you universal life policy, the cash value account	yes
on universal life to increase the term you must provide	proof of insurability
the difference between the cash value and death benefit of a universal life policy is called the	corridor
one most common type of permanent protection is the	universal life
if the cash value is invested in the stock market it would be a	variable universal life policy
in a variable universal life policy the value is based on the	underlying account
insurers must send policy holders of a universal account an	annual statement
you can increase the term of a universal policy as long as you provide	proof of insurability
does a variable universal life policy keep pace with inflation	yes
this is an IRS term of all types of cash value policies and when they would be subject to taxation and penalties	modified endowment contracts
to discourage using life insurance as a tax free investment the IRS enacted a ___ pay test	7
if the policy holder pays more than the required premium in the first 7 years that policy has ____ changed and can be taxed	materially
when a policy is materially changed to be taxed this never changes back to tax free. it is called the 7 pay test or	modified endowment contract
any policy changed to a modified endowment contract is subject to a ___ penalty	10%
which life insurance policies must pass the 7 pay test	all
this insurance is considered temporary written for a specific period of time.	term insurance
this insurance provides death protection benefits only with NO cash, loan or non forfeiture value	term insurance
term insurance is an example of	pure risk
this term insurance has the premium stay the same. protection remains constant. death protection remains level	level term insurance
this term insurance the face amount always decreases but premiums stay level. at the end of the policy period the face amount would be zero	decreasing term insurance
this term insurance the face amount always increases usually premiums do too. starts out with little to no protection.	increasing term insurance
this term insurance you can renew it on the anniversary date with no medical exam and premiums based on your current age	renewable term insurance
this term insurance lets you change the policy to permanent type once term coverage expires based on current age with no proof of insurability	convertible term insurance
this term insurance starts out with temporary coverage and will change to permanent coverage	convertible term insurance
a multiple protection policy is a combination of ____ and ____ ____	term whole life
an insurance policy with both term and whole life is called a	multiple protection policy
this insurance gets you most bang for your buck	term insurance
this insurance gets you most protection for your premium. may be used with other policies. can be written for a certain time period or duration	term insurance
when you convert a whole life policy to term insurance you would need	proof of insurability
succession of beneficiaries are	primary secondary tertiary
the second beneficiary is also called the	contingent
secondary beneficiary receives benefits if the primary beneficiary ____ the insured	predeceases
if no named beneficiary then proceeds to to the	estate
proceeds of a life policy are ___ subject to federal income tax unless going to an ____	not estate
if proceeds go to an estate they are taxed under	estate taxes
if beneficiary is a minor usually courts appoint a	guardian
some parents create a ____ for a minor beneficiary	trust
when policy holders leave their life insurance proceeds to a ____ they have more control over how they are spent	trust
the two types of beneficiaries are	revocable and irrevocable
a beneficiary that can only be changed by declaring them incompetent by a court with with an agreement with the policy owner and beneficiary is called a	irrevocable beneficiary
a revocable beneficiary is vested. true or false	false
an irrevocable beneficiary is vested. true of false	true
can an irrevocable beneficiary get a loan	yes
a policy holder can change _____ options, _____ options and dispose of the policy if no irrevocable beneficiary on the policy	dividend, settlement
under this clause the insured always survives the beneficiary. used in event insured and beneficiary are killed in same accident	common disaster clause
proceeds of a life policy can never be paid or forfeited to the	insurance company
the beneficiary's name first appears in the	application
an ____ or _____ of your estate may be named the beneficiary	executor administrator
when children are named as class they are not	individually named
per capita beneficiaries receive	equal amounts
not everyone receives the same as this type of beneficiary	per stirpes
if mother names 3 sons as her beneficiaries. 1 son has 2 children. this son dies before his mother. when the mother dies she has them split $90,000. The 1st 2 sons receive $30,000 and the last son who died, his 2 children receive $15,000 each. this is	stirpes beneficiaries
when a beneficiary receives proceeds over time then dies. the remaining proceeds are paid to a trust of non profit. this is called a ____ ____ trust	charitable remaining
when proceeds are paid to a beneficiary under the fixed amount or fixed period option they receive part ___ and part ____	principal interest
when the owner or grantor exercises complete control of the trust while living this is called an ___ ___ trust	inter vivos
an upside down life insurance policy is an	annuity
when you give the company your premium in exchange for their promise to pay a death benefit this is called	life insurance
when you give your money to a company and ask them to give your money back usually for the rest of your life this is called	annuity
you use an ____ to liquidate your own estate	annuity
with an annuity your money is	at risk
a temporary annuity pays for a _____ number of years	specific
when an annuity pays for a certain number of years this is a	temporary annuity
a temporary annuity does not pay	for life
the two types of annuities are	immediate or deferred
if you want your annuity money back in a single lump sum you would choose what annuity type	immediate annuity
if you want your annuity money back over time, usually after a year and you pay into if over time you would chose a	deferred annuity
waiting for your deferred annuity to pay out if called the	accumulation period
deferred annuities require you begin withdrawing at a	certain age
when you start withdrawing from your annuity this period is known as the	annuity period
the annuity period is also called the	annuitization period
the annuitization period is called the	liquidation period
if you surrender your annuity during the accumulation period any gains are ____ as ____ income	taxed ordinary
a surrender charge may be charged and must be ____ on annuities	disclosed
when you write a check for one lump sum to a company and defer payments to a later date this annuity is called a	single premium deferred annuity SPDA
is there an accumulation period on a single premium deferred annuity	no
all deferred annuities have a free look or ____	bail out period
annuities can be one of two	fixed or variable
a fixed annuity puts your investment into a ____ account backed by the company's assets	general
a fixed annuity gives you a _____ rate of interest	guaranteed
with a fixed annuity who assumes the risk	the insurer
anything fixed does not	keep up with inflation
which annuity puts your investment in a separate underlying account and invests in the stock market	variable annuity
does a variable annuity guarantee a return	no
whose money is at risk in a variable annuity	yours
variable annuities are based on _____ risk	speculative
anything index based must guarantee a	minimum interest rate
if an index based fixed annuity ties to the CPI falls, it does not fall below a fixed rate. true or false	true
annuities are purchased for retirement so the ____ does not outlive their income	annuitant
the purchaser of an annuity is called a	contract owner
who holds all the rights of a annuity policy	the contact owner
can the owner change the annuitant	no
can the owner change the beneficiary	yes
it is easier to get an ____ than a ____ _____ policy	annuity life insurance
annuity used a different ____ table than life insurance	mortality
life insurance considers how long before the insured	dies
annuity considers how long the annuitant	lives
annuity premiums can be met two ways: ___ ____ sum or _____ of time	one lump period
this annuity pays benefits for lifetime of annuitant with no refunds or survivor benefits. if you die before receiving full amount, company keeps the balance	straight life annuity
a type of pure annuity is called a	straight life annuity
this annuity pays income for life but guarantees payout for a certain period of time. you purchase 10 years and die 3 years in, beneficiary receives 7 more years	life annuity period certain
if you outlive this annuity the beneficiary gets nothing	life annuity period certain
this annuity guarantees payout amount at least equal to what was paid in. requires lump sum payment to purchase. pays out in one lump sum	cash refund annuity
this annuity guarantees payout amount at lease equal to what was paid in. requires lump sum payment to purchase. pays out over period of time	installment refund annuity
annuity based on 2 annuitants. payments stop when first dies	joint life annuity
annuity based on 2 annuitants. 2nd gets reduced payout when 1st dies. recommended for retired couples	joint and survivor annuity
all gains over purchase price are taxed as	ordinary income
what happens when you liquidate your annuity. the company establishes a	new life expectancy
there are two type of retirement plans. they are	qualified and non qualified
a retirement plan approved by the irs is a	qualified plan
a retirement plan where the entire amount withdrawn is taxed is called a	qualified plan
how much can you contribute to an IRA over age 50 as additional to catch up	$1000
IRA inheritors have ____ withdrawal times and pay ____ tax	mandatory income
an advantage for employers of qualified retirement plans is the contributions from the employer are ____ ______ as a legitimate business expense	tax deductible
what type of retirement plan allows the employer's contributions to be tax deductible as a legitimate business expense	qualified
contributions to a qualified retirement plan are	non forfeitable
when you leave your job the qualified retirement account can rolled over to another plan to avoid taxes and penalties within	60 days
to avoid taxes and penalties, keep the qualified retirement plan in ____ ___ ____ when you roll it over	the same name
all qualified plans must meet standards set forth by the employee	vesting schedule
this word means each employee has a right to their funds	vesting
all contributions to a qualified plan by the employee are ____ non forfeitable	100%
to avoid a 10% penalty do not withdraw from a qualified plan prior to ___ but start withdrawing by ___ to avoid a 50% penalty	59.5 70.5
are contributions to a qualified plan tax deductible	yes
can a qualified plan discriminate in some cases	no
___ withdrawals of a qualified plan are taxed	all
Keogh, HR-10, 401K, IRA are examples of what type of retirement plan	qualified
Keogh and HR-10 are for	self employed
can a limited partner participate in a Keogh or HR-10	no
retirement plans where employees have a salary reduction and defer that amount into it are know as	401K
tax sheltered annuities are for those a public schools or nurse at non profit or minister at non profit church. an example is	403B plans
tax sheltered annuities for non profit organizations like parochial schools and charities are	501C plans
employer sponsored IRS with expanded contribution rate is called a	simplified employee pension plan sepp ira
is a simplified employee pension plan an ira	yes
what is an example of a college savings program	529 plan
is a 529 plan a retirement plan	no
when you include life insurance in a retirement plan it is called an	incidental benefit
is a Roth IRA a qualified plan	no
what type of retirement plan lets you withdrawn tax free	non qualified
what is an example of a non qualified retirement plan	Roth IRA
you can contribute to your Roth IRA but only while still	working
this non qualified IRA has no income tax for inheritors and no mandatory withdraws	Roth IRA
if I withdrawn from my Roth IRA for a first time home after having it 5 years will I be penalized	no
can I withdraw from my Roth IRA for educational and disability purposes without a penalty	yes
if you exceed the legal limit and contribute excess to your IRA then penalty is	6%
for a non qualified plan the ____ are taxable. the ____ are not tax deductible	gains contributions
a non qualified plan does not meet IRS approval to be used as a tax writeoff. true of false	true
in non qualified plans can they discriminate	yes
earnings grow tax deferred in a ______ retirement plan	non qualified
life insurance proceeds are	tax free
interest earned on life insurance proceeds are _____ as ordinary income	taxed
proceeds paid to an estate are	taxable
can you do a tax free exchange of a life policy for an annuity	yes
can you do a tax free exchange of one IRA for another IRA	yes
can you do a tax free exchange of one annuity for another annuity	yes
can you do a tax free exchange on an annuity for a life policy	no
business use life insurance premiums are	not deductible
any business use life insurance benefits are	tax free
what life policy are premiums not deductible and benefits are tax free if owned 3 years prior to death	viatical life
most common premium type is	continuous premium
the cheapest form of whole life if the	single premium
three most common individual owned permanent insurance are:	variable life, universal life, whole life
level term means the death protection will	remain same
when face amount decreases but premiums stay level this is called the _____ term	decreasing term
flexible premium, two part contract. renewable term policy with separate cash value account. no dividends. this insurance is called	universal life
what insurance is a combination of life insurance and a variable annuity	variable life
to sell a variable life policy you must be a ____________	representative
a whole life policy taken out by a parent. has level premium and death protection. minor does not sign	juvenile policy
policies sensitive to interest rates are	consumption based whole life
insurance setup for sole purpose of reselling it	STOLI
investor owned life insurance	IOLI
NCOIL Act addresses what two practices	STOLI and IOLI
to restore an individual to where they were prior to loss is called	principal of indemnity
privacy act established to protect the	insured
state department examines insurers at lease ____ every ___ years	once 5
when premiums are returned on a short rate basis who terminated the policy	policy holder
when premiums are returned on a pro rated basis wo terminated the policy	insurer
when premiums are paid at time of application producer gives applicant a	conditional receipt
death benefit in a key person life policy is payable to the	employer
what would a counter offer do to the original offer	void it
an IRA is an example of a _____ annuity	deferred
a ____ _____ makes the insurer liable from time of application regardless of applicant's insurability	binding receipt
once a producer has face to face contact with the client they are considered a	field underwriter
to sell insurance under an assumed name you need to file a certificate with the	department of state
is your licensed issued under your assumed name to sell insurance if you filed a certificate	no under birth name
a producer needs a ____ _____ to be appointed	written agreement
to receive commission a producer must be	appointed
if an insurer terminates a producer they have ___ days to notify the state insurance department	30
you must have a certificate of _____ to be appointed with a insurer to collect ____ unless hired for clerical	qualification premiums
long term care rider reimburses expenses for ____ and ____ services in a nursing home or convalescent facility	health social
what must be present when an applicant is not the insured	an insurable interest
the patriot act requires all insurers to have __ ____ ____ programs	anti money laundering
group AD&D policies have their premiums tax deductible for the ____ as a ____ _____	employer business expense
group AD&D benefits are	tax free
are work related deaths included in a group AD&D policy	no
producers must be at least ___ yrs old	18
producers need ___ hrs of pre licensing with __ hrs of ethics	24 3
pre licensing certificate is valid for __ year	1
passing exam results are valid for ___ year	1
you have how much time after passing your state exam to apply for a license	1 year
a producer will renew their certificate of authority every	2 years
a temporary license is granted for	180 days
you cannot sell ____ policies with a temporary license	new
if a license lapses a producer has _____ to get their CE done and pay renewal fees before needing to retest. active deployed military have longer	1 year
a non resident producer has _____ to apply for a resident producer's license if they buy a home or business in the state	90 days
number of days the department must give notice of a hearing	10
number of days to respond to a department inquiry	30
number of days producers have to correct a violation	15
number of days the insurance commissioner has to approve or disapprove form changes	30
the waiting period for rates by an insurer go into effect is	30 days
if rates are not approved a hearing will be held within ____ days of the insurer being notified	10
resident insurance producer license fee is	$55
non resident producer license fee is	$110
civil penalty for each unintentional violation of unfair methods of competition	$1,000 max $10,000 in 6 months
civil penalty for each intentional violation concerning unfair methods of competition	$5,000
per day fine for failure to correct any violation	$100
NAIC national association of insurance commissioners meet ___ per year	3
NAIC has divided the US into ___ zones	4
the insurance commissioner oversees	pre licensing and continuing education
who can invoke fines, suspend or revoke a license, deny a renewal but cannot sentence to jail or community service or request producer to post a bond	insurance commissioner
can the insurance commission prosecute a producer for violations	no
can the insurance commission file charges against a producer	yes
known as the financial services modernization act of 1990 it removed barriers between baking security and insurance companies . signed by bill clinton	Gramm Leach Bliley Act GLBA
who oversees the national do not call registry	FTC federal trade commission
who oversees the state do not call list	the PA Office of the Attorney General
which one cannot still call due to the do not call list: charities, debt collectors, political organizations, informational calls, telephone surveys, warranty contract organizations	warranty contract organizations
terrorism risk insurance program creates a temporary federal program providing compensation for certain losses of an act of terrorism. TRIA first signed in ____ then TRIPRA signed in ___ and finally ammended TRIP in ____	2002 2007 2020
uncertainty or chance of loss is called	risk
if you do not buy insurance you are considered to be	self insured
mitigation is an example of	risk reduction
insurance is based on	pure risk
pure risk is defined as	chance of loss with no change of gain
risk with a chance of gain is called	speculative risk
facing the risk of financial loss due to loss of life or property creates an	insurable interest
the principle of insurance is also known as	indemnity
fraternal organizations are	tax exempt
producer and client must ____ any changes on the application	initial
underwriters may order	inspection and medical reports
if an underwriter makes unreasonable demands on an applicant this is called	boycotting
the producer should get the _____ information from the client at time of application	maximum
four elements of a legal contract are	1. agreement or Mutual Consent 2. consideration 3. mentally competent parties 4. valid legal purpose or insurable interest
insurance is a ___________ contract. one party must live up to the terms after initial premium is paid	unilateral
insurance contracts are also know as contracts of	adhesion
insurance contracts are non	negotiable
any ambiguous language found in an insurance contract will be found in favor of the	insured
most insurance policies have a free look period of	10 days
LTC and Medigap has a free look period of	30 days
insurance company must pay the claim under condition client pays the premium and complies with terms of contract. This makes insurance contracts considered	conditional
statements made by the applicant or insured are considered	representations
statements made by the applicant can only be changed by the	insured
an insurance contract consists of	application and policy
consideration clause is the	signed application and paid premium
the insuring clause in a health policy contains the	promises of the company
the provision that states who the owner is and describes their rights is called the	ownership provision
the premium charges is considered to be the	Gross premium
what does MIDE HIGH stand for	Morbidity / Interest / Duration / Expenses
gross premium minus company expenses equals	net premium
preferred = lowest premium, standard = average premium, substandard = what premium	highest
Medical Information Bureau is to help _____ companies underwriting expenses	reduce
a public adjuster has ____ days before retesting is required	60
the general definition of the health insurance benefits can be found in the	Insuring Clause
the clause containing the promise of the company to pay a claim in exchange for premium paid and compliance with the terms of contract is the	Insuring Clause
the Outline of Coverage MUST be delivered and explained	at the time the policy is delivered
health policies NEVER provide	retirement income
benefits are never paid during the	probationary period
the probationary period starts when	the policy is issued
in AD&D policy the death benefit is called the	principal sum
in AD&D policy the dismemberment benefit is called the	capital sum
which parts would a dismemberment policy NOT cover: foot, arm, eyesight, leg, finger	finger
what are the following: suicide, mental disorders, self inflicted injuries, disease, war or acts of war	common exclusions
in an AD&D policy the principal sum goes to the_____ if the insured dies	beneficiary
in an AD&D policy the capital sum goes to the ___ in case of dismemberment	insured
in a group AD&D policy the premiums are deducted by whom under what category	by the employer as a business expense
when a health policy will NOT cover more than a specific number of visits to a Dr or therapist this is called a	limitation
when health policy reduces the coverage of claims as paid you can have the coverage increased in the future by utilizing	restoration of benefits
someone needing surgery but not hospitalization would actually need	ambulatory services
ambulatory services is also called	out patient care
hospital pre certification is used to discourage	unnecessary operation
for an emergency situation would you need a hospital pre cert	no
health savings accounts are for	individuals or families not group plan with high deductibles
if you use money in your HSA for anything other than medical expenses it is subject to a ___ penalty tax	20%
an individual can contribute ____ a year to a HSA	$3,350
family coverage can contribute ___ a year to a HSA	$6,650
if over 55 and under 65 you can contribute an extra ____ into your HSA under the catch up law	$1,000
this type of savings account is for self employed	Medical Savings Account MSA
this is an IRS approved employer funded way to reimburse employees for out of pocket medical expenses and health premiums	HRA Health Reimbursement Account
when an employee allows their wages to be lowered so that amount is put in a savings account to use for medical expenses this is called a	Flexible Savings Account FSA
all health policies are written as a	one year contract
all health policies must contain a provision describing how the policy can be	renewed
HRA Health Reimbursement Account is an IRS approved health benefit funded by whom	the employer
an IRS approved health benefit plan that reimburses employees for out of pocket medical expenses is called a	HRA Health Reimbursement Account
a health benefit that employees have their wages lowered to put into this account to be used for medical expenses is called a	FSA Flexible Savings Account
A health benefit where individuals can save for medical expenses is called a	MSA Medical Savings Account
this is a health policy allowing the insured to renew thje policy up to age 65. Company may ONLY cancel due to non payment. Premiums may increase based on terms of policy ONLY	Non Cancelable policy
this health policy allows the insured to renew up to 65. Company can increase premiums for entire class	Guaranteed Renewable policy
This health policy can be renewed up to 65. Company has the right to NOT Renew if they choose.	Conditionally Renewable policy
This health policy is the most restrictive. The insurer can renew or NOT renew. It is up to the company	optionally renewable policy
This health policy can be terminated by the insurer at ANY time. unearned premiums need to be returned to the policy holder	Cancelable policy
There are 12 mandatory health policy / uniform provisions. they are	1.entire contract 2.time limit on certain defense 3. grace period 4. reinstatement 5. notice of claim 6. claim forms 7. proof of loss 8. time payment of claims 9. legal actions 10. payment of claims 11. physical examination & autopsy 12. change of bene
The application, policy & attached papers make the entire contract. Only changed by officer of company in writing. this health provision is called	entire contract provision
limits the insurers rights to contest contract to 3 years. this health provision is called	time limit on certain defense provision
time allowed after due date to pay premiums without penalty. periods based on mode and method of payment. this health provision is called	grace period provision
usually includes payment of overdue premium, accidents covered immediately, sickness 7-10 days later. no response from insurer, reinstated after 45 days. benefits=use your original age. this health provision is called	reinstatement provision
you must notify insurer of claim within 20 days. give notice to producer = giving to insurer. this health provision is called	notice of claim provision
sent to insured within 15 days or 10 working business days. this health provision is called	claim forms provision
insurer should pay immediately or within 60 days unless payment is periodic. this health provision is called	time payment of claims provision
submitted within 90 days of loss, in event of legal incapacity no time frame. this health provision is called	proof of loss
no legal action can be started against company sooner than 60 days, after that you have 3 years. this health provision is called	legal actions provision
will be paid to beneficiary if no beneficiary then to estate. this health provision is called	payment of claims provision
company will pay for exams, may order autopsies when not prohibited by law, company must pay for autopsy and be done asap. this health provision is called	physical examination & autopsy provision
policy owner may change the beneficiary and assign the benefits. this provision is called	change of beneficiary provision
how many mandatory (uniform) health policy provisions are there	12
how many optional health provisions are there	11
if insured changes to less hazardous job, insurer will pay claim & refund unearned premium. Change to more hazardous job they will pay reduced benefits. this optional health provision is called	change of occupation
if insured misstates their age/gender company will(if there is a claim) adjust amount due and pay claim equal to what would have been with correct info. this health optional provision is called	misstatement of age/gender
if have more than 1 policy the company will void the amount in excess and return premiums or insurance will be limited to 1 policy chosen by insured. Premiums for other policy is returned. this optional health provision is called	other insurance with the insurer
you ____ make a profit off of insurance	cannot
are you allowed to profit off of insurance in some situations	no
if have 2 or more policies with other insurers, 1 company must be primary. you cannot collect total benefits from both/all companies. this health optional provision is called	insurance with other insurers
you cannot make a profit off insurance. if have 2 or more policies at different companies, 1 must be primary. you cannot collect total benefits from both/all companies. this pertains to ALL benefits, disability, etc. this optional provision is	insurance with other insurers
can only be used with non cancelable and guaranteed renewable policies. If disability income ? working benefits, will be reduced but not below $200. this optional provision is called	relation to earnings
allows company to deduct unpaid premium from claim payments. this health optional provision is called	unpaid premiums
company must send written notice if intent is to cancel, unearned premiums must be returned to policy holder. this health optional provision is called	cancellation
this optional health provision amends the policy to conform to state statues(laws)	conformity with state statues
liability is denied if insured engaged in illegal practices. not concerned with misdemeanors. this optional health provision is called	illegal occupation
insurer is not responsible for losses while insured is intoxicated or under influence unless prescribed by physician. this optional health provision is called	intoxicants & narcotics
basic medical expense insurance has no ____ and no ____	deductibles coinsurance
basic medical expense insurance covers from the first dollar of claim up to the policies	maximum
basic medical expense insurance can be written as	separate policies
hospital expense policies, miscellaneous expense policies, surgical expense policies are examples of	basic medical expense policies
this basic medical policy can be written as individual or group. It pays expenses for room & board in hospital on actual incurred basis up to max amt. usually reimbursement or indemnity policies.	hospital expense policy
this basic medical policy pays for hospital extras to a limit. listed as reasonable and customary charges. examples are RX, xrays, anesthesia, OR expenses. Benefit is 10x daily room and board with a maximum. in hospital visit by physician also covered	miscellaneous expense policies
including post op expenses. use the relative value schedule. pay on a UCR usual customary reasonable charges basis for unscheduled benefit	surgical expense policies
used to determine amount insurer pays. assigns numeric value to operation then conversion factor multiplied by it to get amount to pay. this is called the	relative value schedule
hospital expense, miscellaneous expense and surgical expense policies are usually combined under 1 policy but may be purchased as	separate plans
complications associated with maternity are covered	immediately
there can be a _____ period for maternity benefits	waiting
a policy will pay ___ charges when certain benefits are not listed on a payment schedule	UCR
the cost of medical treatment is based on	usual customary and reasonable
Usual Customary and Reasonable is based on	geographic area
most basic medical health policies do not pay for	elective cosmetic surgery
this health coverage is a broad form of medical coverage. written as individual or group. picks up where basic medical ends. does have coinsurance and deductibles with max benefits. once max benefits reached insured pays remaining costs.	major medical
under this provision the insured's OOP expenses are limited to an agreed amount. lower this amount higher the premiums. do not pay dental unless from covered accident	stop loss
if dental benefits are a result of a coverage accident ___ ____ will pay dental benefits under this provision	stop loss
what provision in health insurance limits your out of pocket expenses to an agreed amount(does not pay dental benefits)	Stop Loss
This health insurance deductible is beneficial for large families. Can be met per person, family, calendar year but NOT for each covered expense.	Single Accident Deductible
children can stay on their parent's health policy until what age	26
how many hours inpatient care is provided for mother and child natural delivery on health policy	48
major medical benefits are subject to taxation. true or false	false
notify your health insurance of marriage if adding your spouse to your policy within	30 days
health insurance broader than major medical is called	comprehensive major medical
comprehensive major medical is sold on a ______ basis	group
comprehensive major medical are a combination of ___ ____ and ___ ____	basic medical major medical
the deductible under a comprehensive major medical policy is called a	corridor deductible
a corridor deductible is applied ____ basic benefits are exhausted	after
A corridor is favorable to the	insured
when an Individual is paying premiums, premium is tax deductible when medical expenses exceed	7% gross income
a specific or specified health policy is also called a	Limited Health Policy
this health policy covers one specific risk. examples are hospital income, dread disease and credit disability. Sold by direct writers.	limited health policy
dental insurance can be sold as ____ or ____ basis	individual group
how is most dental insurance sold	group
root canals are known as	endodontics
braces are known as	ortodontics
bridge work or crowns are know as	prostodontics
gum and tissue supporting structures of teeth are known as	periodontics
dental policies cover crowns, caps, fillings know as _____ care	restoration
dental coverage does not usually cover denture fittings or	tooth implants
vision policies do not cover	safety glasses
you ____ form a group just to obtain group insurance	cannot
a true group of insurers need ___ participants or more	10
group insurance is ___ written on an individual basis	never
with group insurance the employer gets the policy and employees get	certificates
two types of group plans are:	contributory non-contributory
contributory group plan need how much full time participatants?	75%
non-contributory group plan needs how much full time participants	100%
group plans have probationary period then the _____ period	eligibility
an employee can convert their group plan to an ___ plan when they leave withOUT proof of insurability for 31 days	individual
this provision in health plans is used with coordination fo benefits, allowing doctors from another insurer to review medical records, etc	concurrent review provision
this expression overrides pre-existing conditions when employer replaces a group plan	no loss no gain
COBRA is federal law requiring all employers with ___ + employees to include continuation of benefits	20
COBRA is continued for ___ months under group rates	36
qualifying events for COBRA are death, divorce and	legal separation
COBRA premiums is ___% of premiums paid by active employees	102
if employee ineligible due to termination or reduction of hours COBRA is extended for ___ months	18
the Dept of ____ oversees COBRA	Labor
employers with less than 10 employees are called ____ groups	franchise
each employee receives their own policy and are subject to ____ and insurance ____	medical exams underwriting
A self insured group uses a __ __ ___ to process claims	third party administrator
A self insured group ______ pay claims from their own accounts	does not
when several employers band together to get one group plan this is called a	multiple employer trust
blue cross blue shield are pre-paid plans and members are called	subscribers
what makes HIPPA so nice	portability
if individual covered by prev employer more than ___ days the probationary period on new plan is ___	63 waived
Who oversees HIPPA? The Dept of	Labor
Health Maintenance Organizations are ____ plans	pre-paid
HMO members are called	subscribers
Are HMOs allowed to make a profit?	yes
HMOs are usually written for a group of ___ or more	25
HMOs require you choose a _____ and you are locked into a ____ provider	primary care physician network
if you go OUTSIDE your HMO network will they pay for your claim (non emergency)	no
Type of HMO where doctors are salaried. also for members only	Closed Panel HMO
type of HMO where they are NOT salaried and will treat non members	Open Panel HMO
an actual hospital acting as a HMO is called a ____ model HMO	staff
HMOs can do business in PA but only in approved	counties
type of health insurance that provides more services with less choices	HMO
HMO is known as a ____ plan	service
This health insurance is a select group of medical practitioners and hospitals contracting with BCBS or an insurance company	PPO
in a PPO doctors accept payments as payment __ __ for services provided	in full
PPOs are usually written on a ____ basis rather than pre-paid	reimbursement
this health insurance usually reimburses. also has pre-arranged costs for services renders. May go out of network but pay more	PPO
POS is __ _ __ and is like a HMO, both use a _____ system	point of service gatekeeper
patient care is coordinated by an in network PCP under this health insurance	POS
disability insurance is designed to replace a ___ of insured's lost income if disabled due to injury or sickness	portion
disability insurance pays __% of your base salary for Total disability	60
disability insurance pays ___% of your base salary for Partial disability	50
disability insurance is based on ____ status	occupational
two types of occupational status:	own or any
Own switches to Any after	2 years
all disability policies has both ____ and waiting periods	elimination
elimination period begins once you are	disabled
when you cannot perform one or more assigned duties this is ___ disability	partial
short term disability pays for ______ on a ___ basis	2 years weekly
short term disability only pays for	non occupational
long term disability pays until age ___ on a ____ basis	65 monthly
waiting period for SS while on disability	5 months
to collect SS the disability must end if death or last at least ____ months	12
you must be disabled at least ___ months to collect SS benefits and have worked ____ quarters	5 60
who determines if an individual is disabled	social security
when on SS for 2 years and disabled you qualify for	medicare
you may combine disability with _____ comp	workers
workers comp pays for ______ injuries	on the job
a licensed physician decides if you're workers comp eligible and ____ ___ certifies your benefits	workers comp
non occupational disability policy only pays for ___ work related injuries	non
if you lose a member of the body disability policies pay for _____ disability	permanent
for permanent disability you receive a ___ ___ tax free for the body part lost	lump sum
on a disability policy the premiums are Not deductible but the benefits are	tax free
an employer may use the premiums as a ___ ____ but benefits paid to employee are ____	business expense taxed
when you cannot work at any gainful occupation this is called ____ disability	total
if go back to work after being on disability, original injury returns, and we work less than 90 days this is considered a ___ disability	recurrent
a recurrent disability is part of the ___ claim	original
loss of sight, speech, limbs, you will never recover is called	permanent disability
if you are injured, surgery, broken bones and expected to recover this is called	temporary disability
social security pays you	monthly
this policy is an indemnity plan paying daily benefits to offset high costs of nursing home or home care	Long Term Care
Long Term Care may be added to life insurance policy and pays __ or __% of face amount	2 3
what rider would you need to pay for Health or Social services in a nursing home	Long Term Care Rider
LTC Riders are not for	independent community
if LTC sold as a health plan insured receives a stipulated ___ amount	daily
most LTC policies include a	waiver of premium
LTC are designed for ____ people and underwriting is different	older
LTC underwriting uses the __ __ ___ __ test	activities of daily living ADL
ADL test is such as bathing yourself, feeding and	dressing
is Driving part of the ADl Activities of daily living test?	no
LTC can pay for skilled care if __ a nursing home for _____ illness like senility	IN custodial
alzheimers and senility are oftern excluded in regular health policies and	medicare
what health policy covers Respite care, home care and adult day care	LTC
LTC policies are ____ renewable with ___ premiums	guaranteed level
mots LTC have a _____ pre-existing condition exclusion(probation period) plus an ____ period	6 month
elimination period of a LTC begins once _____ begins	confinement
most LTC plans have life time benefits with minimum period of	1 year
LTC free look period is	30 days
clients must receive a ____ guide prior to LTC application	shoppers
LTC covers 3 levels of care. they are	skilled custodial intermediate
Any LTC premiums that are tax deductible are based on	age
LTC policies may contain a waiver of ____ provision.	premium
LTC are more economical when purchased	individually
all LTC policies provide inflation protection of about ___%	5
the commission for the sale of ____ cannot exceed 50% of first years premium. will receive renewal commission for next 5 years. Renewal commission cannot exceed 10% of renewal premium	LTC
when a LTC policy is replaced the producer is compensated as if it were a	renewal
how many years does a producer receive Renewal commission on a LTC	5
how many TOTAL years does a producer receive commission on a LTC	6
a LTC Partnership policy is a LTC protect but it provides	asset protection
medicare is federally sponsored but funded by	social security taxes
if need kidney dialysis you are eligible for Medicare at what age	any
if disabled 2+years you are eligible for ____ regardless of age	medicare
Medicare has 4 parts	A,B,C,D
Medicare A is	inpatient hospital skilled
Medicare B is	voluntary and preventative covers doctors
medicare C is	medicare advantage
medicare D is	prescription drugs
what medicare part covers hospitalization for 1 year, semi private room, general nursing.	Medicare part A
first ___ days you pay deductible for in hospital under Medicare part A. After that its a copayment	60
first __ pints of blood you pay for on Medicare part A	3
how many lifetime reserve days do you get on Medicare part A	60
If 65 and working what insurance is the primary	employers
what act makes employer/group plan pay first if 65+ and still working	TEFRA
TEFRA is an act by	Social Security
what medicare part covers skilled nursing facility if first in hospital 3 days and enters nursing within 30 days of discharge	part A
home health care when skilled care is needed is paid under medicare	part a
hospice care and all expenses for 210 covered under medicare	part a
phsychiatric care covered under part a for ___ days	190
this part of medicare is voluntary and you must pay for it	part b
part B premiums are deducted from your	ss check
if you dont want part b medicare you must	waive it
medicare part B penalties are ___ per year you should have had it. you also get a 6 month pre existing condition exclusion	10%
what medicare part covers physicians, surgical centers(in or outpatient), speech, tests	b
part b medicare pays what percent of clinic and lab tests	100%
mammography is covered for women at this age under medicare part b	40+
colorectal exams are covered for men at what age under medicare part b	50+
part b pays outpatient hospital treatment of illness or injury at __% after deductible	80
part b pays for _- pint blood once deductible is met	4
medicare does not cover hearing aids, eye glasses, first 3 pints blood, self administered drugs and _____ (hint: a dental item)	dentures
medicare part d covers	prescriptions
medicare part c is a combination of parts	a,b,d
you have ___ premium under medicare advantage	1
if the doctor accepts medicare they must accept the ____ medicare agrees to pay as payment in full	amount
medicare supplements are sold by	commercial insurers or private insurers
the purpose of this medicare policy is to pay deductibles and coinsurance of medicare	medicare supplement
how many med supps are there in medicare	10
some core basic benefits of med supps are: 365 days additional inpatient hospital benefits, first 3 pints of blood and a ___ free look period	30 days
how many med supp plans can you have	1
commission on med supp cannot exceed ___5 of second years commission	200%
medicare supplement policy is also called a	medigap policy
medigap nor medicare cover _____ care	custodial
for an individual health policy the premium is ___ ____ and benefits are ___ ___	not deductible tax free
group premiums are deductible by the ___ and benefits are ___ to employees	employer taxable
for a business use of disability key employee and buy and sell premiums are not deductible by ____ but ___ are tax free	employer benefits
business overhead expense premiums deductible by ___ and benefits are	employer tax free
what business plans premiums are not tax deductible for the employer but the benefits are tax free	key person disability
what business plans premiums are tax deductible for the employer and the benefits are taxable	business overhead
LTC benefits are tax free but up to a certain ____ amount	daily
LTC benefits are taxed if they exceed the	cost of care
any tax deduction for premiums are based on	age
this is a health plan for the needy regardless of age	medicaid
medicaid is funded by the	federal government
medicaid ___ provide custodial care	does
medicaid eligibility is determined by	state law
a condition treated diagnosed or sought advise by a licensed physician	pre-existing
this policy is for illnesses that dont happen frequently but result in lots of out of pocket expense. covers one specific risk	dread disease prolicies
the privacy act is to protect the	insured
to restore an individual to economically prior to loss is called	principle of indemnity
chance of loss with NO chance of gain is called	pure risk
for risk to be insurable it must be	ascertainable
a disabled widow can collect SS at at	50
a counter offer does what to the original offer	voids
when courts are looking at intent of both parties they look at the	entire contract
who signs the insurance replacement authorization	producer and applicant
agency contracts are between the	insurer and producer
the insurer is called the P______	principal
this makes the insurance company liable form the time of application whether or not the applicant is insurable	binding receipt
this is a health deductible that applies to BOTH medical and dental plans	integrated deductible
when one insurance company tries to recover some losses from another insurance company this is called	subrogation
a sole proprietor can write of ___ of medical expenses as a tax deduction	100%
this health rider lists certain conditions in the contract that are excluded	inpairment rider
a revocable beneficiary has ___ vested rights	NO
an ____ beneficiary has legal vested rights	irrevocable
this insurance policy clause contains the promise to pay the claim in exchange for premium	insuring clause
the major advantage of HIPPA is the	portability
this is a federal mandate superseding PA state law. Allows children to stay on parent's insurance until age 26. four tiers are bronze, silver, gold & platinum	Affordable Care Act
what are the 4 tiers of marketplace insurance PENNIE	bronze silver gold platinum

Created by: hollystudies

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