Insurance contract is between what 2 parties?

insurance company and consumer or business entity

what does an insurance contract do?

transfers the risk of a specific financial loss from one party to the other in exchange for payment

insurance industry is regulated by

both state and federal legislation

Each state maintains its own division or department of insurance, consisting of

regulating officers and an insurance commissioner or superintendent.

Once certified by the state, the insurer is considered to be

admitted (able to do business in the state)

Authorized insurance companies oftentimes conduct business in multiple states, and as such, they are authorized based on

the state in which the insurance company’s home office is incorporated

3 U.S. territorial possessions and are within U.S. federal law

Puerto Rico, Guam, and the U.S. Virgin Islands

financial reports must be provided by the insurer to the department for review (6)

audited annual report , statement company’s financial condition, Balance sheets/statements of cash flow, summary of insurer operations, changes in the company’s capital/surplus, company’s notes related to its financial statements which reconcile any

what represents its financial strength and is based on its claims experience, investment performance, and dividend returns, as well as an insurer’s management team among other factors.

insurance company's financial ratings

3 examples of financial rating companies

Standard & Poor’s, Moody’s, and AM Best

type of risk retention between members, known as subscribers, consisting of individual business owners, corporations, or municipalities.

reciprocal insurance aka inter-insurance

Stock Insurance Company is aka

Non-Participating or ‘Non-Par'

The majority of private commercial insurance companies in America are considered to be either

stock or mutual insurance company

private insurance company that is established to provide insurance to policyowners who are also the company’s stockholders (owners)

mutual insurance company participating or par

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life and health

Question	Answer
What is the form of risk management used to protect the financial well-being of an individual, company or other entity in the event of an unexpected financial loss	insurance
Insurance is a type of	Legal Contract
Insurance contract is between what 2 parties?	insurance company and consumer or business entity
what does an insurance contract do?	transfers the risk of a specific financial loss from one party to the other in exchange for payment
What is the legal term for the insurance company	insurer
what is the legal term for the insurered	policy owner or policy holder
what is the legal term for payment of coverage	premium
sum of money that is required to keep a policy in force	premium payment
legal contract between two parties for insurance is called	insurance policy
when the insured incurs a loss, what must be done	a claim is made
death of an individual prior to the age of 65 is called	premature death
legal term for overall purpose of insurance which is to compensate an insured for loss or damage	indemnify
insurance industry is regulated by	both state and federal legislation
Each state maintains its own division or department of insurance, consisting of	regulating officers and an insurance commissioner or superintendent.
what is provided to an insurance company as proof of licensure within the state.	Certificate of Authority
Once certified by the state, the insurer is considered to be	admitted (able to do business in the state)
term for an insurer that is prohibited from conducting business within a state until it becomes licensed by that state.	non-admitted
Authorized insurance companies oftentimes conduct business in multiple states, and as such, they are authorized based on	the state in which the insurance company’s home office is incorporated
refers to the state (or country) in which the insurance company is incorporated.	domicile of incorporation
The following 3 categories determine the status of an insurance company based on its location of incorporation in relation to the location in which it is conducting business	domestic, foreign, alien
A domestic insurer is an insurance company that conducts insurance business in the same state in which it is incorporated	domestic insurer
an insurance company that conducts insurance business in any state that it is not incorporated, such as an insurance company that is incorporated in Florida and conducts insurance business in California or New York	foreign insurer
Any insurance company incorporated outside of the United States	alien insurer
3 U.S. territorial possessions and are within U.S. federal law	Puerto Rico, Guam, and the U.S. Virgin Islands
insurance companies typically invest in	low risk bonds
2 types of low risk bonds	corporate and municipal
To protect against insurer insolvency, each state’s department of insurance mandates company compliance in reporting financial conditions and results of operations on a	quarterly basis
what must be filed with the state department of insurance and must be completed by an independent certified public accountant chosen by the insurer	annual audited report
financial reports must be provided by the insurer to the department for review (6)	audited annual report , statement company’s financial condition, Balance sheets/statements of cash flow, summary of insurer operations, changes in the company’s capital/surplus, company’s notes related to its financial statements which reconcile any
what represents its financial strength and is based on its claims experience, investment performance, and dividend returns, as well as an insurer’s management team among other factors.	insurance company's financial ratings
3 examples of financial rating companies	Standard & Poor’s, Moody’s, and AM Best
Many businesses choose to do what to cover smaller employee claims that can be paid by the company instead of filing a claim through the insurer	self-insure
type of risk retention between members, known as subscribers, consisting of individual business owners, corporations, or municipalities.	reciprocal insurance aka inter-insurance
self-insurance is administered by an attorney, called an	attorney-in-fact
reciprocal insurance is often used by municipalities to	cross-indemnify each other
reciprocal insurance is used in addition to	purchasing formal insurance
Stock Insurance Company is aka	Non-Participating or ‘Non-Par'
The majority of private commercial insurance companies in America are considered to be either	stock or mutual insurance company
private insurance company that is established to provide insurance to policyowners and to make a profit for its stockholders.	stock insurance company
This type of insurer is considered to be what type of company because the insured policyowners do not own the company, nor do they receive any dividends that the company returns.	non-par
Mutual Insurance Company is aka	Participating or ‘Par’
private insurance company that is established to provide insurance to policyowners who are also the company’s stockholders (owners)	mutual insurance company participating or par
Individuals who purchase insurance from a mutual insurer are both	customer and owner/shareholder
what is paid out to its shareholders in the form of Dividends	earned surplus
annual reimbursement of excess premiums that remain after the company has set aside its needed reserves and has deducted the necessary amount to cover annual claims and other company expenses.	dividends
process when a mutual insurance company changes its corporate structure to a stock company status, often to help increase capital needs that is more easily accomplished as a stock insurance company.	demutualization
process when a stock insurance company can also change its corporate structure to become a mutual insurance company	mutualization
sharing of risk between an insurance company and a re-insurance company	reinsurance
re-insurance company, known as a	re-insurer
provide additional insurance coverage for risks that are too large for the single insurer to adequately cover.	re-insurer company
provides the details of the agreed reinsurance policy	re-insurance policy
a reinsurance premium is paid by the	cedent insurer
government-administered insurance is funded by taxes	social insurance
on-profit organizations that are recognized for their social and charitable activities.	fraternal associations
an exchange marketplace consisting of individuals, companies and underwriters who provide ‘high-risk’ insurance products	Lloyd's of London
Each insurer employs statistical analysts, called	actuaries
the potential for an outcome to result in either a gain or a loss based on a given action, event, or occurrence.	risk
2 types of risk	speculative and pure
chance of either loss or gain, such as gambling.	speculative risk
Involves only the chance of loss, such as the chance of an injury from an accident.	pure risk
All varieties of insurance rely on two principles to ensure that an insurance company is profitable and that its insurance claims are satisfied:	risk pooling and law of large numbers
Also known as Loss Sharing, THIS is simply the spreading of a specific risk, or the exposure of a specific loss, across a sizable number of individuals instead of bearing all costs on the individual person.	risk pooling
all insured individuals contribute small amounts of premium on a regular basis to cover a much larger amount of loss, referred to as	loss exposure
what is the combining of similar ‘exposure units,’ is necessary for the law of large numbers to operate.	risk pooling
the economic value of the person’s life or property being insured	exposure units
the larger the number of individual risks that are combined into a group, the more certain an insurance company is to knowing the amount of loss sustained that will occur in any given period of time.	law of large numbers
Elements of Insurable Risk	pure risk, risk pooling, Law of Large Numbers, cannot lead to catastrophic loss for the insurer OR cannot be adversely selected
he tendency of more unhealthy people being insured than healthy people, thus demanding more funding for claims from the insurer.	adverse selection
Calculating risk effectively creates a	‘profitable distribution of exposures,’
Two important factors that lead to loss are called	hazards and perils
is the factor, or underlying condition, that gives rise to a peril.	hazard
specific event that causes, or is the grounds, for loss for ex a fire to a house	peril
A Hazard leads to a Peril which leads to a	loss
Types of Hazards	physical, moral, morale
defined by physical conditions that exist which have the potential to lead to loss, such as unsafe working conditions.	physical hazard
type of hazards are defined by human behavior, actions, habits and lifestyles such as smoking, eating an unhealthy diet, drug abuse, texting while driving	moral
type of hazard temporary lapse in judgment that leads to a brief indifference in attitude towards risk	morale
Methods of Handling Risk (2)	risk avoidance, reducing risk
as accepting and managing risk when it occurs, such as having reserve funds available in the event of an accident or illness.	retaining risk
Classifications of Risk (4)	preferred, standard, substandard, declined
nsurer charges a lesser premium amount than a standard risk policy, usually around 10% lower than the standard risk premium rate.	preferred risk
This class of risk includes applicants with pre-existing conditions that are within the risk acceptance levels of the insurer, and can include a higher premium payment to offset the increased risk	substandard risk
lower-valued life insurance products	Industrial life insurance
a representative of the insurer meets initially with the insured to deliver the policy and COLLECTS the initial premium.	Home Service marketing distribution system
Insurers market products directly to consumers through mass marketing as well as through their own sales force, including company sales employees and ‘captive agents’	direct response marketing
agents who market only one insurer’s products).	captive agents
marketing distribution system incorporates agents, either exclusive to the insurer, or who are considered ‘independent agents,’	agency marketing
are given the authority to solicit insurance to the general public and are paid a commission on insurance sales.	producers
producers are generally categorized as (3)	agents, brokers, solicitors
is authorized by an insurance company to solicit and negotiate insurance products on the company’s behalf	insurance agent
The insurance company is often referred to as the	principal/insurer
works on behalf of a consumer to negotiate and transact insurance with one or more insurers	An insurance Broker
In an effort to increase revenue, some states allow agents and brokers to hire individuals to help with the sales process	solicitor
legal contract between an insurance company and a licensed agent by which the insurance company gives an agent the contractual permission, or ‘express authority,’ to conduct insurance business on behalf of the insurer in exchange for compensation,	an appointment
. Two types of presumed authority are	implied and apparent
the general business practices that an agent could perform that is not necessarily part of the agent’s contract, but could be acceptable by the insurer.	implied authority
possibility of a situation where an applicant is under the impression that the agent has the authority to act on behalf of the insurer, even though no expressed authority actually exists	apparent authority
presumption from a potential customer’s point-of-view that an agent is conducting business on behalf of an insurer, given the materials he or she presents to the potential customer or the clothing he or she wears bearing the company’s name or logo.	presumption of agency
insurance protects the agent from claims resulting from the failure to adequately provide professional service to a client.	errors and omissions insurance
also known as ‘professional liability’ insurance	E&O insurance
2 Types of E&O Policies	occurence, claims made
policy provides an agent with liability coverage against any current or future claims that result from negligent errors or omissions that occur during the period of time in which the E&O policy is in force.	Occurence E&O policy
insures against any claims of current or prior incidents that occurred,	claims made E&O policy
‘tail’ coverage can be purchased as an add-on to a claims-made E&O policy to protect against claims made after the agent cancels his or her E&O coverage and is sued while not currently covered under a claims-made policy.	extended reporting
‘nose,’ provision which retroactively dates the agent’s new E&O policy to an earlier date, usually to the beginning of his or her prior E&O coverage	‘nose,’ provision which retroactively dates the agent’s new E&O policy to an earlier date, usually to the beginning of his or her prior E&O coverage
coverage further protects the agent by covering ANY incidents prior to the current policy, instead of limiting coverage to a specific retroactive date	full prior acts policy
an individual who maintains a certain trust and/or confidence is known as a	Fiduciary
initial premium of the applicant, often called	consideration
acting in a professional manner and protecting both the insurer and insured aka	prudent person’ rule
Once a policy is issued, the agent is responsible for	he delivery and explanation of the policy to the newly insured, as well as the collection any initial premium due, if not already collected
Penalties for soliciting to any number listed on the registry include being subject to up to a	$16k fine
Do-Not-Call Implementation Act was enacted in year	2003
National Do-Not-Call Registry is managed by	ftc
National Do-Not-Call Registry is enforced by	FTC and the Federal Communications Commission (FCC), as well as by each state’s government.
The FCC defines what as any material advertising the commercial availability or quality of any property, goods or services, which is transmitted to any person without that person’s prior express invitation or permission, in writing or otherwise.	Unsolicited Advertisements
As stated by the FTC, an established business relationship with a company exists for	(3) months after the inquiry or application.
implemented additional efforts in removing disconnected and re-assigned phone numbers, as well as retaining phone numbers within the National Do-Not-Call Registry on a permanent basis	Do-Not-Call Improvement Act of 2007
Insurers are required to maintain records on all advertisements for review by the	state Insurance Commissioner
insurers must fully disclose what all all advertisements	their name
Advertisements that quote exact premiums must also disclose	terms of coverage, as well as the age, sex and geographic location of which the quoted coverage is based
must be disclosed when premium is quoted in an advertisement, meaning that the quoted premium is based on a preferred risk class, standard risk class or substandard risk class	Specific classes of risk
Policy limitations must be	clearly disclosed in all advertisements
A Medicare-related advertisement must clearly state its nature as a	Medicare product
Careful use of the words ‘all,’ ‘full,’ and ‘complete’ (and similar words) must be clear as to not	exaggerate benefits beyond policy terms
Policy limitation and exclusion descriptions must be clearly stated as such, and not as	policy benefits
in advertisements, periods must be properly disclosed	Waiting and elimination
Pre-existing conditions must be	properly defined and disclosed
Statistical sources must	be disclosed in all advertisements
All competitors that are used for comparison purposes must be	clearly disclosed in the advertisement –
Advertisements cannot promote, as an inducement to sell, coverage only to individuals based on their	occupation, association, age, sex, or other condition unless such policy is, in fact, only offered to such individuals
Lying to a customer regarding covered benefits or the terms of the policy, or guaranteeing insurance is illegal and grounds for license revocation	Misrepresentation
false or deceptive advertising as well as defamation of an insurer. Promising dividend returns or company profits as an inducement to a sale is also prohibited.	misrepresentation
inducing a policyowner through misrepresentation to forfeit or change insurance from one company to another in order to gain commission	twisting
act of depleting the funds of one insurance policy to purchase another policy within the same company for no purpose other than to generate new commission for an agent or agency from an existing customer.	churning
Charging an applicant for ancillary (supplemental) coverage without their knowledge or advising that such additional coverage is required by law with the purchase of insurance.	sliding
charging different rates of premium, offering different benefits, or charging extra fees based on residence, race, religion, or national origin.	Unfair Discrimination
person engaged in the business of insurance, whose activities affect interstate commerce and who willfully embezzles, or misappropriates any funds or policy premiums of an applicant or insurer shall be punished by	fine or imprisonment for not more than 10 years, or both
f such embezzlement or misappropriation jeopardized the safety and soundness of an insurer and was a significant cause of such insurer being placed in conservation, rehabilitation, or liquidation by an appropriate court	imprisonment shall be not more than 15 years
f the amount or value so embezzled, abstracted, purloined, or misappropriated does not exceed $5,000,	mprisoned not more than one year,
it is common for a health insurance policy to be issued to an applicant based solely on the medical information gathered from the application that is submitted by the applicant to the insurer.	non-medical
typically provides face amounts between $1,000 to $5,000, and is issued based solely on the application, often asking basic applicant questions regarding gender, age, residence address and specific catastrophic medical history	Guaranteed Issue
conducted by a nurse practitioner or paramedic, often at the applicant’s residence	paramedical exam
applicant’s height and weight, verbal questionnaire regarding the applicant’s medical history and lifestyle,blood pressure and pulse rate, blood and urine for analysis	Medical or Paramedical Exam generally includes:
additional medical records or a WHAT to the insurer when confirmation of a current or prior condition is needed by the insurer	atteding physician's statement (aps)
A paper application can be corrected or changed before being submitted; however, any changes should be	initialed by the applicant and agent
the insurer provides the applicant with a ‘receipt of submission,’ known as a	Conditional Receipt.
the process of reviewing an application for insurance where an insurance company determines an applicant’s eligibility and premium amount based on the total overall risk, and how it is classified according to the company’s risk limits and standards.	underwriting
Each applicant is ‘rated’ according to	sex, age, height, weight, medical conditions, medical history, smoking status, occupation, and even hobbies
multinational medical information retention and reporting agency that collects and provides reliable medical information regarding an applicant’s health history.	MIB
Individuals who have not been underwritten for an individual life or health insurance policy in the past how many years are typically not on file	7
death claims, as well as disability claims to better predict the rates in which individuals die	mortality factor
become disabled due to accident or illness	morbidity factor
the process of adding premium dollars to a policy to cover company expenses associated with the issuance of a policy (underwriting and administrative costs).	expense loading
the premium amount before expense loading is added.	net premium
Company Expenses Covered by Insurance Premium	Policy Acquisition Costs, General Company Overhead Costs and Annual Taxes, Contingency Funding, Expected Annual Claims Funding
he premium amount determined after expense loading is added and is the total annual cost of the policy that the insured pays.	Gross Annual Premium
The frequency in which a policyowner pays his or her premium is called the	premium mode
funds that are maintained by the insurance company to pay the future claims of its policyowners	reserves
listed as a liability on the company’s financial records, not as an asset.	reserves
Technically, a company’s reserve should be equal to the amount that	will exactly equal all of the company’s contractual obligations.
defined as the ratio between company losses (annual claims) and company revenue (annual collected premium),	loss ratio
defined as the ratio between annual company operating expenses and company annual revenue,	Expense Ratio
is calculated by dividing operating expenses by total premiums received	expense ratio
defined as the branch of law that regulates the rights and responsibilities of parties that enter into contracts, and any contractual disputes arising from written or verbal agreements.	contract law
is insurance regulated under contract or tort law	contract law
the branch of law covering most civil lawsuits based on personal liabilities and damages resulting from the ‘wrongful acts of others,’ except for contractual disputes	tort law
4 Elements of a Legal Contract	agreement, consideration, legal purpose, competent parties
Defined as selling insurance to oneself and immediate family members, friends or business acquaintances.	controlled business
parties involved with an insurance policy include:	the insurer, the applicant, the policy’s owner, insured individual, beneficiary (life)
The individual who applies for insurance	applicant
Pertains to life insurance. pays the policy’s premiums and owns the life insurance policy.	policy owner
Pertains to health insurance. pays the premium for health insurance on the policy’s insured, most often being the same person.	policy holder
An individual, trust, estate, or institution that is designated by the policyowner of a life contract to receive the life contract’s death benefit upon the death of the insured	beneficiary
actual compensation paid by the insurer to the insured, or to the policy’s beneficiary for loss that has occurred.	indemnity
Refers to the process in which an insurer pursues reimbursement from another insurer for indemnifying an insured when the insurer is ultimately not responsible for paying such claim	subrogation
financial limit of the insurer based on the terms of the contract.	limit of liability
a contract that pays a stated sum, regardless of the amount of loss that has occurred.	valued contract
a contract that pays out benefits that are equal to the actual loss incurred, up to the policy’s stated limits, in order to make the insured ‘whole’ again.	indemnity contract
Anyone to whom the policy is transferred receives full benefits of policy ownership through a process called	policy assignment
health insurance policy creates a Personal Contract , Individuals who are insured under a health contract are considered	policy holders
Characteristics Unique to Insurance Contracts (6)	Contract of Adhesion, Aleatory, Unilateral, Conditional Contract,Utmost Good Faith
only one party, the insurer, defines and prepares the insurance contract, which is non-negotiable by the other party.	Contract of Adhesion
dependent on chance or an uncertain outcome, where one party may receive more value than the other party based on uncertain future circumstances.	Aleatory
because only one party makes promises to the other party	Unilateral
contracts include conditions that must be satisfied in order for benefits to be paid to the insured.	conditional contract
meaning that neither party will attempt to conceal or defraud the other party	Utmost Good Faith
a statement that the applicant promises to be true, such as his or her age or gender.	warranty
a statement that the applicant believes to be true to the best of his or her knowledge.	Representation
in which policy terms are defined to clarify interpretation by the insured.	Definitions Page
defines the scope of the coverage and all promises of insurance coverage made by the insurer in exchange for premium	Insuring Agreement
meaning that all losses incurred by the insured are covered by the policy, except for any losses that are intentionally excluded from coverage, as defined on the policy’s declaration page.	all-risk coverage
court ruling stating that once an insurance contract, including its provisions and riders, is constructed and provided in written form to the insured, it cannot be modified by any oral, or verbal, statements made by either party.	Parol (Oral) Evidence Rule
Grounds for Rescission (3)	Misrepresentation, Concealment, Fraud,
he lawful separation of two parties by canceling the contract from its inception, essentially making it a ‘void’ contract.	Policy Rescission
the voluntary relinquishment of a given right or privilege.	waiver
the legal action and enforcement of a waiver.	Estoppel
one of the first attempts of the federal government to try to regulate insurance as interstate commerce.	Paul v. Virginia (1868)
Supreme Court, however, decided that issuing an insurance policy is not considered a transaction of commerce; therefore, it cannot be regulated by the federal government as interstate commerce.	Paul v. Virginia (1868)
Although this ruling would later be reversed, for 75 years following this Supreme Court decision, insurance was not considered to be interstate commerce	Paul v. Virginia (1868)
known for creating the New York Insurance Code	The Armstrong Investigation (1905)
utcome of this investigation led to stricter regulation of insurance companies by the state, which ultimately led to other states adopting similar insurance regulations.	The Armstrong Investigation (1905)
This Supreme Court case placed the regulation of insurance within the authority of the federal government by defining insurance as a form of interstate commerce	United States v. Southeastern Underwriters Association (1944)
Any state laws that may have been in force at that time that conflicted with the laws of the federal government became void and unenforceable.	United States v. Southeastern Underwriters Association (1944)
Due to the conflicts that arose from this Supreme Court decision, Congress later enacted the ‘McCarran-Ferguson Act’	United States v. Southeastern Underwriters Association (1944)
further define the roles of the federal and state governments.	McCarran-Ferguson Act
This Act ratified legislation in all states to conform to federal law; however, Congress still concluded that state regulation of insurance made the most sense from a consumer’s standpoint.	The McCarran-Ferguson Act (1945)
Under this act, the business of insurance is primarily regulated by the states, allowing the federal government to regulate in addition to, but not to supersede state insurance laws.	The McCarran-Ferguson Act (1945)
In an attempt by the FTC to regulate insurance advertising, the Supreme Court decided, due to the McCarran-Ferguson Act, that a federal agency such as the FTC had no ruling or authority over the states regarding insurance advertising regulation	1958 Intervention by the FTC
Both annuities and variable life insurance were questioned and concluded to be securities, instead of insurance	1959 Intervention by the SEC
Supreme Court decided that insurance companies selling variable life products and annuities were to be regulated under the authority of both the Securities and Exchange Commission (SEC), and the states.	1959 Intervention by the SEC
states that all consumers have the right to keep personal financial information private between the collecting party and the consumer	Fair Credit Reporting Act (1970)
at no time may private personal and financial information be given to a non-affiliated third party unless what is given prior	Initial Privacy Notice
This federal consumer privacy regulation requires disclosure of any ‘financial institution’ that denies coverage to a consumer.	Fair Credit Reporting Act (1970)
, if a consumer is denied coverage, he or she has the right to	dispute this denial and provide correct information if inaccurate information is portrayed about the consumer.
defined as an institution engaged in activities that are financial in nature or incidental to such financial activities.	Financial Institution
This Act was created to ensure that correct information is obtained regarding a consumer and that a consumer’s privacy is not at risk	Fair Credit Reporting Act (1970)
Under FCRA 1970 consumers must be notified w/in how many days a report was requested	3 days report requested
Under FCRA 1970 consumer has the right to know the identity of anyone who is	questioned regarding a credit report.
If the consumer is rejected, due to findings in a credit report information regarding the	consumer reporting agency must be provided to the consumer
The consumer reporting agency must disclose any information in the event an applicant requests it; however,	an insurance company is not obligated to disclose such information to an applicant.
under FCRA 1970, If an individual disagrees with the agency’s report, he or she has the right to	file a statement to the insurer that better clarifies any negative issues presented by the insurer
Due to the size and depth of the information collected by insurers, legislation was passed to regulate and safeguard this personal consumer information.	PrivacyAct 1974
set forth the standards of fair information practices that govern the collection, maintenance, use, and dissemination of personally identifiable information about individuals.	Privacy Act (1974)
Goals of the Privacy Act: 3	minimize consumer intrusiveness, be fair and impartial in collecting and reporting on consumers,build public trust regarding the safeguarding of personal information collection
Also referred to as the Gramm-Leach-Bliley Act (GLBA) or (GLB Act)	Financial Services Modernization Act (1999)
allowed financial institutions to merge together into what are commonly called ‘financial supermarkets,’	Financial Services Modernization Act (1999) GLBA
Under this Act, regulation of financial institutions is based on the type of product or service marketed instead of on the type of company selling the product	Financial Services Modernization Act (1999) GLBA
Due to the large amount of private information disclosed to these financial institutions, a major part of the GLBA is the requirement that	all financial institutions design, implement and maintain ‘safeguards’ to protect private information
an individual, or the legal representative of such an individual, who obtains, from a financial institution, financial products or services which are to be used primarily for personal, family, or household purposes	GLBA defines a Consumer
defined as a consumer who has a continuing ‘customer relationship’ with a financial institution	customer
privacy requirements of the GLBA include the what rule	Financial Privacy Rule
which requires financial institutions to set up and maintain a system of protecting consumer and customer records.	Safeguards Rule
GLBA regulates against attempts to obtain non-public personal information from consumers and customers under false pretenses, a method known as	Pre-texting.
financial institution must disclose to all consumers in advance of any contractual agreement between the consumer and financial institution that it intends to collect and retain both public and private information on the consumer	Financial Privacy Rule
requires clear disclosure by all financial institutions of their privacy policy regarding the sharing of non-public personal information with both affiliates and third parties.	Financial Privacy Rule
defined as personally identifiable financial information	non-public personal information,’ also referred to as NPI
Provided by a consumer to a financial institution, Resulting from any transaction with the consumer, Otherwise obtained by the financial institution	NPI
includes any list, description, or other groupings of consumers (and publicly available information pertaining to them) that is derived without using any non-public personal information.	Public personal information
llow a consumer the opportunity to prevent the sharing of certain non-public financial information with non-affiliated third parties, subject to certain exceptions.	GLBA requires a notice to consumers and an opportunity to Opt-Out,
give permission to an insurer to disclose and share non-public personal information.	Opt-In,
the electronic or physical methods used to access, collect, store, use, transmit, protect or dispose of non-public personal information,	Customer Information Systems
defined as any person or entity that maintains, processes, or otherwise is permitted access to customer information through its provision of services directly to the licensee.	Service Provider
group of laws that determine insurance regulation in a given state	Insurance Code
developed by the legislative branch of each state’s government, define the roles of both the Insurance Commissioner and state’s insurance regulatory body	Statutes
Also known as a Superintendent or Director of Insurance	Insurance Commissioner
protect claimants, policyholders, annuitants, and creditors form insolvent insurers by funding the payments of claims and other related policy benefits.	Federal Deposit Insurance Corporation (FDIC),
Individual and group life insurance policies, as well as individual annuities, long-term care and disability income insurance policies are covered by	life and health guaranty associations.
insurance producer regulation began with the	Producer Licensing Model Act (PLMA)
Producer License Qualifications: age requirement	18
Producer License Qualifications: not committed an act that	could lead to denial, suspension, or revocation of an insurance license
Producer License Qualifications: complete a	pre-licensing course for a specific line of insurance
Producer License Qualifications:PPM	pay fees, pass exams, maintain continuing education
develops and regulates the state exam with the assistance of an outside testing service that administers the exam and collects the state testing fees	the insurance commissioner
If a producer moves to a different state, the producer has ? days to apply for a state license without having to complete any additional pre-licensing education or state testing.	90
promotes uniformity in business standards and practices throughout the insurance industry	National Association of Insurance Commissioners (NAIC
ot a federal or state legislative body, nor does it regulate insurance law, even though its members are the insurance commissioners of each state in the U.S.	NAIC
These members are either elected to their post, or appointed by their states’ governor	NAIC
All members of the NAIC elect these governing members on an	annual basis.
NAIC is composed of seven additional committees including:	life,health, P&C, Market Reg/Consumer Affairs, Financial Reg/Accreditation, Financial Condition Committee, International Relations
class of insurance characterized by a single policy that provides life or health insurance coverage for multiple members of an eligible group.	Group Insurance
a policy that is issued to an individual or family and provides coverage for immediate members of the family	Individual Insurance policy
a single policy that is issued to the administrator, or ‘plan sponsor,’ of an eligible group,	Group Insurance
Group insurance provides coverage for the members of an eligible group, as well as	their dependents
group policy is also referred to as a	master contract,
As proof of coverage under a group insurance policy, eligible members of the group receive a	Certificate of Insurance or Certificate of Coverage
referred to as ? policy can be purchased by someone other than the insured,	Third-Party Ownership
? is not required by each member within a group	proof of insurability
the process of underwriting the group as a whole, not its individual members.	Group Risk Selection
If the group meets the underwriting standards of the insurer, it is accepted. If rejected, the insurer must	reject the entire group,
high risk group which could be denied coverage as a group.	risk adverse
a group that is formed for some reason other than to obtain insurance	Natural Group
Most high-risk professions are insured in	large numbers
meaning that an insurer requires a certain percentage of new members to join the group policy each year in order to maintain the group’s policy.	Turnover Rate
a group with at least 10 members	True Group
the rating provided by the insurer to all people who are covered by the same type of policy in the same geographic area as the group being underwritten.	Community Rating
Also referred to as a ‘non-experience’ rating,	Community Rating,
most states require small group policies, typically with 50 or fewer members, to remain under an	‘adjusted’ community rating
most states mandate that small group premium rates must be based on the	community
most states mandate that small group premium rates must not be based on	claims experience of the group itself
group’s rate is ‘adjusted,’ or modified to account for specific factors, referred to as	‘case characteristics
once a larger group policy has been established, future premium amounts are calculated based on the	‘experiences,’ or claims of the group that are made against the insurer
known as ? insurer considers the specific claims experience made by the group in previous years in order to determine the correct amount of premium	Experience Rating
As a means of preventing large premium increases from one year to the next, states also set limits, referred to as	rating bands
the percentage that an insurer can vary annual premiums based on the case characteristics or experience of the group.	rating bands
premiums are paid entirely by the master contract holder, with no contribution of premium by members of the group.	Non-Contributory group plan
master contract holder, as well as the members of the group, contributes towards the group’s premium together.	Contributory group plan
in a contributory group plan, At least ?% of the group’s members must participate in the group policy	75%
State law requires uniform coverage for insured employees within the same classification based on 3 factors:	tenure, job description or salary
Members of the group can be categorized according to various classifications such as: (3)	full/part time, hourly/salary, union/non union, retired
Most group insurance plans include an initial period of time, called a	probationary period
, also referred to as the ‘enrollment period,’ is the period of 30 or 31 days following the probationary period in which a new member of the group may apply for coverage without having to submit to a medical exam for eligibility	eligibility period
if a new member to a group fails to enroll into the group’s insurance plan during his or her eligibility period, he or she will be required to complete a	paramedical exam
Non-Contributory group plan, new members of the group are	automatically covered by the group’s insurance plan immediately after the new member’s probationary period ends.
Employment Retirement Income Security Act (ERISA) was enacted by Congress in	1974
this federal law established minimum guidelines pertaining to the administration of employer-based pension plans and employee welfare benefit plans such as life, health and disability insurance.	ERISA
ERISA is regulated by the	Department of Labor
ERISA is enforced through the DOL's (which dept)	Employee Benefits Security Administration
ERISA regulation applies to all ....groups who offer....	non-governmental, private employer-groups in the U.S. who offer employee benefit plans.
are exempt from ERISA rules	gov't, religious orgs, private purchasers
ERISA does not ‘preempt,’ or supersede	state insurance laws
employer-sponsored plans involve interstate commerce, such plans also fall under____ _____ for ___ ___ ___	federal jurisdiction, federal taxation purposes
ERISA regulation does not pertain to	types and levels of plan benefits
, for those groups that do establish pension plans, ERISA regulation pertains to	the administration of the group’s benefit plan in how it is managed
ERISA mandates the reporting and disclosure of plan (3)	eligibility, benefits, limitations`
ERISA mandates the reporting and disclosure of plan through what document? In addition to ____	Summary Plan Description (SPD) any policy summary provided by the insurer
While state laws mandate insurer disclosure, ERISA mandates	employer disclosure
As part of the Civil Rights Act, ? was enacted by Congress in 1967 primarily to prohibit the practice of forced retirement	Age Discrimination in Employment Act (ADEA)
ADEA federal law applies to employer groups consisting of # or more employees	20
ADEA protecting both employees and job applicants age	40 and over
ADEA protects employee from discrimination on	hiring, firing, wage setting and benefits
Under the ADEA, employers are required to provide equal what or what for older employees	benefits or equal defined contribution
an employer can limit or reduce an older employee’s benefits to maintain the same cost of coverage as the employer provides for younger employees.	equal costs’ rule,
Older employees may also need to contribute more towards their life and disability coverage/ retirement plan due to the	defined contribution made by the employer
employers must maintain medical coverage on older employees the	ame as it covers younger employees, regardless of the increase in cost to the employer.
Enacted in 1982	Tax Equity and Fiscal Responsibility Act (TEFRA)
expanded on the ADEA by requiring an employer to maintain group health coverage once an employee becomes eligible for Medicare	Tax Equity and Fiscal Responsibility Act
Tax Equity and Fiscal Responsibility Act federal law applies to employer groups of#?	20 or more
Under TEFRA, an employee who is over the age of 65 and actively working, as well as his or her spouse, must be allowed to	aintain group health coverage as his or her primary health coverage, with Medicare being secondary.
Non-discrimination rules established through TEFRA further prohibit eligibility to participate in a group plan to only	highly-compensated key employees such as officers, shareholders or executives
Benefits provided to highly compensated key employees cannot exceed	25% of all benefits provided to the entire group.
in group insurance, If an individual converts his or her certificate of coverage to an individual policy, he or she cannot be	denied coverage if same insurer
arrangements occur between unethical investors or investor groups and the elderly insured aged 65-85.	stranger-Originated Life Insurance (STOLI)
schemes are often advertised as ‘zero premium’ or ‘no cost’ life insurance	stranger-Originated Life Insurance (STOLI)
creates a contract between an individual and a stranger who persuades the individual to purchase a life insurance policy on him or herself with the intent to sell the policy to the stranger at some point in the future.	stranger-Originated Life Insurance (STOLI)
Also referred to as an Investor-Owned Life Insurance (IOLI) arrangement	stranger-Originated Life Insurance (STOLI)
contract’s first two years, known as the policy’s	‘incontestability period.’
Often unbeknownst to the insured, he or she is also responsible for federal taxation on the policy within the	first two year
refers to the different periods of a family’s lifespan, as well as the varying needs of the surviving family.	family ‘income cycle,’
The Family Income Cycle (3)	Family Dependency Period, Pre-Retirement Period,
According to social security, a surviving spouse is eligible for social security survivor benefits during the years he or she is	dependent upon by his or her children.
begins and survivor benefits end after such children are no longer dependent and before the surviving spouse reaches age 60, or age 50 if he or she is disabled.	Blackout Period
Upon reaching age 60, what type of ss benefits resume	survivor
social security benefits begin again at age	62
Premium payments for charitable life policies are	tax deductible.
Death proceeds from an insurance policy are divided equally among the named beneficiaries. If a named beneficiary is deceased, his or her share then goes to the living descendants of that individual	Per Stirpes Rule
Death proceeds from an insurance policy are divided equally among only the living primary beneficiaries.	Per Capita Rule
designation allows the policyowner to change beneficiaries after the policy becomes in force, if he or she so chooses, without the consent of the beneficiary.	Revocable
cannot be changed in the future without the consent of the beneficiary.	Irrevocable
first in line to receive a policy’s death benefits upon an insured’s death.	A primary beneficiary
Next in succession to the primary benificiary	secondary/contingent beneficiary
Third in succession to the primary,	Tertiary (Contingent)
In the event that the policyowner is not the insured, the policy will be included in the policyowner's	estate or handled by his or her will.
Income is derived only from interest gained on the principal. Income is indefinite and creates a legacy for next of kin or for charity.	Estate Conservation (Retention)
Also referred to as capital ‘utilization,’	Life Policy (Capital) Liquidation
income is derived by both interest and principal.	Life Policy (Capital) Liquidation
Funds eventually disappear and could be of concern if the surviving spouse outlives the policy’s death benefit if no additional income is derived.	Life Policy (Capital) Liquidation
Whole life insurance policies generate a	cash value
policy’s cash value can be borrowed against or used as collateral,	Living Benefits
early payment to the terminally ill or injured insured reduces the policy’s death benefit and is usually only payable for a period of one year.	Accelerated Benefits,
If a policyowner is considered terminally ill, an option exists to sell the insurance policy after its contestability period has ended to a	viatical settlement company
will pay anywhere from 60% to 80% of the face amount based on NAIC’s Viatical Settlement Model Regulation,	viatical settlement company
A licensed agent who solicits and sells viatical contracts between a life insurance policyowner and the viatical settlement provider.	Viatical Broker
An individual, company or legal entity that purchases ownership of a life insurance contract from a policyowner who in return receives compensation less than the policy’s death benefit	Viatical Settlement Provider
A life insurance policyowner who sells his or her policy to a viatical settlement provider	Viator
an agent can determine the correct amount of life insurance based on the client’s occupation, annual income, planned retirement age, short and long-term family expenses, and inflation	Human Life Value assessment
agent can determine the correct insurance amount based on the needs of the family.	Family Needs assessment,
plan involves two parties, usually an employer and employee, who split premium payments on a whole life policy.	A split-dollar
in a split dollar plan, upon death the employer receives either	cash value or premiums paid whichever is higher
businesses often purchase life insurance on its key members, paying its premium and assigning itself as the beneficiary in the event of death.	Key-Person Insurance
Life insurance provides the financial assistance needed to maintain a standard of living for surviving dependents of a sole proprietor and to facilitate the potential sale of the business.	Sole Proprietor Business Continuation
also referred to as a ‘buyout’ agreement	A buy-sell agreement
financial agreement or arrangement that protects business partners and corporate shareholders against financial loss by securing a predetermined fair market value for each partner	A buy-sell agreement/buyout
typically used if only a few partners exist within a company.	Cross-Purchase Plan
plan is typically used if several partners exist within a company	Entity Plan
the company itself purchases a life policy on each partner and serves as the policyowner of each policy.	Entity Plan
Entity Plan, , if 5 partners exist, the company purchases	5 policies
when only a few shareholders exist	corporate cross-purchase plan is purchased by each shareholder
when several shareholders exist, an entity plan is purchased by the corporation on each shareholder.	Stock Redemption Plan
basic type of life insurance that is lower in cost to a policyowner, is only in force for a specified period of time, and it does not accumulate cash value, nor does it provide the policyowner with any policy loan value	A Term Life
term life policy can also include an ‘adjustable premium’ schedule which is indeterminate at the time of policy issuance	Indeterminate Level Premiums
Indeterminate Level Premiums are based on	insurer’s current mortality rates, interest earned from premium investments, and company expenses.
Indeterminate Level Premium Policy premiums are guaranteed to never	exceed a certain amount;
term life policy’s face amount remains constant	Level Term
life policy’s face amount decreases over the term of the policy.	Decreasing Term
term life policy’s face amount increases over the term of the policy.	Increasing Term
this type of policy is not often sold as a stand-alone insurance product, it is typically incorporated into a whole life policy as an added rider	Increasing Term
term life policy does not require evidence of insurability at the time of renewal (guaranteed); however, premium rates increase according to the age of the insured at the time of each renewal.	Renewable Term Policy
premium rates increase according to the age of the insured at the time of each renewal.	Step-Rate Premiums.
provides the policyowner with the ability to maintain a lower premium rate if the policyowner passes a medical exam at periodic intervals (typically every 5 years).	‘re-entry option
provides an option to convert the term policy at the end of its term for a permanent whole life or other cash value policy without requiring evidence of insurability.	A convertible term life policy
Although both the current and original age methods of conversion seem to add up to the same amount for the policyowner, choosing the original age method increases the policy’s	cash value quicker as a result of the bulk payment and increased interest that is paid when converting the term policy.
ommonly provided by insurers to ensure immediate temporary term life protection during the underwriting of a whole life policy.	Interim Term
An interim term policy is commonly issued for a period of	1-11 months
premiums for the whole life policy are based on the age of the policyowner when the interim policy converts to the whole life policy not the age	age of the policyowner at the time the interim term began.
more expensive type of term life insurance that provides an ‘end benefit’ to the policyowner at the expiration of his or her policy’s term by returning 100% of the premiums paid into the policy when the insured survives the policy’s term	Return of Premium (ROP) Term Life Policy
provides coverage for an individual’s whole life, rather than a specified term known as whole life and 3 other terms:	Ordinary, Permanent, or Straight-Life
cash surrender’ value, called the	Nonforfeiture Value
allowing the policyowner to recover part of the premium invested in the policy if he or she stops making premium payments and forfeits ownership of the policy.	Nonforfeiture Value
whole life insurance matures at age	100
The following types of whole life insurance policies include (5)	Continuous Premium (Straight Life), Limited Payment, Single Premium, Current Assumption, ‘Economatic’ Policy
Also known as Interest-Sensitive Whole Life,	Current Assumption
Also known as Enhanced Ordinary Life or Extra Ordinary Life	Economatic’ Policy
Economatic’ Policy	combines term and whole
Flexible Premium Policies	Adjustable Life, Universal Life, Guaranteed Universal Life (Term Life / Universal Life Hybrid)
Also known as a ‘flexible premium’	adjustable life policy
form of life insurance that consists of both term and permanent insurance.policyowner can, change various aspects of the policy including increasing or decreasing the face amount, premium, or changing the period of coverage, to continue to be flexible	Adjustable Life
type of permanent insurance, client can control cost of premiums as well as the ability to invest and earn interest on the cash value that the policy builds.	Universal Life
this alternative allows a policyowner to build up savings to protect against inflation	Universal Life
Also referred to as a Universal Term Life policy	Guaranteed Universal Life
universal life designed as term life insurance with guaranteed level premiums and a guaranteed death benefit upon the death the insured during the contract’s term	Guaranteed Universal Life
unlike permanent universal life insurance, a universal term life policy does not accumulate cash value	Guaranteed Universal Life
Unlike general term life policies with terms of 10, 15 or 20 years, guaranteed universal life policies generally provide a	30 year term
variable life policies are also considered to be	securities contracts.
In order to sell variable life insurance policies, not only is a life insurance license required, but also a	Financial Industry Regulatory Authority (FINRA) license
Involves the combination of universal life and variable life policies, containing a varying degree of death benefits, cash values and premium payments.	Variable Universal Life
type of life insurance largely based on the rate of return in the financial markets. ability to transfer funds from a fixed account to an indexed account	Equity Indexed Life
Cash value can only increase if the market is favorable, but cannot decrease when the market declines.	Equity Indexed Life
this form of whole life insurance provides coverage for each family member with the breadwinner’s amount of coverage being four times the spouse’s and five times the children’s coverage amounts.	Family Protection Policy
children’s coverage is usually written as term coverage expiring at age 18 with the ability to convert to long-term coverage without proof of insurability.	Family Protection Policy
Family Protection Policies are usually written for terms of	10 – 20 year
combination of whole life insurance and level term insurance to provide permanent coverage (lump sum payment to the beneficiary when the insured dies) and a monthly family maintenance portion for a set period of time following the insured’s death.	Family Maintenance Policy
insurance can be purchased on multiple lives under a single contract.	Joint Life Policy
under a first-to-die policy, upon the death of the first spouse, the policy’s coverage	ends
joint life policy, also referred to as a Survivorship or Last Survivor life policy,	Second-to-Die
policy’s benefits are paid after the last surviving member of the contract dies	Second-to-Die
Such a policy is also used to pay estate taxes which may be due upon the death of the second spouse.	Second-to-Die
Survivorship life policies are written as	permanent whole life or universal life policies.
Usually written on children under the age of 15	Juvenile Life Policy
policies ‘jump,’ or increase four to five times in value once the child turns 21 without increased premium or proof of insurability.	Jumping Juvenile
Usually more affordable than straight whole life policies in the first few years (often around 5 years) then becomes slightly higher than straight whole life for the remainder of its coverage.	Modified Premium Whole Life
This type of plan is useful for college students just starting out in the work world, who cannot initially afford whole life insurance.	Modified Premium Whole Life
Similar to modified whole life with more affordable premiums for the initial years, graded premium whole life gradually increases for the next few years until finally leveling off at a slightly higher rate than standard whole life.	Graded Premium Whole Life
form of whole life insurance is based on an initial premium payment which allows for cash values to immediately build in the account.	Minimum Deposit Whole Life
Subsequent premium payments are then paid by borrowing from the cash value for a portion of or the entire premium amount instead of contributing additional out-of-pocket premium.	Minimum Deposit Whole Life
Includes a face amount that will adjust depending on the index to which it is fixed, often the Consumer Price Index (CPI)	Indexed Whole Life
If the index to which the policy is tied increases, so too do the policy’s face amount and premiums.	Indexed Whole Life
indexed whole life, t is decided at the time of the policy’s inception who will absorb the additional amounts in premium if it is to occur, either the	insured or the insurer
Indexed Whole Life, If the index rises higher than what the insurer allows for a maximum face amount increase (usually 5%),	no additional amount is added to the policy’s face amount
Indexed Whole Life, If the CPI decreases, the policy’s face amount and premium	do not decrease
Indexed Whole Life, An important feature is that evidence of insurability is not required when	increases occur.
industrial life insurance provides minimal life insurance coverage	Burial Insurance
Associated with industrial life and group life insurance, is a policy provision that permits an insurer to appoint a new beneficiary in an attempt to facilitate the policy’s death benefit due to an extenuating circumstance	Facility of Payment provision
serves to protect both the debtor and creditor in the event that a debtor dies and is not able to finish paying of his or her debt	Credit life insurance
decreasing term life policy that is designed to pay off a policyowner’s mortgage should he or she die	A mortgage redemption policy
designed to pay out to the designated recipient, while living once matured	has ‘matured
This type of endowment does not include a death benefit and only pays out to the insured if he or she survives the endowment period,	Pure Endowment
This type of endowment is a combination of a pure endowment and a term life policy so that the endowment pays out at its maturity, while the term policy pays the beneficiary if the insured dies during the pure endowment period.	Endowment Life Insurance
This type of endowment is used to help fund college expenses and usually matures when a child turns age 18.	Juvenile Endowment
(NAIC) established uniform cost comparison methods	NAIC Life Insurance Solicitation Model Regulation,
NAIC Life Insurance Solicitation Model Regulation, disclosures include requiring a prospective buyer to be provided with 2 things	buyer’s guide’ and a ‘policy summary
generic document that explains the basic terms and definitions related to life insurance, as well as the type of whole life insurance being marketed.	Buyer’s Guide
a life insurance ____ reviews the specific product being purchased in detail	Policy Summary
life insurance Policy Summary includes (7) things	agent and insurer, policy's premium rate, exclusions, dividends, riders, cash values, benefit amounts
whole life insurance, the policy summary is also required to include	‘cost index’ charts
compare similar whole life policies based on the overall cost of each policy to the policyowner.	‘cost index’ charts
Whole Life Insurance Cost Comparison Methods (2)	traditional’ cost comparison method and the ‘interest-adjusted’ cost comparison method.
accounts for the various cost factors of a whole life policy except for the interest earned over the life of the policy,	Traditional Cost Comparison Method
Traditional Cost Comparison Method is less accurate bc it doesn't account for the	time value of money
takes into account and calculates the amount of interest a whole life policy will earn to more accurately compare it with other whole life policies.	Interest-Adjusted Cost Comparison Method
takes into account the various cost factors of a whole life policy and computes an ‘index number’ to more easily compare it similar whole life policies.	Cost Index
As an industry standard, cost index charts compare whole life policies based on each	$1,000 increment of the policy’s face amount for 10-year and 20-year time period
face value of life insurance is	amount of money paid to the beneficiary when the policy expires
Cost Index uses an average annual rate of return in interest of	5%
In determining the cost of a policy, the lower the index #, the	less costly it will be
based on the assumption that a policyowner will surrender a whole life policy in the future and is calculated using the interest-adjusted cost comparison method.	Surrender Cost Index
used to compare similar policies based on the death benefit provided to the beneficiary.	Net Payment Cost Index
Net Payment Cost Index is calculated using the	traditional cost comparison method.
a presentation or depiction that includes non-guaranteed elements of a life insurance policy over a period of years.	Illustration
include premiums, benefits, value, credits or charges under a life insurance policy that are not guaranteed or determined at policy issue	Non-Guaranteed Elements
include premiums, benefits, values, credits or charges under a life insurance policy that are guaranteed and determined at policy issue.	Guaranteed Elements
NAIC categorizes a life insurance policy illustration as either (3)	basic, supplemental, in force
a ledger or proposal used in the sale of a life insurance policy that shows both guaranteed and non-guaranteed elements.	Basic Illustration
an illustration furnished in addition to a basic illustration that may be presented in a format differing from the basic illustration, but may only depict a scale of non-guaranteed elements that is permitted in a basic illustration.	Supplemental Illustration
an illustration furnished at any time after the policy that it depicts has been in force for one year or more.	In force illustration
NAIC, its model regulation applies to all life policies EXCEPT	variable, annuities, credit life insurance, policies with no illustrated death benefits on any individual exceeding $10,000
receipt that does not provide immediate coverage for the applicant,	inspection receipt
which does provide immediate coverage for the applicant while the policy is being underwritten by the insurance company.	conditional’ or ‘binding receipt’
Sometimes an applicant wishes to review, or ‘inspect’ a prospective policy before providing the initial premium to the insurer. When this occurs, a ___ receipt is provided	inspection receipt
receipt, the applicant is covered against loss, should it occur, before the policy becomes effective, on the ‘condition’ that the applicant is found to be insurable	conditional receipt
guarantees temporary coverage at the time of application for a specified benefit amount regardless of whether the insurer later approves or declines the applicant	binding receipt
binding receipt	Temporary Insurance Agreement
Often required by the insurer when a life insurance applicant is applying for a large amount of insurance.	Inspection Report
more formally known as the ‘Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism’ Act,	USA PATRIOT Act,
USA PATRIOT Act, requires financial institutions to establish	anti-money laundering and suspicious activity reporting programs
USA PATRIOT Act each financial institution must maintain	programs, provide company training , comply with a self-assigned audit of company records using a non-company auditing agency.
as benefit limits, exclusions of certain risk or additional premium that the insurer adds to a policy for any applicant underwritten as substandard risk.	Policy Amendments
the date that the application is submitted along with the initial premium and a conditional receipt is given to the applicant.	Effective Date
By law, the insurer is required to provide the death benefit within	60 days of proof of death;
replacing a life insurance policy using its cash value to purchase a larger face amount or to obtain a new policy,	Life insurance replacement
Life insurance replacement	Internal,
is replaced with another policy by a different insurer.	External
defined as maintaining an insured’s current life policy as the policy matures over tim	Retention
Replacing a policy often reduces or forfeits	he current policy’s cash value
this provision details the policy’s documents, including the policy application and any attached riders that may have been added to the policy.	Entire Contract Provision
states that an insurance company will honor its obligation to pay benefits in the event of an insured’s death.	Insuring Clause
specifies the premium amount and date on which payments must be received to maintain the life policy.	Consideration Clause
pecifies a period of time in which a policyowner has the right to review and reject his or her insurance policy if not completely satisfied with its coverage.	Free-Look Provision
tFree-Look Provision period extends	10-14 days from the date of receiving a new policy
After a specific period of time (usually 2 years, but in some states only 1 year), as long as a policy remains in force, an insurance company cannot contest the validity of a policy and must pay its death benefit	Incontestable Clause
Incontestable Clause Exceptions	Impersonation , No insurable interest at time of application , Intent to murder
If the insured commits suicide after the first ?# years, e insurer is obligated to pay the death benefit	If the insured commits suicide after the first
e insurer is obligated to pay the death benefit	policy Assignment.
assignee gains full control of the policy and acquires all rights	Absolute Assignment
policyowner assigns his or her policy to a creditor as collateral for a debt.	Collateral Assignment
In the event that a misstatement of age or sex occurs on the application for life insurance, the insurer will adjust	the amount of future premiums and request payment of the additional premium that the policyowner should have paid.
In the event that a premium is not paid after the policy’s grace period has ended, this provision will automatically take the required premium amount from the policy’s cash value in order to prevent the policy from lapsing.	Automatic Premium Loan Provision
This Act, established under the U.S. Uniform Probate Codedefines the outcome of a life policy’s proceed distribution in the event that both the policy’s insured and primary beneficiary die in the same accident and no proof exists of who lived longer.	The Uniform Simultaneous Death Act
To further define who receives death benefits in the event of the simultaneous or nearly simultaneous death of both the insured and primary beneficiary, a policyowner can include a	a common disaster clause
specifically stating that the primary beneficiary must outlive the insured for a defined period of time in order to receive the policy’s death benefits.	Common Disaster Clause
Common Disaster Clause common period	10 to 30 days after the death of the insured.
clause defines whether the primary or the contingent (secondary) beneficiary is to receive the death benefit	Common Disaster Claus
protects the proceeds of a life insurance policy from the beneficiary’s spending habits or any redirection of proceeds to any of the beneficiary’s creditors.	Spendthrift Clause
Under this clause, the beneficiary cannot receive a lump sum benefit or assign proceeds directly to a creditor	Spendthrift Clause
Until the Armstrong Investigation of 1905, it was common for an insurer to	keep part or all of the accumulated cash value in a forfeited whole life policy.
Today, however, in the event that a cash value life policy is ‘forfeited,’ or surrendered, the insurer must pay out the policy’s	‘cash surrender value’
the amount payable by the insurer to a policyowner who surrenders his or her whole life policy.	Cash Surrender Value
Cash Surrender Value:The amount payable to the policyowner is based on the	policy’s face amount, premium payment structure and length of time in which the policyowner has paid policy premiums.
requires insurers to pay any accumulated cash value in a whole life policy to the policyowner if he or she stops paying policy premiums to the insurer.	Standard Nonforfeiture Law
If the policyowner fails to select a nonforfeiture option	the insurer will automatically issue a paid-up extended term life insurance policy
allows a policyowner immediate access to his or her whole life policy’s cash value;	Cash Surrender Option
many states permit insurers to postpone surrender payments for up to	6 months after the surrender of a whole life policy
before a cash surrender of a whole life policy can occur, most insurers require that the policy be in force for at least	3 years after it is issued.
allows a policyowner to cancel his or her current whole life policy and reinvest the policy’s cash value by purchasing a single-payment whole life policy at a lesser face amount than the original, forfeited policy.	Reduced Paid-up Option
policyowner uses the policy’s cash value to buy a term life policy with the same face amount as the surrendered whole life policy at a lesser term length, based on the amount of cash value available at surrender.	Extended Term Option
Under this option, installments are composed of both the policy’s face amount and earned interest, the amount of which is determined by the length of time in which payments are to be made to the policy’s beneficiary.	Fixed-Period Option
amount of each installment is fixed and is continually paid to the policy’s beneficiary until the policy’s proceeds are exhausted.	Fixed-Amount Option
installments are paid to the policy’s beneficiary throughout the entirety of his or her life through the purchase of a single payment immediate annuity funded by the death benefits of the life insurance policy.	Life Income Option
The policyowner simply receive a cash distribution as his or her return of premium from the mutual insurer.	Cash Dividend Option
This option allows the policyowner to reinvest policy dividends back into the insurance company to continue to accumulate interest at a compounding rate	Accumulation at Interest Option
This option allows a policyowner to purchase additional insurance using dividend returns; however, premiums are higher as a result of the increased age of the insured at the time of purchasing additional insurance.	Paid-up Additions Option
This option uses dividend proceeds to reduce the next year’s premium payments.	Reduce Premium Dividend Option
This option allows the policyowner to pay off the policy earlier than the projected time period using dividend returns in combination with monthly premium payments to reduce the amount of time remaining to pay off the policy.	Paid-Up Option
Paid-Up Option	One-Year Term Dividend Option
lso known as an Endorsement	Rider
this rider offers an additional amount of life insurance equal to the face amount of the primary insurance plan if the insured’s death results from an accident	Double Indemnity
in the event that an insured survives an accident, but still loses a limb or eyesight, this rider provides half of the death benefit amount to the insured.	Accidental Death and Dismemberment Rider
an insured is unable to earn an income due to an illness or disability and is unable to pay his or her insurance premiums, this rider will prevent the policy from lapsing due to the lack of payments.	Waiver of Premium Rider
Waiver of Premium Rider, insured must be unable to work, usually for a period of	90 days to 6 months.
If at the end of this period the insured is still unable to work, all premiums paid during the ‘waiting period’ will be	refunded and the insured will not have to pay premiums until they reach a specific age, which is usually 60 to 65.
this rider waives monthly deductions on a universal life policy while the insured is disabled, typically after a 6-month waiting period	Waiver of Monthly Deduction Rider
Monthly income that is paid to the insured if total and permanent disability occurs	Disability Income Rider
If a guardian who is responsible for paying premiums for a child’s insurance dies or becomes disabled, this rider will waive all premiums until the child reaches a certain age	Payor Rider
This rider, also known as an ‘insurance protection’ rider or an ‘option to purchase other insurance,’	Guaranteed Insurability Rider
Guaranteed Insurability Rider intervals start on a policy’s anniversary date coinciding with the policyowner’s 25th birthday, and increases to a policy’s face amount can be added every	three (3) years thereafter until the policyowner turns age 40.
adding this rider, the beneficiary not only receives the face amount of the policy, but also all premiums paid into the policy up to the death of the insured;	adding this rider, the beneficiary not only receives the face amount of the policy, but also all premiums paid into the policy up to the death of the insured;
Rider: its face amount will automatically increase with a corresponding increase in an inflation index, such as the CPI.	Cost of Living Rider
This rider is referred to as a Family Rider or Child Rider	Other (Additional) Insured(s) Rider
Each family member who is added to either of these policies receives term life coverage as a rider to the whole life policy written on the policyowner, typically the breadwinner in the family.	Family Rider
Also known as a Living Need, Terminal Illness, and/or Critical Illness Rider	Accelerated Death Benefit Rider
Used in conjunction with universal life insurance policies, this rider allows a life policy to continue in force even if its cash value is zero as long as the policyowner satisfies the contract’s minimum premiums requirements, as defined in the policy.	Used in conjunction with universal life insurance policies, this rider allows a life policy to continue in force even if its cash value is zero as long as the policyowner satisfies the contract’s minimum premiums requirements, as defined in the policy.
provides life insurance on a one-year term basis that is most often renewable without proof of insurability and allows the insurer to adjust annual premiums based on the experience of the group.	Annual Renewable Term
involves a combination of both term and whole life policies where the employer pays for the term portion and the employee pays the whole life portion.	Group Paid-Up Life
is established by two or more similar employers within a related industry, but who are not part of a collective bargaining agreement.	Multiple Employer Plan
A multiple employer plan is established through a financial contract called a	Multiple Employer Trust
is established by two or more employers within a related industry who are also part of a collective bargaining agreement	Multiemployer Plan
multiemployer plan is established through a type of trust, known as a	Taft-Hartley Trust,
Taft-Hartley Trust,name of this trust refers to the two Congressmen who spearheaded the	Labor Management Relations Act of 1947, a
Taft-Hartley Trust, Such regulation includes appointing a	joint employer-union board of trustees to serve as the plan’s sponsor.
Welfare arrangements, known as	Multiple Employer Welfare Arrangements, or MEWAs,
In comparison to a typical multiple employer trust in which several small employers group together to purchase insurance at a lower rate as a result of the increased size of the group, MEWAs	are often self-insured or partially insured arrangements.
Blanket insurance is non-specific group insurance provided when a group is constantly changing.	Blanket Customer Groups (teams, passengers and others)
a financial vehicle that provides income at a future date in an individual’s life and is commonly used to save up for higher education costs or as a retirement savings fund.	Annuity
meaning that the contract begins to distribute both the Invested Principal and Earned Interest to the annuitant to serve as future income.	annuitizes,
annuity’s growth period	Accumulation Period
Once the contract annuitizes, a second period, called the	Annuity Period or ‘payout’ period,
Annuity riders commonly added to an annuity include (3)	long-term care riders, guaranteed monthly income riders, and death benefit riders,
This type of annuity structure involves the owner and annuitant being two separate individuals and is designed to benefit the annuitant upon the death of the annuity’s owner.	‘owner-driven’ annuity structure.
Designed as a means of spreading out a lump-sum of money over a specified period of time,	Immediate Annuity
delays payout to allow interest to compound over a period of time.	Single-Premium Deferred Annuity (SPDA)
multiple-premium, deferred annuity that allows the contract owner to control the premium deposit amounts and frequency within certain limits stated in the contract,	Flexible Premium Deferred Annuity (FPDA).
annuity payment option provides an annuitant with a guaranteed income for the entirety of his or her life; however, if the annuitant dies before the principal sum is depleted, distribution payments stop and any remaining amount is forfeited to the insurer	Pure Life annuity
guarantee the distribution of the annuity’s funds, whether it is paid to the annuitant, or to a designated beneficiary	Life with Guaranteed Minimum payout
this distribution option pays out for the life of the annuitant. If the annuitant dies before receiving at least the principal amount invested, the annuity ‘refunds’	Refund Life Annuity Option
payments must be paid for a specified period of time, as stated in the contract. Should the annuitant outlive this period, payments continue to be paid for the rest of the annuitant’s life.	Life with Period Certain Option
This payment option results in the payout of two annuitants.	Joint and Full Survivor Option
however, two-thirds of the original payout amount is payable to the survivor, in comparison to the full payout	Joint and Two-Thirds Survivor –
one-half of the original payout amount is payable to the survivor,	Joint and One-Half Survivor
payments are only paid for the specified period stated in the contract.	Temporary Annuity Certain Option
In the event that an annuitant decides to partake in a partial or early withdrawal from his or her annuity, not only will it be taxed as ordinary income, but it will also incur a	10% penalty tax if the withdrawal occurs prior to reaching 59 ½ years old.
provides a guaranteed rate of return in interest on the annuity and protects the annuity against loss of principal.	Fixed Annuity
generally provides a higher rate of interest on an annuity, but it is riskier, with the potential to provide either a positive or negative return on the annuity based on its performance in the stock market.	Variable Annuity
a unique type of fixed annuity that provides a minimum guaranteed rate of interest return on the annuity while also providing an opportunity for a return in interest higher than the guaranteed minimum,	equity index annuity
interest rate adjustment based on whether the current rate of interest is higher or lower than the rate in which the annuity was guaranteed.	Market Value Adjustment (MVA)
modified guaranteed’ annuity because it provides a minimum guaranteed rate of return unless it is surrendered by the annuity’s owner before it matures.	market value-adjusted annuity
Also referred to as an Internal Revenue Code 403(b) Plan	Tax-Sheltered Annuity (TSA)
, this type of fixed annuity is often utilized by schools, universities, charities, and religious organizations.	Tax-Sheltered Annuity (TSA)
an annuity reserved for non-profit organizations that aid in their employees’ retirement	Tax-Sheltered Annuity (TSA)
type of fixed annuity that is combined with a decreasing term death benefit	Individual Retirement Annuity (IRA)
Individual Retirement Annuity (IRA) : decreasing term policy usually expires when the	annuity matures and is paid out to the annuitant.
Individual Retirement Annuity (IRA): Contribution levels allow up to	100% of an individual’s annual income
Individual Retirement Annuity (IRA):cannot exceed contribution limits set each year by the	federal government.
Individual Retirement Annuity (IRA): Any contribution that exceeds annual limits will be subject to a	6% “excise” tax.
Individual Retirement Annuity (IRA): Individuals who are ?50 years or older are allowed to make “catch up” contributions that exceed normal annual limits.	50 yrs or older
Fixed Annuity: 2 Interest Rates are used to help guarantee a return:	Minimum Guaranteed Rate, Current Rate
defined as the rate used at the time an insurer credits the annuity, typically once a year.	Current Rate
Two important concepts that must be examined before completing variable annuities are	accumulation units’ and ‘annuity units
provide a minimum amount of financial protection for working Americans	Social Security Act of 1935
FICA taxes are imposed on an employee’s wages up to a maximum annual amount, known as the	Social Security Wage Base.
no such income limit exists, meaning that an employee’s entire annual wages are FICA taxable for	Medicare purposes.
to impose a similar payroll tax for self-employed individuals.	to impose a similar payroll tax for self-employed individuals.
The SE tax is only imposed on	92.35% of net earnings
which is determined by how many Quarters of Coverage or Credits he or she has accumulated while being employed and taxed under FICA.	Insured Status,
An individual qualifies as partially insured, also referred to as	Currently Insured
Social Security benefit amounts are based on an individual’s lifetime earnings that were taxed under the FICA payroll tax using an indexed earnings average, called the	Average Indexed Monthly Earnings (AIME).
the benefit amount that an individual receives when he or she chooses to begin receiving retirement benefits at his or her normal retirement age.	Primary Insurance Amount (PIA)
Primary Insurance Amount (PIA)	Dual Benefit Provision
Disability Benefitsare paid after a #? month waiting period to ensure the individual is totally disabled.	5
are paid after a 5 month waiting period to ensure the individual is totally disabled.	Lump-Sum Death (Burial) Benefit
If the surviving spouse is responsible for children dependents, he or she will receive #% of the recipient’s PIA during the period of time when the surviving spouse is responsible for caring for any surviving children.	75%
Upon reaching age 60, the surviving spouse will begin receiving survivor’s benefits of ?%	71.5%
federal organization that was created under ERISA to guarantee payments of pension benefits in ‘defined benefit’ plans that terminate due to a lack of funding to cover benefit payments	Pension Benefit Guaranty Corporation (PBGC)
federal organization that was created under ERISA to guarantee payments of pension benefits in ‘defined benefit’ plans that terminate due to a lack of funding to cover benefit payments	Defined contribution plans
plans guarantee, as specified in an employee’s contract, the amount of benefit or percentage of employment income that he or she will receive once pension benefits are payable at retirement.	Defined benefit plans
type of retirement plan designed to provide certain tax benefits such as tax-free contributions by employees, tax-deducted contributions by employers and tax-deferred earnings growth to allow for greater earning on the investment.	Qualified Plan
type of retirement plan that does not meet IRS guidelines to receive tax advantages.	Nonqualified Plan
Nonqualified Plan are restricted to	top executives and key people within a company’s leadership structure.
the time period in which an employer sets up for employees to gain ownership over employer contributions that are deposited to the employee’s qualified retirement account.	Vesting Schedule
to allow their employees to gain immediate ownership of employer contributions	immediate vesting
occurs when an employer requires a certain number of years of plan accumulation and then provides 100% vesting to the employee	cliff vesting
also referred to as ‘graduated’ vesting, occurs over a number of years where a larger percentage of ownership is gradually transferred to the employee, who eventually gains ownership of 100% of the employer’s contributions.	Graded Vesting
plans provide retirees with shared profits from the company; however, employers are not required to contribute to such plans every year.	Profit-sharing and stock bonus pension plans
a type of defined-contribution plan that is invested primarily in employer stock in which qualified employees receive ownership upon retirement.	Employee Stock Ownership Plan (ESOP)
benefits provided to the employee from stock ownership plans are dispersed in the form of company stock, instead of a monetary pension payout.	Employee Stock Ownership Plan (ESOP)
Also known as an ‘individual account’ plan, this type of defined-contribution plan requires the employer to deposit a fixed amt	Money-Purchase Pension Plan
This type of plan allows an employee to take a reduction in his or her salary and instead, contribute this amount into his or her retirement fund.	401(k) Plan
is part of the Internal Revenue Code that allows employees of state and local governments, as well as for employees of nonprofit organizations, the ability to defer compensation	is part of the Internal Revenue Code that allows employees of state and local governments, as well as for employees of nonprofit organizations, the ability to defer compensation
retirement plans enacted by Congress to provide retirement pension for federal civil service employees and members of the armed forces.	Thrift Savings Plan (TSP)
this tax-favored retirement plan is provided to eligible employees of the public school system and certain non-profit organizations that are considered to be ‘tax-exempt’ organizations.	403(b) Plan /Tax-Sheltered Annuity (TSA
plan sets up an individual retirement account (IRA) to which an employer contributes funds on a tax-deductible basis.	Simplified Employee Pension Plan (SEP)
SEPs do not require employers to make annual contributions but do require	contributions to be made on a continual basis
Employees are fully vested in employer contributions immediately upon beginning the plan SEP	Simplified Employee Pension Plan
This type of salary reduced SEP was reserved for small business owners consisting of 25 or fewer employees.	Salary Reduction SEP Plan (SARSEP
was a more simplified version of a 401(k) plan which incorporated a salary reduction approach in which employees elected to have a portion of their pay directed into the SEP’s IRA fund.	Salary Reduction SEP Plan (SARSEP
Created by the Small Business Job Protection Act of 1996,	Savings Incentive Match Plan for Employees,
plan is marketed towards small businesses with fewer than 100 employees, as well as tax-exempt companies and government.	Savings Incentive Match Plan for Employees,
plans are beneficial to smaller employers because they are less restrictive in establishing a plan and require less administrative costs and plan maintenance than other retirement plans.	Savings Incentive Match Plan for Employees,
‘SIMPLE’ plan, Employers can implement one of two methods in making the required annual contributions	first method is to ‘match’ each employee’s contribution up to 3%. The second method is to make a flat 2% contribution
Established through the Self-Employed Individuals Retirement Act of 1962,	Keogh Plans
provide a retirement plan for self-employed and small business owners who do not qualify to create or participate in a qualified company pension plan.	Keogh Plans
Also known as ‘H.R. 10’ Plans	Keogh Plans
these plans must follow similar qualified corporate plan requirements and are more costly to maintain than a SEP plan, but also allow segain a higher return in investment at retirement, in comparison to employee contribution limits set by SEP plans.lf-emp	these plans must follow similar qualified corporate plan requirements and are more costly to maintain than a SEP plan, but also allow self-employed individuals to deposit higher contributions
Qualified Tuition Programs (QTPs)	Section 529 Plans
hese plans are designed to save for college tuition as well as receive tax credits and deductions towards college expenses	Section 529 Plans
Allows future tuition to be paid for a certain amount of time at current tuition costs.	Prepaid tuition plans
– Allow contributions to be invested with after-tax dollars to allow for a positive return upon time for distribution.	Types of Section 529 Plans
was enacted by Congress in 1974 as part of the Employee Retirement Income Security Act (ERISA).	ndividual Retirement Account, or IRA
Currently, individuals under age 50 are limited to $#(2019/2020) in combined annual contributions between all individual accounts, including ‘Traditional’ and ‘Roth’ IRAs.	$6000
IRA, IRS provides for ‘catch-up’ contributions of up to an additional	$1000per yr
an individual’s contributions are deposited into the IRA using ‘pre-tax’ dollars.	Traditional IRA,
IRS also mandates withdrawal from an IRA account to begin no later than April 1st following the year an individual reaches	70½ years old.
As a result of the Taxpayer Relief Act of 1997,	the Roth IRA was created
Withdrawals from Roth IRAs can be ? in which earnings are distributed tax-free	Qualified,
ira funds must be held in the account for a minimum of	5 yrs
Also known as an ‘individual account’ plan, this type of defined-contribution plan requires the employer to deposit a fixed monetary contribution into an employee’s pension fund, instead of sharing in company profits/issuing shares of the company’s stock.	Money-Purchase Pension Plan
policy’s cash value must not exceed the amount that would be required as a lump-sum premium to fully pay off the policy based on the policy’s face amount, based on the age of the insured.	Cash Value Accumulation Test (CVAT)
policy’s premiums cannot exceed the amount that would be required to fully pay off the policy based on the policy’s face amount	Guideline Premium Test (GPT)
Dividends paid out to participating policyowners in a mutual life insurance contract are considered to be a reimbursement of premium paid to the insurer and are paid back on a	tax-free basis
any interest paid to policyowners in addition to the premium reimbursement is considered to be	income and is taxable
Another tax advantage associated with life insurance is the ability to withdraw funds in the form of a policy loan without	being taxed.
if the policyowner surrenders his or her policy,	an income tax is levied against any gain in the policy’s loan value amount.
do not need to report their employer-paid premiums as income as long as their policy coverage is	do not need to report their employer-paid premiums as income as long as their policy coverage is
To avoid this estate tax, the insured can transfer ownership of his or her life contract to the designated beneficiary, but the transfer must be completed at least	three years before the death of the insured.
Qualified annuities are funded with	pre-tax dollars paid through an employer-based IRA or other qualified retirement plans
Non-qualified annuities are funded with	non-deductible, after-tax dollars
defined as the ‘investment’ in the contract divided by the ‘expected return’.	Exclusion Ratio,
Non-qualified annuity payments are taxed on a ? basis	Last In, First Out (LIFO) basis
for taxation purposes, the after-tax deposits are considered to be deposited into the account first and any interest that was earned is deposited into the account last.	Last In, First Out (LIFO) basis
contracts purchased and maintained by non-living, corporate- or trust-owned entities are considered to be ‘non-natural,’ and do not qualify to receive the same IRS tax advantages provided to ‘natural,’ living individuals.	Non-Natural Person Rule
is defined as the process of moving funds from one financial institution directly to another without the withdrawal or distribution of such funds to the individual.	Transfer
the process of reinvesting distributed funds from one account into another	Rollover
As a result of the over-marketing and aggressive investing in life insurance as a retirement tool, Congress enacted the	Technical and Miscellaneous Revenue Act, known as TAMRA,
intention of defining the tax consequences associated with misusing life insurance primarily as an investment vehicle, instead of its purpose of providing financial protection against possible loss	Technical and Miscellaneous Revenue Act, known as TAMRA,
under ? , flexible premium life insurance contracts are regulated by placing a limit on an individual’s premium contributions and monitoring the contract to ensure that it is not ‘over-funded’ within the first 7 years of the policy.	Technical and Miscellaneous Revenue Act, known as TAMRA,
In order to deter short-term investments from being tax shelters, the IRS monitors the funding of life insurance through what is known as the	‘7-pay test.’
If life insurance fails the 7-pay test, it no longer represents a life insurance policy, and instead, is classified as a ‘	‘modified endowment contract,’ at which point the policy’s living benefits become taxable
is an over-funded life insurance policy that according to its premium contributions within the first 7 years of the policy, has disqualified itself from the IRS tax advantages of a life insurance contract	Modified Endowment Contract
Modified Endowment Contract	tax-free, lump-sum death benefit
the IRS does not levy an income tax against an individual when he or she exchanges one policy of similar nature with another since neither loss nor gain occurs as a result of such transfe	Section 1035 of the Internal Revenue Code
Under Section 1035 of the IRC, A life policy can be exchanged for	another life policy, endowment, or annuity without being taxed
An endowment can be exchanged for	another endowment or annuity without being taxed
An annuity can be exchanged for	another annuity
defined as any healthcare system that is established to manage the costs of medical care	Managed Care
provide financial protection against loss resulting from illness or bodily injury	Health and Disability Insurance
Health insurance can be purchased through a commercial insurer, such as	stock, mutual, or multi-line company.
Health insurance can also be purchased by a service provider,	such as a Blue Cross Blue Shield company, an HMO or a PPO insurer
all health care can be categorized into three broad areas: ‘	medical, disability, accidental death and dismemberment’
Considered to be an ‘??’ type of contract,simply known as ‘health insurance,’	indemnity contract
Considered to be a ? contract, the primary purpose of disability income insurance is to replace a certain percentage of an insured’s income that would otherwise be lost due to a debilitating event	‘valued’
pays out if death occurs,	Principal Sum (face value)
a percentage of the principal sum) pays out if dismemberment or loss of vision occurs.	Capital Sum
defined as any healthcare system that is established to manage the costs of medical care through a network	Managed Care
health insurance can be provided through government-sponsored programs, such as	Medicare, Tricare, Medicaid, SSDisability
commercial insurers provide insurance coverage on a ? basis	Reimbursement
allow a policyholder to assign benefit payments from the insurance company to a healthcare provider directly, known as the	Right of Assignment
service provider organizations operate on a ?basis	Prepaid Basis
Under this type of arrangement a policyholder can only choose to receive healthcare services from healthcare providers that are associated with the insuring provider for all non-emergency care	Exclusive Provider Organization (EPO)
this type allows a policyholder to seek healthcare services from any healthcare provider that he or she chooses, regardless of the insurer’s network, as long as the healthcare provider accepts the insurer’s payment for services rendered	Any providers
policyholder may still choose to receive healthcare services from an ‘out-of-network’ healthcare provider; however, he or she will pay a larger portion of the cost in comparison to an ‘in-network’ healthcare provider.	Mixture of providers
A federal-state welfare healthcare program designed to cover medical expenses such as hospitalization and physician expenses for qualified individuals who cannot afford health insurance coverage on their own.	Medicaid
Eligible individuals over age 65 may supplement their Medicare coverage with	Medicaid
State required coverage by which an employer is responsible to cover an employee in the event of an accident or illness on the job that occurs as a result of their occupation.	Workers’ Compensation
Types of Health Insurance Benefits (4)	medical, income, death, rehabilitation
A federally managed healthcare system designed to provide health care to qualified individuals age 65 and older.	Medicare
A form of managed health care for active and retired members of the armed services	Tricare
Tricare: Coverage also includes family members and survivors of a deceased armed services personnel if not qualified under	Medicare.
established by the Federal Government and is managed by the Social Security office. Funded through payroll taxes,	SSDI
provides disability benefits to qualified individuals who cannot work due to a disability.	SSDI
a nationwide federation of 36 independent insurance organizations, or ‘licensees’	Blue Cross & Blue Shield Association (BCBSA).
considered to be the nation’s largest ‘provider’ of health insurance.	BCBSA
Blue ? covers the hospital and doctor’s expenses,	cross
Blue ? covers medical and surgical expenses	shield
Insured customers under BCBS are called	subscribers
type of service provider in that it assumes both the financial risks associated with providing comprehensive medical services (financing member expenses) and the responsibility for coordinating such healthcare services to members	Health Maintenance Organizations (HMO)
are known for stressing ‘preventive care’ and health ‘maintenance.	HMO's
An HMO operates on a ? basis	service-incurred
HMO Organization-Considered a ‘producer’s cooperative,’ owned and operated by a group of physicians.	profit
HMO:Considered a ‘consumer’s cooperative,’ where doctors are salaried employees of the HMO.	nonprofit
Types of HMO Models ()	staff, group, IPA, network model, mixed model
participating physicians and specialists are considered exclusive employees to the HMO and are paid on a salary basis from the HMO	staff model
Often working out of one or more facilities, an HMO contracts with a third-party employer that employs physicians and specialists to offer services only to subscribers of the HMO	group model
considered a closed-panel plan because physicians do not accept individuals outside of the HMO.	group model
A fixed payment, per HMO member, given on a regular basis paid by the HMO to the third-party employer in a group-model.	Capitation Fee
is considered an open-panel plan because physicians also accept non-HMO individuals on a fee-for-service basis.	IPA, individual practice association model
An HMO that contracts with multiple groups of physicians and IPAs who offer their services to HMO subscribers, and also to non-HMO individuals on a fee-for-service basis.	Network Model
Because HMOs provide comprehensive medical coverage, they generally cannot exclude or limit a policy except for certain benefits such as	eye examinations or corrective glasses or contacts
An HMO uses a grievance procedure to resolve any subscriber complaints and must resolve the complaint within	180 days
Also known as a Leaky HMO	Open-Ended HMO
allows subscribers to better control their choice of health care providers. A subscriber can choose to see a non-HMO physician and receive an indemnity benefit (subject to a deductible and coinsurance).	Open-Ended HMO
allows subscribers to visit an in-network specialist without needing a referral from their PCP.	Open-Access HMO
type of network characterized by its size and resulting convenience in choosing in-network providers within a larger geographical area, usually encompassing several states or throughout the country.	PPO
insurers cover members’ medical expenses for both ‘in-network’ and ‘out-of-network’ services	PPO
newer type of health plan that combines elements of both HMO and PPO coverage together	Point-of-Service (POS) Plan
often used in conjunction with and to complement a PPO where the insured’s health is managed by a primary care doctor, providing services within a specific hospital.	Exclusive Provider Organization (EPO)
Federal legislation requires employers with at least 25 employees to provide the option to receive health coverage through an area	hmo
this type of insurance is marketed to the employees of a small business or members of an association or professional society.	Franchise Insurance
high-deductible health plan associated with a tax favored saving account that an employer creates for each employee.	Health Reimbursement Arrangement (HRA)
Also known as a Flexible Benefits Plan	IRS 125 Plan (Cafeteria Plan)
employers and individuals are allowed to contribute to a savings account on a pre-tax basis and carry over the unused funds at the end of the year.	Medical Savings Account (MSA)
type of health insurance plan that is associated with an HSA or MSA	High Deductible Health Plan (HDHP)
Unlike a Health Reimbursement Arrangement (HRA), the HSA policyholder controls the account and once deposited into the HSA, contributions become the	property of the policyholder, even if he or she changes employment.
Employees often pay premiums in the form of dues to their employer or group.	Self-Insured Plans
Multiple employers within a similar industry or field join and receive health insurance from a series of trusts that are established and maintained to provide insurance to employees of multiple companies at a lower and more affordable rate.	MET
technical term under federal law that is used to define any arrangement not maintained pursuant to a collective bargaining agreement that provides health insurance benefits to the employees of two or more private employers.	Multiple Employer Welfare Association / Arrangement (MEWA)
plans provide limited benefits in the form of indemnity payments which are paid directly to the insured	Basic Medical Insurance
expense plans are also referred to as First-Dollar Coverage	basic medical insurance
because they provide benefits upfront to the insured without having to satisfy any plan deductible.	basis medical insurance (first-dollar coverage)
Basic Medical Insurance Covers: (3)	basic hospital expenses, basic physicians (non surgical), basic surgical expenses
It determines the amount of benefit by assigning a specific value, or dollar amount, to each type of surgical expense provided;	Schedule of Surgical Procedures
This method follows the UCR approach explained earlier to cover the expense according to usual and customary costs based on other similar surgical procedures within a particular geographical area.	Usual, Customary, and Reasonable (UCR) Approach
instead of assigning a specific dollar amount for each procedure, a pre-arranged point system is established	Relative Value Scale
’ covers a wider range of medical expenses with generally higher individual benefits and policy maximums	major medical insurance
Three general types of deductibles exist in major medical insurance	corridor,’ ‘integrated’ and ‘flat’ deductibles.
clause added to a major medical policy that provides for expenses incurred in the final 3 months of the calendar year (October – December) to be carried or ‘rolled over’ and applied toward the next year’s deductible.	deductible carry over
works in conjunction with a basic medical expense policy by ‘bridging’ both policies together.	corridor deductible
is only payable after basic benefits are first paid and exhausted by the insurance company.	corridor deductible
the most common type of coverage in the health insurance industry	Comprehensive Major Medical
Also referred to as ‘percentage participation	Coinsurance
places a limit on the amount of covered medical expenses that a policyholder can be responsible for paying within the calendar year.	stop-loss’ provision
stop-loss’ provision	stop-loss’ provision
Most ‘routine’ dental care including cleanings and x-rays are covered as	Scheduled Benefits
provides the highest amount of benefits including routine dental care, non-routine dental care, and sometimes, orthodontic care, depending on the insurer.	comprehensive dental insurance
Dental insurers use a ‘? list’ method of identifying the procedures that are eligible for coverage.	closed list
where a dentist accepts both prepaid dental plan subscribers as well as nonmembers.	open panel system
only accept subscribers to the prepaid dental plan	closed panel system
A type of low-cost limited risk insurance purchased as a stand-alone policy that protects against a specific infrequent disease outlined in the policy such as heart disease or cancer.	Specified (Dread) Disease Coverage
While accident coverage begins on the date chosen by the policyholder, coverage against illness often has a	15 day waiting period
‘Affordable Care Act (ACA),’ this federal statute is actually 2 laws, called the	‘Patient Protection Act’ and ‘Affordable Care Act
if a health plan excludes pre-existing conditions, it is considered to be a	grandfathered plan
The Open Enrollment Period starts on date? ends?	nov 1, Dec 15
Starting in 2019, the fine for declining to purchase health insurance has been eliminated as a result of the	Tax Cuts and Jobs Act;
APTCs may be available to most households with income not more than ?% of federal poverty level	400%
defined as a set of health care service categories that must be covered in order to be certified and offered in the Marketplace.	Essential Health Benefits
the percentage of total average costs for covered benefits that a plan will cover.	Actuarial Value
pays less than 60% of the total average cost of care on average and are only available to individuals under age 30 or who have a received a ‘hardship’ exemption.	catastrophic plan
discount that lowers the amount payable for out-of-pocket for deductibles, coinsurance, and copayments.	cost sharing reductions
Cost Sharing Reductions , must choose what tier plan	silver
figure used to determine eligibility for lower costs in the Marketplace and for Medicaid and CHIP.	modified adjusted gross income
developed by the (NAIC), was introduced and incorporated, with some modification, into each state’s insurance code.	Uniform Individual Accident and Sickness Policy Provisions Act
if fraudulent statements are made on a health insurance application, the contract can be contestable at any time unless the policy is	guaranteed renewable
health insurance policy grace period paid weekly	7 days
health insurance policy grace period paid monthly	10 days
health insurance policy grace period paid quarterly, semi-annually or annually	31 days
, if notification is not provided by the insurer, the policy will be automatically reinstated on the	45th day after insurer receives premium
A reinstated policy provides coverage immediately for accidents, but requires a #? day period for ilness	10 days
policyholder is responsible to provide the insurer with a ‘written notification of claim’ within	20 days of an event in which the policyholder intends to file a medical claim
The insurer is required to furnish ‘claims forms’ to the insured within	15 days from the time the insurer was notified of a claim.
A claimant has #? days in which he or she is required to submit written documents showing ‘proof of loss.’	90
An insurance company has #? days from the time a policyholder submits proof of loss before legal actions can be taken against the company by a policyholder.	60
, legal action can only be filed against an insurer up to	3 t0 5 years after the date written proof of loss is furnished to the insurer
Relation of Earnings to Insurance	individual has multiple disability income policies and these benefits exceed their monthly earnings at the time disability occurs, this provision will ensure that the insurance company will only be liable for a proportional amount of benefits
cancels on the effective date so that no unearned premium is received by the insurer and is usually on the date that the policy’s premium is due	Flat Cancellation
Policy cancellation rights provide the insurance company the freedom to cancel a policy at any time, as long as written notice is sent to the policyholder at least	45 days
clause states that an insurance company will honor its obligation to pay benefits. It also describes the scope of coverage, provides any required definitions, and sets forth the conditions	insuring clause
specifies the premium amount and date on which payments must be received to maintain the health policy	consideration clause
allows an insurer to terminate a policy on a specific date specified in the contract.	optionally renewable policy
are only canceled in the event of an expressed condition, such as age or the loss of gainful employment.	Conditionally Renewable Policies
These policies can never be terminated nor can premiums ever increase	Non-Cancellable Policies
evaluating, monitoring and planning of health care services by insurers to ensure that appropriate and cost-effective healthcare is ‘utilized’	Utilization Management
conducted prior to any procedure or admission for medical care and includes any pre-hospital admission certification, as well as any second opinion requirements for non-emergency surgeries or procedures before care administered.	Prospective Review
is conducted during treatment, or while admitted to a hospital as medical care is being administered, to maintain appropriateness and timing of care, including establishing a plan for patient discharge.	Concurrent Review and Discharge Planning
conducted after discharge has occurred in order to evaluate the effectiveness and timing of the medical care provided	Retrospective Review
established by two or more similar employers within a related industry, but who are not part of a collective bargaining agreement	Multiple Employer Plan
A multiple-employer plan is established through a financial contract called a	Multiple Employer Trust
established by two or more employers within a related industry who are also part of a collective bargaining agreement.	established by two or more employers within a related industry who are also part of a collective bargaining agreement.
a multiemployer plan is established through a type of trust, known as a	Taft-Hartley Trust,
s are often self-insured or partially insured arrangements.	Multiple Employer Welfare Arrangements, or MEWA
non-specific group insurance provided when a group is constantly changing.	Blanket Customer Groups
is actually disability insurance that covers an insured’s debt to a creditor upon disability.	Credit Health (Disability) Insurance
Under a group health policy, the insurer typically provides for a #day grace period?	31
prevents an insured’s total benefits from exceeding the total medical expenses or loss of wages that he or she incurs	Coordination of Benefits (COB)
COBRA, extends group health coverage to former employees and their families for up to	18 or 36 months after termination of employment.
under COBRA, an employer group must be made up of atleast how many individuals	20
must be given to employees, their spouses and any other dependents on the policy by the employer when the employee group becomes eligible for COBRA coverage, or when a qualifying event occurs	Notification Statement
Qualifying Events for 18 Months of COBRA	Termination of employment (most common) Hours of employment are reduced
Qualifying Events for 36 Months of COBRA	Coverage for surviving dependents of a deceased employee Former spouse of an employee after legal separation or divorce Dependent children that no longer qualify as a dependent
extends COBRA continuation benefits from 18 months to 29 months for disabled employees at the time of the qualifying event or who become disabled during the first 60 days of COBRA coverage who do not already qualify for 36 months under COBRA.	Omnibus Budget Reconciliation Act (OBRA)
applies to employer groups of 15 or more employees. It protects qualified individuals with disabilities in job application procedures, hiring, firing,	Americans with Disabilities Act (ADA)
federal law that generally prevents group health plans that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.	The Mental Health Parity and Addiction Equity Act
has jurisdiction over public sector group health plans (referred to as “non-Federal governmental plans”	US Department of Health and Human Services (HHS)
have jurisdiction over private group health plans.	Departments of Labor and the Treasury
An employee becomes eligible for FMLA protection upon being employed by the same employer for at least	e (1) year and has worked for 1,250 hours over the previous 12 months.
An additional #? weeks of leave during a 12-month period are provided to care for a covered servicemember with a serious injury or illness if the eligible employee is the servicemember’s spouse, child, parent or next of kin.	26 weeks
provides for the portability of group insurance between employer group insurance plans and from an employer-sponsored plan to an individual policy if the individual becomes self-employed	Health Insurance Portability and Accountability Act,
new employer must offer continual coverage to a new employee if the employee is switching from a prior employer’s coverage and was insured for at least the previous	18 months on the prior group plan
Insurance portability through HIPAA is mandated for #? Insurance portability through HIPAA is mandated for	63 days
DI insurers provide for a ‘window’ of time, usually	60-90 days, following an injury in which the insured is still qualified for DI
This provision states that the cause of an injury must be unexpected and accidental.	Accidental Means Provision
result of an injury must be unexpected and accidental.	Accidental Bodily Injury Provision
by adding an exclusionary rider called an ? rider to the policy, the DI insurer can specifically exclude the disqualifying condition in order to still allow the individual to qualify for the DI policy.	impairment
The probationary period is the initial stage of DI coverage which begins on the DI policy’s effective date, and often lasts for	15-30 days
DI Probationary Period does not apply to	accidents
states that an insured is automatically determined to be totally disabled in the event that, as the result of an accident, he or she becomes blind, deaf, loses his or her speech, or suffers the loss of two (2) or more limbs.	Presumption of Disability
Presumptive disability benefits are paid as	lump-sum to the insured, even if he or she is able to continue working.
recurrent eligibility periods range from	90 days to 6 months after the initial benefit period ends.
Also called ‘residual’ disability	partial disability
Waiver of Premium Rider requires the insured to be totally and permanently disabled for at least	3-6 months
Adding this rider to a DI policy helps pay the regular total disability benefit during the elimination period when the insured is hospitalized.	Hospital Confinement Rider
Essentially, this rider provides the insured with a reimbursement of medical expenses resulting from injuries that do not disable the insured.	Non-Disabling Injury (Medical Expense) Rider
option rider allows an insured the right to purchase additional disability insurance at future dates regardless of insurability.	Future Increase Option (FIO)
added rider enables an insured’s DI benefit period to extend beyond the normal benefit period (up to age 65) to the lifetime of the insured.	Lifetime Extension Rider
provides a life insurance death benefit to the insured’s designated beneficiary in the event of the insured’s death. This rider is renewable annually without requiring proof of insurability by the insured.	Annual Renewable Term (ART) Rider
r SSDI benefits include being totally disabled for more than	12 months
r SSDI benefits include how many months elimination period	5 months
provides benefits during the elimination period, as well as the 12 months before disability benefits begin.	additional Monthly Benefit (AMB) Rider
Under a partnership agreement, partners often purchase DI insurance on each other	Disability Buy-Sell Insurance
elimination period is required to allow the disabled partner the opportunity to recover and avoid prematurely losing share in the business.	1 to 2 year elimination period
Disability insurance is often used by small business to pay for company overhead expenses during the period that a business owner or key-person is disabled, thus allowing the business to continue to operate.	Business Overhead Expense Insurance (BOE)
Defined as the benefit amount that is paid to the insured as a result of dismemberment or the loss of eyesight.	Capital Sum (Dismemberment Benefit)
Enacted as part of the Social Security Act of 1965, ? ,was created to provide healthcare coverage for U.S. citizens and permanent residents age 65 and older	Medicare
medicare is administerd by the	Centers for Medicare and Medicaid Services (CMS)
Medicare eligibility and premium processing is conducted through the	social security administration
federal government contracts through several types of non-governmental claims processing companies including:	Fiscal Intermediaries (FI)’, ‘Carriers,’ and other types of Medicare Administrative Contractors, called ‘Part A MACs’ or ‘Part B MACs.’
Medicare costs associated with inpatient hospital care, long term care centers, hospice care centers and other skilled nursing facilities are processed through ? and ? AKA Part ? insurance	FIs and Part A MACs. (Part A Insurance)
Medicare costs associated with physician services, outpatient hospital care, various types of outpatient therapy, diagnostic testing, and other services provided by qualified practitioners are processed through ? and ? aka as Part	Carriers, and Part B MACs. (Part B Insurance)
Every 3 months, Medicare provides enrollees with a	Medical Summary Notice (MSN)
Medical Summary Notice (MSN), also known as	Explanation of Medicare Benefits (EOMB)
MSN provides a Medicare enrollee with a specific explanation of the costs incurred from his or her healthcare in order to effectively coordinate private ? or ?	Medigap insurance or Medicare Advantage coverage
5 levels of appeals of Medicare decisions:	Redetermination, Reconsideration, Hearing , Review, : Judicial review
5 levels of appeals of Medicare decisions: Level 1 Redetermination is done by	the company that handles claims for Medicare
5 levels of appeals of Medicare decisions: Level 2, reconsideration is done by	Qualified Independent Contractor (QIC)
5 levels of appeals of Medicare decisions: Level 3, hearing is done before	Administrative Law Judge (ALJ)
5 levels of appeals of Medicare decisions: Level 4 Review is done by:	Medicare Appeals Council
5 levels of appeals of Medicare decisions: Level 5 Judicial review is done by:	a federal district court
Medicare Appeal requests must be in writing and filed within	60, 120 or 180 days, depending on the current level of appeal.
Medicare part A is	Compulsory Hospital Insurance (HI
Medicare Part B is	Supplementary Medical Insurance
Medicare Part D is	prescription drug coverage
s an alternative to Parts A and B, individuals can choose to elect coverage through	part c
Part C, also known as	Medicare Advantage
As an alternative to Part C, an enrollee may instead purchase a Medicare	‘supplement insurance’ plan that works in conjunction with Medicare Part A and B coverage.
Private Medicare supplement insurance, called	Medigap’ insurance
defined as private insurance that helps fill in the ‘gaps’ that Medicare insurance leaves for an enrollee to cover.	Medigap’
, the only difference between Medigap insurers is their ? and ?	customer service and premium rates.
Individuals who have not earned the necessary 40 credits through Social Security may still purchase	Medicare Part A.
In addition to the general enrollment requirements, individuals may also qualify for free Medicare Part A coverage under the following circumstances:	regardless of age, who have been diagnosed with permanent kidney failure, known as ‘End-Stage Renal Disease (ESRD)’
To purchase Premium Part A coverage,He or she must also enroll in or already have	Part B coverage.
A temporary license shall be effective for ? months	6
temporary license renewable for periods of ? months and up to ? months	3, 15
Individuals licensed less than 20 years must complete 24 hours of continuing education (CE)	every 2 years
Individuals licensed less than 20 years must complete ? hours of ethics training	3
Renewals must be filed and CE credits satisfied by	DEC 31
A revoked license must wait at least ? yrs before reapplying	5
Any engagement in or compensation from an unauthorized insurer in the state of Georgia is punishable by fines up to	an amount equal to the taxes and license fees that are normally required from authorized insurers in Georgia.
Protects policyowners, insureds, and beneficiaries of life, health, annuity, and supplemental policies from insolvent insurers who cannot maintain insurance contracts due to inadequate funding.	The Georgia Guaranty Association
Guaranty Association benefits cannot exceed	$100,000 per insured individual.
If the Commissioner does not deny a certificate of authority within	90 days after an application is filed, it is considered approved.
Certificates of authority are renewed	annally
Yearly renewals must be submitted by	March 1
Certificates of authority expirations happen what date	midnight on June 30
Administrative Fines Cannot exceed $? for each non-willful violation or $? for each willful violation	$1000, $5000
foreign insurer incorporated in a different state can qualify for a certificate of authority in the state of Georgia , also known as	re-domestication
agent or insurer must maintain # years of consumer complaints since last inspected by the Commissioner	3
Non-cancellable policies cannot allow for	premium or rate revisions
must be advertised with the allowance of premium return if the customer is dissatisfied	must be advertised with the allowance of premium return if the customer is dissatisfied
All advertisements must be kept on file with the insurer for a minimum of	3 years
Before an insurer can offer a life or annuity product to the general public, it must file such product with the Commissioner at least	90 days before commencing sales of such product
Words such as (3)? (and similar words) cannot be used to refer to a rate of interest return or guaranteed return in interest to the insured, or to hide or minimize the cost of the insurance	deposits, savings, or investment
Deposit cannot be used for premium paid by the insured unless it is	fully refundable if requested by the insured
for life insurance, An insurer must guarantee a ?-day grace period for late premium payments, after the initial premium, in which the policy’s death benefit remains in force.	30 day
states that the application and life policy constitute the entire contract between the insurer and insured.	entire contract provision
A life insurance policy becomes incontestable after being in force for	2 years
After ? years of premium payments, an insured may borrow from the life policy’s cash value.	3 years
Prepayment of a policy’s death benefit may be paid out to the insured while still alive (living benefit) if the insured is diagnosed with a long-term or terminal illness.	accelerated living benefit provision
The insurer must pay the policy’s death benefit to the beneficiary no later than	2 months after proof of the insured’s death.
After a life policy has been in force for ? years, the reinstatement provision must allow the policyowner to reinstate a lapsed policy due to non-payment of premium.	3 years
If a policyowner defaults on any premium payment after the first 3 years of the policy, he or she has ?	60 days to elect to receive the cash surrender value of the policy.
A provision that requires any lawsuit that arises from the policy to be filed within	2 years of the event that prompts the lawsuit.
A minor’s life contract must be signed by a	parent, grandparent, adult sibling, or if necessary, the guardian of the minor’s estate
regarding minor's life insurance, Georgia law allows for written objection to such a contract if made by the	minor's parents
Contributory plan premiums are jointly paid by the	employer and employees
mon-contributory plan premiums are paid entirely by the	employer
Georgia law requires at least #? employees to qualify as a group plan	2
Individual and group family health coverage must also provide for newborns from the moment of birth with all the health benefits applicable to children (how many days)	31 days after birth
Additional premium is required for a newborn or adopted child added to an existing policy and must be paid within	31 days
1 baseline mammogram for women between ages	35-39
1 mammogram every 2 years for women between ages	40-49
1 mammogram every year for women age	50+
Annual prostate exam for covered males age	40+ IF ordered by physician
Accident and sickness insurers must notify group policyholders at least ? before refusing to renew a policy unless	60 days
To qualify to convert group insurance to individual coverage if the group ends, an employee must be a member of the group for the past	6 months
To qualify to convert group insurance to individual coverage if the group ends, an employee must request conversion within	30 days of losing the group coverage
Medicare Supplement Requirements Cannot exclude or limit benefits incurred more than	6 months prior to the effective date due to a preexisting condition
An insurer cannot refuse to issue or discriminate in the pricing of a Medicare supplement based on health status or any medical conditions of an applicant if the policy application is submitted during the	6 month period beginning with the first month in which an individual first enrolled
Long-Term Care Requirements Provides coverage for at least	24 consecutive months OR recurring confinement of up to 6 months with a min total of 2 years

Created by: amandasandralee

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