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accident and health

accident and health insurance info to help study for state exam

QuestionAnswer
the form of assignments where all rights are transfered to another person is known as..? absolute assignment.
social security pays 4 types of benefits, what are they? retirement, disability survivor (death benefits), and medical (medicare & medicade)
primary goal of social security benefits, will determine a worker's social security benefit at age 65. primary insurance amount- PIA
total amount the health policy will pay such as Million Dollars. maximum limit.
maximum limit for a disibility policy. aggregate.
within a policy it will limit specific charges sucha as "private duty nurses, mental illness" inside limits.
this is used when an inside limit is used up, then at a later time it can be added back. restoration of benefits.
a case where a person might deliberately create a claim to collect on a policy (false claim) moral hazard.
a person who is sloppy or careless can create a situation that will result in a loss morale hazard.
if more than one member of a family are in the same accident then they only have to meet the deductible once. common accident deductible.
can adopted children be covered on a major medical policy? yes.
insurance company pays right away. first dollar.
how many days do you have for "proof of loss"? 180
a disability that reoccurs within how many months is considered a continuation of previous claim and will pay full benefits? 6 months.
a company can reduce benefits if you change to a more hazardous job - they can reduce premiums if you go to a less hazardous job - optional prevision. what is this called? change of occupation clause.
dental plan that has deductible &co-payments. comprhensive dental.
if you meet deductible in the last 3 months of the year then some of the expenses can be used towards the deductible of the following year what is this called? carryover provision.
in an HMO only doctors that are employed by the HMO can be used, what is this called? closed panel.
HMO can use doctors outside of HMO employees, what is this called? open panel.
this person makes all decisions regarding refferals & treatments primary care physician.
when doctor will not see you unless you are referred by primary care phyiscian. gate keeper.
a statement that is guaranteed to be true. warranties.
a risk whose physical condition, occupation, mode of living, and other characteristics indicate a prospect for longevity for unimpaired lives of the same age. preffered risk.
process through which an insurer determines whether, and on what basis, an insurance application will be accepted. underwriter.
in a contributory plan at least how many percent must participate? 75%
designed to fund retirement of self-imployed individuals. Keogh.
provides for payment of annuity beneti
group insurance that entitles members to services of participating hospitals, clinics, and physicians. HMO.
what does HMO stand for? health maintenance organization.
person named to receicve proceeds in case the original beneficiary is not alive. also referred to as a secondary or tertiary beneficiary. contingent beneficiary.
unforesceen, unexpected, unintended cause of an accident. Requirement of an accident-based policy that the casue of the mishap must be accidental for any claim to be payable. accidental means provision.
typical accident resulting for activity. accidental bodily injury.
the amount under an AD&D policy that is payable as a death benefit if death id due to an accident. principal sum.
amount provided for accidental dismemberment or loss of eyesight. Indemnities for loss of one member of sight of one eye are percentages of this. capital sum.
specific amounts for specific accidents AD&D policy.
given to the policyowners when they pay a premium at time of application. such receipts bind the insurance company if the risk is approved as applied for, subject to any other conditions stated on the receipt. conditional receipt.
given by a company upon an applicant's first premium payment. The policy, if approved, becomes effective from the date of the receipt. binding receipt.
duration of time between the beginning of an insured's disability and the commencement of the period for which benits are payable. elimination period.
Created by: shelleys
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