General Insurance
The term for when the insurer writes the policy and the customer takes it or leaves it.
What is adhesion?
A group of doctors and hospitals who join together to provide prepaid medical.
What is HMO?
Generic brochure for life insurance. Must be given at time of application.
What is a buyer's guide?
The two things required in the Entire Contract provision.
What are policy and application?
Has first dollar coverage. Hospital (Part A of Medicare) covers rooms. Medical (Part B of Medicare) covers medicine/treatment. Surgical covers surgery and hospital.
Owned by shareholders, issue non-participating policies and dividends are taxed.
What are stock companies?
HMO's are all about... (Hint: 2 aspects)
What is preventative care and keeping costs low?
A specific summary of the insured's policy. It must be given to the insured at the time of policy delivery.
What is a policy summary?
Provision that tells the insurer who they are paying a claim to
What is Payment of Claims?
What is Loss of Income from Disability?
Both parties have rules and duties they must follow and do.
What is conditional?
HMO's operate on ...
What is a capitated basis?
A deep dive into a person's medical history/past diagnoses.
What is an APS?
A 2 year period where the insurer is allowed to deny a claim if they find an inaccuracy or lie in the Health Insurance Application.
What is Time Limit on Certain Defenses?
Pays full amount of AD&D coverage compared to 50%. The death has to occur within 90 days to actually receive payout, and it covers 2 limbs. It may be referred to as accidental death, but it can also be referred to as this.
What is principal sum?
The agent will submit the collected premium to the insurance company
What is Fiduciary Responsibility?
How much does a PPO cover out-of-network?
What is 70%?
When an insurance company takes too many bad risks.
What is adverse selection?
According to the Legal Action provision, how many days does the insured have to wait to sue the insurer after denying a claim and submitting proof of loss?
What is 60 days, but cannot be longer than 2 years?
Comprehensive covers everything not excluded. It is also a part of this.
What is major medical?
What are the elements of a legal contract?
What are acceptance (offer and acceptance), competent parties, legal purpose, and consideration?
Who is the PCP (primary care provider)?
Something you receive after paying a premium
What is a conditional receipt?
If you file a claim and are in the grace period, the insurer will deduct the amount of the missing payment from the claim payout.
What is Unpaid Premium?
A doctor can see people either in an HMO or in a PPO. What is this term referred to as?
What is closed panel?