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A Health Insurance plan is:
Answer:
A legal agreement between two or more parties
Promising a certain performance
Exchange for valuable consideration
CLOC
Answer:
Competetent Parties- Age
Legal Purpose
Offer and Acceptance
Consideration- Statements in the Applications
Duress
Answer:
person who proves that they were compeled to sign a contract when they were
incompetent
adhesion contract
Answer:
A standard-form contract in which the stronger party dictates the terms.
Sticky on one side
Take it or leave policy
,Unilateral Contract
Answer:
only the insurer makes a legally enforceable promise
Aleatory
Answer:
The insured may recieve a great deal more from the insurer than what was paid
to them in premiums.
Personal Contract
Answer:
the contract is between the insured and the insurer
Conditional Contract
Answer:
Insurance company's obligation to pay any claims is subject to the insured
performing certain acts such as paying premiums and providing proof of the
claim.
Two Sources of Loss
Answer:
Accident and Sickness
Person suffering from accident or sickness may need protection from two risks
Answer:
Loss of Income and expenses incurred from medical care.
General Catagories of health insurance are:
Answer:
Disability Income
Medical Expense
disability income insurance
Answer:
,Policies pay periodic benefits weekly or monthly to a person whe can no longer
work to earn a regular incomeas a result of disability
Medical Expense Policies
Answer:
cover both accidents and illnesses, various hospital expenses
May cover various combinations of hospital, surgical, and medical expenses and
normally pays benefits in a lump sum to reimburse for medical expenses.
Accident
Answer:
an event that is completely unforseen and unintended and generally results in an
injury.
Accident Benefits
Answer:
will pay only for accident, not for sickness and commonly pays for loss of life,
loss of limb or sight resulting in loss of time, medical expenses
Dismemberment
Answer:
loss of sight or limb
Loss of Limb
Answer:
actual severance above the main joint by which the limb is attached to the body
Loss of Sight
Answer:
must be complete and permenant loss of vision
Capital Sum
Answer:
"Decapitation"
The amount payable for the loss of one member is 1/2 of the principle sum.
Principal Sum
, Answer:
The amount paid for accidental death
Beneficiaries
Answer:
The person who recieves the death benefits.
Primary Beneficiary
Answer:
The person who is named as first to receive benefits from a policy.
Contingent Beneficiary
Answer:
entitled to the proceeds if the primary beneficiary dies before the insured
Teritary Beneficiary
Answer:
third in line for the benefits
Indemnity
Answer:
The amount paid by the insurer in the event of a loss
Fractional Indemnity
Answer:
partial payment versus full
Multiple Indemnity
Answer:
2,3 or 4 times the full benefit; that is double the indemnity, triple etc.
Accidental Bodily Injury
Answer:
where only the result is required to be accidental
Accidental Bodily Injury by Accidental Means