Massachusetts Health & Accident Insurance Exam Latest Version Graded A+

Massachusetts Health & Accident Insurance Exam Latest Version Graded A+ Hazard Situation that increases chance of loss Annuity Policy issued by an insurance company to promise you an income that can last you a lifetime Insurer An insurance company Insured A person or business covered by an insurance policy Health Insurance Broad field of insurance plans that provide protection against financial consequences of illness, accidents, injury, and disability - Paid on a year-to-year basis - Subject to periodic premium increases - Benefits not fixed Medical Expense Insurance Pays benefits for nonsurgical doctors' fees commonly rendered in a hospital; sometimes pays for home and officecalls Disability Income Insurance Provide a replacement income when wages are lost due to disability; based on education, training, experience - income creates limits - monthly income payments - highest premium = 14 day waiting period w/ 10 year benefit - ceiling amount Accidental Death and Dismemberment Insurance (AD&D) Provides the insured with a lump- sum benefit amount in the event of accidental death or dismemberment under accidental circumstances Interim Coverages Term insurance for a period of months or less by special agreement of the company; it permits a permanent policy to become effective at a selected future date. Interim the intervening time Subrogation the right for an insurer to pursue a third party that caused an insurance loss to the insured Business Continuation Plans continue the operation of the business in the event of a disabling sickness to a business owner or key employee Employee Benefit Plans - help employee in event of disabling sickness or injury - rare to not include provision of health insurance/benefits - contributes to morale and productivity of employee - provides needed benefits (helps hold down demands for wage increases) - gives employer tax deductions - enhances employer image Business Overhead Expense Insurance - sold individually - designed to reimburse business for overhead expenses in the event a business owner becomes disabled (day to day operations) - does not include compensation for disabled owner - premiums are tax-deductible as insurance expense - benefits are taxable income Disability Buy-Sell Plan/Disability Buy-Outs An agreement between business co-owners that provides that shares owned by any one of them who becomes disabled shall be sold to and purchased by the other co-owners or by the business using funds from disability income insurance. - legal binding agreement funded with disability income policy - pay benefits in periodic payments - buy-out plan contains provision allowing for a lump-sum payment of the benefit - benefits tax-free - premiums not tax deductible - lengthy elimination periods (2+ yrs) Key Person Disability Insurance - pays monthly benefit to a business for additional help or outside services when an essential person is disabled - key persons economic value to a business is determined by potential loss of business income that could occur (hiring price) - business = owner and premium payer of policy - benefits tax-free - premiums not tax deductible - policies reserved for "hard to replace" employees or key sales members Group Health Insurance - between insurance company and group (employer) - health insurance through group master contracts - employer may pay premium or require contribution from each member - master policy - insureds receive certificates of insurance and an outline that describes benefits - more extensive benefits - higher benefit maximums - benefits predetermined by employer - group health coverage = natural group - minimum number of persons covered established by state law - impose eligibility requirements before participating - less costly/less expenses Premium The amount you pay for your health insurance every month Probationary Period period of time where a new employee is ineligible for group health insurance coverage (start a new job) Enrollment Period limited period of time where all members may sign up for a group loan Coordination of Benefits Provision - Designed to prevent duplication of group insurance benefits. Limits benefits from multiple group health insurance policies in a particular case to % of the expenses covered and designates the order in which the multiple carriers are to pay benefits.(married couples) Provider designation of any healthcare provider Overutilization when health benefits are too high Group Health Insurance Premium Factors - size of group - claims experienced with previous insurers