PA Life & Health Insurance Exam, ALL CHAPTERS FOR EXAM
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1. Accident An unplanned, unforeseen event which occurs suddenly and at an unspecified
place.
2. Accident Insur- A type of insurance that protects the insured against loss due to accidental bodily
ance injury.
3. Accidental Bodily Unplanned, unforeseen traumatic injury to the body.
Injury
4. Accidental Death An insurance policy which pays a specified amount or a specified multiple of the
and Dismember- insured's benefit if the insured dies, loses his/her sight, or loses two limbs due to
ment an accident.
5. Accidental Death A policy rider that states that the cause of death will be analyzed to determine if it
Benefits complies with the policy description of accidental death.
6. Acquired An infectious and incurable caused by the human immunodeficiency virus (HIV).
Immunodeficien-
cy Syndrome
(AIDS)
7. Activities of daily Activities individuals must do every day such as moving about, getting dressed,
living eating, bathing, etc.
8. Actual Charge The amount a physician or supplier actually bills for a particular service or supply.
9. Adhesion A contract offered on a "take it or leave it" basis by an insurer, in which the insured's
only option is to accept or reject the contract. Any ambiguities in the contract will
be settled in favor of the insured.
10. Admitted (Autho- An insurance company authorized and licensed to transact insurance in a partic-
rized) Insurer ular state.
11. Adult Day Care
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A program for impaired adults that attempts to meet their health, social, and
functional needs in a setting away from their homes.
12. Adverse Selec- The tendency of risks with higher probability of loss to purchase and maintain
tion insurance more often that the risks who present lower probability.
13. Agent An individual who is licensed to sell, negotiate, or effect insurance contracts on
behalf of an insurer.
14. Aleatory A contract in which participating parties exchange unequal amounts. Insurance
contracts are aleatory in that the amount the insured will pay in premiums is
unequal to the amount the insurer will pay in event of the loss.
15. Alien Insurer An insurance company that is incorporated outside the united states.
16. Alzheimer's Dis- A disease that causes the victim to become dysfunctional due to degeneration of
ease brain cells and severe memory loss.
17. Ancillary Additional, miscellaneous services provided by a hospital, such as x-rays, anesthe-
sia, and lab work, but not hospital room and board.
18. Apparent Au- The appearance or the assumption of authority based on the authority actions,
thority words, or deeds of the principal or because of circumstances the principal creat-
ed.
19. Approved The amount Medicare determines to be reasonable for a service that is covered
Amount under Part B of medicare.
20. Assignment A claim to a provider or medical supplier to receive payments directly from
medicare.
21. Attained Age The age of the insured at a determined date.
22. A statement ussualy obtained from the applicant's doctor
, PA Life & Health Insurance Exam, ALL CHAPTERS FOR EXAM
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Attending Physi-
cian's Statement
(APS)
23. Avoidance A method of dealing with risk (e.g. if a person wanted to avoid the risk of being
killed in an airplane crash, he/she might choose to never fly in a plane).
24. Basic Hospital Ex- Coverage that provides benefits for room, board an miscellaneous hospital ex-
pense Insurance penses for a certain number of days during a hospital stay.
25. Basic Medical Ex- Coverage for doctor visits, x-rays, lab tests, and emergency room visits; benefits
pense Insurance however, are limited to specified dollar amounts
26. Beneficiary The person who receives the proceeds from the policy when the insured dies.
27. Benefit Period The length of time over which the insurance benefits will be paid for each illness,
disability, or hospital stay
28. Birthday Rule The method of determining primary coverage for a dependent child, under
which the plan of the parent whose birthday occurs first in the calendar year, is
designated as primary.
29. Blanket Medical A policy that provides benefits for all medical costs, including doctor visits, hospi-
Insurance talization, and drugs.
30. Boycott An unfair trad practice in which one person refuses to do business with another
until he or she agrees to certain conditions.
31. Buyer's Guide A booklet that describes insurance policies and concepts, and provides general
information to help an applicant make an informed decision.
32. Cafeteria Plan A selection of health care benefits from which an employee may choose the ones
that he/she needs.
, PA Life & Health Insurance Exam, ALL CHAPTERS FOR EXAM
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33. Capital Amount A percentage of the principal amount of a policy paid to the insured if he/she
suffered the loss of an appendage
34. Carriers Organizations that process claims and pay benefits in an insurance policy
35. Cease and Desist A demand of a person to stop committing an action that is in violation of a
Order provision
36. Certificate of Au- A document that authorizes a company to start conducting business and specifies
thority the kind(s) if insurance a company can transact. It is illegal for an insurance
company to transact insurance without this certificate.
37. Certificate of In- A written document that indicates that an insurance policy has been issued, and
surance that states both the amount and types of insurance provided.
38. Claim A request for payment of the benefits provided by an insurance contract.
39. Coercion An unfair trade practice in which an insurer uses physical or mental force to
persuade an applicant to buy insurance.
40. Coinsurance An agreement between an insurer and insured in which both parties are expected
to pay a certain portion of the potential loss and other expenses.
41. Coinsurance A provision that states that the insurer will share the losses covered by the policy
Clause in a proportion agreed upon in advance.
42. Commissioner The chief executive and administrative officer of the Insurance Department.
43. Comprehensive A plan that provides a package of health care services, including preventive care,
Policy routine physicals, immunizations, outpatient services, and hospitalization.
44. Comprehensive A combination of basic coverage and major medical coverage the features low
Major Medical deductibles, high maximum benefits, and coinsurance.
45. Concealment The withholding of known facts which, if material, can void a contract.
Study online at https://quizlet.com/_7wub79
1. Accident An unplanned, unforeseen event which occurs suddenly and at an unspecified
place.
2. Accident Insur- A type of insurance that protects the insured against loss due to accidental bodily
ance injury.
3. Accidental Bodily Unplanned, unforeseen traumatic injury to the body.
Injury
4. Accidental Death An insurance policy which pays a specified amount or a specified multiple of the
and Dismember- insured's benefit if the insured dies, loses his/her sight, or loses two limbs due to
ment an accident.
5. Accidental Death A policy rider that states that the cause of death will be analyzed to determine if it
Benefits complies with the policy description of accidental death.
6. Acquired An infectious and incurable caused by the human immunodeficiency virus (HIV).
Immunodeficien-
cy Syndrome
(AIDS)
7. Activities of daily Activities individuals must do every day such as moving about, getting dressed,
living eating, bathing, etc.
8. Actual Charge The amount a physician or supplier actually bills for a particular service or supply.
9. Adhesion A contract offered on a "take it or leave it" basis by an insurer, in which the insured's
only option is to accept or reject the contract. Any ambiguities in the contract will
be settled in favor of the insured.
10. Admitted (Autho- An insurance company authorized and licensed to transact insurance in a partic-
rized) Insurer ular state.
11. Adult Day Care
, PA Life & Health Insurance Exam, ALL CHAPTERS FOR EXAM
Study online at https://quizlet.com/_7wub79
A program for impaired adults that attempts to meet their health, social, and
functional needs in a setting away from their homes.
12. Adverse Selec- The tendency of risks with higher probability of loss to purchase and maintain
tion insurance more often that the risks who present lower probability.
13. Agent An individual who is licensed to sell, negotiate, or effect insurance contracts on
behalf of an insurer.
14. Aleatory A contract in which participating parties exchange unequal amounts. Insurance
contracts are aleatory in that the amount the insured will pay in premiums is
unequal to the amount the insurer will pay in event of the loss.
15. Alien Insurer An insurance company that is incorporated outside the united states.
16. Alzheimer's Dis- A disease that causes the victim to become dysfunctional due to degeneration of
ease brain cells and severe memory loss.
17. Ancillary Additional, miscellaneous services provided by a hospital, such as x-rays, anesthe-
sia, and lab work, but not hospital room and board.
18. Apparent Au- The appearance or the assumption of authority based on the authority actions,
thority words, or deeds of the principal or because of circumstances the principal creat-
ed.
19. Approved The amount Medicare determines to be reasonable for a service that is covered
Amount under Part B of medicare.
20. Assignment A claim to a provider or medical supplier to receive payments directly from
medicare.
21. Attained Age The age of the insured at a determined date.
22. A statement ussualy obtained from the applicant's doctor
, PA Life & Health Insurance Exam, ALL CHAPTERS FOR EXAM
Study online at https://quizlet.com/_7wub79
Attending Physi-
cian's Statement
(APS)
23. Avoidance A method of dealing with risk (e.g. if a person wanted to avoid the risk of being
killed in an airplane crash, he/she might choose to never fly in a plane).
24. Basic Hospital Ex- Coverage that provides benefits for room, board an miscellaneous hospital ex-
pense Insurance penses for a certain number of days during a hospital stay.
25. Basic Medical Ex- Coverage for doctor visits, x-rays, lab tests, and emergency room visits; benefits
pense Insurance however, are limited to specified dollar amounts
26. Beneficiary The person who receives the proceeds from the policy when the insured dies.
27. Benefit Period The length of time over which the insurance benefits will be paid for each illness,
disability, or hospital stay
28. Birthday Rule The method of determining primary coverage for a dependent child, under
which the plan of the parent whose birthday occurs first in the calendar year, is
designated as primary.
29. Blanket Medical A policy that provides benefits for all medical costs, including doctor visits, hospi-
Insurance talization, and drugs.
30. Boycott An unfair trad practice in which one person refuses to do business with another
until he or she agrees to certain conditions.
31. Buyer's Guide A booklet that describes insurance policies and concepts, and provides general
information to help an applicant make an informed decision.
32. Cafeteria Plan A selection of health care benefits from which an employee may choose the ones
that he/she needs.
, PA Life & Health Insurance Exam, ALL CHAPTERS FOR EXAM
Study online at https://quizlet.com/_7wub79
33. Capital Amount A percentage of the principal amount of a policy paid to the insured if he/she
suffered the loss of an appendage
34. Carriers Organizations that process claims and pay benefits in an insurance policy
35. Cease and Desist A demand of a person to stop committing an action that is in violation of a
Order provision
36. Certificate of Au- A document that authorizes a company to start conducting business and specifies
thority the kind(s) if insurance a company can transact. It is illegal for an insurance
company to transact insurance without this certificate.
37. Certificate of In- A written document that indicates that an insurance policy has been issued, and
surance that states both the amount and types of insurance provided.
38. Claim A request for payment of the benefits provided by an insurance contract.
39. Coercion An unfair trade practice in which an insurer uses physical or mental force to
persuade an applicant to buy insurance.
40. Coinsurance An agreement between an insurer and insured in which both parties are expected
to pay a certain portion of the potential loss and other expenses.
41. Coinsurance A provision that states that the insurer will share the losses covered by the policy
Clause in a proportion agreed upon in advance.
42. Commissioner The chief executive and administrative officer of the Insurance Department.
43. Comprehensive A plan that provides a package of health care services, including preventive care,
Policy routine physicals, immunizations, outpatient services, and hospitalization.
44. Comprehensive A combination of basic coverage and major medical coverage the features low
Major Medical deductibles, high maximum benefits, and coinsurance.
45. Concealment The withholding of known facts which, if material, can void a contract.
