Health Insurance Licensing
Study online at https://quizlet.com/_34c3hk
1. Blackout Period Social Security pays a benefit to a surviving spouse left to care for a child under
the age of 16. That benefit stops when the child turns 16 and will not resume until
the surviving spouse is at least 60.
2. Misstatement of If the insured's age or sex is misstated in an application for insurance, the benefit
Age or Sex Provi- payable is adjusted to what the premiums paid should have purchased.
sion
3. Change of Occu- This provision is found in health insurance stating if the insured changes to a
pation Provision more hazardous occupation, benefits are reduced; if changing to a less hazardous
occupation, premiums are reduced.
4. Fraud An act of deceit; concealment or misrepresentation of material fact.
5. Medicare Supple- Health insurance that provides coverage to fill the gaps on Medicare coverage.
ment Policy
6. Basic Medical Ex- Health insurance policy that provides *first dollar* coverage for specified (and
pense Policy limited) health care, such as hospitalization, surgery, or physician services. Char-
acterized by limited benefit periods and relatively low coverage limits.
7. Own Occupation A definition of total disability. The insured must be unable to work at her own
occupation. It is easier for the insured to receive benefits under policies using this
definition.
8. Aleatory Insurance premiums will always be unequal to the benefits received. Benefits will
usually be larger than the premium.
9. Indemnity Ap- Payment based on a predetermined, fixed amount for the medical services pro-
proach vided, regardless of the actual expenses incurred or reimbursement received from
other insurance.
10. The four ways risks are classified.
1/8
, Health Insurance Licensing
Study online at https://quizlet.com/_34c3hk
Preferred, Stan-
dard, Substan-
dard, or Decline
11. Limited Policies Restrict benefits to specified accidents or diseases, such as travel policies, dread
disease policies, and so forth. (Ex. HITABCD)
12. Primary Insur- Amount equal to a covered worker's full Social Security retirement benefit or
ance Amount disability benefit.
(PIA)
13. Recurrent Dis- A disability income policy provision that specifies the period of time during which
ability Provision the reoccurence of a disability is considered a continuation of a prior disability.
14. Peril The reason for the loss (fire, wind, hail, etc.).
15. Skilled Nursing Medical care leading to recovery which is received on a daily basis.
Care
16. Open-Panel HMO A network of physicians who work out of their own offices and participate in the
HMO on a part-time basis.
17. Medicare Part B Covers physicians and outpatient treatment, subject to a monthly premium, annual
deductible, and coinsurance.
18. Accidental Means Accident policies require that claims must result from an accident, rather than an
Provision illness. For example, a dismemberment policy will not pay for amputation of a
diseased limb.
19. Corridor De- In *superimposed* or *comprehensive* major medical plans, a deductible amount
ductible is not required until the insurer has paid coverage under the *base plan*. The
deductible then creates what looks like a corridor between the base plan and the
major medical benefits.
2/8
Study online at https://quizlet.com/_34c3hk
1. Blackout Period Social Security pays a benefit to a surviving spouse left to care for a child under
the age of 16. That benefit stops when the child turns 16 and will not resume until
the surviving spouse is at least 60.
2. Misstatement of If the insured's age or sex is misstated in an application for insurance, the benefit
Age or Sex Provi- payable is adjusted to what the premiums paid should have purchased.
sion
3. Change of Occu- This provision is found in health insurance stating if the insured changes to a
pation Provision more hazardous occupation, benefits are reduced; if changing to a less hazardous
occupation, premiums are reduced.
4. Fraud An act of deceit; concealment or misrepresentation of material fact.
5. Medicare Supple- Health insurance that provides coverage to fill the gaps on Medicare coverage.
ment Policy
6. Basic Medical Ex- Health insurance policy that provides *first dollar* coverage for specified (and
pense Policy limited) health care, such as hospitalization, surgery, or physician services. Char-
acterized by limited benefit periods and relatively low coverage limits.
7. Own Occupation A definition of total disability. The insured must be unable to work at her own
occupation. It is easier for the insured to receive benefits under policies using this
definition.
8. Aleatory Insurance premiums will always be unequal to the benefits received. Benefits will
usually be larger than the premium.
9. Indemnity Ap- Payment based on a predetermined, fixed amount for the medical services pro-
proach vided, regardless of the actual expenses incurred or reimbursement received from
other insurance.
10. The four ways risks are classified.
1/8
, Health Insurance Licensing
Study online at https://quizlet.com/_34c3hk
Preferred, Stan-
dard, Substan-
dard, or Decline
11. Limited Policies Restrict benefits to specified accidents or diseases, such as travel policies, dread
disease policies, and so forth. (Ex. HITABCD)
12. Primary Insur- Amount equal to a covered worker's full Social Security retirement benefit or
ance Amount disability benefit.
(PIA)
13. Recurrent Dis- A disability income policy provision that specifies the period of time during which
ability Provision the reoccurence of a disability is considered a continuation of a prior disability.
14. Peril The reason for the loss (fire, wind, hail, etc.).
15. Skilled Nursing Medical care leading to recovery which is received on a daily basis.
Care
16. Open-Panel HMO A network of physicians who work out of their own offices and participate in the
HMO on a part-time basis.
17. Medicare Part B Covers physicians and outpatient treatment, subject to a monthly premium, annual
deductible, and coinsurance.
18. Accidental Means Accident policies require that claims must result from an accident, rather than an
Provision illness. For example, a dismemberment policy will not pay for amputation of a
diseased limb.
19. Corridor De- In *superimposed* or *comprehensive* major medical plans, a deductible amount
ductible is not required until the insurer has paid coverage under the *base plan*. The
deductible then creates what looks like a corridor between the base plan and the
major medical benefits.
2/8
