New Hampshire Accident and Health
Insurance Exam 2024/25 RATED A+
Ahesion - An insurance policy is described as this because it is drafted by the insurer and
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accepted by the applicant. In other words, the insurer "draws up" all the contract language
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and the applicant must act according to the language of the agreement.
ii ii ii ii ii ii ii ii ii ii ii ii
Aleatory - An insurance policy can be described as this because one party may recover
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
more in value than he or she has parted with based upon a possible future event. A
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
contract characterized by an unequal payment or consideration.
ii ii ii ii ii ii ii ii
Blue Cross/Blue Shield - Community or service organizations that provide health care to
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
subscribers. This covers hospital charges on a UCR basis. They function on either a for-
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
profit or nonprofit basis depending upon State legislation in a particular locale. They
ii ii ii ii ii ii ii ii ii ii ii ii
receive favorable tax treatment as well since many states exempt them from premium and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
income taxation.
ii ii
CHAMPUS - Civilian Health and Medical Program of the Uniformed Services. A
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
government organization that provides health care benefits for the families of members of
ii ii ii ii ii ii ii ii ii ii ii ii ii
the armed services.
ii ii ii
Conditional - An insurance policy may be described as this since it depends upon the
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performance of the parties arriving at an agreement.
ii ii ii ii ii ii ii ii
Competent Parties - The parties arriving at an agreement must possess the capacity to
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
enter into that contract. In other words, the parties involved in the agreement must be
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
competent to enter into that agreement.
ii ii ii ii ii ii
Consideration - In order for an insurance agreement to be binding, both parties must
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
provide each other with something of value. The premiums paid and the representations
ii ii ii ii ii ii ii ii ii ii ii ii ii
made on the application. The promise to pay legitimate claims for coverage provided
ii ii ii ii ii ii ii ii ii ii ii ii ii
during the policy period.
ii ii ii ii
Contract Law - States that elements that must be present in order for any contract to be
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
legal and enforceable in a court of law include: (1) Offer and Acceptance; (2)
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Consideration; (3) Competent Parties; and (4) legal purpose.
ii ii ii ii ii ii ii ii
Employer Plans - These plans provide coverage for employees and their dependents.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Employers administer and manage their health related exposures by using commercial
ii ii ii ii ii ii ii ii ii ii ii
insurers or other entities which provide health care services such as an HMO or PPO. May
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
be self-funded or self-insured.
ii ii ii ii
, Errors and Omissions - When a producer makes an unintentional error or honest mistake.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Insurer can purchase this type of insurance to cover the malpractice or negligence of
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
producers.
ii
Estoppel - A legal principle involving a broken promise. It prohibits an insurer from
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
denying a claim due to specific actions by the insurer or its representatives or due to
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
inaction by the insurer
ii ii ii ii
Exclusions - Provision in an insurance policy eliminating coverage for certain risks or
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
limiting coverage
ii ii
HMO - A type of managed care plan that does not provide coverage for treatment outside
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
of the managed care network since they required subscribers to utilize the services of pre-
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
approved providers. They combine health care delivery with prepaid financing.
ii ii ii ii ii ii ii ii ii
ii Legal Purpose - A contract must be in existence with the public interest in mind.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Legal Capacity - Requirement that a party to a contract be of legal age and have requisite
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
mental capacity to enter into contract.
ii ii ii ii ii ii
MET/MEWA - These plans provide a mechanism for the employees of small businesses
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
to band together to purchase more affordable group health insurance.
ii ii ii ii ii ii ii ii ii ii
No Loss / No Gain Provisions - These are state laws that supposedly prevent a policy
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
owner from profiting from the purchase of insurance. They state that the purpose of
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
insurance policies are primarily to indemnify a person for a loss.
ii ii ii ii ii ii ii ii ii ii ii
Offer and Acceptance - Also known as an agreement. A valid offer and unconditional
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
acceptance must be present in order for the contract to be enforceable. Genuine Assent
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
must exist.
ii ii
Open Panel Plans - HMOs that function on an individual practice association basis. these
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
plans offer more flexibility with regard to subscribers selecting physicians.
ii ii ii ii ii ii ii ii ii ii
PPO - An organization , generally administered by a third-party administrator, which
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
enters into a contractual arrangement with doctors or hospitals in order to secure medical
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
coverage for its insureds. It is not a traditional comprehensive health care provider. The
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
provider is the physician or hospital "providing" medical services. The objective is to
ii ii ii ii ii ii ii ii ii ii ii ii ii
channel patients to providers that discount their medical services.
ii ii ii ii ii ii ii ii ii
Point of Service Plans - A hybrid arrangement that combines aspects of a traditional HMO
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
and PPO. These plans are characterized by a higher degree of managed care than that
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
provided by a PPO. In this plan, members elect whether to receive treatment within the
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
network or outside the network.
ii ii ii ii ii
Insurance Exam 2024/25 RATED A+
Ahesion - An insurance policy is described as this because it is drafted by the insurer and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
accepted by the applicant. In other words, the insurer "draws up" all the contract language
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
and the applicant must act according to the language of the agreement.
ii ii ii ii ii ii ii ii ii ii ii ii
Aleatory - An insurance policy can be described as this because one party may recover
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
more in value than he or she has parted with based upon a possible future event. A
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
contract characterized by an unequal payment or consideration.
ii ii ii ii ii ii ii ii
Blue Cross/Blue Shield - Community or service organizations that provide health care to
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
subscribers. This covers hospital charges on a UCR basis. They function on either a for-
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
profit or nonprofit basis depending upon State legislation in a particular locale. They
ii ii ii ii ii ii ii ii ii ii ii ii
receive favorable tax treatment as well since many states exempt them from premium and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
income taxation.
ii ii
CHAMPUS - Civilian Health and Medical Program of the Uniformed Services. A
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
government organization that provides health care benefits for the families of members of
ii ii ii ii ii ii ii ii ii ii ii ii ii
the armed services.
ii ii ii
Conditional - An insurance policy may be described as this since it depends upon the
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
performance of the parties arriving at an agreement.
ii ii ii ii ii ii ii ii
Competent Parties - The parties arriving at an agreement must possess the capacity to
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
enter into that contract. In other words, the parties involved in the agreement must be
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
competent to enter into that agreement.
ii ii ii ii ii ii
Consideration - In order for an insurance agreement to be binding, both parties must
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
provide each other with something of value. The premiums paid and the representations
ii ii ii ii ii ii ii ii ii ii ii ii ii
made on the application. The promise to pay legitimate claims for coverage provided
ii ii ii ii ii ii ii ii ii ii ii ii ii
during the policy period.
ii ii ii ii
Contract Law - States that elements that must be present in order for any contract to be
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
legal and enforceable in a court of law include: (1) Offer and Acceptance; (2)
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Consideration; (3) Competent Parties; and (4) legal purpose.
ii ii ii ii ii ii ii ii
Employer Plans - These plans provide coverage for employees and their dependents.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Employers administer and manage their health related exposures by using commercial
ii ii ii ii ii ii ii ii ii ii ii
insurers or other entities which provide health care services such as an HMO or PPO. May
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
be self-funded or self-insured.
ii ii ii ii
, Errors and Omissions - When a producer makes an unintentional error or honest mistake.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Insurer can purchase this type of insurance to cover the malpractice or negligence of
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
producers.
ii
Estoppel - A legal principle involving a broken promise. It prohibits an insurer from
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
denying a claim due to specific actions by the insurer or its representatives or due to
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
inaction by the insurer
ii ii ii ii
Exclusions - Provision in an insurance policy eliminating coverage for certain risks or
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
limiting coverage
ii ii
HMO - A type of managed care plan that does not provide coverage for treatment outside
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
of the managed care network since they required subscribers to utilize the services of pre-
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
approved providers. They combine health care delivery with prepaid financing.
ii ii ii ii ii ii ii ii ii
ii Legal Purpose - A contract must be in existence with the public interest in mind.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Legal Capacity - Requirement that a party to a contract be of legal age and have requisite
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
mental capacity to enter into contract.
ii ii ii ii ii ii
MET/MEWA - These plans provide a mechanism for the employees of small businesses
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
to band together to purchase more affordable group health insurance.
ii ii ii ii ii ii ii ii ii ii
No Loss / No Gain Provisions - These are state laws that supposedly prevent a policy
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
owner from profiting from the purchase of insurance. They state that the purpose of
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
insurance policies are primarily to indemnify a person for a loss.
ii ii ii ii ii ii ii ii ii ii ii
Offer and Acceptance - Also known as an agreement. A valid offer and unconditional
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
acceptance must be present in order for the contract to be enforceable. Genuine Assent
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
must exist.
ii ii
Open Panel Plans - HMOs that function on an individual practice association basis. these
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
plans offer more flexibility with regard to subscribers selecting physicians.
ii ii ii ii ii ii ii ii ii ii
PPO - An organization , generally administered by a third-party administrator, which
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
enters into a contractual arrangement with doctors or hospitals in order to secure medical
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
coverage for its insureds. It is not a traditional comprehensive health care provider. The
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
provider is the physician or hospital "providing" medical services. The objective is to
ii ii ii ii ii ii ii ii ii ii ii ii ii
channel patients to providers that discount their medical services.
ii ii ii ii ii ii ii ii ii
Point of Service Plans - A hybrid arrangement that combines aspects of a traditional HMO
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
and PPO. These plans are characterized by a higher degree of managed care than that
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
provided by a PPO. In this plan, members elect whether to receive treatment within the
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
network or outside the network.
ii ii ii ii ii
