INSURANCE CORRECT 100%
Accident - ANSWER An unplanned unforseen event which occurs suddenly at an
unspecified place
Accident insurance - ANSWER A type of insurance that protects the insured against
loss due to an accidental bodily injury
Accidental bodily injury - ANSWER Unplanned unforseen traumatic injury to the body
Accidental Death and Dismemberment - ANSWER An insurance policy which pays a
specified number or specified multiple of the insurer's benefit if the insured dies, loses
his/her sight, or loses two limbs due to an accident.
Acquired Immunodeficiency Symdrome - ANSWER An infectious and incurable disease
caused by the human immunodeficiency virus (hiv)
Activities of daily living - ANSWER Activities individuals must do every day such as
moving about, getting dressed, eating, bathing, etc.
Actual charge - ANSWER The amount a physician or supplier actually bills for a
particular service or supply.
Adhesion - ANSWER A contract offered on a "take it or leave it" basis by an insured, 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 imsured.
Admitted (Authorized) Insurer - ANSWER An insurance company authorized and
licensed to transact business in a particular state.
Adult Day Care - ANSWER A program for impaired adults that attempts to meet their
health, social, and functional needs in a setting away from their homes.
Adverse Selection - ANSWER The tendency of risks witha higher probability of loss to
purchase and maintain insurance more often than the risks who present lower
probability
Agent - ANSWER An individual who is licensed to sell, negotiate, or effect insurance
contracts on behalf of an insurer.
Aleatory - ANSWER 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 the event of a loss.
,Alien Insurer - ANSWER An insurance company that is incorporated outside the United
States.
Blanket Medical Insurance - ANSWER A policy that provides benefits for all medical
costs, including doctor visits, hospitalization, and drugs.
Buyers Guide - ANSWER A booklet that describes insurance policies and concepts, and
provides general information to help an applicant make an informed decision.
Cafeteria Plan - ANSWER A selection of health care benefits from which an employee
may choose the ones that he/she needs.
Capital Amount - ANSWER A percentage of the principal amount of a policy paid to the
insured if he/she suffered the loss of an appendage.
Carriers - ANSWER Organizations that process claims and pay benefits in an insurance
policy
Cease and Desist Order - ANSWER A demand of a person to stop committing an action
that is in violation of a provision.
Certificate Authority - ANSWER A document that authorizes a company to start
conducting business and specifies the kind(s) of insurance a company can transact. It is
illegal for an insurance company to transact insurance without this certificate.
Certificate of Insurance - ANSWER A written document that indicates that an insurance
policy has been issued, and that states both the amounts and types of insurance
provided.
Claim - ANSWER A request for payment of the benefits provided by an insurance
contract.
Coercion - ANSWER An unfair trade practice in which an insurer uses physical or
mental force to persuade an applicant to buy insurance.
Coinsurance - ANSWER 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.
Coinsurance clause - ANSWER A provision that states that the insurer and the insured
will share the losses covered by the policy in a proportion agreed upon in advance.
Commissioner - ANSWER The chief executive and administrative officer of the
insurance department
, Comprehensive policy - ANSWER A plan that provides a package of health care
services, including preventive care, routine physicals, immunization, outpatient services
and hospitalization.
Comprehensive Major Medical - ANSWER A combination of basic coverage and major
medical coverage that features low deductibles, high maximum benefits, and
coinsurance.
Concealment - ANSWER The withholding of known facts which, if material, can void a
contract.
Conditional Contract - ANSWER A type of an agreement in which both parties must
perform certain duties and follow rules of conduct to make the contract enforceable.
Consideration - ANSWER The binding force in a contract that requires something of
value to be exchanged for the transfer of risk. The consideration on the part of the
insured is the representations made in the application and the payment of premium; the
consideration on the part of the insurer is the promise to pay in the event of loss.
Consideration Clause - ANSWER A part of the insurance contract that states that both
parties must give something of value for the transfer of risk, and specifies the conditions
of the exchange.
Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 - ANSWER The law
that provides for the continuation of group health care benefits for the insured for up to
18 months if he/she terminates employment or is no longer eligible, and for the insured's
dependents for up to 36 months in case of loss of eligibility due to deaththe of the
insured, divorce, or attainment of limiting age.
Consumer report - ANSWER A written and/or oral statement regarding a consumer's
credit, character, reputation, or habits collected by a reporting agency from employment
records, credit reports, and other public sources.
Contract - ANSWER An agreement between two or more parties that enforceable by
law
Contributory - ANSWER A group insurance plan that requires the employees to pay part
of the premuim
Coordination of Benefits - ANSWER A provision that helps determine the primary
provider in situations where an insured is covered by more than one policy, thus
avoiding claims overpayments.
Copayment - ANSWER An arrangement in which an insured must pay a specified
amount for services "up front" and the provider pays the remainder of the cost.