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Questions and Answers
What is the primary distinction between a standard consumer report and an investigative consumer report?
What is the primary distinction between a standard consumer report and an investigative consumer report?
According to the Fair Credit Reporting Act (FCRA), what is the consumer's right regarding information about a consumer report used in an insurance application?
According to the Fair Credit Reporting Act (FCRA), what is the consumer's right regarding information about a consumer report used in an insurance application?
An insurance applicant is notified that an investigative consumer report has been requested. What is the timeframe in which this notification must occur?
An insurance applicant is notified that an investigative consumer report has been requested. What is the timeframe in which this notification must occur?
What is the purpose of the Fair Credit Reporting Act (FCRA)?
What is the purpose of the Fair Credit Reporting Act (FCRA)?
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An underwriter classifies an applicant as 'substandard'. What does this indicate about the applicant's risk profile?
An underwriter classifies an applicant as 'substandard'. What does this indicate about the applicant's risk profile?
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Which of the following actions is NOT a component of the underwriting process used by insurance companies?
Which of the following actions is NOT a component of the underwriting process used by insurance companies?
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An individual is considered to be of 'preferred' risk. Which of the following characteristics would be most likely?
An individual is considered to be of 'preferred' risk. Which of the following characteristics would be most likely?
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In the context of life insurance, when must insurable interest exist for a policy to be valid?
In the context of life insurance, when must insurable interest exist for a policy to be valid?
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Within how many days must consumers be provided with additional information about a consumer report, if requested?
Within how many days must consumers be provided with additional information about a consumer report, if requested?
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Which scenario exemplifies insurable interest in life insurance?
Which scenario exemplifies insurable interest in life insurance?
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Which risk classification would an underwriter assign to an applicant whose risk is deemed 'uninsurable'?
Which risk classification would an underwriter assign to an applicant whose risk is deemed 'uninsurable'?
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What type of information does the Medical Information Bureau (MIB) maintain?
What type of information does the Medical Information Bureau (MIB) maintain?
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Under what condition can insurers access an applicant’s information from the Medical Information Bureau (MIB)?
Under what condition can insurers access an applicant’s information from the Medical Information Bureau (MIB)?
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According to the content, can an insurer deny an insurance policy solely based on information received from the MIB?
According to the content, can an insurer deny an insurance policy solely based on information received from the MIB?
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For what purpose is a consumer report used?
For what purpose is a consumer report used?
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What is a requirement an entity must meet to obtain a consumer report on an individual?
What is a requirement an entity must meet to obtain a consumer report on an individual?
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Which of the following best describes the motivation behind STOLI arrangements?
Which of the following best describes the motivation behind STOLI arrangements?
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In IOLI arrangements, what is the typical agreement between the insured, the agent/broker, and the investors regarding the policy premiums?
In IOLI arrangements, what is the typical agreement between the insured, the agent/broker, and the investors regarding the policy premiums?
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What happens to the IOLI policy if the insured survives beyond the initial 2-year loan period?
What happens to the IOLI policy if the insured survives beyond the initial 2-year loan period?
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A health insurance policy includes 'inside limits.' What does this provision primarily regulate?
A health insurance policy includes 'inside limits.' What does this provision primarily regulate?
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Which scenario best describes the 'restoration of benefits' feature in a major medical policy?
Which scenario best describes the 'restoration of benefits' feature in a major medical policy?
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Which of the reasons explains why STOLI and IOLI arrangements are considered ethical dilemmas?
Which of the reasons explains why STOLI and IOLI arrangements are considered ethical dilemmas?
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How do STOLI and IOLI differ from a standard life insurance policy?
How do STOLI and IOLI differ from a standard life insurance policy?
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What is a primary characteristic of Health Maintenance Organizations (HMOs) concerning access to specialist care?
What is a primary characteristic of Health Maintenance Organizations (HMOs) concerning access to specialist care?
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What is the role of an agent/broker in IOLI arrangements?
What is the role of an agent/broker in IOLI arrangements?
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How are physicians typically compensated within a Health Maintenance Organization (HMO) model?
How are physicians typically compensated within a Health Maintenance Organization (HMO) model?
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Why are elderly or terminally ill individuals often the target of STOLI and IOLI schemes?
Why are elderly or terminally ill individuals often the target of STOLI and IOLI schemes?
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What best describes how Preferred Provider Organizations (PPOs) differ from Health Maintenance Organizations (HMOs)?
What best describes how Preferred Provider Organizations (PPOs) differ from Health Maintenance Organizations (HMOs)?
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In STOLI and IOLI schemes, who is the beneficiary of the life insurance policy upon the death of the insured?
In STOLI and IOLI schemes, who is the beneficiary of the life insurance policy upon the death of the insured?
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An employer's contributions to a qualified retirement plan offer which immediate tax benefit?
An employer's contributions to a qualified retirement plan offer which immediate tax benefit?
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What is the tax implication for an employee who withdraws funds from a qualified retirement plan before the age of 59 ½?
What is the tax implication for an employee who withdraws funds from a qualified retirement plan before the age of 59 ½?
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Under what circumstance can an employee withdraw funds from a qualified retirement plan before age 59 ½ without incurring the 10% penalty?
Under what circumstance can an employee withdraw funds from a qualified retirement plan before age 59 ½ without incurring the 10% penalty?
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What is the tax consequence for failing to take the required minimum withdrawal from a qualified retirement plan at age 70 ½?
What is the tax consequence for failing to take the required minimum withdrawal from a qualified retirement plan at age 70 ½?
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What is a key difference between qualified and nonqualified retirement plans regarding IRS approval?
What is a key difference between qualified and nonqualified retirement plans regarding IRS approval?
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Which of the following is a defining characteristic of nonqualified retirement plans?
Which of the following is a defining characteristic of nonqualified retirement plans?
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In the context of life insurance, what does 'survivor protection' primarily aim to provide?
In the context of life insurance, what does 'survivor protection' primarily aim to provide?
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Which statement accurately compares the tax treatment of contributions in qualified vs. nonqualified retirement plans?
Which statement accurately compares the tax treatment of contributions in qualified vs. nonqualified retirement plans?
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Which of the following statements accurately describes the funding mechanism for a Flexible Spending Account (FSA)?
Which of the following statements accurately describes the funding mechanism for a Flexible Spending Account (FSA)?
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How did the Patient Protection and Affordable Care Act (ACA) impact contribution limits for Flexible Spending Accounts (FSAs)?
How did the Patient Protection and Affordable Care Act (ACA) impact contribution limits for Flexible Spending Accounts (FSAs)?
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What are the tax advantages associated with Flexible Spending Accounts (FSAs)?
What are the tax advantages associated with Flexible Spending Accounts (FSAs)?
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Which of the following is a key characteristic of a Health Reimbursement Account (HRA)?
Which of the following is a key characteristic of a Health Reimbursement Account (HRA)?
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What are the tax benefits associated with Health Reimbursement Accounts (HRAs) for employers and employees?
What are the tax benefits associated with Health Reimbursement Accounts (HRAs) for employers and employees?
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What is a key difference between Health Reimbursement Accounts (HRAs) and Flexible Spending Accounts (FSAs) regarding contribution limits?
What is a key difference between Health Reimbursement Accounts (HRAs) and Flexible Spending Accounts (FSAs) regarding contribution limits?
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An employee is trying to decide between enrolling in a Health Reimbursement Account (HRA) and a Flexible Spending Account (FSA). Which of the following considerations is MOST important in making this decision?
An employee is trying to decide between enrolling in a Health Reimbursement Account (HRA) and a Flexible Spending Account (FSA). Which of the following considerations is MOST important in making this decision?
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Which of the following scenarios illustrates a permissible use of funds from a Flexible Spending Account (FSA)?
Which of the following scenarios illustrates a permissible use of funds from a Flexible Spending Account (FSA)?
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Flashcards
Underwriting Process
Underwriting Process
The procedure used by insurance companies to evaluate risk and determine premium rates.
Adverse Selection
Adverse Selection
A situation where high-risk individuals are more likely to seek insurance, potentially leading to insurer losses.
Insurable Interest
Insurable Interest
A financial stake in the continued life of an insured person, required when applying for life insurance.
Categories of Insurable Interest
Categories of Insurable Interest
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Medical Information Bureau (MIB)
Medical Information Bureau (MIB)
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MIB Information Use
MIB Information Use
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Consumer Reports
Consumer Reports
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Business Need for Reports
Business Need for Reports
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Stranger-originated Life Insurance (STOLI)
Stranger-originated Life Insurance (STOLI)
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STOLI Investor Role
STOLI Investor Role
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Profit from STOLI
Profit from STOLI
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Investor-originated Life Insurance (IOLI)
Investor-originated Life Insurance (IOLI)
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Loan in IOLI
Loan in IOLI
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Two-Year Premium Payment Period
Two-Year Premium Payment Period
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Ethical Dilemmas of STOLI/IOLI
Ethical Dilemmas of STOLI/IOLI
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Investigative Consumer Reports
Investigative Consumer Reports
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Fair Credit Reporting Act (FCRA)
Fair Credit Reporting Act (FCRA)
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Consumer Reporting Agencies
Consumer Reporting Agencies
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Right to Request Information
Right to Request Information
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Risk Classification
Risk Classification
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Preferred Risk
Preferred Risk
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Substandard Risk
Substandard Risk
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Inside Limits
Inside Limits
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Maximum Lifetime Benefit
Maximum Lifetime Benefit
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Restoration of Benefits
Restoration of Benefits
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Health Maintenance Organization (HMO)
Health Maintenance Organization (HMO)
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Preferred Provider Organization (PPO)
Preferred Provider Organization (PPO)
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FSA
FSA
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FSA Contribution Limits
FSA Contribution Limits
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HRA
HRA
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Employee contributions in FSA
Employee contributions in FSA
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Employer contributions in FSA
Employer contributions in FSA
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Tax benefits of FSA
Tax benefits of FSA
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HRA Contribution Limits
HRA Contribution Limits
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Tax benefits of HRA
Tax benefits of HRA
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Tax-Deferred Earnings
Tax-Deferred Earnings
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Employer Contributions
Employer Contributions
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Employee Contributions
Employee Contributions
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Withdrawal Taxation
Withdrawal Taxation
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Early Withdrawal Penalty
Early Withdrawal Penalty
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Mandatory Withdrawals
Mandatory Withdrawals
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Nonqualified Plans
Nonqualified Plans
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Life Insurance - Survivor Protection
Life Insurance - Survivor Protection
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Study Notes
Types of Policies
- Life insurance protects against premature death
- Whole Life (Ordinary, Limited-pay, Single-premium): Permanent protection for life
- Variable Whole Life: Interest-sensitive, fluctuating rates. No guaranteed cash value.
- Universal Life: Flexible premiums, policy owner can skip payments (with cash value); adjustable.
- Term Life (level, decreasing, increasing): Temporary coverage for a set period
- Combination Plans (Joint, Survivorship): Cover multiple lives.
Group vs. Individual
- Individual policies are more expensive and restrictive than group policies
- Group policies provide coverage for many people under one policy (master policy). Individual certificates are issued per insured member.
Traditional Whole Life
- Ordinary (straight life): Level face amount & premiums throughout the insured’s entire life
- Limited-pay Life: Premiums are paid for a limited time, but coverage for life, level face amount
- Single-premium Life: Paid in a lump sum, level premiums for entire life
- Adjustable Life: Mix of whole & term life; policies have changeable features (e.g., premiums, face amount, coverage period)
Interest/Market-Sensitive Life Products
- Variable Life: Policyowners earn higher investment returns on cash values
- Universal Life (Flexible Premium Adjustable Life): The primary difference between adjustable and universal life is the ability to skip premium payments as long as cash value covers costs.
Variable Universal Life
- Flexible premiums, investment choices of variable life, cash value based on investment in separate account, access to policy loans and withdrawals.
Interest-Sensitive Whole Life
- Flexible (varying) premiums based on changing interest rate, adjustable premiums.
Equity-Indexed Universal Life
- Interest rate tied to the stock market. Offers higher potential cash value growth. Fixed guaranteed rate. Nonguaranteed indexed rate is often high (15%–20% or more).
Term Life
- Level Term: Level face amount throughout the policy period
- Decreasing Term: Face amount decreases over the policy period
- Return of premium (ROP): Premiums are returned to the insured if no death benefit is paid
- Annually renewable: Level face amount with increasing premiums
- Increasing term: Increasing face amount with level premiums
Special Features
- Renewable policies allow renewal without proving insurability
- Convertible policies allow term policies to convert to permanent policies without proving insurability.
Annuities
- Protect against outliving savings, systematically liquidates an estate
- Single Premium Immediate Annuity (SPIA): Lump sum, immediate payments
- Single Premium Deferred Annuity (SPDA): Lump sum, deferred payments
- Flexible Premium: Variable premium amount and frequency.
Combination Plans and Variations
- Joint Life: Pays out upon the first death of two or more people within a set policy period, after the first death, the contract does not provide additional coverage.
- Survivorship Life: Pays benefits upon the second death in the set policy period only.
Policy Riders, Provisions, Options, and Exclusions
- Policy characteristics and how policies function.
- Policy Provisions: Terms of a policy reflecting rights, duties and responsibilities
- Options involve how policy funds are used (e.g., premium payment modes);
- Riders modify coverage.
Policy Riders
- Waiver of premium: Waiving premium payments during disability
- Guaranteed insurability: Purchasing additional permanent coverage later with no proof of insurability.
- Pay-or benefit: Premium waiver for insured's death or disability
- Accidental death/dismemberment: Pays benefits for accidental death or dismemberment
- Term riders: Add term coverage to existing life policy
- Other Insureds: Protecting other lives (e.g., spouse, children)
Policy Provisions and Options
- Entire contract: All parts of the contract, including riders and endorsements
- Insuring clause: Company’s promise to pay benefits if covered loss occurs
- Free Look Period: Time to review policy and return it
- Consideraion Period: Payment of premium by insured in exchange for insurer's promise to pay benefits
- Owner Rights: Provides rights of the policyowner regarding the policy
- Beneficiary designations: Selecting beneficiaries
- Revocable & Irrevocable: beneficiaries
- Primary/Contingent beneficiaries: Ordered list of people who receive funds in the event of death.
Special Features
- Renewable Term Policies: Allow renewal without proving insurability
- Convertible Term Policies: Allow conversion to permanent policies without proving insurability
- Long-Term Care Riders: Insurance that covers costs of prolonged care
Settlement Options
- Cash Payment (Lump Sum): Not taxable
- Life Income: Pays out installments until recipient dies
- Interest Only: Pays interest until recipient dies
- Fixed-period Installments: Gradual payments over a fixed period
- Fixed-amount Installments: Fixed payments until funds are exhausted.
Accelerated Death Benefits
- Allows insured to receive a portion of the death benefit before death due to terminal illness
Policy Exclusions
- Sections that exclude certain risks or conditions from coverage based on the insurer's discretion. This protects the insurer.
Policy Provisions, Clauses, and Riders
- Suicide clause: Policy is voided if insured commits suicide within a certain timeframe.
- Aviation clause: Policy is voided if the insured dies while flying (or involved with) an aircraft
- War or Military Service clause: Policy is voided if death occurs during active military service or acts of war
- Hazardous Occupation or Hobby: Policy is voided if death occurs as a result of hazardous occupation or hobby.
Completing the Application, Underwriting, and Delivering the Policy
- Application: Primary source of information for underwriting
- Signatures (agent, applicant, and proposed insured)
- Changes require initialing and not erasing the original writing.
- Consequences of incomplete application: insurer may waive rights and be estopped from reasserting rights if a completed application is approved.
- Warranties: Statements that are guaranteed to be true from the insured
- Representations: Statements made to the best of the applicant's knowledge
- Collecting the initial premium and issuing the receipt.
- Replacement insurance policy: The proposed coverage replaces existing insurance coverage.
- Disclosures (HIPAA/HIV ): Must be provided to the applicant
- USA Patriot Act and/or anti-money laundering provisions
Insurable Interest
- Financial motivation to want the insured to stay alive.
Medical Information and Consumer Reports
- Medical Information Bureau: Collected medical information to determine individual insurability; Insurers may access information only on need.
- Consumer Reports: Any communication about a consumer's creditworthiness or other information about their lives
- Investigative Consumer Reports: Information from personal interviews with neighbors etc.
Risk Classification
- Preferred, Standard, Substandard, Declined
- Factors include lifestyles, health, hobbies, and occupations
Stranger-Originated Life Insurance (STOLI) and Investor-Originated Life Insurance (IOLI)
- STOLI: Third-party agent/broker or investor purchases policy; Insured receives profit on their death
- IOLI: Similar to STOLI, but investors loan money upfront to pay premiums to the party until the death of insured. Policy sold to investor after a set period.
Delivering the Policy
- Effective date of coverage: Date the policy becomes effective.
- Explaining the policy's provisions, riders (additional terms), exclusions, and rating to the client. Insurance policy summary or policy outline is issued with the policy.
Taxes, Retirement, and Other Insurance Concepts
- Third Party Ownership: Policyowner has insurable interest in the life of the insured
- Group life insurance: Purchased by businesses for employee protection. Provides benefits for family members. Employers are responsible for payment.
- Group conversion provisions: Insured has right to convert group coverage to individual policy
- Tax qualified plans: Retirement plans which are written in writing, permanent, favor employees, not high-paid employees, and communications are appropriate for employees.
Other Health Insurance Concepts
- Total, Partial, and Residual Disability: Definitions and eligibility
- Owner's rights: include the right to change beneficiaries, and pay premiums.
- Dependent Children Benefits: Include the right to continue coverage, and notification must be provided if a child or dependent's coverage is to continue or not.
- Premium Payment Modes: How and to whom premiums should be paid (e.g., annually, quarterly)
- Non-duplication/Coordination of Benefits: Determining primary/secondary insurer for covered losses (if multiple policies cover the person)
- Tax treatment of premiums and proceeds is based on whether premiums are taxed; tax consequences of benefit payments depend on whether tax was deducted.
Health Policy Provisions, Clauses, and Riders
- Dread disease plans and Critical Illness plans: Cover specific illnesses
- Hospital indemnity plans: Flat dollar benefit for each day in hospital
- Dental; policies may exclude plans
- Vision: Pay for eye exams, or eyeglasses/contacts (often included in group plans)
Mandatory Provisions
- Entire Contract: Includes policy, application, and endorsements.
- Incontestability: Cannot contest policy after a period of time, except for fraud.
- Grace Period: Time for paying premiums without penalty
- Reinstatement: Policy can be reinstated after missing payment under certain conditions
- Notice of Claim: Procedure and timeframe for submitting a claim
- Claim Forms: Providing claim forms
- Proof of Loss: Timeframe for submitting written documents proving loss.
- Payment of Claims Procedures: Payment timelines and methods
- Physical Examinations & Autopsies: Right to conduct exams
- Legal Action Provisions
- Beneficiary Change Provisions: Rules for changing beneficiaries.
- Misstatement of Age Implications: How age misstatements affect benefits
Optional Provisions
- Change of Occupation
- Free Look Period (or Free Look)- 10 days to review the policy (return it for a full refund)
- Consideration Clause
- Elimination Period: Time between when injury/sickness/disability occurs and payment begins
- Waiver of Premium: Premium payments are waived if the person is permanently and totally disabled
- Exclusions (list specific exclusions), Pre-Existing Conditions (limitations), Recurrent Disability (existing or new claim), Coinsurance, Deductibles, Expense Coverage,
Other Health Insurance Concepts
- Social Security benefits: Supplemental Security Income (SSI) is for low-income, blind, disabled, or elderly people.
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Description
Test your knowledge about the insurance underwriting process and its regulatory framework, including the Fair Credit Reporting Act (FCRA). This quiz covers distinctions between consumer reports, rights of consumers, and characteristics of risk profiles. Enhance your understanding of important concepts in insurance applications.