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Massachusetts Health & Accident Insurance Exam
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Massachusetts Health & Accident Insurance Exam
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Massachusetts Health & AccidentInsurance Exam
Hazard - -Situation that increases chance of loss
-Annuity - -Policy issued by an insurance company to promise you an
income that can last you a lifetime
-Insurer - -An insurance company
-Insured - -A person or business covered by an insurance policy
-Health Insurance - -Broad field of insurance plans that provide protection
against financial consequences of illness, accidents, injury, and disability
- Paid on a year-to-year basis
- Subject to periodic premium increases
- Benefits not fixed
-Medical Expense Insurance - -Pays benefits for nonsurgical doctors' fees
commonly rendered in a hospital; sometimes pays for home and officecalls
-Disability Income Insurance - -Provide a replacement income when wages
are lost due to disability; based on education, training, experience
- income creates limits
- monthly income payments
- highest premium = 14 day waiting period w/ 10 year benefit
- ceiling amount
-Accidental Death and Dismemberment Insurance (AD&D) - -Provides the
insured with a lump-sum benefit amount in the event of accidental death or
dismemberment under accidental circumstances
-Interim Coverages - -Term insurance for a period of months or less by
special agreement of the company; it permits a permanent policy to become
effective at a selected future date.
-Interim - -the intervening time
-Subrogation - -the right for an insurer to pursue a third party that caused
an insurance loss to the insured
-Business Continuation Plans - -continue the operation of the business in the
event of a disabling sickness to a business owner or key employee
, -Employee Benefit Plans - -- help employee in event of disabling sickness or
injury
- rare to not include provision of health insurance/benefits
- contributes to morale and productivity of employee
- provides needed benefits (helps hold down demands for wage increases)
- gives employer tax deductions
- enhances employer image
-Business Overhead Expense Insurance - -- sold individually
- designed to reimburse business for overhead expenses in the event a
business owner becomes disabled (day to day operations)
- does not include compensation for disabled owner
- premiums are tax-deductible as insurance expense
- benefits are taxable income
-Disability Buy-Sell Plan/Disability Buy-Outs - -An agreement between
business co-owners that provides that shares owned by any one of them who
becomes disabled shall be sold to and purchased by the other co-owners or
by the business using funds from disability income insurance.
- legal binding agreement funded with disability income policy
- pay benefits in periodic payments
- buy-out plan contains provision allowing for a lump-sum payment of the
benefit
- benefits tax-free
- premiums not tax deductible
- lengthy elimination periods (2+ yrs)
-Key Person Disability Insurance - -- pays monthly benefit to a business for
additional help or outside services when an essential person is disabled
- key persons economic value to a business is determined by potential loss of
business income that could occur (hiring price)
- business = owner and premium payer of policy
- benefits tax-free
- premiums not tax deductible
- policies reserved for "hard to replace" employees or key sales members
-Group Health Insurance - -- between insurance company and group
(employer)
- health insurance through group master contracts
- employer may pay premium or require contribution from each member
- master policy
- insureds receive certificates of insurance and an outline that describes
benefits
- more extensive benefits
- higher benefit maximums
- benefits predetermined by employer
, - group health coverage = natural group
- minimum number of persons covered established by state law
- impose eligibility requirements before participating
- less costly/less expenses
-Premium - -The amount you pay for your health insurance every month
-Probationary Period - -period of time where a new employee is ineligible for
group health insurance coverage (start a new job)
-Enrollment Period - -limited period of time where all members may sign up
for a group loan
-Coordination of Benefits Provision - -- Designed to prevent duplication of
group insurance benefits. Limits benefits from multiple group health
insurance policies in a particular case to % of the expenses covered and
designates the order in which the multiple carriers are to pay benefits.
(married couples)
-Provider - -designation of any healthcare provider
-Overutilization - -when health benefits are too high
-Group Health Insurance Premium Factors - -- size of group
- claims experienced with previous insurers
- ages
-Contributory - -- employees share portion of premium
- require 75% participation
-Noncontributory - -- employer pays entire premium and employee does not
contribute
- require 100% participation from eligible members
- minimum requirements protect insurer against adverse selection
-Shared Funding Arrangement
(Group Funding Option) - -allows employer to self-fund healthcare expenses
up to a certain point
-Minimum Premium Arrangement
(Group Funding Option) - -allows employer to self-insure normal and
expected claims up to a given amount (insurer funds excess amounts)
-Retrospective Premium Arrangement
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