Pennsylvania Life and Health Insurance License
Exam
- Earliest 60 days after proof of loss
- Maximum three years after proof of loss is filed (proof of loss is required to be filed no later
than 90 days from the date of loss) - ANS-Legal Action Provision Against Insurer
-Adjustments allowed for family coverage, geography, age, and tobacco use
-No adjustments permitted for pre-existing conditions, occupation, gender, duration of coverage,
credit worthiness - ANS-Modified Community Rating
A chance of loss, no loss, or gain. This risk is uninsurable. EX, gambling and investments -
ANS-Speculative Risk
A clause that prevents the debtors of a beneficiary from collecting the benefits before he/she
receives them. - ANS-Spendthrift Clause
a contract where the values exchanged may not be equal but depend on an uncertain event.
You are paying a $100 monthly premium, yet the insurance company promises to pay $10,000
for a covered loss. Uneven exchange. - ANS-Aleatory Contract
A contractual provision within an annuity contract or life insurance policy that provides that if a
client misses a scheduled payment, there is no forfeiture of the accumulated value. Instead, the
benefits will be paid at a reduced rate based upon the payments actually made. -
ANS-Nonforfeiture Provision
A decision by an insurance company, such as a health or disability insurer, to deny or terminate
insurance or to increase rates, usually based on information obtained from a consumer
reporting agency. - ANS-Adverse Action
A disability income policy that can be purchased on the owners and key employees of a
business that will pay a monthly benefit to the business so that they can meet its ongoing
overhead - ANS-BOE insurance (Business Overhead Expense)
A federal law that established procedures that consumer-reporting agencies must follow in order
to ensure that records are confidential, accurate, relevant and properly used. - ANS-Fair Credit
Reporting Act (FCRA)
A federal law that places restrictions on telephone solicitation - ANS-Telephone Consumer
Protection Act of 1991
, A federal law under which unsolicited fax advertisements and solicitations may only be sent to
persons with whom the sender has an established business relationship. - ANS-Junk Fax
Prevention Act of 2005
a fixed amount of money per patient per unit of time paid in advance to the physician for the
delivery of health care services - ANS-Capitation
a flexible premium policy that offers the insured the option to adjust the policy's face amount,
premium, and length of protection without ever having to complete a new application or have
another policy issued - ANS-Adjustable Life Insurance
A form of misrepresentation in which an agent induces an insured/owner to cancel, lapse, or
switch policies, even when it's to the insured's disadvantage. - ANS-Twisting
A form of permanent life insurance that features a guaranteed fixed death benefit and a
minimum rate of return on the policy's cash value by investing premiums in the company's
general account. - ANS-Fixed Life Insurance
A group of small employers who do not qualify for group insurance individually, formed to
establish a group health plan or self-funded plan. - ANS-Multiple Employer Trust (MET)
a health care plan that contracts with health care professionals to provide services at a reduced
fee and gives patients financial incentives to use network providers - ANS-Preferred Provider
Organization (PPO)
A high-risk person benefits more from insurance, so is more likely to purchase it. Occurs when
only those at high risk of loss purchase insurance to cover that risk. - ANS-Adverse Selection
A legal contract that determines what will be done with a business in the event that an owner
dies or becomes disabled. - ANS-Buy-Sell Agreement
a level-premium policy that provides lifetime protection - ANS-Ordinary Whole Life Insurance
A liability insurance company owned by its members, which are exposed to similar liability risks
by virtue of being in the same business or industry. Self Insurers are a form of this. - ANS-Risk
Retention Group
A life insurance or annuity settlement option with a life contingency that provides income
payments for the life of the payee. If the payee dies before receiving payments equal to the
amount placed under the settlement option, then the remainder goes to a beneficiary in the form
of a refund - ANS-Life Income with Refund
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