Insurance and Health Care Policies Review

These flashcards cover key vocabulary related to insurance and health care policies, emphasizing definitions and fundamental concepts.

Capitation

A managed care payment system where a fixed amount is paid per patient to a physician for health care services.

Mortality tables

Statistical tables that show the probability of death at each age.

Long-term care policy triggers

Conditions that must be met before benefits can be collected from a long-term care insurance policy.

Waiver of premium rider

Provisions that keep insurance policies in force without premiums during periods of disability.

Insurance solicitor

A natural person assisting an agent or broker in insurance transactions, excluding life, disability, or health insurance.

Insurable interest

A requirement that the policyholder must have a financial stake in the life or property being insured.

Consolidated Omnibus Budget Reconciliation Act (COBRA)

A law allowing individuals to continue group health insurance coverage for a limited time after certain qualifying events.

A layperson definition of insurance

A contract that provides indemnity against loss.

Life annuity

A contract that guarantees income payments for the lifetime of the annuitant.

Primary care physician (PCP)

The healthcare professional who serves as a first point of contact and coordinates care within the health plan.

Adverse selection

The tendency of individuals with higher risk to seek insurance more vigorously than those at lower risk.

Medi-Cal

California's Medicaid program providing health coverage for low-income individuals.

Exclusion rider

A provision that excludes coverage for certain conditions or risks.

Guaranteed renewable policy

A health policy that cannot be cancelled by the insurer as long as premiums are paid.

Long-term care (LTC) insurance

Insurance designed to cover the cost of long-term care services.

Non-contributory group policy

A group insurance policy in which the employer pays the full premium.

Beneficiary

The person designated to receive benefits from an insurance policy.

Requesting a reconsideration

A process allowing individuals to appeal decisions made by insurance companies regarding claims.

Mortality risk

The risk associated with potential loss of life in insurance.

Surety bond

A monetary guarantee of the performance of a contract or obligation.

Participating policy

A life insurance policy that provides dividends to the policyholder.

Conversion privilege

The option to convert a term life policy to a permanent policy without proving insurability.

Universal life insurance

A flexible premium, adjustable benefit form of life insurance.

Occupational exposure

The exposure to risk of loss resulting from a specific type of occupation.

Health Maintenance Organization (HMO)

A health care plan that requires members to use providers within its network for coverage.