Accident and Health Insurance Concepts

These flashcards cover key vocabulary and concepts related to accident and health insurance from the lecture.

Perils

Causes of loss in insurance, specifically sickness and accidental injury in health insurance.

Sickness

A physical illness that first manifests while a health insurance policy is in force; does not include mental illnesses.

Accidental Injury

An unforeseen and unintended bodily injury resulting from an accident.

Medical Expense Insurance

Covers costs related to doctor's bills, office visits, and other medical services.

Disability Income Insurance

Provides replacement income for insured individuals who cannot work due to a disability.

Dental Expense Insurance

Covers treatment and prevention of dental diseases or injuries.

Long Term Care Insurance

Provides benefits for medically necessary services received in nursing homes or through home health care.

Aleatory Contract

An insurance contract defined by unequal exchange of values; depends on uncertain future events.

Contract of Adhesion

An insurance contract prepared by the insurer, with terms accepted or rejected by the insured without negotiation.

Unilateral Contract

A contract where only one party, the insurer, is legally obligated to fulfill promises made.

Conditional Contract

A contract requiring certain conditions to be met by both parties for obligations to be fulfilled.

Adverse Selection

The tendency for higher-risk individuals to purchase insurance more frequently than lower-risk individuals.

Limited Policy

An insurance policy that covers specific perils or a limited range of services, such as specified disease policies.

Comprehensive Policy

An insurance policy that offers broad coverage with fewer limitations, covering all illnesses and accidents unless excluded.

Blanket Policy

Covers a group participating in a specific activity; all participants are included automatically.

Expense Paid Basis

Policy reimbursement where the insured is reimbursed for out-of-pocket expenses incurred.

Indemnity Basis

Policy pays a set amount directly to the insured for a claim.

Credit Disability Insurance

Covers loan payments for an insured who becomes disabled and cannot earn income.

Exclusions

Causes of loss that are not covered by health insurance policies, such as war and self-inflicted injuries.

Deductible

Amount the insured must pay out-of-pocket before insurance starts to cover costs.

Copayment (Copay)

A fixed fee the insured must pay for services, usually at the time of treatment.

Coinsurance

The percentage of costs the insured pays after meeting the deductible; typically expressed as a ratio.