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LIFE AND HEALTH INSURANCE - OHIO LICENSING 2025
EXAM PREP
Absolute Assignment - The assignment by the policy owner of all control and rights to a third party. This differs from collateral assignment, which allows all the rights and control to revert to the owner once a loan is paid off Accident - A fortuitous event; unforeseen and unintended Accidental Death Insurance - A form of health insurance that provides payment if death of the insured results from accident. Accidental death insurance is often combined with dismemberment insurance in a form called accidental death and dismemberment (AD&D) Accident and Sickness - Insurance against bodily injury, disability, or death by accident or accidental means, or expense thereof, or against disability or expense resulting from sickness and the insurance relating thereto Accident means - The unexpected cause of an accidental bodily injury. Under an accidental means definition, the mishap itself must be accidental. If a person does something to contribute to the accident, the claim would not be paid under this restrictive definition Accelerated benefit - Available only if the benefits are available during the insured's lifetime, benefit amounts are fixed when accelerated, and the benefits, when paid, reduces the death benefit
Accumulation at interest option - A dividend option under which the policy owner allows dividends to accumulate at interest with the company. Only the interest on the dividends is taxable as income (participating policies only). Actuary - Once concerned with the application of probability and statistical theory to insurance. This person sets expenses, and interest assumptions. ADB - Accidental death benefit, also known as double indemnity. There is another variation called triple indemnity. AD&D - Accidental death and dismemberment insurance. Administrator - The person appointed by a court to settle a deceased's estate, sometimes called and executor. Adverse selection - Selection against the insurance company. The tendency of poorer risks to want insurance more often than standard risks. Agent - The individual appointed by an insurance company to solicit, negotiate, effect, or countersign insurance contracts on its behalf. Aleatory - Something that depends upon chance or is random. It is derived from the Latin idea of "rolling the dice."
Assignment - The transfer of rights in a policy to someone other than the policy owner. Attained age - The present age of the insured. This is a factor when a person converts term insurance to whole life insurance or buys added disability under a GIR provision Attorney-in-fact - A person to whom authorization is given by an individual to exchange insurance with other persons. Always present in a reciprocal insurance company. Authorized company - An insurer permitted to sell insurance within a state, evidenced by a certificate of authority from the insurance commissioner, also called ADMITTED Automatic premium loan - A provision in a life policy authorizing the insurance company to use the loan value to pay premiums not paid by the end of the grace period. May be present in whole life or other traditional cash value policies only, but never in term policies Aviation clause - Limits or excludes coverage when the insured is participating in specified types of air travel, cush as private planes. Coverage is usually fully in force for people on regularly scheduled commercial flights. The limit or exclusion often applies to student pilots Beneficiary - A person who may become eligible to receive, or is receiving, benefits under an insurance plan, other than as a participant.
Blanket Insurance Contract - A contract of Health Insurance that covers all of a class of persons not individually identified. No certificates are issued and people covered may not be aware that the coverage is in place. Blue Plan - The generic term for those insurers (usually on a service rather than a reimbursement bases) who are authorized to use the designation Blue Cross or Blue Shield and the insignia of either. Broker - One who represents an insured in the solicitation, negotiation, or procurement of contracts of insurance, functions. This person is also called an independent agent. Business Insurance - Life or Health insurance written to vober business situations, such as key person, sole proprietor, partnership, corporations, ect. Cancelable - A contract of Insurance that may be terminated by the insurance company or insured at any time. Virtually every form of insurance is cancelable except Life insurance and those health policies designated as guaranteed renewable, or non-cancelable and guaranteed renewable. Cancellation - The termination of a contract of insurance in force by voluntary act of the insurance company or insured, effected in accordance with provisions in the contract or by mutual agreement.
receives that proceeds. The provision is designed to protect the rights of the contingent beneficiary in the event of simultaneous death of the insured and the primary beneficiary. The time limit is up to 90 days, depending on state law. Comprehensive Health or Major Medical Insurance - A form of Health insurance that combines the coverage of major medical and basic medical exspenses crontracts into one broad contract that provides coverage for almost all types of medical expense with few internal limits. Usually subject to a corridor deductible for expenses after the first dollar base plan limits are exceeded, and to a co- insurance clause applicable to all or some of the remaining covered expenses. Concealment - The withholding of facts by an applicant for insurance that materially affect an insurance risk or loss. Conditional Receipt - A provision that, if premium settlement accompanies the application, coverage shall be in for from the date of application, provided the insurance company would have issued the coverage on the basis of facts as revealed by the application and other usual sources of underwriting information. A physical does not have to be completed for the company to make this judgment Conditionally Renewable - A contract of Health Insurance that provides that the insured may renew the contract to a stated date or an advanced age, subject to the right of the insurer to decline renewal only under conditions defined in the contract. Conditions - The part of an insurance contract setting out the responsibilities of both the insured and the insurer
Consideration - The exchange of value on which a contract is based. In life and health insurance, the consideration is the premium plus the statements in the application. Consideration Clause - A clause in a Life policy specifying the premium due for the insurance protection and the frequency of payment. Also called mode. Contingent Beneficiary - The person or persons named to receive benefits if the primary beneficiary is not alive. Contract - A legal agreement between two parties for the consideration, such as an insurance policy. Contributory Group - Group insurance for which the employees pay part of the premium. Controlled Business - Life insurance coverage written on the agent's own life and on the lives of such persons as the agent's relatives and business associates, or employees of a company in which an agent has an interest. Convertible term insurance - A term policy that can be converted to a permanent type of coverage without proof of insurability
Disability income insurance - A form of health insurance that provides periodic payments to replace income, actually or presumptively lost, when the insured is unable to work as a result of sickness or injury. Dismemberment benefits - Benefits paid for the loss of eyesight or limbs. Dividend - The return of part of the premium paid for a participating policy Dividend options - Ways an insured may receive policy dividends. Domestic insurance company - An insurance company formed under the laws of the state in which the insurance is written. Double indemnity - Payment of twice the basic benefit in the event of loss resulting from specified cause or under specific circumstances. Dread Disease Policy - A policy, usually offering blanket coverage up to a very high maximum, for certain specified diseases only, such as cancer. Earned premium - The portion of the premium for which policy protection has already been given during the non-expired portion of the policy term. Effective Date - The date on which an insurance policy or bond goes into effect and from which protection is furnished.
Eligibility Period - The period following the probationary period, during which the employee is eligible to obtain non-medical coverage under the group life plan. Embedded Deductible - Embedded deductible will only cover a family member in a high deductible health insurance plan after the individual's personal deductible has already been met. Employer mandate - A requirement under the affordable care act that businesses that employ 50 or more people and do not offer health insurance will pay a tax penalty beginning 2015 Endorsment - A form attached to an insurance contract changing part of the contract. Sometimes called a rider. Essential Health Benefits (EHB) - The minimum coverage requirements for health insurance under the affordable care act. the qualified plans must be guarantee issue with a no pre-existing conditions and no lifetime benefit maxiumums Estoppel - This concept is related to waiver. Once a person or company waives a known right, the waiver cannot be reversed. Exclusions - Causes, conditions, or property listed in the policy that are not covered and for which no benefits.
Fraud - An intentional misrepresentation made by a person with intent to take advantage of another. General Agent - An individual appointed by an insurer to administer its business in a given territory. Grace period - A period of time after the premium due date during which a policy remains in force without penalty, even though the premium due has not been paid. Grievance - A written or oral complaint involving an urgent care request in which the covered person complained during a utilization review, claims payment, handling, or reimbursement, or the contractual relationship with the carrier. Group Contract - A contract of insurance made with an employer or other entity that covers a group of people identified as individuals by reference to their relationship to the entity. A group contract may be life insurance, health insurance, or an annuity. Group Life Insurance - Life insurance that a person is eligible to purchase through membership in a group. The group may not be formed just to buy insurance. Guaranty Association - A state association that takes control of an insolvent insurance company and provides the funds to pay for claims that the company is unable to pay.
Guaranteed Insurability - A rider in life and health insurance contracts that permits the insured to buy addition prescribed amounts of insurance, at prescribed intervals, without evidence of insurablility. Guaranteed Renewable - A contract that gives the insured continued coverage in return for the timely payment of premiums for a substantial period of time. During that period of time, the insurer has no right to make any change in any provision of the contract other than a change in the premium rate for all insureds in the same class. Hazard - Any factor tending to make a policy owner a less desirable risk for the insuring company. May be physical or moral (health, occupation, dangerous sports, criminality, or immorality) Health Insurance - Broadly, coverage to provide benefits on the occurrence of disabling sickness or accident or accidental death or dismemberment, or loss of income due to disability. Health insurance association - A state fund that provides health insurance to residents who have been denied coverage, and the fund is maintained by assessments of the authorized health insurers in the state. Health Insuring Corporation (HIC) - An organization of health providers: this is the Ohio term for an HMO. Each member pays a premium for which he receives medical care when desired. The emphasis is on preventive medicine.
government to perform any of the activities and duties identified above those on an insurance navigator. Incontestable Clause - Provides that, after the policy has been in force a certain length of time, the company can no longer contest or void it, except for nonpayment of premiums or the insurer proving fraud. The time period is usually two years. Indemnify - To restore the victim of a loss, in whole or in part, by payment, repair, or replacement. Indemnity - Insurance is designed to restore the policy owner to the same financial condition enjoyed prior to a loss. The intent is to cover the amount of the actual loss only: the insured should not profit from a loss situation. Individual Contract - A contract of life or health insurance made with an individual that covers him, and in certain instances (like health policies), Specified members of the househould Industrial Life - Life insurance generally with a face amount of less that $1,000, with premiums collected monthly or more frequently by the agent in person. The grace period for this type of insurance is 28 days. Premiums were traditionally collected at the factory or workplace. Inpatient - A patient admitted to a hospital as a resident patient.
Insurability - The acceptability of an applicant to the insurance company for insurance. Insurable Interest - An interest in the case of an individual owning a policy on the life of another by which there will be a loss if the insured dies. The interest may be based on either a family relationship or economic factor. Insurable interest must exist at the time of application, but not at the time of loss. Insurance - A contract or device for the transfer of pure risk to an insurer, who agrees, for a consideration, to indemnify or pay a specified amount for losses suffered by the insured. Insurance age - an age upon which current premium rates may be established. It is commonly based on age at last birthday, age at next birthday, or age at nearest birthday. Insurance Director - The common title for the head of the state deparment of insurance Insurance navigator - A person or entity selected to perform certain duties identified in the affordable care act and is performing these functions under a grant. Insurance policy - A contract or legal document that establishes the terms of agreement between the insurer and insured.
Jumping Juvenile - Juvenile insurance on which the face amount increases by a multiple, usually five, of the original face amount when the insured reaches 21. Key person Insurance - Life or health insurance on important employees whose death or disability would cause the employer financial loss. The insurance is usually owned by the payable to the employer. Lapse - The termination of a policy because of failure to pay the premium. Law of Large Numbers - An insurance company might protect losses on a homogeneous group. Risks are not usually considered insurable unless the insurer has a large enough base of previous loss experience to be able to accurately predict future losses. It is the law of large numbers that makes accurate predictions of similar risks possible. Mortality tables are based on groups of at least 10,000,000 people Legal reserve - The amount required as a reserve to pay claims and benefits, using he mortality table and a maximum assumed interest rate prescribed by state law. Level premium insurance - Life insurance, the premium for which remains at the same level (amount) throughout the life of the policy Level Term Insurance - The amount of insurance protection in the term policy remains constant during the policy period.
Life Annuity - An annuity that provides a periodic income to the annuitant during the annuitant's lifetime. Life annuity with installments certain - An annuitant or a beneficiary is guaranteed to receive payments for a specified number of years or for life, whichever is longer. If the annuitant dies before all all guaranteed payments have been made, the beneficiary receives the payments for the rest of the certain period. Life Income Option - A settlement option that provides for payments during the entire life of the payee. There are four methods: 1. Straight life income - the payee receives a specified income for life, with no refunds upon death. 2. Refund Annuity - income is paid for the lifetime of the payee and a remainder goes to a second payee in installments or a lump sum if the first dies before receiving the full proceed of the policy; 3. Life income certain - The payee receives installments for life with a second payee receiving the payments if the first dies before the end of the time specified in the certain period; 4. Joint and reduced survivor life income - two payees are recipients of the income for the life of the firs. The surviving payee then receives a lesser amount. Life Insurance - Pays a specified amount on the death of the insured, to his estate or to a beneficiary. Limited Health Policies - Do not provide the same level of coverage as other health policies and provide fewer types of medical expenses and higher coinsurance, co-payments, and deductibles. Limited Pay Life - A permanent Life insurance policy on which premiums are paid for a specified number of years or to a specified age of the insured. Protection
