LOMA 302 Module 4 Questions And Answers, Exams of Insurance law

Download LOMA 302 Module 4 Questions And Answers and more Exams Insurance law in PDF only on Docsity! LOMA 302 Module 4 Questions And Answers Temporary insurance agreement (TIA) - The Answer is A contract between an insurer and an applicant that provides temporary coverage on the proposed insured before a policy is issued and delivered; such coverage may be subject to certain conditions. Binding premium receipt - The Answer is A premium receipt that provides temporary insurance coverage that becomes effective on the date specified in the receipt. Conditional premium receipt - The Answer is A premium receipt that specifies certain conditions that must be met before the temporary insurance coverage provided by the receipt becomes effective. Insurability premium receipt - The Answer is A conditional premium receipt that provides temporary insurance coverage on condition that the insurer finds that the proposed insured was insurable at least as a standard risk on a certain date specified in the receipt. Approval premium receipt - The Answer is A conditional premium receipt that provides temporary insurance coverage only when the LOMA 302 Module 4 Questions And Answers insurer approves the proposed insured as a standard or better-than-average risk. Presumptive death certificate - The Answer is A court-issued document stating that a person is presumed to be dead. Rescission - The Answer is A legal remedy provided to an insurer to avoid a contract when the policy was issued based on a material misrepresentation of a fact contained in an application. Paid-up additional insurance - The Answer is A supplemental benefit that allows the owner of a whole life insurance policy to purchase additional insurance on stated dates without proving the insured's insurability. Accidental death benefits - The Answer is A supplemental benefit that provides a death benefit in addition to the policy's basic death benefit if the insured dies as a result of an accident. Unearned premiums paid in advance - The Answer is Sometimes a policyowner chooses to pay LOMA 302 Module 4 Questions And Answers insurer will deduct this amount and pay out the remaining death benefit. Retained asset account (RAA) - The Answer is A life insurance policy settlement option that allows an insurer to pay a life insurance policy's proceeds into an interest-bearing account in the payee's name; the payee can then withdraw all or part of the proceeds at any time. NAIC Retained Asset Accounts Sample Bulletin - The Answer is An NAIC sample bulletin that establishes disclosure standards which insurers must meet when they pay a beneficiary's life insurance benefits into a retained asset account. settlement options - The Answer is Choices given to the owner or beneficiary of a life insurance policy regarding the method by which the insurer will pay the policy's proceeds when the policyowner does not receive the benefits in one single payment. Interest option - The Answer is A life insurance policy settlement option under which the policy proceeds are left on deposit with the insurer and the interest earned on those proceeds is LOMA 302 Module 4 Questions And Answers paid out annually, semiannually, quarterly, or monthly to the beneficiary or other payee. Fixed-period option - The Answer is A life insurance policy settlement option under which the insurance company agrees to pay a policy's proceeds plus interest in equal installments to the payee for a specified period of time. Fixed-amount option - The Answer is A life insurance policy settlement option under which the insurance company uses the policy proceeds plus interest to pay a preselected amount in a series of installments to the payee for as long as the funds last. Life income option - The Answer is A life insurance policy settlement option under which the insurance company agrees to use the policy proceeds to provide a life annuity for the policy's payee. Claim philosophy - The Answer is A statement of the insurer's objectives for administering claims. LOMA 302 Module 4 Questions And Answers Claim practices - The Answer is Statements that guide the day-to-day handling of claims. Claim form - The Answer is A document containing information about a loss under an insurance policy that is submitted to an insurance company to begin the claim evaluation process. Also called a claimant's statement. Claim analyst - The Answer is An insurance company employee who reviews claims and determines the company's liability for each claim. Vice President/Director of Claim Administration - The Answer is The Vice President or Director of Claims oversees management, administration, and support of claims operations. The director ensures that the department adheres to the claims philosophy and is responsible for strategic planning, building partnerships, and leading initiatives to improve efficiency and reliability. In some companies, this person may also establish procedures, make decisions pertaining to technologies used in claims, provide training, review compliance issues, and recommend system changes. LOMA 302 Module 4 Questions And Answers Death Master File (DMF) - The Answer is A Social Security Administration database of information about people who had a Social Security number and whose deaths were reported to the Social Security Administration. Model Privacy Act - The Answer is In the United States, the Model Privacy Act's general prohibition of pretext interviews directly affects how a claim analyst conducts a claim evaluation. A pretext interview is an interview in which one person attempts to gain information from another person by (1) pretending to be someone he is not, (2) pretending to represent someone he does not represent, (3) refusing to identify himself, or (4) misrepresenting the purpose of the interview. An insurer may conduct a pretext interview during a claim investigation only if the insurer has a reasonable basis to suspect criminal activity, fraud, material misrepresentation, or material nondisclosure in connection with the claim. The insurer may not conduct a pretext interview with any person who has a protected relationship with the person who is the subject of the interview. Protected relationships include husband and wife, lawyer and client, and doctor and patient. LOMA 302 Module 4 Questions And Answers HIPAA - The Answer is HIPAA includes privacy provisions that affect life insurers. Personnel in the contact center, customer service, claims, or any area of the company that takes calls from customers must carefully verify the caller's identity before disclosing any private health information. Companies generally verify the Social Security number and date of birth for the insured. They may also verify the caller's name, relationship to the insured, address, and policy number. HIPAA places limits on many claims activities, requiring analysts to follow specific processes before approving payment. Since individual employees can be held liable for errors, insurance companies take these requirements very seriously. W-8 form - The Answer is A U.S. tax form that grants a nonresident alien or foreign person exemption from certain tax withholding requirements. W-9 form - The Answer is A U.S. tax form that verifies the taxpayer identification number (TIN) for a U.S. person or resident alien. LOMA 302 Module 4 Questions And Answers Insurance fraud - The Answer is Any fraud that involves an insurance company, whether committed by consumers, insurance company employees, producers, health care providers, or anyone else connected with an insurance transaction. Claim fraud - The Answer is An action by which a person intentionally uses false information in an unfair or unlawful attempt to collect benefits under an insurance policy. Insurance Fraud Prevention Model Act - The Answer is An NAIC model law designed to permit the state insurance departments to (1) investigate and discover fraudulent insurance acts more effectively, (2) stop fraudulent insurance acts, and (3) receive assistance from state, local, and federal law enforcement and regulatory agencies in enforcing laws that prohibit fraudulent insurance acts. Invasion of privacy - The Answer is A civil wrong that occurs when a person (1) appropriates someone's name or personality; (2) publicizes someone's private affairs; (3) intrudes into someone's private affairs and the wrong causes mental suffering, shame, or humiliation; or (4) places someone in a false light in the public eye. LOMA 302 Module 4 Questions And Answers Supplemental benefits - The Answer is 1. Waiver of premium for disability (WP) benefit 2. Accidental death benefit (ADB) 3. Family benefit 4. Guaranteed insurability benefit 5. Accelerated death benefit Terminal Illness (TI) Benefits - The Answer is With a terminal illness (TI) benefit, the insurer pays a portion of the policy's death benefit to a policyowner-insured who suffers from a terminal illness and has a physician-certified life expectancy of less than a stated time, generally 12 or 24 months. The benefit amount payable varies by insurer, and some TI benefits permit payment of the full face amount prior to the insured's death. But generally, the maximum TI benefit payable is a stated percentage—usually between 25 and 75 percent—of the policy's face amount up to a specified maximum dollar limit such as $250,000. Insurers usually pay the benefit in a lump sum to the policyowner, and pay the remainder to the beneficiary following the insured's death. Critical Illness (CI) Benefits - The Answer is With a critical illness benefit, also known as a dread disease benefit, the insurer agrees to pay a LOMA 302 Module 4 Questions And Answers portion of the policy's face amount to the policyowner- insured if the insured suffers a specified disease. Insurers usually pay these benefits in a lump sum, but some pay the benefit in monthly installments over a period of 6 to 12 months. Some insurers do not make payments for multiple or recurring events. Long Term Care (LTC) Benefits - The Answer is With the long-term care (LTC) benefit, the insurer agrees to pay a benefit to a policyowner-insured if the insured requires constant care for a medical condition. The amount of each monthly LTC benefit payment generally is a stated percentage of the policy's death benefit. For example, the benefit may state that the insurer will pay 2 percent of the policy's death benefit each month if the insured requires nursing home care and 1 percent of the death benefit each month if the insured requires home health care. The insurer usually pays monthly benefits until a specified percentage, typically between 50 and 100 percent, of the policy's basic death benefit has been paid out. The insurer pays any remaining death benefit to the beneficiary after the insured's death. Most LTC benefits impose a 90-day waiting period before accelerated death benefits are payable. Some LTC benefits specify that coverage must be in force for a given period of time, usually one year or more, before the insured will qualify for LTC benefits.