HS 351 Ch. 1

The state of being in good health.

A progression of care from less intensive to more intensive as the care delivered moves from family members to professionals and from the home setting to supportive-living arrangements based on the needs of the care recipient and the availability and capacity of family and other caregivers.

A voluntary association of all state insurance commissioners. The organization's specific objectives are the development of uniform regulatory policy and the coordination of regulations of multistate insurers.

A state fund to pay claims of insolvent insurers. It is usually funded by assessments of other insurers licensed in the state.

A standardized contract that the insurer offers to its policyowners. In many states, it must be filed with the insurance department.

A required policy provision that limits an insurer's right to rescind a policy to 2 years (3 years in some states) with respect to any misstatement made by the insured on the application.

A required policy provision that gives an insured a specific number of days beyond the due date to pay each premium. States usually require a 31-day grace period for most policies.

A provision in an insurance contract that sets forth procedures for allowing an insured to request a policy to be restored to full effectiveness should a premium not be paid by the end of the grace period.

A benefit, beyond routinely available benefits, that a medical insurance plan must offer or provide as required by law.

Legislation, usually a state statute, that requires insurers to offer mandated benefits in an insurance plan for purchase by consumers at their discretion. Thus, if consumers decline the mandated benefits, policies may be sold without them.

The return of any part of the premium (except as dividends) to the policyowner by the insurer or agent as a price-cutting sales inducement. Rebating is prohibited under the Unfair Trade Practices Act.

A form of misrepresentation in which an agent may induce a policyowner to cancel disadvantageously the contract of another insurer in order to take out a new one.

The unlawful keeping of funds belonging to another.

A period of time, typically 30 days, after a policyowner receives a policy, during which the policyowner may return the policy for a full refund of any premium paid and the policy is void from its inception.

A renewal provision in an insurance contract whereby the insurance company cannot make any unilateral changes in any coverage provision or refuse to renew the coverage. The insured has the right to continue coverage by the timely payment of premiums that the insurer may revise periodically for broad classes of insureds.

A federal act protecting the interests of both participants in employee benefit plans and their beneficiaries.

Federal legislation for the primary purpose of making medical insurance more available, particularly when an employed person changes jobs or becomes unemployed. However, the legislation contains other provisions related to health care data standards and privacy, as well as the requirements for the tax-preferred status of long-term care insurance policies that are described as contracts.

The process of finding insurance solutions that are appropriate for the needs and wants of consumers.

A document that addresses what should be done when a person is clearly in a terminal medical condition.

A document that appoints someone else to make decisions about a person's health care in the event of medical incapacity.