Passtrak Health Insurance License Exam Manual Book

	Acknowledgments	vii
	Introduction	ix
	How to Use the License Exam Manual	xi
Part 1	Principles of Insurance	1
1.	Purpose of Insurance	3
	The Role of Insurance	3
	An Industry Overview	4
	The Nature of Insurance	5
	The Concept of Risk	7
	Elements of Insurable Risk	10
	Economic Basis of Health Insurance	11
	Summary	11
	Key Concepts	12
2.	The Insurance Industry	17
	Types of Insurers	18
	How Insurance Is Sold	22
	Regulation of the Insurance Industry	25
	Summary	33
	Key Concepts	33
3.	Law and the Insurance Contract	39
	General Law of Contracts	39
	Special Features of Insurance Contracts	42
	Agents and Brokers	48
	Other Legal Concepts	51
	Summary	53
	Key Concepts	54
Part 2	Principles of Health Insurance	59
4.	Introduction to Health Insurance	61
	Basic Forms of Health Insurance Coverage	61
	How Health Insurance Is Purchased	63
	Characteristics of Health Insurance	64
	Summary	66
	Key Concepts	67
5.	Health Insurance Providers	73
	Commercial Insurance Providers	74
	Service Providers	74
	Government Insurance Programs	77
	Alternative Methods of Providing Health Insurance	79
	Summary	81
	Key Concepts	82
6.	Medical Expense Insurance	87
	Purpose of Medical Expense Insurance	87
	Basic Medical Expense Plans	88
	Major Medical Expense Plans	92
	Other Types of Medical Expense Coverage	99
	Summary	100
	Key Concepts	100
7.	Disability Income Insurance	105
	Purpose of Disability Income Insurance	106
	Disability Income Benefits	106
	Disability Income Policy Provisions	111
	Disability Income Policy Riders	114
	Summary	115
	Key Concepts	116
8.	Accidental Death and Dismemberment Insurance	121
	Nature of AD&D Policies	121
	AD&D Benefits	122
	Other Forms of AD&D	123
	Summary	124
	Key Concepts	125
9.	Government Health Insurance Programs	131
	Original Medicare Plan	132
	Medicare+Choice Program	134
	Medicaid	136
	State Workers' Compensation Programs	137
	Summary	138
	Key Concepts	138
10.	Private Insurance Plans for Seniors	143
	Medicare Supplement Policies	144
	Long-Term Care Insurance	146
	LTC Policy Provisions and Limits	150
	Summary	153
	Key Concepts	154
11.	Health Insurance Policy Provisions	159
	NAIC Model Health Insurance Policy Provisions	160
	Common Exclusions or Restrictions	167
	Renewability Provisions	169
	Summary	170
	Key Concepts	171
12.	Health Insurance Underwriting and Premiums	179
	Risk Factors in Health Insurance	180
	Health Insurance Premium Factors	183
	Tax Treatment of Health Insurance Premiums and Benefits	185
	Managed Care	189
	Summary	191
	Key Concepts	191
13.	Group Health Insurance	197
	Nature of Group Health Insurance	198
	Group Health Insurance Coverages	201
	Tax Treatment of Group Health Plans	208
	Summary	209
	Key Concepts	210
14.	Uses of Health Insurance	215
	A Proper Health Insurance Program	216
	Individual Needs for Health Insurance	216
	Business Needs for Health Insurance	218
	Summary	221
	Key Concepts	221
	Final Exam	227
	Glossary	243
	Appendix	259
	Index	277