Accelerated Benefits - Rider A life
insurance rider that allows for the early payment of some portion of the
policy's face amount should the insured suffer from a terminal illness or
injury.
Accidental Death Benefit Rider - A
life insurance policy rider providing for payment of an additional cash benefit
related to the face amount of the base policy when death occurs by accidental
means.
Agent - An authorized representative
of an insurance company who sells and services insurance contracts.
Assignment - The transfer of the
ownership rights of a Life Insurance policy from one person to another.
Attained Age - Your current age. Your
attained age is one of the factors life insurance companies use to determine
your premiums. The older you are, the greater chance you'll die while you are
covered - so the higher your premium.
Beneficiary -
The person(s) named in the policy to receive the life insurance proceeds upon
the death of the insured.
Binder - A temporary insurance
policy that expires at the end of a specific time period or when the permanent
policy is written. A binder is given to an applicant for insurance during the
time the complete policy paperwork is being completed.
Capitation
- A method of paying for healthcare services on the basis of the number of
patients who are covered for specific services over a specified period of time
rather than the cost or number of services that are actually provided.
Cash Benefits - Money that is paid to
the insured upon settlement of a covered claim. Often found with Hospital Income
Programs, "cash benefits" are paid directly to the insured rather than the
doctor or the hospital directly.
Cash (Surrender) Value -The amount that is available in cash for loans and that may be available for
withdrawals. Accessing Cash Surrender Value may reduce the death benefit and
may increase the risk of lapse.
COBRA - See Consolidated Omnibus
Budget Reconciliation Act.
Coinsurance
- A method of cost-sharing in a health insurance policy that requires a
group member to pay a stated percentage of all remaining eligible medical
expenses after the deductible amount has been paid.
Conditional Receipt - Given to
policy owners when they pay a premium at time of application. Such receipts
bind the insurance company if the risk is approved as applied for, subject to
any other conditions stated on the receipt.
Consolidated Omnibus Budget
Reconciliation Act (COBRA) - A federal act which requires each group
health plan to allow employees and certain dependents to continue their group
coverage for a stated period of time following a qualifying event that causes
the loss of group health coverage. Qualifying events include reduced work
hours, death or divorce of a covered employee, and termination of employment.
Contestable Clause - A provision in
an insurance policy setting forth the conditions under which or the period of
time during which the insurer may contest or void the policy. After that time
has lapsed, normally two years, the policy cannot be contested. Example:
Suicide.
Copayment
- A specified dollar amount that a member must pay out-of-pocket for a
specified service at the time the service is rendered.
Convertible Term Insurance -
Term insurance which can be exchanged (converted), at the option of the
policyowner and without evidence of insurability, for a permanent insurance
policy.
Contingent Beneficiary - Person or
persons named to receive proceeds in case the original beneficiary is not
alive. Also referred to as secondary or tertiary beneficiary.
Coverage - Another word for
insurance. Insurance companies use the term coverage to mean either the dollar
amounts of insurance purchased ($200,000 of liability coverage), or the type
of loss covered (coverage for theft).
Conversion Privilege - Allows the
policy owner, before an original insurance policy expires, to elect to have a
new policy issued that will continue the insurance coverage.
Convertible - Term A policy that
may be changed to another form by contractual provision and without evidence
of insurability. Most term policies are convertible into permanent insurance.
Cross-Purchase Plan - An agreement
that provides that upon a business owner's death, surviving owners will
purchase the deceased's interest, often with funds from life insurance.
Death Benefit - The amount of money
paid to the beneficiary when the insured person dies.
Dental health maintenance
organization (DHMO) - An organization that provides dental services
through a network of providers to its members in exchange for some form of
prepayment.
Dental point of service (dental
POS) option - A dental service plan that allows a member to use either a
DHMO network dentist or to seek care from a dentist not in the HMO network.
Members choose in-network care or out-of-network care at the time they make
their dental appointment and usually incur higher out-of-pocket costs for
out-of-network care.
Dental POS option - See dental
point of service option.
Dental PPO - See dental
preferred provider organization.
Dental preferred provider
organization (dental PPO) - An organization that provides dental care to
its members through a network of dentists who offer discounted fees to the
plan members.
Deductible
- A flat amount a group member must pay before the insurer will make any
benefit payments.
Decreasing Term Insurance - Term life insurance on which the face value
slowly decreases in scheduled steps from the date the policy comes into force
to the date the policy expires, while the premium remains level. The intervals
between decreases are usually monthly or annually.
DHMO - See dental health
maintenance organization.
Diagnostic and treatment codes -
Special codes that consist of a brief, specific description of each diagnosis
or treatment and a number used to identify each diagnosis and treatment.
Double Indemnity - Payment of twice the basic benefit in the event of
loss resulting from specified causes or under specified circumstances.
Dividend -A return of part of the premium on participating insurance that is based on
the insurer's investment, mortality, and expense experience. Dividends are not
guaranteed.
Evidence of Insurability - Any
statement or proof of a person's physical condition, occupation, etc.,
affecting acceptance of the applicant for insurance.
Exclusions - Specified hazards listed in a policy for which benefits will
not be paid.
Expiry - The termination of a term life insurance policy at the end of
its period of coverage.
Face Amount -
The amount stated on the face of the policy that will be paid in case of
death. It does not include additional amounts payable under accidental death
or other special provisions, or acquired through the application of policy
dividends.
First To Die Insurance - Insurance
policy whose death benefit is paid to the surviving insured upon the death of
one of the insured's.
Free Look - Provision required in
most states whereby policy owners have up to 20 days to examine their new
policies at no obligation.
Grace Period - Period of time after
the due date of a premium during which the policy remains in force without
penalty.
Graded Premium Policy - A type of
whole life policy designed for people who want more life coverage than they
can currently afford. They pay a lower premium rate that increases gradually
over the first three to five years and then remains constant over the life of
the policy.
Guaranteed Insurability
(Guaranteed Issue) - Arrangement, usually provided by rider, whereby additional
insurance may be purchased at various times without evidence of insurability.
Incontestable Clause - A clause in
a policy providing that a policy has been in effect for a given length of time
(two or three years), the insurer shall not be able to contest the statements
contained in the application.
Insurability -
Acceptability to the company of an applicant for insurance.
Insured or Insured Life -The person on whose life the policy is issued.
Insurable Interest - Requirement of
insurance contracts that loss must be sustained by the applicant upon the
death of another and it must be sufficient to warrant compensation.
Insurance - A formal social device
for reducing risk by transferring the risks of several individual entities to
an insurer. The insurer agrees, for a consideration, to pay for the loss in
the amount specified in the contract.
Insured - The party who is being
insured. In life insurance, it is the person because of his or her death the
insurance company would pay out a death benefit to a designated beneficiary.
Irrevocable Beneficiary - A
beneficiary that cannot be changed without that beneficiary's consent.
Increasing Term Insurance - Term life insurance in which the death
benefit increases periodically over the policy's term. Usually purchased as a
cost of living rider to a whole life policy.
Lapse -Termination of a policy upon the policy owner's failure to pay
the premium within the grace period.
Level Premium (Life Insurance) -
Life insurance for which the premium remains the same from year to year. The
premium is normally more than the actual cost of protection during the earlier
years of the policy and less than the actual cost in the later years. The
building of a reserve is a natural result of level premiums. The payments in
the early years, together with the interest that is to be earned, serves to
balance out the underpayment of the later years.
Life Expectancy - The average
number of years remaining for a person of a given age to live as shown on the
mortality or annuity table used as a reference.
Life Insurance - An agreement that guarantees the payment of a stated
amount of monetary benefits upon the death of the insured.
Loan (Policy Loan) -
A loan made by a life insurance company from its general funds to a
policyowner on the security of the cash value of a policy. Generally, loans
may reduce the policy's death benefit and cash value.
Misrepresentation - Act of making,
issuing, circulating or causing to be issued or circulated an estimate, an
illustration, a circular or a statement of any kind that does not represent
the correct policy terms, dividends or share of surplus or the name or title
for any policy or class of policies that does not in fact reflect its true
nature.
Mortality Rate - The number of
deaths in a group of people, usually expressed as deaths per thousand.
Mortality Table A table showing
the incidence of death at specified ages. Non medical Insurance A contract of
life insurance underwritten on the basis of an insured's statement of his
health with no medical examination required.
Network - The group of
physicians, hospitals, and other medical care providers that a specific
managed care plan has contracted with to deliver medical services to its
members.
Original Age - The age you were
when you bought the policy.
Out-of-pocket
maximums - Limit the amount a member has to pay out of his or her
own pocket for particular healthcare services during a particular time period.
Also called Maximum Out of Pocket (MOOP)
Paid-up Insurance -
Insurance that will remain in force with no need to pay additional premiums.
Participating Policy -
A life insurance policy that is eligible for the payment of dividends by the
insurer (see also Dividend.)
Permanent (Life Insurance) -
Any form of life insurance except term; generally insurance that builds up a
cash value, such as whole life.
Policy Owner -
The person who owns a life insurance policy. This is usually the insured
person, but it may also be a relative of the insured, a partnership or a
corporation.
Preferred Risk - A risk whose
physical condition, occupation, mode of living and other characteristics
indicate a prospect for longevity superior to that of the average longevity of
unimpaired lives of the same age.
Premiums -
Payments to the insurance company to buy a policy and to keep it in force.
Primary Beneficiary - In life
insurance, the beneficiary designated by the insured as the first to receive
policy benefits.
Provisions - Statements contained
in an insurance policy which explain the benefits, conditions and other
features of the insurance contract.
Rated - Coverage's issued at a higher rate than standard because of some
health condition, or impairment of the insured.
Renewable Term Insurance -
Term insurance which can be renewed at the end of the term, at the option of
the policyowner and without evidence of insurability, for a limited number of
successive terms. The rates generally increase at each renewal as the age of
the insured increases.
Reinstatement - Putting a lapsed
policy back in force by producing satisfactory evidence of insurability and
paying any past-due premiums required.
Replacement - A new policy written
to take the place of one currently in force.
Revocable Beneficiary - The
beneficiary in a life insurance policy in which the owner reserves the right
to revoke or change the beneficiary. Most policies are written with a
revocable beneficiary.
Rider - An attachment to a policy that modifies its conditions by
expanding or restricting benefits or excluding certain conditions from
coverage.
Risk Selection - The method a home
office underwriter uses to choose applicants that the insurance company will
accept. The underwriter must determine whether risks are standard, substandard
or preferred and set the premium rates accordingly.
Term Insurance -
Life insurance that does not build up cash value and where the premium
normally increases as the insured gets older.
Underwriter - Company receiving
premiums and accepting responsibility for fulfilling the policy contract.
Also, company employee who decides whether the company should assume a
particular risk; or the agent who sells the policy.
Uninsurable - Risk A person who is
not acceptable for insurance due to excessive risk.
Universal Life Insurance -A flexible premium life insurance policy under which the policyowner may
change the death benefit from time to time (with satisfactory evidence of
insurability for increases) and vary the amount or timing of premium payments.
Premiums (less expense charges) are credited to a policy account from which
mortality charges are deducted and to which interest is credited at rates,
which may change from time to time.
Variable Life - Life insurance
under which the benefits relate to the value of assets behind the contract at
the time the benefit is paid. The assets fluctuate according to the investment
experience of funds managed by the life insurance company. Premium payments
may be fixed as to timing and amount (scheduled premium variable life) or
subject to change by the policy holder (flexible premium variable life).
Waiver of Premium - Rider or
provision included in most life insurance policies exempting the insured from
paying premiums after he or she has been disabled for a specified period of
time, usually six months.
Whole Life Insurance -
A basic type of permanent life insurance which can provide lifetime
protection at a level premium. Premiums must generally be paid for as long as
the policy is in force.