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Insurance Definitions

Here's an alphabetical listing of the most common used insurance words and terminology.

 

 

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 Glossary - Insurance Terminology

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.

 

Chris Kudryk
Employee Benefits Advisor

732-580-3671 (phone)
732-556-0447 (fax)
HealthPlansNJ@yahoo.com

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