Accelerated Benefits
Riders on life insurance policies which allow the life insurance policy's death
benefits to be used to offset expenses incurred in a convalescent or nursing
home facility.
Accident Insurance
A form of insurance against loss by accidental bodily injury to the insured.
Accidental Death and Dismemberment
A policy or a provision in a Disability Income policy which pays either a
specified amount or a multiple of the weekly disability benefit if the insured
dies, loses his or her sight, or loses two limbs as the result of an accident. A
lesser amount is payable for the loss of one eye, arm, leg, hand, or foot.
Accidental Death Benefit
An extra benefit which generally equals the face of the contract or principal
sum, payable in addition to other benefits in the event of death as the result
of an accident. See also Double Indemnity and Multiple Indemnity.
Accidental Death Insurance
A form that provides payment if the death of the insured results from an
accident. It is often combined with Dismemberment Insurance in a form called
Accidental Death and Dismemberment. See also Accidental Death and Dismemberment.
Additional Drug Benefit List
Prescription drugs listed as commonly prescribed by physicians for patients'
long-term use. Subject to review and change by the health plan involved. Also
called drug maintenance list.
Additional Monthly Benefit
Riders added to disability income policies to provide additional benefits during
the first year of a claim while the insured is waiting for Social Security
benefits to begin.
Adjusted Average Per Capita Cost (AAPCC)
The estimated average cost of Medicare benefits established on a per county
basis _ factors include age, sex, Medicaid, institutional status, disability,
and end stage renal disease status. Used to determine payments to cost
contractors for Medicare benefits.
Aftercare
Individualized patient services required after hospitalization or
rehabilitation.
Adjuster
An individual employed by a
property/casualty insurer to evaluate losses and settle policyholder claims.
These adjusters differ from public adjusters, who negotiate with insurers on
behalf of policyholders, and receive a portion of a claims settlement.
Independent adjusters are independent contractors who adjust claims for
different insurance companies.
Agent
Insurance is sold by two types of
agents: independent agents, who are self-employed, represent several insurance
companies and are paid on commission, and exclusive or captive agents, who
represent only one insurance company and are either salaried or work on
commission. Insurance companies that use exclusive or captive agents are called
direct writers.
Aggregate Indemnity
A maximum dollar amount that may be collected by the claimant for any
disability, for any period of disability, or under the policy as a whole.
Allocated
Benefits
Payments
authorized for specific purposes with a maximum specified for each. In hospital
policies, for instance, there may be scheduled benefits for X-rays, drugs,
dressings, and other specified expenses.
Allowable
Costs
Charges which
qualify as covered expenses.
Alternative Delivery Systems
Systems which
cover health care costs, other than on the usual fee-for-service basis. Could
include HMOs, IPAs, PPOs, etc.
Alternative Dispute Resolution (ADR)
Alternative to going to court to
settle disputes. Methods include arbitration, where disputing parties agree to
be bound to the decision of an independent third party, and mediation, where a
third party tries to arrange a settlement between the two sides.
Ancillary
Additional
services (other than room and board charges) such as X-rays, anesthesia, lab
work, etc. Fees charged for ancillary care such as X-rays, anesthesia, and lab
work. This term may also be used to describe the charge made by a pharmacy for
prescriptions which exceed the health insurance plan's maximum allowable cost
(MAC).
Appraisal
A survey to determine a
property’s insurable value, or the amount of a loss.
Arbitration
Procedure in which an insurance
company and the insured or a vendor agree to settle a claim dispute by accepting
a decision made by a third party.
Assigned Risk Plans
Facilities through which drivers
can obtain auto insurance if they are unable to buy it in the regular or
voluntary market. These are the most well-known type of residual auto insurance
market, which exist in every state. In an assigned risk plan, all insurers
selling auto insurance in the state are assigned these drivers to insure, based
on the amount of insurance they sell in the regular market.
Auto Insurance Policy
There are basically
six different types of coverage. Some may be required by law. Others are
optional. They are: (1) Bodily injury liability, for injuries the policyholder
causes to someone else. (2) Medical payments or Personal Injury Protection (PIP)
for treatment of injuries to the driver and passengers of the policyholder’s
car. (3) Property damage liability, for damage the policyholder causes to
someone else’s property. (4) Collision, for damage to the policyholder’s car
from a collision. (50 Comprehensive, for damage to the policyholder’s car
not involving a collision with another car (including damage from fire,
explosions, earthquakes, floods, and riots), and theft. (6) Uninsured motorists
coverage, for costs resulting from an accident involving a hit-and-run driver or
a driver who does not have insurance.
Auto Insurance
Premium
The price an
insurance company charges for coverage, based on the frequency and cost of
potential accidents, theft and other losses. Prices vary from company to
company, as with any product or service. Premiums also vary depending on the
amount and type of coverage purchased; the make and model of the car; and the
insured’s driving record, years of driving and the number of miles the car is
driven per year. Other factors taken into account include the driver’s age and
gender, where the car is most likely to be driven and the times of day – rush
hour in an urban neighborhood or leisure-time driving in rural areas, for
example. Some insurance companies may also use credit history-related
information.
Go to top
Benefit Levels
The maximum amount
a person is entitled to receive for a particular service or services as spelled
out in the contract with a health plan or insurer.
Benefit
Package
A description of
what services the insurer or health plan offers to those covered under the terms
of a health insurance contract.
Blanket
Insurance
A contract of
Health Insurance that covers all of a class of persons not individually
identified in the contract.
Blanket
Medical Expense
A policy or
provision in a Health Insurance contract that pays all medical costs, including
hospitalization, drugs, and treatments, without limitation on any item except
possibly for a maximum aggregate benefit under the policy. It is often written
with an initial deductible amount.
Bodily Injury
Coverage
This coverage is
one of the most important types of coverage in your auto insurance policy. It
helps you pay for an injured person's medical expenses and lost wages if you're
at fault in a car accident. Bodily injury coverage can also help protect you in
the event of a related lawsuit. Covered costs are subject to the limits
you choose when you buy your auto insurance policy. Most states require
you to have bodily injury coverage as a part of your auto insurance policy.
Capitation (CAP)
A rate paid,
usually monthly, to a health care provider. In return, the provider agrees to
deliver the health services agreed upon to any covered person.
Carry Over
Provision
In major medical
policies, allowing an insured who has submitted no claims during the year to
apply any medical expenses incurred in the last three months of the year toward
the new calendar year's deductible.
Cestui Que
Vie
The person whose
life measures the duration of a trust, gift, estate, or insurance contract.
Thus, in Life and Health Insurance it is the person on whose life or health the
policy is written, commonly called the insured, policyholder, or policy owner.
Civilian
Health and Medical Program of the Uniformed Services (CHAMPUS)
Part of the
Uniformed Services Health Benefits Program which supplements the medical care
available for families of active, deceased, and retired military personnel.
Closed
Access
A situation where
covered insureds must select one primary care physician. That physician is the
only one allowed to refer the patient to other health care providers within the
plan. Also called Closed Panel or Gatekeeper model.
COBRA
Consolidated
Omnibus Budget Reconciliation Act - Legislation providing for a
continuation of group health care benefits under the group plan for a period of
time when benefits would otherwise terminate. Continuation rights apply to
enrolled persons and their dependents. Coverage may be continued for up to 18
months if the insured person terminates employment or is no longer eligible.
Coverage may be continued for up to 36 months in nearly all other cases, such as
loss of dependent eligibility because of death of the enrolled person, divorce,
or attainment of the limiting age.
Coinsurance Clause
A provision
stating that the insured and the insurer will share all losses covered by the
policy in a proportion agreed upon in advance, i.e., 80-20 would mean that the
insurer would pay 80% and the insured would pay 20% of all losses. See also
Percentage Participation.
Collision Coverage:
Collision
coverage pays for damages to your covered auto that are caused by an impact with
another vehicle, stationary object, or moving object. Usually, the most your
collision coverage will pay is the actual cash value (ACV) of the vehicle. ACV
reflects the value of your vehicle at the time of the accident. Collision
coverage comes with a deductible, which is the amount you agree to pay out of
your pocket before your collision coverage takes over.
Collision Deductible
Waiver:
In states where
it's available, you have to buy the collision deductible waiver in conjunction
with your collision coverage. The collision deductible waiver pays your
collision deductible if your insured car is involved in an accident in which an
uninsured motorist is held legally responsible.
Composite Rate
One rate for all members of the group regardless of their status as single or
members of a family.
Comprehensive
Coverage
This coverage
pays for accidental damage to your auto that is caused by reasons other than a
collision, such as fire, theft, vandalism, riots, hail and windstorms.
Comprehensive coverage comes with a deductible.
Comprehensive Major Medical
A plan of
insurance which has a low deductible, high maximum benefits, and a coinsurance
feature. It is a combination of basic coverage and major medical coverage which
has virtually replaced separate hospital, surgical and medical policies with
each having its own deductible requirements. Also see Major Medical Insurance.
Conditional Binding Receipt
This is the more
exact terminology for what is often called a binding receipt. It provides that
if a premium accompanies an application, the coverage will be in force from the
date of application or medical examination, if any, whichever is later, provided
the insurer would have issued the coverage on the basis of the facts revealed on
the application, medical examination and other usual sources of underwriting
information. A Life and Health Insurance policy without a conditional binding
receipt is not effective until it is delivered to the insured and the premium is
paid.
Conditionally Renewable
A contract that
provides that the insured may renew it to a stated date or an advanced age,
subject to the right of the insurer to decline renewal only under conditions
stated in the contract.
Coordination of Benefits (COB)
A group policy
provision which helps determine the primary carrier in situations where an
insured is covered by more than one policy. This provision prevents an insured
from receiving claims overpayments.
Copay
This is an
arrangement where the covered person pays a specified amount for various
services and the health care provider pays the remainder. The covered person
usually must pay his or her share when the service is rendered. Similar to
coinsurance, except that coinsurance is usually a percentage of certain charges
where the co-payment is a dollar amount.
Copay
Provision
Often used with
major medical policies. The copay provision states what percentage of a claim
the company will pay and what percentage the insured will pay. For example, an
80 percent copay provision would provide that the insurer pay 80 percent of
claims and the insured pay 20 percent.
Corridor
Deductible
A Major Medical
deductible that provides for a deductible, or "corridor," after the full payment
of basic hospital and medical expenses up to a stated amount. In the event of
further expenses, payment is on the basis of participation or coinsurance, such
as 80%-20% or 85%-15%, and the deductible is that portion paid by the insured.
Covered
Expenses
Health care
expenses incurred by an insured or covered person that qualify for reimbursement
under the terms of a policy contract.
Credit
Health Insurance
A group disability
income insurance contract whereby a creditor is protected in the event of the
total disability of a debtor. The policy will pay benefits equal to the monthly
installment of the debtor.
Credit
Insurance
Insurance on a
debtor in favor of a creditor to pay off the balance due on a loan in the event
of the death or disability of the debtor. Liability Insurance for abnormal loss
from bad debts.
Deductible Carryover Credit
During the last
three months of a calendar year, charges incurred for health services can be
used to satisfy the deductible for the following calendar year. These credits
may be applied whether or not the prior calendar year's deductible had been met.
Dependent
Coverage
Insurance coverage
on the head of a family which is extended to his or her dependents, including
only the lawful spouse and unmarried children who are not yet employed on a
full-time basis. "Children" may be step, foster, and adopted, as well as
natural. Certain age restrictions on children usually apply.
Disability
Income Insurance
A form of health
insurance that provides periodic payments to replace income, actually or
presumptively lost, when the insured is unable to work as a result of sickness
or injury.
Dismemberment Benefit
The benefits
payable for various types of dismemberment. See also Accidental Death and
Dismemberment and Multiple Indemnity.
Drug
Formular
A schedule of
prescription drugs approved for use which will be covered by the plan and
dispensed through participating pharmacies.
Duplication of Benefits
A situation where
identical or overlapping coverage exists between two or more insurance companies
or service organizations.
Eligibility Period
(1) The period of
time during which potential members of a Group Life or Health program may enroll
without providing evidence of insurability. (2) The period of time under a Major
Medical policy during which reimbursable expenses may be accrued.
Elimination Period
A loosely used
term, sometimes designating the probationary period, but most often designating
the waiting period in a Health Insurance policy. See also Probationary Period
and Waiting Period.
Emergency
Accident Benefit
A group medical
benefit which reimburses the insured for expenses incurred for emergency
treatment of accidents.
Emergency Road Service Coverage
Emergency Road Service is an
optional type of car insurance coverage that helps you pay for towing if your
car becomes disabled.
Evidence
of Insurability
The statement of
information needed for the underwriting of an insurance policy.
Exclusive
Provider Organization (EPO)
A type of
preferred provider organization where individual members use particular
preferred providers rather than having a choice of a variety of preferred
providers. EPOs are characterized by a primary physician who monitors care and
makes referrals to a network of providers.
Extended
Coverage
A provision in
certain Health policies, usually Group, to allow the insured to receive benefits
for specified losses sustained after the termination of coverage, such a
maternity expense benefits incurred for a pregnancy in progress at the time of
the termination.
Extension
of Benefits
A condition in the
insurance policy which allows coverage to continue beyond the expiration date of
the policy in the case of employees who are not actively at work or dependents
who are hospitalized on that date. The extended coverage applies only where the
employee or dependent is disabled as of that date and continues only until the
employee returns to work or the dependent leaves the hospital.
First Party Benefits
Coverage (FPB)
This coverage
applies to the state of Pennsylvania, and is required when you purchase
your auto insurance policy. FPB helps pay for your medical expenses if you or
relatives living in your household are injured in an accident. When you buy your
auto insurance policy, you can also choose optional FPB coverage to help pay for
lost income, accidental death, and/or funeral costs. Covered costs are subject
to the coverage and limits you choose when you buy your auto insurance policy.
Go to top
Gap Coverage: Full New Car
Insurance Coverage
If you’re buying a new car also
consider buying gap coverage to cover your car’s immediate depreciation. Gap
coverage covers the difference between what your new car’s actually worth and
what you still owe. Gap coverage is typically inexpensive and is an intelligent
addition to standard new car insurance.
Get more details on Gap Insurance.
Health Savings Account (HSA)
The new law provides broad access to Health Savings Accounts, which allow
consumers to pay for qualified medical expenses with pre-tax dollars (income-tax
free!) and save for retirement on a tax-deferred basis.
HMO
A Health Maintenance Organization (HMO) is like a club for both patients and
health care providers. Subscribers to an HMO receive medical services from
participating physicians, clinics and hospitals.
Individual & Family
Health Insurance
Individual and family health insurance is a type of health insurance coverage
that is made available to individuals and families, rather than to employer
groups or organizations.
Liability Coverage
This coverage
helps you compensate others for their losses if you're responsible for injuring
another person or if you're responsible for damaging another person's vehicle or
property. Liability coverage also helps you pay the costs of related lawsuits. Bodily injury and
property damage coverage are the two main types of liability coverage in your
auto insurance policy. This type of auto insurance coverage is so important that
most states require you to have it as a part of your auto insurance policy.
Medical Payments
Coverage
This coverage pays
medical bills and/or funeral expenses if a covered driver and/or accompanying
passengers are injured or killed while in an insured vehicle, regardless of
who's at fault in an accident. This may also cover policyholders and their
family members when in others' vehicles, or when policyholders and their family
members are on foot and hit by a car. Covered costs are subject to the limits
you choose when you buy your auto insurance policy.
Personal Injury
Protection - No-Fault (PIP) Coverage
This coverage is
available only in certain states, and i these states it's often a mandatory part
of your auto insurance policy. This coverage
pays benefits for the cost of personal injuries resulting from an automobile
accident. This coverage applies without regard to who was at fault in the
accident. Personal Injury Protection applies only to injuries to people. It does
not cover damage to a car or to any other property. Check the details on the PIP coverage available in
your state when you get your online auto insurance quote.
PPO
PPO is a health plan that offers choices and access, but there is typically a
cost associated with that freedom that is higher than HMO costs. Like an HMO, it
is a network, but rather than choosing a primary care physician, you can see any
health care professional in the network any time you choose to make an
appointment. You don't need referrals for specialists or other services.
Point-of-Service
These health plans combine characteristics of HMOs and PPOs. You choose a
primary care physician who controls all aspects of care, including referrals to
specialists. All care received under that physician's guidance (including
referrals) is fully covered. Care received by out-of-plan providers is
reimbursed, but you have to pay a significant co-payment or deductible.
Property Damage
Coverage
This coverage is
one of the most important types of coverage in your auto insurance policy. It
helps you pay for damages to another person's property (such as a fence, car, or
home) if you cause an accident. Property damage coverage can also help protect
you in the event of a related lawsuit. Covered costs are subject to the
limits you choose when you buy your auto insurance policy. Most states require you to
have property damage coverage as a part of your auto insurance policy.
Rental Car
Reimbursement Coverage
In some states,
you can buy this optional coverage when you buy auto insurance. This type of car
insurance coverage helps you pay for a rental car if your insured car is damaged
or stolen.
Go to top
Short-term
Health Insurance
Short-term health insurance plans provide you with coverage for a limited period
of time, and may be an ideal solution for those between jobs or those waiting
for other health insurance to start. Typically, short-term plans offer coverage
up to six months, although some plans may offer coverage up to 12 months.
Student Health
Insurance
Student health insurance plans provide individual health insurance for
undergraduate and graduate students enrolled with at least 9 credits at a
college or university.
Towing and Labor
[Roadside Assistance]
If your car becomes
disabled, this coverage pays for towing and labor to repair your car up to your
policy limits.
Traditional Indemnity/Major Medical
This is a health plan that has the least restrictive option of the three main
plan types. TI lets you see any licensed health care professionals for anything
covered by the insurance. You choose deductible and other options when you
enroll, and those apply to you and any dependents you enroll in the plan.
Uninsured Motorist Coverage
This coverage pays bodily injury or death expenses for you and any
passengers in your vehicle up to your policy limits if you're struck by a driver
who doesn't have insurance, or if you're struck by a "hit-and-run" driver that
you cannot identify.
Underinsured Motorist Coverage
This coverage pays benefits for the bodily injury or death of you
and any passengers in your car if you are involved in an accident caused by a
driver who has some insurance, but not enough to cover the losses that result
from the accident. In some states, this coverage applies only if the other
driver's Bodily Injury limits are less than the Underinsured Motorists limits
you selected on your policy.
VIN - Vehicle Identification Number
This is the unique number assigned to your car and your car only. The
manufacturer assigns the number and etches it into the body of the car.
ZIP Code Loss History
This is an umbrella
term that includes your area’s claim’s history, crime rate, and number of
drivers.
|
