GLOSSARY OF LIFE AND HEALTH INSURANCE TERMS AND DEFINITIONS
Our mission is to help our clients make informed life and health insurance choices by embracing a consultative approach
Accident and Health Insurance
These are policies that will cover you for medical expenses, catastrophic events, preventative services, accidental injury and accidental death. Limits are applicable.
Agents are either captive or independent. Captive agents exclusively represent one insurance company while independent agents represent several companies. The Benefits Management Team is an independent agency.
This is usually the owner of the policy or spouse who receives the income from an annuity contract.
The two basic types of annuities are: deferred and immediate. Deferred annuities grow tax free over time while immediate annuities make payments within about a year of purchase. These are life insurance contracts that pay income benefits to the annuitant over the course of their lifetime.
Annuity Death Benefit
If the contract owner dies before the payment phase (annuitization) the beneficiary will receive the due value of the annuity.
Where claim disputes between the insured and the insurance company are agreed to be settled by a third party.
Life and health insurance brokers must be licensed to sell policies. They are the intermediary between the insurance company and client. The broker should understand the needs of the client and present the most appropriate coverage.
The Consolidated Omnibus Budget Reconciliation Act is a federal law where employer group health plans must offer continuation of coverage to employees (and their dependents) who leave their jobs. The employee must pay the entire premium.
For health insurance, this is the percentage that the policyholder has to pay above the deductible. Coinsurance is explained in this video.
This receipt is issued to the policy owner after the premium has been paid at the time of application.
If the primary beneficiary is no longer alive at the time life policy proceeds are to be paid, the named contingent beneficiaries will receive the proceeds.
The amount that must be paid by the policyholder before insurance kicks in. The higher the deductible, the lower the premium is charged.
An annuity where payments begin at a predetermined point in time, for example, retirement. Premiums contributed are intended to grow tax deferred for future use.
Is a waiting period commonly found in disability insurance. It acts like a deductible and is determined in days from the start of the illness or injury.
The exclusion provision in an insurance policy eliminates coverage for certain people and risks.
Measure the probability or possibility of loss.
This endorsement or clause to an insurance policy provides additional coverage for risks defined other than those in a basic policy.
Free Look Period
Usually lasts from 10 to 30 days where the purchaser of an insurance policy can cancel the contract without any penalty. If the purchaser is not satisfied with the policy, a full refund is issued.
This is a single insurance policy (master policy) covering a group of people, for example, employees of the same company.
Guaranteed Death Benefit
The guaranteed death benefit amount under a variable annuity contract.
Some insurance companies use an insurance score to determine underwriting. These scores are confidential rankings based on credit information and help determine how well the applicant manages their financial affairs.
Key Person Insurance
These insurance policies are used to cover an individual who’s death or disability could cause substantial financial loss to a business.
A life insurance policy pays out a sum of money on the death of the insured person to their beneficiaries, or pays out a sum of money after a set period.
The maximum amount of insurance that can be paid for an insured loss.
Long Term Insurance Care
LTC insurance coverage pays for services for individuals who are not able to perform certain daily living activities without assistance.
Medical practice guidelines set out cost effective procedures and protocols. Managed care is an arrangement to provide comprehensive health care to members of an insured group.
Mediation attempts to resolve conflicts by a third party and is nonbinding.
This is a federal or state public assistance program for individuals who do not have sufficient resources and income to pay for health care.
Medical Payments Insurance
This coverage agreement will pay, regardless of fault, for medical or funeral expenses as a result of bodily injury or death by accident.
Medical Utilization Review
For the purposes of controlling costs, insurance companies use this to review medical treatment claims.
This is a federal program for individuals 65 years or older that pays part of the costs of hospitalization, surgery, doctors’ bills, skilled nursing care and home health care. Medicare also covers certain younger people with disabilities and people with ESRD (End Stage Renal Disease).
Medigap / Medsup
These are supplemental health insurance policies that cover expenses not paid under federal insurance benefits.
Mutual Insurance Company
An insurance company owned by its policy holders. Part of its profits are paid to policyholders as dividends while the rest are retained as reserves.
Point of Service Plan (POS)
Terms of a health insurance policy where the employee can choose between out-of-network and in-network care each time medical treatment is needed.
The price of an insurance policy which is typically charged monthly. Premiums can also be paid annually or semi-annually.
This is the named person specified in the policy to receive the proceeds first.
Pure Life Annuity
A fixed or variable annuity that ends payments when the annuitant dies.
The cost of a unit of insurance usually calculated per $1,000.
States use this process to monitor insurance companies changes in rates.
Rating agencies determine and monitor the financial strength of insurance companies.
Denial of insurance must be risk based and cannot be refused based on where applicants live.
Reinsurance reduces the primary insurers’ risk by insuring the insurance company itself. Reinsurers do not pay policyholder claims.
An insurance policy provision to the basic policy that provides additional benefits at an additional cost. For example, a Return of Premium rider on a Term Life policy will pay all the premiums back if the individual outlives the guaranteed term.
Every policy holder who is subject to co-payments and deductibles is self-insured by assuming that portion of financial risk. Some of these risks can be protected by purchasing supplemental insurance.
If you smoke or have smoked in the past year, your insurance premiums will be higher than a non-smoker. If you have not smoked during the past year, most insurers will consider you as a non-smoker.
According to underwriting standards, an individual with a standard risk rating will be insured without special restrictions.
Most life insurance policies contain this clause – if the insured commits suicide within two years after the issue date of the policy, the insurers’ liability will be limited to a return of premiums paid.
Term Certain Annuity
An annuity that pays out over a fixed period.
Term Life Insurance
A life insurance policy that covers the insured person for a specified period of time. The designated beneficiary is paid when the insured dies within the specified policy time period. Coverage ends when the term period ends but can be renewed. Renewal premiums will be increased with age.
The methodology used by an insurer to determine and classify the risks of insuring – insurance is either accepted or rejected and the premiums are determined.
A hazard or condition where high risk will not be insured.
Universal Life Insurance
A flexible type of permanent life insurance offering the protection of term life insurance as well as a savings element which is invested to provide a cash value buildup. Subject to conditions the death benefits can be changed during the life of the policy.
Variable Life Insurance
A permanent life insurance policy with an investment component that can consist of stocks, bonds and other investments.
Viatical Settlement Companies
These companies purchase life insurance policies, assume the premium payments and collect the face value of the policy when the policyholder dies.
In terms of the policy conditions, a policy can become free of legal effect. For example, when information that a policyholder provided is proven untrue.
Is an act or surrendering a right or claim. For example, a Waiver of Premium rider that waives the policyholder’s obligation to pay any further premiums should he/she become seriously ill or disabled.
Whole Life Insurance
Is a policy with level premiums that has an insurance and investment component. The insurance component pays a stated amount upon the death of the insured. Premiums are level, fixed, and guaranteed throughout the policy’s lifetime. For example, a final expense insurance policy.