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Because not everyone is familiar with insurance terms, we have included
a dictionary for your convenience. All the terms are in alphabetical order,
but Types of Insurance are listed first and link down the page
to definitions.
Comprehensive Health Insurance or Major Medical
Health Insurance
Health Maintenance Organization (HMO)
Major Medical Insurance
Term Insurance
Decreasing Term Insurance
Level Term Insurance
Whole Life
Disability Income Insurance
Mortgage Insurance Policy
Alphabetical List of Terms
Accident: A fortuitous event, unforeseen and unintended.
Agent: The individual appointed by an insurance company to solicit
negotiate, effect, or countersign insurance contracts on its behalf.
Annuity: 1) An amount of money payable yearly or, by extension,
at other regular intervals. 2) An agreement by an insurer to make periodic
payments that continue during the survival of the annuitant(s) or for
a specified period.
Applicant: The party making application to the insurance company
for the policy.
Application: A form on which the prospective insured states facts
requested by the insurer and on the basis of which (together with any
information from medical examiners, attending physicians, hospitals, investigators,
and the agent) the insurer decides whether or not to accept the risk,
modify the coverage offered, or decline the risk. An application without
premium money is a Request for an Offer. With premium money, it is an
Offer itself. If attached to the policy at issue, it becomes part of the
Entire Contract.
Assignee: The person to whom policy rights are assigned in whole
or in part by the policyholder.
Assignment: Transfer of rights in a policy to other than the policyholder.
Authorized Company: An insurer permitted to sell insurance within
a state. Must obtain a Certificate of Authority from the Director.
Beneficiary: A person who may become eligible to receive, or is
receiving, benefits under an insurance plan, other than as a participant.
Business Insurance: Life or Health insurance written to cover business
situations such as key person, sole proprietor, partnership, corporations,
etc.
Cancellation: Termination of contract of insurance in force by
voluntary act of the insurance company or insured, effected in accordance
with provisions in the contract or by mutual agreement.
Cash Surrender Value: The value reposing in a policy that is the
legal property of the policyholder, and that may be expected by him should
he surrender it for cash. Synonymous with Cash Value.
Claim: A demand for payment under the insurance policy.
Coinsurance: 1) In Property insurance, a clause under which the
insured shares in losses to the extent that he is underinsured at the
time of the loss. 2) In Health insurance, a provision that the insured
and insurance company will share covered losses in agreed proportion.
In Health insurance, the preferred term is percentage participation.
Collateral Assignment: Assignment of part of the proceeds of an
insurance policy to a bank as collateral to settle the loan balance that
may exist at the insured's death.
Comprehensive Health Insurance or Major Medical: A form
of Health insurance that combines the coverage of Major Medical and Basic
Medical Expense contracts into one broad contract that provides coverage
for almost all types of medical expense with few internal limits, usually
subject to a Corridor Deductible for some or all expenses and to a Percentage
Participation clause (sometimes called Coinsurance) applicable to all
or some of the covered expenses.
Concealment: The withholding of facts by an applicant for insurance
that materially affects an insurance risk or loss.
Conditional Receipt: The more exact term for what is often called
a "binding receipt" in Life and Health insurance. It provides that if
premium settlement accompanies the application, coverage shall be in force
from the date of application (whether the policy has yet been issued or
not) provided the insurance company would have issued the coverage on
the basis of facts as revealed by the application and other usual sources
of underwriting information.
Conditionally Renewable: A contract of Health insurance that provides
that the insured may renew the contract to a stated date or an advanced
age, subject to the right of the insurer to decline renewal only under
conditions defined in the contract.
Contingent Beneficiary: Person or persons named to receive benefits
if the Primary Beneficiary is not alive.
Contract: A legal agreement between two parties for consideration,
such as an insurance policy.
Death Benefit: The policy proceeds to be paid upon the death of
the insured.
Deductible: Dollars or percentage of expense that will not be reimbursed
by the insurer.
Decreasing Term Insurance: Term insurance whose
amount of coverage starts out at the full amount then gradually decreases
until the expiration date of the policy.
Deferred Annuity: An Annuity on which payments to the annuitant
are delayed until a specified future date.
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.
Dividend: The return of part of the premium paid for a Participating
policy.
Dividend Options: Ways an insured may receive policy dividends.
Earned Premium: That portion of the premium for which policy protection
has already been given during the now-expired portion of the policy term.
Effective Date: The date on which an insurance policy or bond goes
into effect and from which protection is furnished.
Endorsement: A form attached to an insurance contract changing
part of the contract. Sometimes called a rider.
Exclusions: Causes, conditions, or property listed in the policy
that are not covered and for which no benefits are payable.
Face Amount: The amount indicated on the face of the policy that
will be paid at death or when the policy matures.
Fiduciary: A person who occupies a position of special trust and
confidence (for example, in handling or supervising the affairs or funds
of another).
Fraud: An intentional misrepresentation made by a person with intent
to gain advantage, and relied upon by a second party that suffers a loss.
Group Life Insurance: Life insurance that a person is eligible
to purchase through membership in a group. The group may not be formed
just to buy insurance.
Guaranteed Insurability: A rider in Life and Health contracts that
permits the insured to buy additional prescribed amounts of insurance
at prescribed future time intervals without evidence of insurability.
Guaranteed Renewable: A contract that gives the insured the right
to continue in force by the timely payment of premiums for a substantial
period of time as set forth in the contract. During that period of time,
the insurer has no right to make any change in any provision of the contract
other than a change in the premium rate for all insureds in the same class.
Hazard: Any factor tending to make a policyholder a less-desirable
risk for the insuring company. May be Physical or Moral (health, occupation,
dangerous sports, criminality, immorality).
Health Insurance: Broadly, coverage
to provide benefits upon the occurrence of disabling sickness or accident,
or accidental death or dismemberment, or loss of income due to disability.
Health Maintenance Organization (HMO): An organization
of health providers. Each member pays a premium for which he receives
medical care when desired. The emphasis is on preventative medicine as
an alternative to traditional employee benefit plans. Employers of more
than 25 persons are required to offer this alternative to employees, if
an HMO is located in the area, but not if the cost exceeds that of present
employee health plans.
Immediate Annuity: A lump-sum Annuity on which the income payments
to the annuitant are to begin at once.
Indemnify: To restore the victim of a loss, in whole or in part,
by payment, repair, or replacement.
Indemnity: Insurance is designed to restore the policyholder to
the same financial condition enjoyed prior to a loss. The intent is to
cover the amount of the actual loss only and to avoid paying amounts that
allow an insured to profit from a loss situation.
Individual Contract: A contract of Health -insurance made with
an individual that covers her and, in certain instances, specified members
of the household. In general, any insurance policy except Group or Blanket.
Insurability: Acceptability of an applicant for insurance to the
insurance company.
Insurance: A contract or device for the transfer of pure risk to
an insurer, who agrees, for a consideration, to indemnify or pay a specified
amount for losses suffered by the insured.
Insured: The party to an insurance arrangement to whom, or on behalf
of whom, the insurance company agrees to indemnify for losses, provide
benefits, or render service. In Prepaid Hospital Service plans, the insured
is called the subscriber.
Joint Life and Survivorship Annuity: Payments are made to two annuitants
with the survivor continuing to receive payments after the first annuitant
dies.
Joint Life Annuity: Payments continue to two annuitants for only
as long as both live.
Key Person Insurance: Life or Health insurance on important employees
whose absence would cause the employer financial loss. The insurance is
usually owned by or payable to the employer.
Lapse: Termination a policy because of failure to pay the premium.
Level Term Insurance: The amount of insurance protection
in the Term policy remains constant during the policy period.
Loan Value: That amount of Cash Value reposing in a policy that
may be borrowed by the insured.
Major Medical Insurance: A type of Health insurance
that provides benefits for most types of medical expenses incurred up
to a high limit, subject to a deductible. Such contracts may contain a
Percentage Participation clause (sometimes called the Coinsurance clause).
A Major Medical policy pays expenses both in and out of the hospital.
Mortgage Insurance Policy: In Life
and Health insurance, a policy from which the benefits are intended to
pay off the balance due on a mortgage or meet the payments on a mortgage
as they fall due upon or after the death or disability of the insured.
National Association of Insurance Commissioners (NAIC): An organization
of the insurance Commissioners designed to provide a way to exchange information
and work toward uniformity of insurance regulation among the states.
Non-cancelable: A contract of Health insurance that the insured
has a right to continue in force by payment of premiums, as set forth
in the contract for a substantial period of time, and that the insurer
has no right to change any provision of the contract.
Policy: The written contract effecting insurance or the certificate
thereof by whatever name called, and papers attached thereto and made
a part thereof.
Policyowner: The person who has the right to exercise the privileges
and rights in the policy contract. Also called policyholder.
Pre-existing Condition: A condition of health or physical condition
that existed before the policy was issued.
Premium: 1) Consideration for the insurance. 2) Periodic payment
made to keep a policy in force.
Proof of Loss: A formal statement by the insured to the insurance
company regarding a loss. The purpose is to place before the company sufficient
information concerning the loss to enable it to determine its liability
under the policy.
Reinstatement Clause: Provides the conditions under which a lapsed
policy may be reinstated, if approved by the insurance company.
Reinsurance: Agreement between insurance companies under which
one accepts all or part of the risk of loss of the other.
Scheduled Property: Examples include jewelry, antiques, furs, silver,
fine rugs, golf equipment, electronics equipment
Single-Premium Annuity: An Annuity purchased with one lump-sum
payment.
Term Insurance: Life insurance that normally
does not have cash accumulation and is issued to remain in force for a
specified period of time, following which it is subject to renewal or
termination.
Underwriting: The process of evaluating a risk for the purpose
of issuing insurance coverage on it.
Variable Annuity: An Annuity contract in which the amount of the
periodic benefits varies, usually in relation to security market values,
a cost-of-living index, or some other variable factor in contrast to a
Fixed or Guaranteed Return Annuity
Waiting Period: A period of time between the beginning of a disability
and the date benefits begin. Also known as Elimination Period.
Warranty: A statement made on an application for insurance that
is wan-anted to be true in all respects. If untrue in any respect even
though the untruth may not have been known to the person giving the warranty,
the contract may be voided without regard to the materiality of the statement.
Statements on Life and Health insurance applications are, in the absence
of fraud, not warranties, but representations.
Whole Life: A Life policy that runs for the
insured's whole life - that is, until death or the ultimate age on the
mortality table being used (age 100). Premiums for a Whole Life policy
may be paid for the whole life or for a limited period (for example, 20-Pay-Life
or LP65) during which the higher premium charged pays up the policy.
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