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Additional Insured |
One who qualifies as "insured" under the terms of a policy even though not
named as insured. Officers of a corporation may be included as insureds under
the terms of a policy written in the name of the corporation. |
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Agency |
An insurance company that produces business through an agency network. |
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Applicant |
Individual that is applying for insurance. |
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Application Fee |
A charge for the processing of an application. |
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Approved |
Acceptance of an application for an insurance policy as meeting the
underwriting standards of the company. |
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Benefits |
The money or services that is provided by an insurance policy |
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Billing |
A bill for the purchase of an insurance policy. Usually the premium due. |
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Brochure |
A informational guide to the insurance carrier's guidelines of plans and
exclusions. |
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Cancer |
A malignant new growth anywhere in or on the body of a person. |
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Carriers |
Another term for insurer, or the insurance company that "carries" the risk for
the policy owners. |
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Claims |
A policy owner's request on the insurance company for payment of benefits
according to the provisions of a policy. |
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Co-Insurance |
The percentage of a charge for services that you may have to pay after you pay
any plan deductibles. The coinsurance payment is a percentage of the cost of
the service . |
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Condition |
A provision in a contract that has the effect of modifying, suspending, or
revoking the principal obligation if a future event happens or fails to happen.
" |
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Co-Payment |
The amount you pay for each medical service, like a doctor visit. A co-payment
is usually a set amount you pay for a service. |
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Couple |
Two people that are married, and are seeking insurance as a pair. |
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Coverage |
The guarantee against specific losses provided under the terms of an insurance
policy. The amount and extent of the insurance provided under an insurance
contract." |
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Crown |
An enamel cover put on the tooth to protect below the gum line. |
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Death Benefit |
Policy proceeds to be paid upon the death of the insured. The sum payable as
the result of the death of the insured. |
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Declined |
Rejection of an application for insurance by the insurer or carrier. |
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Deductible |
The amount you must pay for health care before the plan begins to pay. |
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Dependent |
A covered person who relies on another person for support or obtains health
coverage through a spouse (in CA domestic
partner) or parent who is the covered person under a plan. |
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Disability |
A physical or mental impairment caused by accident or illness that partially or
totally limits one's ability to perform everyday activities. |
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Disability Income |
A disability benefit provided by a specific health insurance contract that pays
a regular monthly income if the insured is disabled by sickness or accident. |
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Download Application |
An application usually available online, that is downloaded from the internet
to your computer. The application is usually in what is called a PDF form or
adobe acrobat type of file that can only be uploaded in adobe acrobat. |
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Effective Date |
The date insurance coverage begins. |
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Employee |
An individual who works for a person or organization having the right to direct
and control that individual in the way he or she works, both as to the final
results and as to details of when, where and how the work is to be done. It may
also be a self-employed person, an owner-employee or a common law employee." |
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Enrollee |
A person who is enrolled in an insurance plan. |
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Enrollment Fee |
A fee or payment for the process of becoming enrolled. |
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Estimates |
An approximate calculation, close to the exact amount. |
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Exams |
A medical evaluation of a person. |
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Exclusions |
A provision in an insurance policy excluding certain risks or otherwise
limiting the scope of coverage. Certain causes and conditions, listed in the
policy that are not covered. |
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Extraction |
The pulling of the tooth to be extracted. |
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Family |
Usually, a male and female couple with one or more children (CA includes domestic
partner). |
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Fees |
A payment for services or the amount of the premium. |
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Fillings |
The protective filling in a cavity. |
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Group |
In insurance it is a company or organization that the employees are covered by
the employer. |
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Health |
The state which your body is in. i.e. good health, poor health. |
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HMO |
Health maintenance organization- A group of doctors, hospitals, and other
health care providers who agree to give health care to beneficiaries for a set
amount of money every month. In an HMO, you usually must get all your care from
the providers that are part of the plan. |
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Individual |
A single person applying for insurance |
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Insurance |
Protection through specified money compensation or reimbursement for loss,
provided by written contract against the happening of specified chance or
unexpected events. |
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Insured |
A person who has obtained health insurance coverage under a health insurance
plan. |
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International |
Outside of the United States. |
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Licenses |
Certification issued by the appropriate state department of insurance policies,
that an individual is qualified to sell insurance for the period stated and
renewable upon application without the necessity of the applicant's undergoing
the original requirements. |
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Life Insurance |
The transfer of part of the financial loss due to death of an insured person to
an insurance company. The risk insured against is the death of a particular
person, the insurance company agrees to pay a stated sum or income to the
beneficiary. |
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Limitations |
Exceptions to coverage and limitations of coverage as contained in an insurance
contract. |
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Long Term |
Insurance policies that cover specified services for a specified period of
time. Long-term care policies (and their prices) vary significantly. |
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Max Benefit |
The maximum or most you can receive in services provided by an insurance
company. |
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Medical History |
Any medical problems or conditions from the past to the present. |
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Member |
An individual that is insured through an insurance provider. |
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Non Smoker |
A person who does not smoke. |
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Orthodontics |
A branch of dentistry that corrects and prevents irregularities in teeth. |
| Out-of-Pocket Maximum |
The most a member will be required to pay out-of-pocket in a benefit year, coinsurance
and deductibles. |
| Out-of-Pocket Cost |
Health care costs that a patient or member must pay for out of his or her own
pocket, including co-payments, coinsurance, deductibles, etc. |
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Pending |
In insurance it is usually when an application is being processed, and the
information is being determined acceptable or not. |
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Plan Details |
The details of a particular plan through a provider of insurance that includes
rates, premiums, deductibles, coinsurance, etc. |
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Policy |
The written contract or agreement between the insurance company and the policy
owner. |
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PPO |
Preferred Provider Organization-a health care arrangement which offers
insured's access to participating providers at reduced costs. PPOs provide
insured's lower deductibles and co-payments, to use providers in the network.
Network providers agree to negotiated fees in exchange for their preferred
provider status. |
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Pre-Enrollment |
Prior to enrolling, usually the screening of the application before it approved
or declined. |
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Pre-existing conditions |
Any illness or health problem that existed prior to an individual obtaining
medical coverage. |
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Premium |
The periodic payment required to keep a specific insurance policy in
force. It is the rate multiplied by the number of units of insurance purchased. |
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Quote |
An estimated price for the insurance being purchased. |
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Rates |
The cost of a given unit of insurance. |
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Representative or Agent |
This person helps in the placing of risks, delivery of policies, or collection
of premiums on behalf of an insurance company. |
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Risk Class |
The class or group level of risks, or the individual. |
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Search Engine |
The engine used to search for information. i.e. Google, Yahoo, AOL, Netscape,
etc. |
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Short Term |
An insurance contract in effect for less than one year. |
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Single |
One, or individual. Not married or with children. |
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Single Parent |
One parent with one or more children. |
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Smoker |
A person who uses tobacco. |
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Spouse |
The partner in marriage (includes domestic partner in CA). |
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Submitting |
Applications for coverage submitted to the insurance company but not yet acted
upon. |
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Subscriber |
A policy owner of a health plan that is underwritten by a service insurance
carrier. |
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Teeth Cleaning |
Cleaning of the teeth by a dentist. Sometimes a benefit covered by insurance. |
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Temporary |
Not permanent. Also can be short-term insurance. |
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Term Life |
Life insurance issued for a specific number of years. |
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Two Party |
A couple or pair applying for insurance. |
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Underwriting |
The agency above the broker who provides the quote and accepts the application;
the act of reviewing and evaluating prospective insureds for risk assessment
and appropriate premium. |
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Workers Compensation |
Life and health coverage for employees while they are on the job. Premiums are
paid by the employer. |
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X-ray |
A photograph made by means of x-rays. |