Is a life insurance rider that allows for the early payment of some portion of the policys value should the insured suffer from a terminal illness of injury?
Insurance that provides payment if the insured dies and the result of that death is to an accident. In addition it provides payment if the insured accidentally severs a limb above the wrist or ankle joints or totally and irreversibly loses the insured’s eyesight.
An employee of an insurer who usually performs mathematical as well as statistical analyses for the purposes of setting premiums and for reserves other than loss reserves.
Is a person authorized by and on behalf of an insurer to transact insurance on its behalf. An agent must be licensed be each state in which they intend d to do business.
This is an agreement under which a third party or an insurance company for a fee handles the administration of benefits and claims as well as other administrative functions for a self insured group. This is most common with business groups over 100 employees.
Where one individual (an agent) has the power to act on behalf of another (the customer or principal) in dealing with insurance carriers, and third parties.
A general term referring to any service (such as an office visit, laboratory test, surgical procedure, etc.) or supply (such as prescription drugs, durable medical equipment, etc.) covered by a health insurance plan in the normal course of a patient`s healthcare.
A statistic used by health insurance companies describing the number of inpatient hospital days for each 1000 persons covered under a health insurance plan within a given time period.
Is a person most often licensed and appointed with the state who transacts insurance for another person for compensation, most often in the form of a commission. Most commissions today are a percent of the premium.
Individuals enrolled in a group medical plan are protected by a federal law that guarantees a continuation of their medical coverage if their employment is terminated for reasons other than gross misconduct. In short, the law protects those who are laid of, but not those who are fired for cause.
The “Consolidated Omnibus Budget Reconciliation Act of 1985” extended group health coverage to terminated employees up to 18 or 36 months.
The law does not require the business owner to pay any portion of the cost. Typically, the employee is left with the responsibility of paying the monthly premium which can be up to 102 percent of the usual premium paid.
Is a concept under which the company insures only a part of the potential loss, and the policy holder pays another portion. This loss is represented by a flat dollar amount most commonly due at the point in which a member or policy holder is seeking services.
The amount available to the owner, “cash back”, when a life insurance policy is surrender to the insurance company. This is typically the reserve less the surrender charge.
Typically offered through and employer where by employees have a benefit arrangement in which employees can select form a range of different and comparable benefits
A period specified in the policy during which the company may contest a claim on a policy because of incomplete or misleading information provided in the application.
A summary of an applicant’s credit history made by and independent organization that investigates the applicant’s current credit standing.
*Health Insurance Companies may run a credit report on an applicant.
Most policies require the insured to pay some portion of the health care bills. A typical arrangement is that the insurer pays 80 percent and the insured 20 percent, up to $5,000 of covered expenses after the insured has paid the deductible. After the insured hits the maximum out-of-pocket limit, the insurance company pays 100 percent of covered expenses during the remainder of the calendar year, up to any applicable annual benefit or lifetime maximum of the policy.
Is a full Major Medical health insurance plan with maximum out-of-pocket limits and minimum annual deductibles. The requirements of a qualifying high-deductible medical plan are determined by the Internal Revenue Service (IRS). These requirements are subject to change each year.
A Health Savings Account or HSA is a tax deductible, interest bearing savings account designed to assist in paying your medical expenses tax free.
An HSA is designed to work with a qualified High Deductible Health Plan (HDHP). The funds in your HAS can help pay both medical expenses covered, and not covered by your health plan, including your deductible and co-insurance on the qualified plan. An HSA is your account. When used to pay your medical expenses, all of the money you contribute is tax-deductible and goes with you when you retire or change jobs. In this way, an HAS is portable.
Is a group of contracted medical providers in which members of the HMO may seek medical services at a pre-negotiated rate. Most HMO programs have a co-pay for services rendered.
Insurance to protect one from loss due to sickness or accidental bodily injury. This is sometimes called accident and health, or accident and sickness insurance. Health Insurance plays a key roll in protecting its members from the financial hardships caused by medical bills due to an unexpected accident or
sickness.
A benefit covered under the insurance policy for charges incurred while the insured is confined to, or treated in a hospital. The extent of this benefit is defined in a health insurance policy.
A hospital benefit subject to a specified daily maximum for a period of time while the injured is confined to a hospital. Sometimes the policy will allow for miscellaneous hospital expenses, such as the operating room, anesthesia, and laboratory fees.
Individual and family health insurance plans are either Managed-care plans or Indemnity. The differences concern choice of health care providers, the out of pocket cost for a member, and how the bills are paid to a provider of services.
Indemnity health insurance plans involve a broader selection of healthcare providers than managed care plan. However, different form managed care plans, indemnity plans pay their share of the cost for covered serviced only after they receive a bill.
Provides that for a misstatement on the application, the insurance company may not void a policy after it has been in force during the insured’s lifetime, usually one or two years.
Key person Insurance is typically a life insurance policy for an individual who is the key person in an organization whose contribution to the operation and success of the business is essential. When a key person dies, the primary purpose of the life insurance is to offset the economic loss.
It is a contract between the insured person, and the insurance company that is providing the insurance. If you die and the contract is in force, the insurance company pays a specified sum of money, usually called a Death Benefit, free of income tax, to the person or persons you name as beneficiaries. The beneficiaries can usually use the proceeds with out restriction.
A Managed care health insurance plans involve several different types of choice HMO, PPO, and POS plans. These plans typically have a provider network of contracted physicians and hospitals that agree to perform services for manage-care patients at a pre negotiated rate.
A voluntary give up of a legal given right. An agreement waiving the company’s liability for a certain type or types of medical benefit usually cover in a policy.
A healthcare provider who has a contractual relationship with a health insurance company. This contractual relationship may establish standards of care, clinical protocols, and allowable charges for specific services. In return for entering into this kind of relationship with an insurance company, a healthcare provider typically gains in numbers of patients and a primary care physician may receive a capitation fee for each patient assigned to their care. In addition, the insurance carrier typically receives large discounts for products and services for their members.
Is a group of providers, mainly hospitals and physicians that contract with insurers, employers and third party administrators to provide health care services at a pre-negotiated fee. Typically, a PPO plan will pay a fee to the provider when service is rendered (fee for service).
Is a hybrid of the HMO and the PPO. Typically, the POS is an HMO with an added out-of-network benefit. In most circumstances, a POS plan has “Open Access”. This feature allows a member to access providers both in, and out of network, without a referral at the time they need services.
An employer who typically employees less than 50 full time employees. Employees size may very from state to state when applying the term “Small Employer”.
Short term health insurance is an affordable solution that provides valuable basic protection against an unexpected illness or injury under a temporary health insurance policy. The policy in most circumstances is issued for approximately 6 to 12 mounts. It is ideal for people who are, between jobs or laid off, looking for a lower cost alternative to COBRA, in the waiting period for group coverage to start, or are working temporary or as a seasonal employee.
Is an affordable solution for a college student that provides valuable basic protection against an unexpected illness or injury? It is typically offered to full time students under the age of 30. The student usually must maintain full time status for a minimum of 31 days following the effective date of the policy and must attend a state accredited college or university.
It provides protection for a specified period of time and pays a benefit only if the insured individual dies during that period. Term Insurance is issued for varying coverage periods, but some common ones are 10-year and 20-year Term. Most consultants believe that term live insurance give you the most comprehensive coverage for the cost of the premium.
Offers a flexible premium with a two part contract containing renewable term insurance and a cash value account that earns interest at a higher rate than a traditional life policy.
The premiums are deposited in the case value account only after the insurance company deducts its fee and monthly cost for the life coverage.
Interest in the cash value account is most often offered at variable rate.
This is an optional insurance usually offered with group health insurance plans. Vision insurance typically pays for charges incurred during eye exams; eyeglasses and contact lenses are usually not covered at all or offered only at a discounted rate when using a network provider. Note: Today some plans are starting to offer coverage for contact lenses.
One who sells his or her life insurance policy to a viatical company because they are suffering form a terminal illness or sever chronic illness. When the insured dies the company receives the death benefits.
An agreement where by the owner of a life insurance policy sells the policy to another person or company in exchange for a bargained for payment, that is customarily less than the expected death benefit under the policy.
Benefits including medical benefits paid to employees for injury, disability or disease contracted in the course of their employment. These benefits and conditions are set by state law. Some states have monopolistic state compensation funds.
Statements made for the purposes of obtaining insurance that are warranted to be true, that is, they are exact in every detail as opposed to representations. These statements are usually on the application for insurance and are rarely warranties, unless fraud is involved.
A rider or provision usually in a life insurance policy and some health insurance policies exempting the insured from paying premiums after the beneficiary has been disabled for a specified period of time. Most often six mounts in a life policy and 90 days or six mounts in a health insurance policy.
A life insurance policy the has a permanent level insurance protection for the “whole of life,” from the date in which the policy is effective to the death of the insured.
