Glossary Of Insurance Terms

General Insurance Terms For T

noreply@blogger.com (insurance terms) — Tue, 08 Jan 2008 10:03:00 +0000

Target risk - ‘The big one’- This is an insurer’s term for large ,sometimes hazardous risk.Such as risk may well be the biggest on the schedule of risk and may thefore have to be treated schedule of risk and may therefore have to be treated separetly in other to arrange reinsurance to cover it fully.

Tariff - A premium rate,often estabalished by rating body representing the majority of insurers.Theoretically,statistic can be gleaned from wider cross section,therefore a fair premium can be worked out.Tariff tend only to exist in protected insurance market rather than in areas of free competition.

What is Temporary disablement?
Benefits payable under personal accident policies where disability in short term,measured in weeks ,as opposed to permanent.Quite often,waiting period,like a time excess is imposed before claims can be made.Temporary disablement can be total or partial.

Temporary removal
An extension to the standard Fire policy to cover property temporarily removed from insured premises for repair,cleaning of some other sated reason.

Tenants Improvements - Renovations and improvements that you make to rented premises need premises need to be insured by you.They will not be covered by the building owner because they are your interest.

Tenants Liability -Cover for damage to rented buildings.Its worth checking whether or not your public Liability policy covers this.

Territorial Limits -Do also check these under the policy liability policy to make sure they are not restricted if you need covers overseas.There may be other geographical limits to consider under All risk policies,for example:even if cover is stated as ‘worldwide,’this would normally exclude North Korea,Laos,Cambodia.

Terrorism - Fire insurance,even if extended to cover riot cover,can exclude ‘terrorism’,which is normally defined as the use of violence for political ends.The term ‘terrorism’ usually also includes any violence intended to put the public in a state of fear.A limit market does exist for this specialist cover.

Theft Insurance -This is vital part of any modern insurance programme.You would be amazed at the variety of possessions,products commodities that thieves apparently find attractive.Dont forget that even ordinary office premises nowdays contain sophiscated and expensive machines likely to attracted thieves’unwelcome attentions.Theft insurance on business premises usually limits cover to incidents involving forcible or violent entry to,or exit from,the premises.
A wider form of cover,known as full theft cover,which waives this restriction,is available for certain trades.

What is Third party liability?
Exactly the same as Public Liability Insurance,involving three parties – the insured as the first party,the insurer as second party,and the other person involved as third party.

Time-on Risk Charge - Premium charged for a period during which an insurer is holding a risk covered ,by means of a temporary cover note,for example,rather than an annual policy.
It is important to note that,if you take out an initial cover note but then a short a while later change your mind and decide to change your insurers,or your policy ,you will still have to pay the first insurer pro-rata for the time you have been insured with him since issued you a cover note.
As far as insurer is concerned,you have been covered for that time ,whether you have been paid or note,and wether or not you are still arguing about details of the cover.Had you claimed during that time,he would have honoured your claim.

Time Policy - This is one of the various types of Marine Insurance policies.A time policy is more common for hull insurance and refers to cover for a fixed period,usually not more than 12 months.

Tort -A civil breach of personal duty owed to one fellow citizens in general,as opposed to a breach of contract.The injured person has the right to damages from the wrongdoers.

What is total loss?
The complete loss or destruction of all the property insured under particular policy .Under Marine insurance,it is quite common to find a total loss only insurance.

Travel Insurance - Nobody should leave home without it,yet the vast majority of travellers do.Quite a few different covers are available,including Personal Accident,Medical Loss of luggage and money,and Personal Liability.

Turnover -The money earned for good supplied or services rendered.Insurers need to have this static when managing earnings related insurance such as Business Interruption or Products Liability,where it is a rating factor.

General Insurance Terms For S

noreply@blogger.com (insurance terms) — Sat, 29 Dec 2007 13:30:00 +0000

Salvage -

This means about the same as it does in ordinary laymans language- to save damage property for futher use,thereby reducing the amount of any loss.

Salvages Charges

The expenses of recovering property by a salvor.In marine insurance,these charges would be properly apportioned between hull,the vessel itself,and cargo interest,in the event of a ship being salvaged.

Self Insurance

Some large industrial concerns prefer to set aside their own funds to cover any future losses,rather than insure with ouside insurer.It is a step which should never be taken without the benefits of prfessional advice first.

Whilst day to day losses might not prove to much of a financial burden to a really large company a truly catastrophic event,such as an earthquake,could put it out of business for lack of insurance.

Self Inflicted

Excluded under Medical Insurance as this is intentional and not accidental.

Single Article Limit

This is limit often imposed on All Risks policies for jewellery and household effect,stating the maximum amount allowable for any one item.

Slander

It may seem odd that is insurance is available against such a deliberate act libel and slander,but limited insurance market does exist,normally for the large corporations.

Travel Insurance Terms

noreply@blogger.com (insurance terms) — Wed, 26 Dec 2007 13:26:00 +0000

Travel Insurance
Nobody should leave home without it,yet the vast majority of travellers do.Quite a few different covers are available,including Personal Accident,Medical Loss of luggage and money,and Personal Liability.

General Insurance Terms For T

noreply@blogger.com (insurance terms) — Tue, 25 Dec 2007 15:43:00 +0000

Target risk
‘The big one’- This is an insurer’s term for large ,sometimes hazardous risk.Such as risk may well be the biggest on the schedule of risk and may thefore have to be treated schedule of risk and may therefore have to be treated separetly in other to arrange reinsurance to cover it fully.

Tariff
A premium rate,often estabalished by rating body representing the majority of insurers.Theoretically,statistic can be gleaned from wider cross section,therefore a fair premium can be worked out.Tariff tend only to exist in protected insurance market rather than in areas of free competition.

What is Temporary disablement
Benefits payable under personal accident policies where disability in short term,measured in weeks ,as opposed to permanent.Quite often,waiting period,like a time excess is imposed before claims can be made.Temporary disablement can be total or partial.

Temporary removal
An extension to the standard Fire policy to cover property temporarily removed from insured premises for repair,cleaning of some other sated reason.

Tenants Improvements
Renovations and improvements that you make to rented premises need premises need to be insured by you.They will not be covered by the building owner because they are your interest.

Tenants Liability
Cover for damage to rented buildings.Its worth checking whether or not your public Liability policy covers this.

Territorial Limits
Do also check these under the policy liability policy to make sure they are not restricted if you need covers overseas.There may be other geographical limits to consider under All risk policies,for example:even if cover is stated as ‘worldwide,’this would normally exclude North Korea,Laos,Cambodia.

Terrorism
Fire insurance,even if extended to cover riot cover,can exclude ‘terrorism’,which is normally defined as the use of violence for political ends.The term ‘terrorism’ usually also includes any violence intended to put the public in a state of fear.A limit market does exist for this specialist cover.

Theft Insurance
This is vital part of any modern insurance programme.You would be amazed at the variety of possessions,products commodities that thieves apparently find attractive.Dont forget that even ordinary office premises nowdays contain sophiscated and expensive machines likely to attracted thieves’unwelcome attentions.Theft insurance on business premises usually limits cover to incidents involving forcible or violent entry to,or exit from,the premises.
A wider form of cover,known as full theft cover,which waives this restriction,is available for certain trades.

What is Third party liability?
Exactly the same as Pblic Liability Insurance,involving three parties – the insured as the first party,the insurer as second party,and the other person involved as third party.

Three-Fourth Collision Liability
Under Marine hull insurance,this clause covers liability for damages to another vessel caused negligence of the insured vessel.This cover,which is supplementary to cover on the vessel itself ,covers up to three quarters of extent of liability.the past quarter of amount is included in the shipowner’s P & I Club cover.

Time-on Risk Charge
Premium charged for a period during which an insurer is holding a risk covered ,by means of a temporary cover note,for example,rather than an annual policy.
It is important to note that,if you take out an initial cover note but then a short a while later change your mind and decide to change your insurers,or your policy ,you will still have to pay the first insurer pro-rata for the time you have been insured with him since issued you a cover note.
As far as insurer is concerned,you have been covered for that time ,whether you have been paid or note,and wether or not you are still arguing about details of the cover.Had you claimed during that time,he would have honoured your claim.

Time Policy
This is one of the various types of Marine Insurance policies.A time policy is more common for hull insurance and refers to cover for a fixed period,usually not more than 12 months.

Tort
A civil breach of personal duty owed to one fellow citizens in general,as opposed to a breach of contract.The injured person has the right to damages from the wrongdoers.

What is total loss?
The complete loss or destruction of all the property insured under particular policy .Under Marine insurance,it is quite common to find a total loss only insurance.

Turnover
The money earned for good supplied or services rendered.Insurers need to have this static when managing earnings related insurance such as Business Interruption or Products Liability,where it is a rating factor.

General Insurance Terms For U

noreply@blogger.com (insurance terms) — Tue, 25 Dec 2007 15:41:00 +0000

Umbrella Liability
Terms used mainly in the US market describing a liability policy where the limits of liability are in excess of the amount covered uner primary policy.It can also fill in gaps in cover such as a Different Conditions/Diference in Limits policy in the U.K market.

Under – Insurance
A common mistake.You have only youself to blame if you insure your property for less than its full value.

Underwriter
An insurer’s employee who decides whether or not to accept a proposal or insurance and,if so ,on what terms and conditions.
Underwriting agency
An intermediary who is allowed to underwrite and accept risk on behalf of an insurer,subject to certain laid-down criteria and limits.

Uninsurable Risks
There are many different types of insurance cover available,but some things are just uninsurable.For example,if you are a cocaine smuggler,you cannot expect any insurer to give you cover against the possibility of arrest and detention.

Ununsured/Untraced Drivers
The motor Insurer’s bureau,collectively financed by all motor insurance companies,in some countries deals with third party injury claims arising from uninured drivers and hit and run accidents.

Unoccupancy
Some policies have a condition that premises should not be left unoccupied for more than a specified time.Premiums sre set for a risk with a stated occupation on unoccupancy can result in an increased hazard.

Unspecified Valuables.
Collective cover for valuable items such as jewellery,which are individually worth less than a certain specified limit.This cover saves having to individually specify each item and if evidence of value is provided,the claim can be made up to the specified limit.

Utmost Good Faith
A duty imposed upon both parties to an insurance contract,the insured and the insurer.This legal duty implies that both parties must make full discolusure of all the facts relevant to the insurance contract before entering into it.In other words,tell the truth to the insurer ,who should also make sure you informed of the terms and conditions of the insurance.

General Insurance Terms For V

noreply@blogger.com (insurance terms) — Tue, 25 Dec 2007 15:15:00 +0000

Valuations

Claims are much more easily and satisfactorily handlsed if you have valuations.With buildings,of course,you have to look at rebuilding cost than market value,as you do not insure the land.With other property,such as jewellery,it is equally important to keep valuation to update.

Valued or Agreed Value policy
This provides a pre determined fixed amount to be paid out for the loss of property.Not a very common policy unless you are collector of fine art or vintage cars.

Variable Charges
Those expenses which vary in direct proportion to business activity or volume of production,which are included as ‘specified working expenses’when calculating the sum insured under a Business Interruption policy.

Void and Voidable
A contract is considered legally void,that is invalid,if obtained by fraud or if the contract is voidable on the other hand if it can be avoided by the aggrieved party.He can get out of the contract if there has been a breach of utmost good faith.

Voyage Policy
Marine insurance covering goods for as long a they are moving from one place to another,as opposed to a Time policy where cover is simply for definite period of time.

General Insurance Terms For W

noreply@blogger.com (insurance terms) — Tue, 25 Dec 2007 15:12:00 +0000

War Risk
Excluded under standard policy forms.In Marine Insurance,it can be readily included subject to cancellation provisions.In non-marine insurance,war risk tend to only be covered in a specialist market.Insurers are always wary of selection against them.In the other words,why should they grant cover if hostilities look likely when the insured did not request over when there were no problems.

Warehouse to Warehouse
This cover is quite usual under any Marine Cargo policy covering goods moving from manufactures premises to the con signee’s warehouse at the fin final destination.

Warranty
A Policy condition which,if not complied with,may have the effect of invalidating the whole the whole policy.An example is the requirement to use a burglar alarm in a jewellery shop.

Wear and Tear
Policies exclude this sort of damage.It is not accidental but inevitable with most goods.

With average
Marine cargo insurance term where cover includes partial losses.The term is now obsolete since the introduction of the Institute Cargo Clause.

Workers (Workman’s )Compensation
See Employee’s Compensation.Payment to employees injured at work under a scale of benefits set down under status in various countries.

What is Waiting Period ?

noreply@blogger.com (insurance terms) — Tue, 25 Dec 2007 15:10:00 +0000

Waiting period
A period of time which must lapse after after,say,the inception of a disability,before benefits become payable.Commonly found in permanent Health Insurance Policies.

General Insurance Terms For Y

noreply@blogger.com (insurance terms) — Tue, 25 Dec 2007 15:06:00 +0000

York Antwerp Rules
The treaty adopted buy major countries to determine adjustment for general average in Marine Insurance.

marine insurance terms

Life Insurance Terms W

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 08:40:00 +0000

WLRT.
See Women Leaders Round Table.

Waiver of Premium.
A provision of a Life Insurance policy which continues the coverage without further premium payments if the insured becomes totally disabled.

War Clause.
A provision excluding liability of an insurer if a loss is caused by war.

Weekly Premium Insurance.
(1) A policy the premium on which is collected weekly by an agent calling at the door. It is usually sold in small face amounts. (2) A form of Debit or Industrial Life Insurance. See also Industrial Life Insurance.

Whole Life Insurance.
Insurance which may be kept in force for a person's whole life and which pays a benefit upon his death, whenever that may be. All Whole Life policies build up nonforfeiture values, but they are paid for in 3 different ways. Under a Straight or Ordinary Life policy, premiums are paid for as long as the insured lives. A single premium policy is paid for at one time in one premium. Between these two types there are many limited-payment plans, under which the insured pays premiums for a certain period or until reaching a certain age. Contrast with Term Insurance.

Wholesale Group Insurance.
See Franchise Insurance.

Wisconsin Life Fund.
The system of state underwritten and issued Life Insurance established by the state of Wisconsin and providing Life Insurance for citizens who apply. Wisconsin is unique among the 50 states in this respect.

Women Leaders Round Table (WLRT).
An association of women Life Insurance agents who produce the volume of business required by the organization for membership. It is sponsored by the National Association of Life Underwriters.

Written Business.
Insurance on which an application has been taken out but which is not yet delivered and/or the first premium settled.

Life Insurance Terms Y

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 08:38:00 +0000

YRT.
See Yearly Renewable Term.

Yearly (or Annual) Renewable Term (YRT).
(1) Term Life Insurance that may be renewed annually without evidence of insurability until some stated age. (2) A form of Life, and sometimes Health, Reinsurance in which the reinsurer assumes only the mortality risk, which is usually calculated as the face amount of reinsurance minus the terminal reserve.

Years Certain Annuity.
See Annuity Certain.

Life Insurance Terms Z

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 08:36:00 +0000

Z Table.
A mortality table showing ultimate experience on insured lives computed from the experienced mortality on Life policies issued by major companies from 1925 to 1934. The Z Table was a step in the development of the Commissioners' Standard Ordinary (CSO) Table of Mortality.

Exclusions for MHI policies

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 07:25:00 +0000

A MHI policy also contains certain exclusions, just like other insurance policies. You must be aware what these are and if you don’t understand them, ask your agent or insurance company. Some common exclusions are the following:

• Pre-existing conditions – Conditions and illnesses experienced by you prior to applying for the policy. These conditions and illnesses would be excluded from coverage by your
insurance company. You should check with your insurance company regarding the details of pre-existing conditions for the policy that you intend to buy.

• Specified illnesses – These are defined as 12 disabilities (e.g. tumours and gastritis) and their related conditions. You will not be covered for these illnesses if the illnesses have been treated or occurred during the first 12 months of your policy.

• Qualifying/waiting period – You will not be eligible for any claim arising from any medical or physical conditions within the first 30 days of the cover, except for accidental injuries.

Cancelling your policy

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 07:23:00 +0000

You may cancel your MHI policy by giving a written notice to the insurance company. For certain types of MHI policies, you may be entitled to a certain amount of refund of the premium, provided that you have not made a claim on the policy. You can obtain details of the policy cancellation process, including the amount of premium refund, in the policy contract, or from your insurance company or its agents.

It is important that you understand the terms used in a MHI policy. If you have any doubts about the meanings of these terms, you should ask your agent or the insurance company. As a MHI policy is a legal contract, the meanings used in the policy will apply when a claim is made. Some of the more important terms are as follows (These are not the legal meanings. Please refer to your policy contract for the actual definitions):

• Pre-existing conditions – These are conditions or illnesses that existed before the effective date of a MHI policy, for which you are receiving treatment or have shown symptoms. It doesn’t matter whether you are aware of them or not. If you had consulted a medical doctor for any pain or discomfort, this would be regarded as a symptom of a disability.

• Overseas treatment – You may or may not be covered for treatment obtained overseas, subject to the exclusions, limitations and conditions specified in the policy contract.

• Misstatement of age – Your age is an important rating factor in your MHI policy. If you have misstated your age and the premium paid as a result is not enough, any claim payable under the policy will be pro-rated, based on the ratio of the actual premium paid to the correct premium that should have been charged.

• Qualifying/waiting period – Most MHI policies contain a waiting period for illness and disease, which means that eligibility for benefits under the policy will only start 30 days after the effective date of the policy.

• Residence overseas – If you were to live or travel out of Malaysia for more than 90 consecutive days, no benefits will be payable for medical treatment outside Malaysia.

• Free-look period – If you decide not to take up a MHI policy, you can cancel the policy by returning it to the insurance company within 15 days from the date of issue. You will be entitled to a refund of the full premium, after deducting administrative expenses incurred by the insurance company for issuing the policy. These expenses shall be RM50 or 10% of the gross premium paid, whichever is lesser.

Premium on renewal of policy

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 07:07:00 +0000

When you want to renew your policy, the insurance company might take one of the following decisions:
• renew the policy with a level premium;
• renew the policy with an increased premium; or
• decline to renew the policy.
The insurance company is required to provide you with the reason for its decision on a change in the premium level or why a policy is not renewed.

Importance considerations when shopping for MHI policies

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 07:04:00 +0000

This is importance consideration before you buy MHI policies:

• Shop wisely before you buy – Policies differ as to coverage, benefits and costs (i.e.premiums), and companies differ as to services. Compare before buying.

• Don't buy more than you can afford – A single comprehensive policy is better and cheaper than several policies with overlapping or duplicate coverage.

• Know whom you are dealing with – Only deal with a licensed insurance company or its authorised agents or a licensed insurance broker when you buy a MHI policy. If a person cannot verify that he or she is an authorised agent of an insurance company, do not buy from that person. If in doubt, ask for evidence of the agent’s registration or check directly with the insurance company. Please note that a business card does not necessarily mean that the person is an authorised agent.

• Get information on the agent and insurance company – Write down the agent’s and/ or the insurance company’s name, address and telephone number or ask for a business card that provides all that information. This information is important if you want to enquire, renew or claim on a policy.

• Take your time – Don’t be pressured into buying a policy. A professional insurance agent will not rush you. If you are not certain whether a policy is what you need, ask the agent or insurance company to explain it to you properly.

• Complete the application form carefully – If you decide to buy a policy, you will need to disclose material facts to the insurance company. Some insurance companies ask for detailed medical information. If you leave out any of the information requested, coverage could be refused for a period of time for any medical condition you neglected to mention. The insurance company also could deny a claim for treatment of an undisclosed condition and/ or cancel your policy.

• Look for an outline of coverage – You should be given a brochure containing the important features of a particular MHI policy, when you are approached to purchase a MHI policy. After buying the policy, you should be given the policy contract. Read the terms and conditions in the contract carefully.

• Do not pay with cash – Pay by cheque, money order, auto-debit or bank draft made payable to the insurance company, not to the agent or anyone else. Get a receipt with the insurance company's name, address and telephone number for your records.

• Notification of the decision on the application – Insurance companies must make the decision whether or not to accept your application within 30 days of the application date. If you do not receive the decision within the stipulated period, contact the insurance company and obtain in writing the reason for the delay. If 15 days go by without a response, contact Bank Negara Malaysia (BNM).

• Read your policy contract carefully – Check to be sure that a copy of the original application is attached to the policy, and that it is complete and accurately reflects your medical information. Review the schedule of benefits and make sure that the information is correct and what you were expecting. There should be no missing pages and no unexpected riders or exclusions in the policy.

Important: Your policy is a legally binding contract. If you have questions about it, call the insurance company and get the questions resolved during the 15-day ‘free-look’ period.

How do I buy a MHI policy?

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 07:03:00 +0000

You can buy a MHI policy directly from the insurance company, or through its authorised agents, licensed insurance brokers (generally or group MHI policies), or banks/ financial institutions which have bancassurance arrangements with insurance companies.

Where can You get a MHI policy?

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 07:01:00 +0000

You may get a MHI cover through:
• a group plan at work, where your employer pays the premiums or you pay the premiums on your own. If it is a group plan sold under a scheme, you should get the details on terms of the arrangement between the organiser of the scheme and the insurance company especially on terms of continuity of the scheme. Also, please ensure that the insurance cover offered under the scheme is provided by a licensed insurance company; or
• buying an individual plan on your own. Individual insurance generally costs more than group insurance, but you may be able to customise your MHI plan to meet your needs according to your financial capability.

What is Health Insurance?

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 06:46:00 +0000

Medical and Health Insurance or known as (MHI), is an insurance policy which is designed to cover the cost of private medical treatment, which can be very expensive, especially with hospitalisation and surgery. MHI also ensures that you won't have to worry about the cost of seeking treatment during emergencies. In addition, MHI also provides you with an income stream while you undergo treatment.

Health Insurance Terms L

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 05:56:00 +0000

LPRT
See Leading Producers Round Table.

Large Claim Pooling
A system designed to help stabilize premium fluctuations in smaller groups. Large claims (those over a stated amount) are charged to a pool contributed to by many small groups who belong and share in that pool. The smaller the group of groups, the lower the pooling level. Larger groups will have a larger pooling level.

Leading Producers Round Table (LPRT)
An organization of agents who qualify for membership annually or on a lifetime basis by producing certain high levels of Health Insurance premium volume in a year. It is sponsored by the International Association of Health Underwriters.

Legend Drug
A drug which has on its label "caution: federal law prohibits dispensing without a prescription."

Length of Stay (LOS)
The total number of days a participant stays in a facility such as a hospital.

Line Slip
A document (most commonly used at Lloyd's) which describes a risk to be insured. It is circulated by brokers, and underwriters subscribe to it by indicating what percentage of the risk they are willing to take.

Living Benefits Rider
A rider attached to a life insurance policy which provides LTC benefits or benefits for the terminally ill. The benefits provided are derived from the available life insurance benefits. (H)

Living Need Benefits
A combination of life insurance and long-term care insurance which allows life insurance benefits to generate long-term care benefits. Up to a certain percentage of the life insurance policy's death benefit may be used in advance to offset nursing home or medical expenses, reducing the face amount of the life policy.

Long Term Care (LTC)
Care which is provided for persons with chronic diseases or disabilities. The term includes a wide range of health and social services provided under the supervision of medical professionals.

Long Term Care Facility
Usually a state licensed facility which provides skilled nursing services, intermediate care and custodial care.

Long-Term Disability Insurance
A group or individual policy which provides coverage for longer than a short term, often until the insured reaches age 65 in the case of illness and for the remainder of his lifetime in the case of accident. See also Short-Term Disability Insurance.

Loss-Of-Income Benefits
Benefits paid for inability to work for remuneration because of disability resulting from accidental bodily injury or sickness. The loss of income may be real or presumptive.

Loss of Income Insurance
Insurance paying loss of income benefits.

Loss of Time Benefits
See Loss of Income Benefits.

Loss of Time Insurance
See Loss of Income Insurance.

Health Insurance Terms I

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 05:55:00 +0000

Identification Card
A card given to each person covered under the plan which identifies him or her as being eligible for benefits.

Identification of Benefits
A provision that the cost of putting a disabled insured in touch with and in the care of relatives will be reimbursed, usually up to a maximum amount.

In-Area Services
Services which are provided within the "authorized" service area as designated in the plan.

Individual Contract
A contract made with an individual that covers that individual and perhaps also specified members of his family for benefits as described in the policy.

Individual Practice Association (IPA) Model HMO
A situation where an individual practice association is contracted with to provide health care services. The individual practice association contracts with individual physicians or groups of physicians for their services.

Inflation Factor
A premium loading to provide for future increases in medical costs and loss payments resulting from inflation.

Inflation Protection
Provisions in a health insurance policy that increase benefit levels to account for anticipated increases in the cost of covered services.

In-Force Business
Life or Health Insurance for which premiums are being paid or for which premiums have been fully paid. The term refers to the total face amount of a Life insurer's portfolio of business. In Health Insurance it refers to the total premium volume of an insurer's portfolio of business.

Initial Eligibility Period
The time period during which prospective members can apply for coverage without providing evidence of insurability.

Inside Limits
Limits placed on hospital expense benefits which modify benefits from the overall maximums listed in the policy. An inside limit when applied to room and board, limits the benefit to not only a maximum amount payable, but also limits the number of days the benefit will be paid. (H)

Insurance In Force
The annual premium payable on current contracts of insurance.

Integrated LTC Rider
A LTC rider which is added to a life insurance policy whereby LTC benefits paid will reduce the life insurance policy's benefits. LTC benefits are dependent on the life insurance benefits available.

Intentional Injury
An injury resulting from an act, the doer of which had as his intent, inflicting injury. In an accident insurance contract, an intentionally self-inflicted injury is not covered (because it is not an accident). In general, intentional injuries inflicted on the insured are covered (assuming no collusion).

Intermediate Care
A level of care associated with a skilled nursing facility which provides nursing care under the supervision of physicians or a registered nurse. The care provided is a step down from the degree of care described as skilled nursing care.

Intermediate Care Facility
A facility licensed by the state, which provides nursing care to persons who do not require the degree of care which a hospital or skilled nursing facility provides.

Intermediate Disability
See Temporary Partial Disability and Permanent Partial Disability.

Intermediate Report
A claim report on the condition of a continuing disability. (H,WC)***

International Association of Health Underwriters
An association of agents and related personnel on the Health Insurance business. (H)

Invalidity
Sickness.

Health Insurance Terms H

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 05:54:00 +0000

HCFA
Health Care Financing Administration.
HCFA 1500
A form used by providers of health services to bill their fees to health carriers. It was developed by the government agency known as Health Care Financing Administration.
HI.2
See Health Insurance and Medicare,

HIAA
See Health Insurance Association of America.
HII
See Health Insurance Institute.

HIQA. Health Insurance Quality Award
An award granted annually by the International Association of Health Underwriters or the National Association of Life Underwriters for high persistency of Health Insurance policies written by agents. See also Persistency.

HMO
See Health Maintenance Organization.

Home Health Agency
A certified facility approved by a health plan to provide services under contract.

Home Health Care
Care received at home as part-time skilled nursing care, speech therapy, physical or occupational therapy, part-time services of home health aides or help from homemakers or choreworkers.

Home Health Services
Health care services provided by a licensed home health agency in the patient's home which is a covered expense under Part A of Medicare.

Health Benefits Package
The coverages offered by a health plan to an individual or group.

Health Care Financing Administration (HCFA)
Part of the Department of Health and Human Services, responsible for administration of the Medicare and Medicaid programs. The HCFA establishes standards for medical providers which must be complied with if the provider is to meet certification requirements.

Health History
A form used by underwriters to assist in evaluating groups or individuals to determine whether they are acceptable risks.

Health Plan
This refers to any kind of plan that covers health care services such as HMOs, insured plans, preferred provider organizations, etc.

Health Insurance (HI)
. Insurance against loss by sickness or bodily injury. The generic form for those forms of insurance that provide lump sum or periodic payments in the event of loss occasioned by bodily injury, sickness or disease, and medical expense. The term Health Insurance is now used to replace such terms as Accident Insurance, Sickness Insurance, Medical Expense Insurance, Accidental Death Insurance, and Dismemberment Insurance. The form is sometimes called Accident and Health, Accident and Sickness, Accident, or Disability Income Insurance.

Health Insurance Association of America (HIAA)
An association supported by Life and Health insurers to provide the research, public relations, education, and legislative base for the promotion of voluntary private Health Insurance.

Health Insurance Institute (HII)
The public relations arm of the Health Insurance Association of America. It provides for a flow of information from Health insurers to the public and from the public to the insurers.

Health Maintenance Organization (HMO)
An HMO is a prepaid medical service plan which provides services to plan members. Medical providers contract with the HMO to provide medical services to plan members. Members must use contracted providers. The emphasis is on preventive medicine, and it is an alternative to employee benefit plans. Employers of more than 25 persons are required to offer the alternative of HMO to employees, but not if the cost exceeds that of present employee benefit plans. (H)

Health Service Agreement (HSA)
The agreement between employer and the health plan which outlines a description of benefits, enrollment procedures, eligibility standards, etc.

Health Services
The benefits covered under a health contract.

Hospice
An organization which is primarily designed to provide pain relief, symptom management and supportive services for the terminally ill and their families. Hospice care is covered under Part A of Medicare.

Hospital Affiliation
A contract whereby one or more hospitals agrees to provide benefits to members of a specific health plan.

Hospital Alliances
A group of hospitals that work together to share common services and thereby reduce health costs. By grouping together, they are better able to compete with other alliances or chains. (H)

Hospital Benefits
Benefits payable for hospital room and board, plus miscellaneous charges resulting from hospitalization.

Hospital Expense Insurance
See Hospitalization Insurance.

Hospital Income Insurance
A form of insurance that provides a stated weekly or monthly payment while the insured is hospitalized, regardless of expenses incurred and regardless of whether or not other insurance is in force. The insured can use the weekly or monthly benefit as he chooses, for hospital or other expenses.

Hospital Indemnity
Coverage that pays based on daily, weekly, or monthly limits regardless of the amount of actual hospital expenses.

Hospital Insurance (HI)
Also identified as Part A of Medicare. HI provides inpatient hospital care, skilled nursing care home health and hospice care subject to a benefit period deductible and copayments for certain services.

Hospitalization Expense Policy
A policy which covers daily hospital room and board charges and also covers miscellaneous hospital expenses (such as X-ray, etc.). It also often covers emergency treatment charges and many times will also include a surgical benefit.
Hospitalization Insurance

A form of insurance that provides reimbursement within contractual limits for hospital and specific related expenses arising from hospitalization caused by injury or sickness.

House Confinement
A provision in some Health Insurance contracts which requires an insured to be confined to the house in order to be eligible for benefits. This provision is most commonly found in policies providing loss of income benefits.

Hunter Disability Tables
Tables which show the probability of total and permanent disability.

Health Insurance Terms G

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 05:54:00 +0000

GAMC
See General Agents and Managers Conference.

Gatekeeper Model
Under this model of HMO and PPO organizations, the primary care physician (the gatekeeper) is the initial contact for the patient for medical care and for referrals. This is also called a closed access or closed panel.

General Agent (GA)
An individual appointed by a Life or Health insurer to administer its business in a given territory. He is responsible for building his own agency and service force and is compensated on a commission basis, although he possibly has some additional expense allowances. (LI,H)

General Agents and Managers Conference
An association of insurance general agents and managers affiliated with the National Association of Life Underwriters.

General LTC Rider
A LTC rider which is attached to a life insurance policy but stands alone or is independent of the life policy. Any LTC benefits paid do not reduce any of the life insurance benefits. (H)

Generic Drug
A drug which is exactly the same as a brand name drug and which is allowed to be produced after the brand name drug's patent has expired. It is also called a "generic equivalent." (H)

Generic Equivalence
See Generic Drug.

Grievance Procedure
A procedure which allows a member of a health plan or a provider of benefits to express complaints and seek remedies.

Group
Coverage of a number of individuals under one contract. The most common "group" is employees of the same employer.

Group Certificate
The document provided to each member of a group plan. It shows the benefits provided under the group contract issued to the employer or other insured. (LI,H)***

Group Contract
A contract of insurance made with an employer or other entity that covers a group of persons identified by reference to their relationship to the entity buying the contract. The group contractual arrangement is generally used to cover employees of a common employer, members of a trade association or trusteeship, members of a welfare or employee benefit association, members of a labor union, or members of a professional or other association not formed only for the purpose of obtaining insurance.

Group Credit Insurance
Insurance on the Life or Health of debtors of a creditor, payable for reduction or extinguishment of the debts in case of the disability or death of the debtor. (LI,H)***

Group Disability Insurance
Coverage provided for a group of individuals for loss of compensation due to accident or sickness.

Group Health Insurance
The same definition as Life Insurance but with the application to Health Insurance coverages. See Group Life Insurance. (H)

Group Model HMO
A health plan where a group of physicians is reimbursed for services they provide at a negotiated rate. The HMO also contracts with hospitals for the care of the patients of the physicians who belong to the group. (H)

Guaranteed Standard Issue (GSI)
An underwriting term used to describe the fact that a group insurance contract was issued without reference to any medical underwriting. All group participants are covered regardless of health history.

Health Insurance Terms F

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 05:53:00 +0000

FASB
The Financial Accounting Standards Board.

Family Dependent
A person entitled to coverage because he or she is: 1. The enrollee's spouse, or 2. A single dependent child of either the enrollee or the enrollee's spouse (including stepchildren or legally adopted children), and 3. A resident of the enrollee's home.

Family Expense Policy
A policy which insures the medical expenses of all members of a family.
Federal Qualification
Approval of any HMO made by the HCFA after conducting their evaluation of methods of doing business, documents, contracts, facilities, and systems.
Fee-for-Service Equivalency
The difference between the amount a provider receives from a reimbursement system such as capitation (a flat charge per month, for instance) compared to fee-for-service reimbursement.

Fee-for-Service Reimbursement
A health care system where physicians and other providers receive payment based on their billed charge for each service provided.

Fee Maximum
The maximum amount available to a provider for specific health care services under a contract.

Fee Schedule
A list of maximum fees for providers who are on a fee-for-service basis.

Field Underwriting
The initial screening of prospective buyers of health insurance, performed by sales personnel "in the field." May also include quoting of premium rates.

Financial Accounting Standards Board (FASB)
A non-governmental group that sets standards for generally accepted accounting principles. (H)

Fiscal Intermediary
A commercial insurer contracted by the Department of Health and Human Services for the purpose of processing and administering Part A Medicare claims.

Flat Maternity Benefit
A stipulated benefit in a Hospital Reimbursement policy that is paid for maternity confinement, regardless of the actual cost of the confinement.

Flexible Benefit Plan
A type of program where employees can tailor their benefits to meet their own specific needs. (H)

Formulary
See Drug Formulary.

Franchise Insurance
A plan for covering groups of persons with individual policies having uniform provisions, although they may differ in benefits. Individual contracts are issued to each person with individual underwriting. It is usually applied to groups too small to qualify for true group coverage, and the solicitation of cases usually takes place among an employer's work force with his consent. In Life Insurance, it is sometimes called Wholesale Insurance. Contrast with True Group Insurance. (LI,H)***

Fraternal Insurance
Insurance offered a special group of people, namely, members of a lodge or a fraternal order. Such insurance may be written on an assessment basis or on a legal reserve basis. (LI,H)***

Free-Standing Emergency Medical Service Center
A facility whose primary purpose is the provision of care for emergency medical conditions. Also called emergi-center or urgi-center.

Free-Standing Outpatient Surgical Center
A facility which only provides outpatient surgical services. Also called surgi-center. (H)

Frequency
The number of times a service is provided over a given time period. (H)

Fringe Benefits
See Employee Benefit Program.

Funding Level
The dollar amount required to purchase a particular medical care program. Usually measured by the premium rate for an insured program, or an amount assessed for expected claim loss and related fees under a self-funded program.

Funding Methods
The agreed means by which an employer pays for health coverage. Future Increase Option. An option which allows the insured to increase disability income benefits at predetermined times, specified in the policy, without evidence of insurability.

Health Insurance Terms D

noreply@blogger.com (insurance terms) — Sat, 22 Dec 2007 05:53:00 +0000

DBL
See Disability Benefits Law. (H)

Date of Service
The date that the health service was provided. (H)

Death Spiral
The potentially destructive cycle that may occur in an indemnity plan as a result of increased HMO penetration. The process can occur if indemnity plan rates continuously escalate because healthier and younger employees choose HMOs, leaving less healthy individuals in experience-rated indemnity plans. Employer contribution strategies and HMO pricing techniques may aggravate the problem. (H)

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. (H)

Deferred Compensation Administrator
This refers to a company that provides services under a deferred compensation plan. Services may include administration of self-insured plans, compensation planning, salary surveys, retirement planning, etc. (H)

Delete
This refers to the process of taking an individual off Medicare coverage. (H)

Dental Insurance
A group Health Insurance contract that provides payment for certain enumerated dental services. (H)

Department of Health and Human Services
A federal department whose responsibility is primarily dealing with social service functions such as administration and supervision of the Medicare program.

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.

Designated Mental Health Provider
The organization hired by a health plan to provide mental health and substance abuse services.

Detoxification
The process an individual goes through when withdrawing from alcohol. Usually is done under guidance of medical personnel.

Diagnosis
The process of identifying a disease.

Diagnosis Related Groups (DRGs)
A method of classifying inpatient hospital services. It is used as a method of determining financing to reimburse various providers for services performed.

Disability Benefits Law
A state law requiring an employer to provide disability benefits to covered employees for nonoccupational injuries, in contrast to Workers Compensation, which pays for occupational injuries. These laws are currently in effect in New York, New Jersey, Rhode Island, California, and Hawaii.

Disability Buy-Sell
A disability income policy used to fund a disability buy-sell agreement whereby the business interest of a disabled stockholder following the elimination period. The policy's benefits may be paid in a lump sum or in installments.

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.

Disability Insurance Training Council, Inc
The educational arm of the International Association of Health Underwriters, the Health Insurance agents' professional society. It seeks to encourage agent educational projects by local Health associations, conducts university seminars in advanced Health underwriting areas, and conducts annual seminars for home office executives in sociological social insurance and demographic trends that may affect future application of policy forms and Health Insurance.

Disability, Long-Term
See Long-Term Disability.

Disability, Permanent Partial
See Permanent Partial Disability.

Disability, Permanent Total
See Permanent Total Disability.

Disability, Short-Term
See Short-Term Disability.

Disability, Temporary Partial
See Temporary Partial Disability.

Disability, Temporary Total
See Temporary Total Disability.

Discharge Planning
Determining what the patient's medical needs will be after discharge from a hospital or other inpatient treatment.

Dismemberment
The loss of, or loss of use of, specified members of the body resulting from accidental bodily injury.

Dismemberment Benefit
The benefits payable for various types of dismemberment. See also Accidental Death and Dismemberment and Multiple Indemnity.

Dread (or Specified) Disease Policy
Coverage, usually with a high maximum limit, for all types of medical expenses arising out of diseases named in the contract. Common diseases covered are poliomyelitis, diphtheria, multiple sclerosis, spinal meningitis, and tetanus. Cancer is sometimes covered or may be added with some companies by a rider.

Drug Formulary
A schedule of prescription drugs approved for use which will be covered by the plan and dispensed through participating pharmacies.

Drug Price Review (DPR)
A procedure used to determine drug price maximums. It involves determining wholesale drug prices based on the American Druggist Blue Book.

Drug Utilization Review (DUR)
A method for evaluating or reviewing the use of drugs in order to determine the appropriateness of the drug therapy.

Dual Choice
The federal requirement that employers having 25 or more employees who are within the service area of a federally qualified HMO, who are paying at least minimum wage and offer a health plan to their employees, must offer HMO coverage as well as an indemnity plan.

Duplicate Coverage Inquiry (DCI)
A request to determine whether or not other coverage exists. Used to apply the coordination of benefits provisions where two or more insurance companies are involved.

Duplication of Benefits
A situation where identical or overlapping coverage exists between two or more insurance companies or service organizations.