A policy provision, rider or feature of some life insurance policies that lets you collect part of your death benefit before you die to pay for long term expenses. If you have a terminal illness the policy advances you a specified part of your death benefit to pay medical bills or other expenses. The amount is subtracted from the death benefit your beneficiary receives. Some policies also permit you to use the death benefit to pay for long-term care (nursing home) expenses. Also called living need."
A provision or rider that promises to pay more (usually double) if you die in an accident. Also known as double indemnity.
Daily Living (ADL)
Many Long Term Care policies start paying benefits when you are no longer able to perform basic actions without help. These actions are called activities of daily living.
The amount a damaged or stolen item was actually worth (as “used” goods) at the time of the loss. This is almost always less than replacement cost.
The dollar amount that a health care provider bills to a patient for a particular medical service or procedure.
A mathematics expert who applies probability theory to the business of life insurance and is responsible for calculating premiums, risks, policy reserves and other values.
A person the insurance company pays to settle insurance claims. The adjuster may be either a company employee or under contract to the insurance company.
These are the charges that some policies deduct from cash value accumulation each year. Administrative fees are often highest in the first few years after you buy the policy and lower in the later years (especially with life insurance policies).
Adult Day Care
This is care that is typically provided during daytime hours in a local community center or senior center and is particularly associated with Long Term Care Insurance.
An agent is an insurance company representative licensed by the state who solicits and negotiates contracts of insurance, and provides services to the policyholders for the insurer. An agent can be independent agent who represents at least two insurance companies or a direct writer of insurance who represents and sells policies for one insurance company only.
A person who receives an income benefit from an annuity.
An annuity is a contract purchased through an insurance company, usually in order to accumulate funds that can be used after retirement. After an age specified in the policy, the insurance company promises to pay you monthly ("annuity") payments. The company is taking the risk that you could live longer than expected, meaning the company would pay you more than you had invested in the policy. In short then it is contract that provides a periodic income at regular intervals, usually for life.
An annuity certain is a contract that provides an income for a number of years that are specified, regardless of life or death.
This is a statement of information and facts made by a person applying for life insurance, health insurance, auto insurance or any other type of insurance.
It helps the insurance company assess the acceptability of risk that they may be taking on. Statements made in the application are used to decide on an applicant's underwriting classification and premium rates.
An appraisal is an evaluation of your property, such as you may get for example when pricing household items for home insurance or renters insurance; or a car for auto insurance.
The approved charge is the dollar amount on which an insurance company bases its payments and your co-payments. This may be less than the actual charge.
Assignment means that you give rights under the insurance policy to someone else. You can assign beneficiary rights or policy ownership. For example this may happen with a life insurance policy.
This is the actual age that you have reached at any particular time.
Automatic Premium Loan
This is a provision in an insurance policy that authorizes the insurance company to use money from your cash value to pay your premiums.
This is the person you designate to be paid a death benefit when you die. Anyone can be named as a beneficiary and a policy may have one or more beneficiaries.
The most a health insurance policy will pay for a specified loss or covered service. The benefit can be expressed as either a specific period of time, a dollar or cash amount, or a percentage of the approved amount. Benefits may be paid to a third-party or the policyholder.
The benefit period is the length of time an insurance policy will pay for services. A policy may include different benefit periods for different kinds of treatment or services. It is usually described in years (one year, two years, three years etc.) A policy with a "lifetime" benefit period does not limit the number of years it will pay, but it may limit the total amount of dollars it will pay.
The medical condition (or other event if not health insurance) that qualifies you to begin receiving benefits from the insurance policy.
Bonus Rate Annuity
An extra percent of interest credited to a life insurance annuity during the first year that it is in force. The extra amount is above the interest rate to be credited beginning the second year and the remaining years that the life annuity is in force. The extra rate is paid in the first year in an effort to attract new policyholders.
A life insurance policy with a relatively small death benefit, intended only to cover your funeral and burial expenses.
Often associated with long term care insurance. Most insurance companies will have a system for reviewing your medical records and verifying what kind of care you need. The insurance company may then contract with a separate "care management" organization.
Cash Surrender Value
The amount available in cash upon voluntary termination of a life insurance policy by its owner before it becomes payable by death or maturity. The amount is the cash value stated in the policy minus a surrender charge and any outstanding loans and any interest thereon.
The "savings" portion of a life insurance policy. When your premium payments are more than the cost of the insurance, the excess goes into a cash value account and draws interest. The cash value is usually not part of your death benefit.
The evidence of coverage received by persons insured through an insurance policy.
An employee or other insured person named under an insurance policy.
Underwriter - CLU
Chartered Life Underwriter - CLU - Is a title that agents and other insurance professionals can achieve after taking a series of classes and passing exams regarding life insurance. An agent with CLU after his or her name should know a lot about life insurance.
A continuous or prolonged illness or condition. Examples might include: asthma, diabetes, varicose veins.
Commonly referred to in health insurance and life insurance policies.
Insurance agents are said to "churn" their business when they repeatedly persuade their customers to replace existing policies with new ones. An agent may be tempted to churn because commissions are higher in the first year of the policy or because the agent has begun representing a different insurance company.
The description of a loss you must give the insurance company in order to collect on your insurance policy.
COBRA is an acronym that refers to the Consolidated Budget Reconciliation Act of 1985.
It is a law that states that if an employer wishes to take a tax deduction for health insurance costs, the employer must provide employees who have been covered by the plan (but who have ended employment for specified reasons) with the right to continue coverage at the employee's cost (at the group rate) for a period of time (usually 18 months, but in some cases, 29 months or 36 months.)
An inability to take care of yourself as a result of loss of memory or some other mental deterioration. This includes such diseases as Alzheimer's and Parkinson's.
Getting a precise definition of what the insurance company classifies this as can be particularly important for being able to claim on long term care insurance policies.
The portion of your premium payments that goes to the insurance agent who sells the policy. Agents typically receive a percentage of each premium payment you make. The percentage may be highest in the first year you buy the policy.
The title many states give to the official in charge of regulating insurance companies.
An insurance policy that the insurance company will renew with each premium payment, as long as you meet certain conditions.
During the contestable period (which is usually a period of two years from the date of issue), the insurance company can cancel the life insurance policy (if you are still living) or refuse to pay a death benefit because it discovers your answers on the original application were misleading or false.
Changing a term life insurance policy to some other form. This can be done only when the life policy is described as convertible.
Coordination of Benefits (COB)
Coordination of Benefits - COB - These are the provisions and procedures used by insurers to avoid duplicate payments when a person is covered by more than one policy.
A specified dollar amount or percentage of covered expenses which an insurance policy or Medicare requires a beneficiary to pay toward eligible medical bills.
Cost of Insurance
The amount a company calculates that it needs to insure your life (if life insurance), or cover you as specified in your insurance policy.
Although your insurance premiums may never change, the cost of insurance goes up every year because you are unavoidably getting closer to death (with life insurance). And each year an increasing amount of your premium payment for a cash value policy is used to pay for insurance - and less goes to cash value.
The "cost of insurance" will inevitably depend on your particular circumstances, age, medical condition and other factors such as your credit rating.
Services for which an insurance policy will pay out.
A life insurance policy that is intended to pay off a debt (loan for car, furniture, appliances, etc.) if you die.
The maximum amount the policy will pay for each day of care. This is often associated with health insurance (hospital stays) and also long term care insurance.
The money that a life insurance policy promises to pay your beneficiary when you die.
A form of life insurance which requires the agent to collect your premiums on a weekly or monthly basis.
A term life insurance policy whose death benefit goes down each year. Credit life insurance is a form of decreasing term; because your loan balance is lower each year, you need less insurance to cover it.
This is the part of a loss that you must pay out of your own pocket. In other words, a specified dollar amount which the beneficiary must pay before an insurance policy will pay out on a claim.
Insurance sold directly to the insured by an insurance company through its own employees by mail or over the counter.
When a company collects more money from policyholders than is needed to cover the cost of insurance, profit and other expenses, the company may return some of the money as a dividend. Dividends are paid only if you have a "participating" policy (typically certain types of life insurance policies).
You generally can choose to receive the dividend as a cash payment, apply it to your premium payments, buy more insurance, or add it to the policy's cash value. Dividends are like a bonus. There is no guarantee that the company will pay dividends.
A provision or rider that promises to pay more (usually double) if you die in an accident. Also known as an "accidental death clause."
Period during which individuals may enroll for an insurance policy, Medicare, or Health Insuring Corporation/Health Maintenance Organization (HMO) benefits.
An enrollment period is typically associated with medical insurance.
A procedure, condition or occurence which an insurance policy does not cover.
A medical treatment which is not generally accepted within the medical profession. Health Insurance policies often do not cover these procedures. Companies often disagree with doctors on whether a specific procedure or treatment is experimental or not.
Explanation of Benefits
A statement from an insurance company showing which payments have been made on a claim.
A cash value life insurance policy that sets a specific time at which the cash value will equal the death benefit. If you buy a $30,000, 25-year endowment policy, you will immediately be insured for $30,000. If you are still living at the end of 25 years, you will receive $30,000 in cash.
The number of days you have to pay nursing home bills from your own pocket before the Long Term Care Policy starts to pay. Some policies call this the "elimination" period. Others call it the "deductible" period.
A written attachment to an insurance policy that adds or subtracts coverage.
Things your insurance policy does not cover. These are set down in the policy douments for the insurance.
The sum a life insurance policy promises to pay when the insured person dies, or at the maturity of the contract.
Information about medical or mental problems of your parents and other family members. Companies may charge you higher premiums or reject you if your family has a history of cancer, heart attacks, or such diseases as Huntington's.
Eligible Individual (FEI)
A person who meets federal standards for continuing or obtaining health care coverage under HIPAA.
Fee for Service
Traditional health insurance that does not place restrictions on which doctors you can use. The insurer pays for the expenses you incur.
A private firm's evaluation of the financial stability of an insurance company. There are numerous rating services and each has its own grading system. For example, Moody's, A.M.Best and Standard & Poor's are examples of three such services.
First to Die
Provision in a life insurance policy that insures both husband and wife. When the first spouse dies, the survivor collects the full death benefit.
Any time you knowingly provide false or incomplete information on an application for insurance or on a claim.
The period during which you may reconsider the purchase of an insurance policy, cancel, and get a full refund. After you recieve the policy you can review it again and consider whether it is what you really want. Individual health policies have a free look of at least 10 days. Medicare Supplement & Long-Term Care Insurance policies have 30-day free look periods.
During the free look period (usually 10 days for life policies) you can review, cancel, and return it for a full refund of any premiums you have paid. The free look period for replacement life policies is generally 20 days.
Using modern scientific analysis of your blood to determine whether you have any genetic defects that might make it more likely that you would die earlier than the average person. Many states do permit insurance companies to use the results of genetic testing for life insurance policies, but in practice only a few companies actually require genetic testing.
The time after an insurance premium is due during which the premium can still be paid with no interest charged, and coverage remains in force. This period is usually 30 or 31 days.
A contract between an insurer and an employer or association.
Group Life Insurance
A policy issued to an employer, association, or other organization. Employees or association members obtain insurance as group members and receive certificates rather than policies. Group life policies are usually annual, renewable term with an option to convert to an individual policy when you leave the group.
A policy that is sold to all applicants without regard to their health. Because the company does not exclude high risk people, guaranteed issue policies are generally more expensive than policies that underwrite (screen out) applicants.
The only interest amount that the insurance company promises to pay on any cash value in the life insurance policy. The guaranteed rate is generally much lower than non-guaranteed projections the company may make in its illustrations.
An agreement by an insurance company to insure a person for as long as premiums are paid. With a guaranteed renewable policy you generally have the right to renew your insurance policy for life, as long as you pay the premiums. The company cannot change the benefits. It can, however, increase premiums for all policies at the same time.
An insurance company's explanation of how a life insurance policy will work. An illustration projects the policy into the future, showing each year's premium payments and death benefits as well as any guaranteed interest payments and the company's description of additional benefits that might be paid if the company does well.
A policy is "in force" when all conditions have been met to establish or maintain the company's obligation to pay if you die.
A contract between an insurance company and an insured person.
A form of life insurance which requires the agent to collect your premiums on a weekly or monthly basis. This is also known as 'debit policy'.
A provision in a long-term care policy that permits benefits to increase in the future. There are different kinds and levels of inflation protection.
A person who has been admitted to a hospital or other health care facility to receive diagnosis, treatment or other health services.
In order to be the owner and beneficiary of a life insurance policy, there must be some relationship to the insured person. This protects you from the stranger who might have murder in mind when he takes out a multi-million dollar policy on your life. Family members have insurable interests in each other, and employers have insurable interests in their employees.
An individual or organization protected by an insurance policy.
A legal procedure used by insurance companies when there is a dispute over who is entitled to the death benefit. Interpleader resembles escrow, with the court holding the money until the dispute is resolved.
Permanently signing over your policy rights to someone else. Irrevocable means you cannot take it back.
The termination of an insurance policy as a result of failure to pay the premium.
This is a term that is often associated with Long Term Care Insurance. Long-term care is divided into three levels, determined by how much assistance you need.
• Skilled care: daily care provided by a nurse or therapist under a doctor's supervision, skilled care usually lasts for relatively short periods
• Intermediate care: occasional nursing & rehabilitative care, supervised by medical professionals; less specialized than skilled care, often continuing much longer
• Custodial care: help with your daily activities (eating, dressing, bathing, etc.), this level of care does not require medical personnel; much of nursing home care is custodial and if you need long-term care, it's the most likely level you will need"
The total amount an insurance policy will pay during an insured persons lifetime.
Similar to bankruptcy for an individual. A state official serves as the company's liquidator, and attempts to meet the company's fiscal obligations (e.g., paying claims) by "liquidating" its assets. Most States have safety net arrangements in place if this happens, but these are generally designed to meet minimal claims, so it is important to check the financial viability of your insurance company before purchasing a policy.
A policy provision or rider in a life insurance policy that lets you collect part of your death benefit before you die. If you have a terminal illness the policy advances you a specified part of your death benefit to pay medical bills or other expenses. The amount is subtracted from the death benefit your beneficiary receives. Some policies also permit you to use the death benefit to pay for long-term care (nursing home) expenses. Also called 'accelerated death benefit'.
If your life insurance policy has accumulated cash value, you may borrow part of it. Interest rates are generally better than bank rates. The amount you borrowed will be deducted from your death benefit until you have repaid it. If your loan and accumulated interest add up to more than the cash value, the policy will lapse.
Long-Term Care (LTC)
The medical and social care given to one who has a severe chronic impairment over a long period of time.
The basis for a claim under an insurance policy. In health insurance loss can refer to medical expenses (or, in a disability policy, loss of income) resulting from illness or injury. Similarly, in an auto insurance policy it may refer to the theft from the car.
The dollar amount an insurer pays in claims compared to the amount it collects from all customers in premiums. Loss ratio is usually shown as a percentage of claims for every dollar collected.
Low Value Policy
A life insurance policy that has a high premium and small death benefit.
A special kind of account that is eligible for a tax credit when combined with catastrophic care insurance that has high deductibles.
Treatments or services an insurance policy will pay for as defined in the contract.
The frequency of sickness and accidents among a group of people.
These are statistics that show how long people are expected to live under various situations (women longer than men, smokers shorter than non-smokers, etc.). Companies use mortality tables to calculate the cost of insuring you at any specific age.They are a measurement of the frequency of sickness and accidents among a group of people, and help the insurance company to decide on the relative risks of insuring you.
Employer Welfare Arrangement (MEWA)
An organization of employers who “jointly self-insure” and pool funds to provide health care benefits for their employees.
Discussion between you and the insurance company's adjuster about the value of your loss.
Often associated with Long Term Care Insurance. In this context it would mean that you have the right to renew your Long Term Care policy for life, as long as you pay the premiums. The company cannot change the benefits or increase premiums.
If you cancel a cash value life insurance policy after several years, the company is required to refund part of the cash value. Many options are also available to you other than a lump sum payment.
Nonforfeiture of Benefits
Nonforfeiture guarantees you will receive something (such as limited benefits or a return of premium) if you cancel the policy or the company cancels because your payments stop. This feature usually increases the policy premium. Many States now require every company selling long-term care insurance to offer the nonforfeiture option.
The amount the insurance company adjuster proposes to give you for your loss.
A period of time when new subscribers may enroll in a health insurance plan regardless of their health.
The amount you pay the insurance company for insurance (same as premium).
A summary of a policy's benefits and limitations which is intended to make it easier to understand the policy and compare it with other policies.
A group insurance policy which was sold outside the state. Example: you may live in California and be covered by a policy your group purchased in New York. That policy may be regulated by New York law rather than Californian law.
A patient who receives care at a hospital or other health care facility without being admitted to the facility. Out-patient care also refers to care given in other locations such as out-patient clinics.
A policy on which all premium payments have been made. In reference to a life insurance policy this would mean that although you are still alive, you don't have to make any more payments, and your beneficiary is assured a full death benefit.
Additional insurance purchased with policy dividends.
Policy ("Par" Policy)
A policy that has the possibility of paying dividends. Always remember that dividends are never guaranteed.
How a beneficiary receives payment of the death benefit. The company may pay a lump sum or set up a money market account in the beneficiary's name and give the beneficiary the choice of leaving the money in the account or withdrawing part or all of it. (See also 'Settlement Option')
The cause of a loss. Examples: fire, tornado, theft, explosion.
The person who contracts with an insurance company for an insurance policy. In the case of a life insurance policy for example the owner of the policy has the right to designate beneficiaries. Ordinarily you are the owner of the policy on your own life, but you might also be the owner of policies on the lives of your children. You can sell the ownership to a stranger, who could then make himself the beneficiary of your policy (see viatical settlement).
A requirement that you obtain the insurance company's approval before a medical service is provided. If you fail to follow the pre-certification procedures the company may reduce or deny claim payment. Please note: getting pre-certification does not guarantee claim payment. Also called Utilization Review.
Health conditions or problems that existed before health insurance was purchased. Check your policy for specific language defining pre-existing conditions.
Typically it will be a medical condition which was treated or diagnosed in the six months before you bought the policy (though this varies so you will need to read the policy wording carefully). If you need care due to a pre-existing condition, and the care begins during the waiting period, some policies will not pay the claim.
The rate the company charges people who have the lowest risks. These people are called preferred risks.
The amount you pay the insurance company for insurance (also called outlay).
A contract with a funeral home that makes it possible to pay your funeral expenses in advance. (Often mentioned in conjunction with life insurance death benefits). The terms of pre-need contracts are generally regulated by the relevant States laws.
An insurance policy that pays first when a person is covered by more than one insurance plan (usually associated with health insurance).
An organization or person that provides medical services, such as a hospital, doctor, x-ray company, home health agency, pharmacy, etc.
A person that you may hire to help settle your claim with the insurance company.
When applied to Long Term Care Insurance this gives protection against unintentional (accidental) lapse. Reinstatement lets you save your LTC policy from cancellation if you miss payments because of mental impairment (such as Alzheimer's, senility, etc.).
Restoration of a policy that has lapsed due to non-payment of premium after the grace period has ended. The reinstatement period in life insurance is 3 years from the premium due date. You must pay all past due premiums plus interest and prove insurability to have a policy reinstated.
A term life insurance policy that guarantees you the right to renew at the end of the term.
An insurance agent “replaces” your policy when he sells you a policy to take the place of one you already have. Some States laws requires you to sign replacement forms whenever money from one policy is used to buy or fund another policy. If the new policy is with a different company, the agent must notify your old company. The old company then has a chance to persuade you not to switch (called “conservation”). The free look period when replacing a life policy is 20 days.
How much it will cost you to replace a stolen or damaged item with a comparable, new item at today's prices? This is often used with auto insurance, home and renters insurance when deciding on the costs involved in replacing possessions covered by insurance.
An addition or amendment to an insurance policy. A legal document which modifies an insurance policy. Riders may either extend or decrease benefits, or add or exclude specific conditions.
For life insurance this would refer to the likelihood that you will die while insured. Young, healthy children are the lowest risks. Old folks and skydivers are very high risks. Life insurance companies charge a premium appropriate to the risk.
Similarly for health insurance the insurance company will take into account such risks as smoking, a family history of heart disease etc before deciding on an appropriate premium.
Things about you that affect your risk. Some examples would include older age, smoking, hazardous occupation, family history of heart disease, dangerous hobbies (rock-climbing, sky-diving etc).
Applies only when you have more than one health insurance plan. The secondary payer is the plan whose payments cannot be made until another plan (the primary payer) has processed the claim. (Also see Coordination of Benefits.)
With regards to health insurance this refers to an organization (usually an employer) that pays health care costs out of the organization's own pocket.
After negotiating, the amount you agree to accept from the insurance company as full payment for your loss.
With regards to a life insurance policy this would refer to how a beneficiary receives payment of the death benefit. The company may pay a lump sum or set up a money market account in the beneficiary's name and give the beneficiary the choice of leaving the money in the account or withdrawing part or all of it.
Specific Disease Policy
A health insurance policy that covers the expenses incurred only for a specific disease named in the policy. The most common type is cancer insurance. Also known as a Dread Disease policy.
A process by which you become eligible for Medicaid by using your own resources to pay medical bills until you reach the eligible income limits.
A life insurance policy will not pay a death benefit if you commit suicide within the first two years after you buy the policy.
If you surrender an annuity or universal life policy prematurely, the company may deduct a fee from the amount it owes you.
This is known as a surrender charge.
TAMRA - Technical and Miscellaneous Revenue Act. A 1988 federal law that created a new class of life insurance contracts. These contracts' policy loans and surrender payments are subject to taxation rules similar to deferred annuities.
Term Life Insurance
The simplest form of life insurance, it generally offers no cash value feature. You pay a premium and the company promises to pay your beneficiary if you die. The policy lasts for a specific length of time or "term" such as 1, 5, 10 or more years, or to a designated age such as 65 or 100. If you are living at the end of the term, the policy expires unless the company agrees to renew it. Renewal premiums are based on your attained age. Sometimes called temporary insurance.
The insurance company's process for determining whom it will insure. An underwriter's decision may be based on your insurance application, physical exam, medical records, and other information to determine whether you meet the company's standards for cover.
Universal Life Insurance
A flexible-premium life insurance contract which accumulates values and pays a death benefit. You choose the policy's premium and face amount, and you can adjust these as long as the policy is in effect. It is possible that the cash value will earn more than the guaranteed minimum interest rate. It is also possible that the cash value will grow faster than is needed to cover the cost of the insurance.
Customary and Reasonable (UCR)
The dollar amount a company has determined to be appropriate for a particular medical service. Each company develops its own UCR. It is often less than doctors actually charge.
Utilization Review - See "Pre-Certification" above.
An insurance company's projection on an illustration suggesting that your life insurance policy could reach a point where you would not have to make premium payments because the policy would have enough cash value to take care of the premiums.
Variable Life Insurance
A type of whole life insurance in which the face amount and cash value rely on the investment performance of a special fund. Reserves are placed in investment accounts that are separate from the company's general account. Most policies guarantee a minimum face amount, but a cash value minimum is rarely guaranteed.
An agreement to sell the ownership of your life insurance policy to another, unrelated person, who becomes both the owner and beneficiary of the policy. Different States license companies and individuals who deal in viatical settlements in different ways.
The time that must pass after becoming insured on a health insurance policy before the policy will begin to pay benefits for a pre-existing condition or specified illness. It may also refer to the time you must wait before you can get group health insurance from a new employer.
An amendment to a health insurance policy which excludes coverage for a specific condition.
A provision that suspends your obligation to pay premiums when you are disabled or you meet some other policy requirement. This is a common feature in life insurance polices.
Whole Life Insurance
Life insurance with a savings feature. Premiums generally are the same (level) every year. When you are young, your premiums are more than the cost of insuring your life at that time. The excess amount accumulates and resembles a savings account, called cash value. This excess is used by the company to insure you later in life, when your level premium is no longer enough to cover you.
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