Glossary of Terms

A

Agency - An insurance agency is a company, usually specialized, that provides insured with a plan on behalf of the carrier

Agent - An insurance agent is a licensed representative or salesperson of an insurance company who is able to advise and sell insurance to costumers.

Appraisal - To give an appraisal is to assess the value of a claim.

B

Benefit Level - The benefit level of a plan is the maximum amount an insurer will pay for a benefit.

Benefit Period - The benefit period is the time frame in which you are covered under a policy

Benefits - A plan’s benefits are the elected coverages included in a plan.

Blanket Policy - A blanket policy is one policy that covers a group of individuals. It can also mean a policy that covers multiple properties.

C

Carrier - A carrier is an insurance company that provides the insurance and takes the underwriting risk.

Claim - A claim is a request made by the insured for the benefits provided by the policy.

Co-insurance - Co-insurance is the amount the insured is required to pay for services after the deductible has been reached.

Co-Pay - A co-pay is a pre-determined fee that insured pays for specified services in addition to covered costs.

Compulsory plan - A compulsory plan is an insurance plan that is required by law

Coverage level - The coverage level is the maximum amount an insurer will pay for a benefit

Covered person - The person or people eligible to receive benefits under a given plan are the covered person(s).

D

Deductible - A deductible is a set amount the insured is responsible for paying before the insurer will cover costs.

Dependent - Dependents are individuals named by the insured who rely on the policy holder for insurance benefits.

Disclaimer - A disclaimer is language that highlights limitations of services offered that the insured should be aware of in relation to the plan.

E

Eligible - If an individual qualifies for coverage under policy language, they are eligible for that particular insurance coverage.

Endorsements - An endorsement is an addition to a policy that contains language that can modify coverage.

Excess - insurance Excess insurance is an insurance policy set to cover expenses when losses exceed a specific amount, also referred to as secondary insurance.

Exclusions - Items not covered by an insurance policy are exclusions.

G

Guaranteed Issue - The right to insurance without any underwriting requirements is called guaranteed issue.

I

In-Network - In a health insurance plan, the discounted providers or services that are provided under the plan are considered in-network.

Indemnity - Making a policy holder whole after a loss by payment, repair or replacement is an indemnity.

L

Liability - In insurance, a liability is when the insured is legally responsible for loss

Limits - Maximum amount of losses paid for a plan

Loss - The loss of assets that is the basis for an insurance claim

M

Mandated benefits - Mandated benefits are benefits required by law

Mandated minimum - Minimum amount of coverage required by law is the mandated minimum. These may vary by state.

Maximum Benefit - The maximum amount a plan will pay in benefits is the maximum benefit.

P

Period of Coverage - The time frame in which you are covered under a policy

Policy - A policy is a written contract of insurance between the insurer and the insured

Pre-authorization - In a health plan, the requirement that your health plan provider gain approval for treatments is the pre-authorization.

Pre-certification - In health insurance, approval by an insurance representative to be admitted to a hospital or in-patient facility is pre-certification.

Pre-Existing Condition - A pre-exisiting condition is a coverage limitation where certain conditions that may already exist will not be covered under the insurance policy

Premium - A premium is the amount insurer charges for coverage

Pro-rata refund - A pro-rata refund is an insurance refund where the amount returned to the insured is based on the number of days remaining in the policy compared to the total number of days in the policy

R

Renew - To renew a plan is to reestablish or continue an insurance plan

Replacement cost - The cost associated replacing a covered item rather than the actual cash value of the item is the replacement cost.

Risk - A risk is the chance that a given activity or action will lead to a loss

S

Subrogation - When another party is liable for a loss, the process by which the insurer recovers the amount of loss after payment to the insured is called subrogation.

T

Trigger - A trigger is the event that must occur before a policy can cover a loss

U

Underwriter - The underwriter is the insurer, who is trained in measuring risk and determining acceptable rates and pricing

W

Waiting period - Period of time following start of coverage before insured can make certain claims and receive insurance benefits is the waiting period.