Term
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Definition
| A selection of health care benefits from which an employee may choose the ones that he/she needs. |
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Term
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Definition
| A percentage of the principle amount of a policy paid to the insured if he/she suffered the loss of an appendage. |
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| Organizations that process claims and pay benefits in an insurance policy. |
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Definition
| The amount to which a policyowner is entitled if the policy is surrendered before maturity. |
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Term
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Definition
| A demand of a person to stop committing an action that is in violation of a provision. |
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Term
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Definition
| A statement (or booklet) that confirms that a policy has been written and that describes the coverage in general. |
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Term
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Definition
| A document that authorizes a company to start conducting business and specifies the kind(s) of insurance a company can transact. It is illegal for an insurance company to transact insurance without this certificate. |
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Term
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Definition
| A legal document that indicates that an insurance policy has been issued, and that states both the amounts and types of insurance provided. |
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Definition
| A request for payment of the benefits provided by an insurance company. |
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Term
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Definition
| An unfair trade practice in which an insurer uses physical or mental force to persuade an applicant to buy insurance. |
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Term
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Definition
| An agreement between an insurer and insured in which both parties are expected to pay a certain portion of the potential loss and other expenses. |
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Term
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Definition
| A provision that states that the insurer and the insured will share the losses covered by the policy in a proportion agreed upon in advance. |
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Term
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Definition
| A practice in which a person in a fiduciary capacity illegally mixes his/her personal funds with funds he/she is holding in trust. |
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Term
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Definition
| The payment made by insurers to agents or brokers for the sale and service of policies. |
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Term
| Commissioner (Superintendent, Director) |
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Definition
| The chief executive and administrative officer of a state insurance department. |
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Term
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Definition
| A plan that provides a package of health care services, including preventive care, routine physicals, immunization, outpatient services and hospitalization. |
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Term
| Comprehensive Major Medical |
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Definition
| A combination of basic coverage and major medical coverage that features low deductibles, high maximum benefits, and coinsurance. |
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Term
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Definition
| the withholding of known facts which, if material, can void a contract. |
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Term
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Definition
| A type of an agreement in which both parties must perform certain duties and follow rules of conduct to make the contract enforceable. |
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Term
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Definition
| The binding force in a contract that requires something of value to be exchanged for the transfer of risk. The consideration on the part of the insured is the representations made in the application and the payment of premium; the consideration on the part of the insurer is the promise to pay in the event of loss. |
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Term
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Definition
| A part of the insurance contract that states that both parties must give something of value for the transfer of risk, and specifies the conditions of the exchange. |
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Term
| Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 |
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Definition
| The law that provides for the continuation of group health care benefits for the insured for up to 18 months if he/she terminates employment or is no longer eligible, and for the insured's dependents for up to 36 months in cases of loss of eligibility due to death of the insured, divorce, or attainment of the limiting age. |
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Term
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Definition
| Written and/or oral statements regarding a consumer's credit, character, reputation, or habits collected by a reporting agency from employment records, credit reports, and other public sources. |
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Term
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Definition
| An agreement between two or more parties enforceable by law. |
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Term
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Definition
| A group insurance plan that requires the employees to pay part of the premium. |
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Term
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Definition
| An entity that obtains and possesses a license solely for the purpose of writing business on the owner, immediate family, relatives, employer and employees. |
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Term
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Definition
| A policy that may be exchanged for another type of policy by contractual provision, at the option of the policyowner, and without evidence of insurability (i.e. term life changed to a form of permanent life). |
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Term
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Definition
| A provision that helps determine the primary provider in situations where an insured is covered by more than one policy, thus avoiding claims overpayments. |
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Term
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Definition
| An arrangement in which an insured must pay a specified amount for services "up front" and the provider pays the remainder of the cost. |
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Term
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Definition
| The act of signing an insurance policy by a licensed resident agent. |
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Term
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Definition
| The inclusion of causes of loss (perils) which are covered within a scope of a policy. |
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Term
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Definition
| A special type of coverage written to pay off the balance of a loan in the event of the death of the debtor. |
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Term
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Definition
| (The Commissioner's Standard Ordinary Table) A mortality table used in life insurance that mathematically predicts the likelihood of death. |
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Term
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Definition
| Care that is rendered to help an insured complete his/her activities of daily living. |
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