Term
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Definition
| The maximum amount an insurance company will pay if you file a claim. |
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Term
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Definition
| The amount of a loss you must pay out of your own pocket before the insurance company will step in and pay the rest. |
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Term
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Definition
| A way to guarantee your financial protection against various risks. |
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Term
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Definition
| A written contract detailing how much you will pay for insurance coverage and what an insurance company will cover and pay in the event of a loss. |
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Term
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Definition
| The amount you pay for an insurance policy. |
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Term
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Definition
| The probability that injury, damage, or loss will occur. |
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Term
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Definition
| The process of dealing with the chance of a potential personal or financial loss. |
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Term
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Definition
| An additional benefit in case of death as a result of an accident. |
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Term
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Definition
| The individual(s) named in the policy as the recipient(s) of the life insurance payment upon the insured's death. |
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Term
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Definition
| The cash available to the owner of a life insurance policy if the policy is surrendered or "cash in". |
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Term
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Definition
| Typically a fixed percentage of the health care costs that the insured has to pay. Usually applies after the insured meets the deductible. |
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Term
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Definition
| A flat fee charged for a specified health care service such as $10 for a doctor's visit. Usually in addition to any coinsurance and deductible payments. |
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Term
| Convertible Term Insurance |
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Definition
| Term insurance that can be converted to a whole life policy without evidence of insurability. |
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Term
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Definition
| A return of part of the premium by the insurer based on their investment, mortality and expense experience. |
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Term
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Definition
| An option for the insured to purchase additional insurance in the future without having to show evidence of insurability. |
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Term
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Definition
| A provision which will allow the insurance company to keep the insurance in effect without a premium payment. Typically available in the event of disability. |
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Term
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Definition
| The amount the policy-holder or his sponsor (e.g. an employer) pays to the health plan to purchase health coverage. |
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Term
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Definition
| Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs. |
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Term
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Definition
| Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and health insurance pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year. |
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Term
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Definition
| A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or co-payments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers. |
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Term
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Definition
| A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an authorization means that the insurer is obligated to pay for the service, assuming it matches what was authorized. Many smaller, routine services do not require authorization. |
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Term
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Definition
| A document that may be sent by an insurer to a patient explaining what was covered for a medical service, and how payment amount and patient responsibility amount were determined. |
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Term
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Definition
| where the patient pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan. |
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