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Insurance Terminology

Life Insurance Terminology
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Are you starting a new family?  Do you have a spouse or children who you want to provide for in life and in death? Owners Choice Benefits offers adult and children’s life insurance to help you protect your family’s future. Here is some of the basic terminology for life insurance:

  • InsuredThe person(s) covered by the insurance policy.

  • PremiumsThe monthly or annual amount that you must pay in order to have the insurance coverage.

  • Face AmountThe dollar amount that the insurance policy would pay out upon the death of the Insured.

  • Primary BeneficiaryThe person(s) designated to receive the proceeds of the life insurance policy upon the death of the Insured.

  • Contingent BeneficiaryThe person(s) designated to receive the proceeds of the life insurance policy if the Primary Beneficiary is no longer living.

  • Term Life CoverageThe type of coverage that lasts for only a specified period of time (the “term”) and has a defined ending date. The face amount would be paid to the designated beneficiary if the Insured dies while the policy is in force.

  • Whole Life CoverageThe type of coverage that can last for as long as the Insured is alive, provided that all of the premiums are paid. This type of coverage usually keeps the same premium rate throughout the life of the policy.

Health Insurance Terminology
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The Patient Protection and Affordable Care Act enables more Americans to have access to quality, affordable health insurance. The federally facilitated marketplaces are just one place where people can compare plans. Here is some of the basic terminology for health insurance:

  • InsuredThe person(s) covered by the insurance policy.

  • DeductibleThe annual amount of money that you must pay out of pocket for medical expenses before your insurance kicks in and starts to make payments.

  • PremiumsThe monthly or annual amount that you must pay in order to have the insurance coverage.

  • Co-paymentA flat fee that you must pay toward the cost of medical visits, your insurance provider pays the remaining balance. For example, you could be responsible for a $10 co-pay for each visit to the doctor.

  • CoinsuranceThe percentage that you must pay to share responsibility for your medical claims after you meet your annual deductible. For example, your insurance provider might pay 80% of your claim leaving you responsible for paying the remaining 20%.

Glossary
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Annualized Premium: The total amount of premiums paid within 12 policy months. For example, if the monthly premium is $10, the annualized premium is $120 ($10 x 12 months).

Assignment: The transfer of ownership rights in a life insurance policy or other type of contract from one party to another, or the document that causes the transfer of ownership rights to go into effect.

Beneficiary: an individual who may become eligible to receive payment due to will, life insurance policy, retirement plan, annuity, trust or other contract.

Benefits (medical and hospital expenses): total expenditures for health care services paid to or on behalf of a member.

Benefit Period: Number of days benefits are paid to you.

Cafeteria Plan/Flex Plan — Participating: A benefit plan maintained by an employer for its employees, under which all participants have the opportunity to select benefits that are suitable for their lifestyles, and for which premiums can be deducted from their paychecks on a pre-tax basis.

Cafeteria Plan/Flex Plan — Non-participating: A benefit plan maintained by an employer for its employees, under which all participants have the opportunity to select benefits that are suitable for their lifestyles, and for which premiums can be deducted from their paychecks on an after-tax basis.

Canceled: Policy terminated by request.

Claim: A request for benefit payment when you receive a service.

Claims History: History of claims previously processed.

Compliance (or Conformity With State and Federal Statutes): To abide by the statutory requirements established at the federal, state, and industry levels.

Continuous Coverage: Occurs when a person is deleted from a policy and issued a new policy under one of the following conditions: policy upgrade, divorce of a husband and wife who hold a family policy, dependent child has reached the age limit or marries, a husband and wife decide they want separate policies.

Conversion: The process of exchanging benefits for the purpose of increasing or decreasing coverage.

Coverage: the amount and type of benefits that are covered on your insurance policy.

Decline: An applicant is denied coverage with Aflac for specified reasons.

Denial: The process of reviewing a claim and deciding that, due to the terms of the policy contract, no benefits are due for the claim.

Dependent Children: Please see your policy for specific definition.

Direct Billing: A mode of premium payment in which policies are billed on an individual basis to the policyholder at home.

DOD: Date of death.

Downgrade: Change in coverage to a plan with lower premiums/benefits than that of the original plan.

Due Date: Date to which premiums have been paid.

Each Subsequent Year: Every 12-month period after the policy year.

Effective Date: The date your coverage begins that’s stated in your policy. This is NOT the day that you signed the application for the coverage.

Effective Date Family: Date family coverage was added to the policy.

Elimination Period: Please see your policy for a specific definition.

Employer Statement: Part of the Aflac claim form that is to be completed by the employer.

Endorsement: An endorsement adds or deletes a person or benefit to/from an existing policy. The endorsement is mailed to the policyholder to attach to the original policy.

Entire Contract Clause: A provision in an insurance contract stating that the entire agreement between the insured and the insurer is contained in the contract, including the application (if it is attached), declarations, insuring agreements, exclusions, conditions, and endorsements.

Evidence of Insurability: Health questionnaire used to verify if you’re healthy enough to be considered for a specific coverage.

Excessive Coverage: A policyholder is covered by two or more like policies which, when combined, provide more coverage than Aflac guidelines allow.

Exclusion: An exclusion refers to a person(s) or a condition(s) not covered by the policy due to policy provisions or underwriting requirements.

Face Amount: The amount of money stated on the policy, to be paid upon death or maturity.

First Policy Year: The period of time that begins on the effective date of coverage as shown in the Policy Schedule and ends 365 days from the effective date.

Flex One®: The trademarked name of Aflac's Section 125 Cafeteria Plan (see Cafeteria Plan above for more detail).

Grace Period: A period of time beyond the due date for premium payment (usually 31 days) during which time a policyholder may still remit the premium payment without losing coverage.

Group Number: An identification code assigned by Aflac for group billing.

Guaranteed-Issue: Insurance company won’t deny you. You can purchase coverage regardless of your health status – no underwriting questions.

Guaranteed Renewable: Your coverage is guaranteed as long as premiums are paid.

Hospital Confinement: A stay in a hospital bed for 23 hours or more (does not include emergency rooms).

Husband and Wife Only: Coverage for the insured and the spouse only.

Immediate Family: Anyone related to the insured in the following manner: spouse, brother, or sister (includes stepbrother and stepsister); children (includes stepchildren); parents (includes step-parents); grandchildren; father- or mother-in-law; and spouses of any of these, as applicable.

Inactive: Term used to describe a policy that is lapsed, terminated, or canceled.

Indemnity: Term used to describe a benefit that pays a specific dollar amount rather than the actual charges or a percentage of the charges.

Individual: Coverage for only the insured person listed in the Policy Schedule.

Initial Start Date: The actual date the account was established.

Insured: Party(ies) covered by an insurance policy.

Insurer: The party to an insurance arrangement who undertakes payment for losses, provides benefits, or renders services.

 

Issue Date: The effective date of the policy.

 

Issue State: State in which the policy was issued.

 

L&E's: Limitations and exclusions regarding policy provisions and benefits.

 

Lapse: Termination of a policy due to failure to pay the required renewal premium.

 

Limits: Maximum value to be derived from a policy.

 

Line of Business: Refers to various types of policies sold by Aflac (for example, cancer, intensive care, accident).

 

Lump Sum Benefit: One-time benefit payment from insurance company.

 

Minimum Salary Requirements: Salary required to qualify for the total amount of coverage provided by the policy.

 

Occurrence Date: Initial date of loss for a specified claim.

 

One-Parent Family: Please see your policy for a specific definition.

 

Original Effective Date: The effective date of the policy as stated in the Policy Schedule.

 

Out-of-pocket expenses: Expenses not covered by insurance that are your responsibility.

 

Paid-to Date: The day, month, and year through which a policy is paid.

 

Participating Employee: Status of an employee who chooses to participate in an account's Section 125 Cafeteria Plan.

Pending: A claim that cannot be processed completely until additional information requested by the claims specialist is received.

 

Physician Statement: The part of the claim form that is to be completed by the physician.

Plan Effective Date: Beginning date of coverage for a current plan.

Plan Code: Six-digit code used to identify the type of policy payable under the plan.

Policy: A written contract ratifying the legality of an insurance agreement.

Policy Period: Time period during which insurance coverage is in effect.

Policyholder: Person listed as the owner of the policy and who is responsible for premium payment.

Portable: If you change jobs or retire, you can still keep your benefits.

Premium: The monthly amount an individual pays for coverage.

Pre-existing Condition: An illness, disease, infection, disorder or injury that occurred within 12 months of the start date of your coverage.

 

Pre-tax: Premiums that are deducted from the employee's paycheck before taxes are calculated and deducted.

 

Primary Policyholder: The person to whom the policy was issued.

 

Proof of Loss: Written proof that is required to be furnished to the insurer about a loss to help determine the extent of insurer liability.

 

Provider: A facility, licensed as such, that provides health services for an individual.

 

Reinstatement: The act of putting a lapsed policy back in force.

 

Reinstatement Date: Date the lapsed or terminated policy was put back in force.

 

Replacement Policy: A policy that has replaced a similar product from another company.

 

Rider: A product add-on.

 

Supplemental Insurance: Insurance policies designed to supplement other basic coverage.

 

Term: Period of time the policy is in force with effect.

 

Term Insurance: Life insurance payable only if death of insured occurs within a specified time, such as five or 10 years, or before a specified age.

 

Terminated: A term used to describe a policy or account that is no longer active.

Termination Date: The actual date the coverage ceased.

Transit One®: Name of Aflac's Section 132 transportation expense program.

Two-Parent Family: Please see your policy for a specific definition.

Underwriting: Process of assessing your medical risk.

Unearned Premium: The portion of the written premium that can be applied to the unexpired or unused part of the period for which the premium has been paid or refunded to the insured. For example, in the case of an annual premium, at the end of the first month of the premium period, 11/12 of the premium is unearned.

Waiting Period: Please see your policy for a specific definition.

Waiver of Premium: The provision of the policy that relieves payment responsibility for the policyholder as defined in the policy.

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