Insurance Glossary of Terms used in Visitors Health Insurance, Visitors Medical Insurance, Travel Health Insurance, Travel Medical Insurance
A model of HMO and PPO organizations that uses the insured’s primary care physician (the gatekeeper) as the initial contact for the patient for medical care and for referrals.
Period of time after the premium due date in which premiums may still be paid, and the policy and its riders remain in force.
Group Disability Insurance:
A type of insurance that covers a group of individuals against loss of pay due to accident or sickness.
Group Health Insurance:
Health coverage provided to members of a group.
A circumstance that increases the likelihood of a loss.
The effect of a person’s reputation, character, living habits, etc. on his/her insurability.
The effect of a person’s indifference concerning loss has on the risk to be insured.
Hazardous sports coverage:
Coverage for injuries incurred during amateur athletic activities which are non-contract and engaged in by an insured person solely for leisure, recreation, entertainment or fitness purposes.However, activities not covered include amateur or professional sports or other athletic activity which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition. Usually, following hazardous activities can be included by optional sports rider at additional premium cost: scuba diving, mountain climbing(up to 4500 meters or where ropes or guides are normally used), jet, snow and water skiing and snowboarding, sky diving, amateur racing, piloting an aircraft, bungee jumping and spelunking.
A type of hazard that arises from the physical characteristics of an individual, such as a physical disability due to either current circumstance or a condition present at birth.
Protection against loss due to sickness or bodily injury.
Health Maintenance Organization (HMO):
A prepaid medical service plan in which specified medical service providers contract with the HMO to provide services. The focus of the HMO is preventive medicine.
Health Reimbursement Accounts (HRAs):
Plans that allow employers to set aside funds for reimbursing employees for qualified medical expenses.
Health Savings Accounts (HSAs):
Plans designed to help individuals save for qualified health expenses.
Home Health Care:
Type of care in which part-time nursing or home health aide services, speech therapy, physical or occupational therapy services are given in the home of the insured.
Home Health Services:
A covered expense under Part A of Medicare in which a licensed home health agency provides home health care to an insured.
A facility for the terminally ill that provides supportive care such as pain relief and symptom management to the patient and his/her family. Hospice care is covered under Part A of Medicare.
Hospital Confinement Rider:
An optional disability income rider that waives the elimination period when an insured is hospitalized as an inpatient.
Authority that is not expressed or written into the contract, but which the agent is assumed to have in order to transact the business of insurance for the principal.
Income Replacement Contracts:
Policies which replace a certain percentage of the insured’s pure loss of income due to a covered accident or sickness.
To restore the insured to the same condition as prior to loss with no intent of loss or gain.
An insurance policy (life, health, or disability) that provides coverage for an individual person (and, in some cases, his/her immediate family members), as opposed to a group policy that provides coverage for a group of individuals such as coverage through an employer.
The acceptability of an applicant who meets an insurance company’s underwriting requirements for insurace.
A contract whereby one party (insurer) agrees to indemnify or guarantee another party (insured) against a loss by a specified future contingency or peril in return for payment of a premium.
The person or organization that is protected by insurance; the party to be indemnified.
An entity that indemnifies against losses, provides benefits, or renders services (also known as “company” or “insurance company”).
A general statement that identifies the basic agreement between the insurance company and the insured, usually located on the first page of the policy.
Integrated LTC Rider:
A rider that is added to a life insurance policy to pay Long-Term Care benefits. The amount of benefits available for LTC depends upon the life insurance benefits available; however, the benefits paid toward LTC will reduce the life insurance policy’s benefits.
An act that is intended to cause injury. Self-inflicted injuries are not overed under accident insurance; intentional injuries inflicted on the insured by another are covered.
Organizations that process inpatient and outpatient claims on individuals by hospitals, skilled nursing facilities, home health agencies, hospices and certain other providers of health services.
A level of care that is one step down from skilled nursing care; provided under the supervision of physicians or registered nurses.
Investigative Consumer Report:
A report similar to consumer report, but one that also provides information on the customer’s character, reputation and habits.
Termination of the policy because the premium has not been paid by the end of the grace period.
Law of Large Numbers:
A principle stating that the larger the number of similar exposure units considered, the more closely the losses reported will equal the underlying probability of loss.
The accounting measurement of an insurer’s future obligations to pay claims to policy owners.
Health insurance policies that cover only specific accidents or diseases.
The maximum amount a physician may charge a Medicare beneficiary for a covered service if the physician does not accept assignment of the Medicare approved amount.
Organizations that provide support facilities for underwriters or groups of individuals that accept insurance risk.
Long-Term Care (LTC):
Health and social services provided under the supervision of physicians and medical health professionals for persons with chronic diseases or disabilities. Care is usually provided in a Long-Term Care Facility which is a state licensed facility that provides services.
Long-Term Disability Insurance:
A type of individual or group insurance that provides coverage for illness until the insured reaches age 65 and for life in the case of an accident.
The reduction, decrease, or disappearance of value of the person or property insured in a policy, by a peril insured against.
Loss of Income Insurance:
Insurance that pays benefits for inability to work because of disability resulting from accidental bodily injury or sickness.
This benefit will be paid in the event that the common carrier permanently looses an insured person’s checked luggage.This coverage is secondary to any other available coverage, including the carrier’s.
Major Medical Insurance:
A tpe of health insurance that usually carries a large deductible and pays covered expenses up to a high limit whether the insured is in or out of the hospital.
A medical benefits program jointly administered by the individual states and the federal government.
Medical Expense Insurance:
A type of insurance that pays benefits for medical, surgical, and hospital costs.
Medical Information Bureau (MIB):
An information database that stores the health histories of individuals who have applied for insurance in the past. Most insurance companies subscribe to this database for underwriting purposes.
Medical Savings Account:
An employer-funded account linked to a high deductible medical insurance plan.
The United States federal government plan for paying certain hospital and medical expenses for persons who qualify.
Medicare Supplement Insurance:
A type of individual or group insurance that fills the gaps in the protection provided by Medicare, but that cannot duplicate any Medicare benefits.
Medicare supplement plans issued by private insurance companies that are designed to fill some of the gaps in Medicare.
A false statement or lie tht can render the contract void.
The ratio of the incidence of sickness to the number of well persons in a given group of people over a given period of time.
The table showing the incidence of sickness at specified ages.
Multiple-Employer Welfare Association (MEWA):
Any entity of at least two employers, other than a duly admitted insurer, that establishes an employee benefit plan for the purpose of offering or providing accident and sickness or death benefits to the employees.
Insurance organizations that have no capital stock, but are owned by the policy holders.
Non-admitted or Non-authorized carrier is an insurance company that has not applied for, or has applied and been denied a Certificate of Authority and may not transact insurance in a particular state.
An insurance contract that the insured has a right to continue in force by payment of premiums that remain the same for a substantial period of time.
A life or health insurance policy that is underwritten based on the insured’s statement of health rather than a medical examination.
A termination of a policy by an insurer on the anniversary or renwwal date.
An agent licensed in a state in which he or she is not a resident.
Notice of claim:
A provision that spells out an insured’s duty to provide the insurer with reasonable notice in the event of a loss.
Omnibus Budget Reconciliation Act:
A federal law which extends the minimum COBRA continuation of group health care coverage from 18 to 29 months for qualified beneficiaries who are disabled at the time of qualification.
Operative treatment of the mouth such as extractions of teeth and related surgical treatment.
A special field in dentistry which involves treatment of natural teeth to prevent and/or correct dental anomalies with braces or appliances.
Amounts an insured must pay for coinsurance and deductibles before the insurer will pay its portion.
An excessive amount of insurance that would result in over payment to the insured in the event of a loss.
Out of pocket maximum:
Maximum amount of money that the insured must pay on his own before the insurance company will pay 100% for insured’s healthcare expenses.