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USEFUL INSURANCE TERMS:
'G'
General Agency System: Type of life insurance marketing system in which the general agent is an independent businessperson who represents only one insurer, is in charge of a territory, and is responsible for hiring, training, and motivating new agents.
General Average: In ocean marine insurance, a loss incurred for the common good that is shared by all parties to the venture.
General Damages: Damages awarded to an injured person for intangible loss which cannot be measured directly by dollars. Popularly known as "pain and suffering." General damages are distinguished from special damages which are awarded for actual economic loss, such as medical costs, loss of income, etc.
General Liability Insurance: Coverage that pertains, for the most part, to claims arising out of the insured's liability for injuries or damage caused by ownership of property, manufacturing operations, contracting operations, sale or distribution of products, and the operation of machinery, as well as professional services.
Generally Accepted Accounting Principles (GAAP): Principles of accounting and reporting business results developed by the American Institute of Public Accountants.
Generation skipping tax: a transfer tax imposed on gift or inheritance to those at least two generations younger than the person making the transfer
Glass Insurance: Protection for loss of or damage to glass and its appurtenances.
Good Student Discount: Reduction of automobile premium for a young driver at least sixteen who ranks in the upper 20 percent of his or her class, has a B or 3.0 average, or is on the Dean's list or honor roll. It is based on the premise that good students are better drivers.
Grace Period: A specified period after a premium payment is due, in which the policyholder may make such payment, and during which the protection of the policy continues.
Graded Commission Scale: A commission scale providing for payment of a high first-year commission and lower renewal commissions.
Gross estate: All of the assets and liabilities owned at death.
Gross Negligence: the intentional failure to perform a manifest duty in reckless disregard of the consequences as affecting the life or property of another
Gross Premium: The premium paid by the policyholder.
Gross Rate: The sum of the pure premium and a loading element.
Group Annuity: A pension plan providing annuities at retirement to a group of people under a master contract. It is usually issued to an employer for the benefit of employees. The individual members of the group hold certificates as evidence of their annuities.
Group Annuity Contract: A contract issued by a life insurance company that may be used as the funding instrument for benefits to be made in accordance with a pension plan. A single master contract provides that the group of persons participating in the plan will receive annuities during retirement. Individual certificates stating coverage may be issued to members of the group.
Group Contract: A contract of insurance made with an employer or other entity that covers a group of persons identified as individuals by reference to their relationship to the entity.
Group Creditor Life Insurance: Life insurance provided to debtors by a lending institution to provide for the cancellation of any outstanding debt should the borrower die. Normally term insurance limited to the amount of the loan.
Group Insurance: Insurance written on a number of people under a single master policy, issued to their employer or to an association with which they are affiliated.
Group Life Insurance: Life insurance usually without medical examination, on a group of people under a master policy. It is typically issued to an employer for the benefit of employees, or to members of an association, for example a professional membership group. The individual members of the group hold certificates as evidence of their insurance.
Group Major Medical Plan: See Supplementary Major medical Insurance.
Group Ordinary Life Insurance: Group insurance plan providing life insurance for employees. Traditional whole life policy is split into decreasing insurance protection and increasing cash values.
Group Paid-Up Life Insurance: Accumulating units of single premium whole life insurance and decreasing term insurance, which together equal the face amount of the policy. Provided through a group life insurance plan.
Group Permanent Plan: Type of pension plan in which cash value life insurance is issued on a group basis and cash values in each policy are used to pay retirement benefits when a worker retires.
Group Survivor Income Benefit Insurance (SIBI): See Survivor Income Benefit Insurance.
Group Term Life Insurance: Most common form of group life insurance. Yearly renewable term insurance on employees during their working careers.
Group Universal Life Products (GULP): Universal life insurance plans sold to members of a group, such as individual employees of an employer. There are some differences between GULP plans and individual universal life plans; for instance, GULP expense charges generally are lower than those assessed against individual policies.
Guaranteed Insurability Option: (see "Future Increase Option")
Guaranteed Investment Contract: An investment contract with an insurer in which the insurer guarantees both principal and interest on a pension contribution.
Guaranteed Purchase Option: Benefit that can be added to a life insurance policy permitting the issured to purchase additional amounts of life insurance at specified times in the future without requiring evidence of insurability.
Guaranteed Renewable: A contract that the insured has the right to continue in force by the timely payment of premiums (1) until at least age 50 or (2) in the case of a policy issued after age 44 for at least five years from its date of issue, during which period the insurer has no right to make unilaterally any change in any provision of the contract while the contract is in force, except that the insurer may make changes in premium rate by classes.
Guaranteed Renewable Contract: A contract that the insured person or entity has the right to continue in force by the timely payment of premiums for a substantial period of time, during which period the insurer has no right to make unilaterally any change in any provision of the contract, while the contract is in force, other than a change in the premium rate for classes of policyholders.
Guaranteed Renewable Contract: A health policy which the company guarantees to renew for life or until the insured reaches a specified age, usually 65.
Guaranty Fund: A fund, derived from assessments against solvent insurance companies, to absorb losses of claimants against insolvent insurance companies.
'H'
Hard Market: That part of the insurance sales cycle in which competitive pricing is at a minimum as companies charge the premiums necessary to meet their underwriting losses in order to avoid insolvency and boost capacity; usually associated with a sharp decline in capacity (see "Soft market").
Hazard: Condition that creates or increases the chance of loss.
Health Insurance: Insurance against financial losses resulting from sickness or accidental bodily injury.
Health Insurance: Protection which provide payment of benefits for covered sickness or injury. Included under this heading are various types of insurance such as accident insurance, disability income insurance, medical expense insurance, and accidental death and dismemberment insurance.
Health Insurance: Insurance providing for the payment of benefits as a result of sickness or injury. Includes various types of insurance such as accident insurance, disability income insurance, medical expense insurance, accidental death insurance, and dismemberment insurance.
Health Maintenance Organization (HMO): An organization that provides a wide range of comprehensive health care services for a specified group at a fixed periodic payment. The HMO can be sponsored by the government, medical schools, hospitals, employers, labor unions, consumer groups, insurance companies, and hospital-medical plans.
Hedging: Technique for transferring the risk of unfavorable price fluctuations to a speculator by purchasing and selling options and futures contracts on an organized exchange.
High-Risk Automobile Insurer: Company that specializes in insuring motorists who have poor driving records or have been canceled or refused insurance.
Hold-Harmless Clause: Clause written into a contract by which one party agrees to release another party from all legal liability, such as a retailer who agrees to release the manufacturer from legal liability if the product injures someone.
Homeowners Policy: A package of insurance providing home owners with a broad range of property and liability coverages.
Home Service Life Insurance: Industrial life insurance and monthly debit ordinary life insurance contracts that are serviced by agents who call on the policyowners at their homes to collect the premiums. The amount of life insurance per policy generally is larger than .
Hospice: Health care facility providing medical care and support services such as counseling to terminally ill persons.
Hospital Admissions Program: An arrangement to facilitate admission of persons covered by health insurance to hospitals and to assure the prompt payment of applicable insurance benefits to hospitals.
Hospital Expense Insurance: Health insurance protection against the cost of hospital care resulting from the illness or injury of the insured person.
Hospital Expense Insurance: A form of health insurance that provides specific benefits for daily hospital room and board and hospital services during hospital confinement. Generally the policy also provides benefits for surgical operations and for in- hospital doctor's visits, in which case the policy is referred to as a hospital and Surgical Expense Policy.
Hospital Indemnity: A form of health insurance which provides a stipulated daily, weekly, or monthly indemnity during hospital confinement. The indemnity is payable on an unallocated basis without regard to the actual expense of hospital confinement.
Hospital Medical Insurance: A term used to indicate protection which provides benefits for the cost of any or all of the numerous health care services normally covered under various health care plans.
Hospital Miscellaneous Services: Services other than room and board and general nursing services provided by a hospital during hospital confinement. Included are such items as x- ray examinations, laboratory tests, medicines, surgical dressings, anesthetics (including the administration thereof), and use of operating room.
Hull Insurance: (1) Class of ocean marine insurance that covers prysical damage to the ship or vessel insured. Typically written on an "all-risks" basis. (2) Physical damage insurance on aircraft- similar to collision insurance in an automobile policy.
Human Life Value: For purposes of life insurance, the present value of the family's share of the deceased breadwinner's future earnings.
Hurricane: A tropical storm marked by extremely low barometric pressure and circular winds with a velocity of 75 miles an hour or more.
'I'
Immediate Annuity: An annuity providing for payment to begin immediately.
Immediate Participation Guarantee Plan: (IPG) Type of pension plan in which all pension contributions are deposited in an unallocated fund and used directly to pay benefits to retirees.
Imputed Negligence: Case in which responsibility for damage can be transfered from the negligent party to another person, such as an employer.
Incontestability: Life policies provide that, except for non-payment of premiums and certain other circumstances, the policy shall be incontestable after the policy has been in force for two years during the lifetime of the insured.
Incontestable Clause: An optional clause which may be used in noncancelable or guaranteed renewable health insurance contracts providing that the insurer may not contest the validity of the contract after it has been in force for two (sometimes three) years.
Incurred Claims: Incurred claims equal the claims paid during the policy year plus the claim reserves as of the end of the policy year, minus the corresponding reserves as of the beginning of the policy year. The difference between the year end and beginning of the year claim reserves is called the increase in reserves and may be added directly to the paid claims to produce the incurred claims.
Incurred-but-not-reported (IBNR) reserves: liability account on an insurer's balance sheet reflecting claims that are expected based upon statistical projections but which have not yet been reported to the insurer
Indemnification: Compensation to the victim of a loss, in whole or in part, by payment, repair, or replacement.
Indemnity: Legal principle that specifies an insured should not collect more than the actual cash value of a loss but should be restored to approximately the same financial position as existed before the loss. Independent Adjustor: Claims adjustor who offers his or her services to insurance companies and is compensated by a fee.
Independent Agent: an independent business person who usually represents two or more insurance companies in a sales and service capacity and who is paid on a commission basis.
Independent Agency System: Type of property and liability insurance marketing system, sometimes called the American agency system, in which the agent is an independent businessperson representing several companies. The agency owns the expirations or renewal rights to the business, and the agent is copensated by commissions that vary by line of insurance.
Indeterminate Premium Whole Life Insurance: Nonparticipating whole life policy that permits the insurer to adjust premiums based on anticipated future experience. Initial premiums are guaranteed for a certain preriod. After the initial guaranteed period expires, the insurer can increase premiums up to some maximum limit.
Indexing: Adjusting of values over time to reflect the impact of inflation.
Indirect Loss: See Consequential Loss.
Individual Contract: A contract of health insurance made with an individual called the policy holder or the insured, which normally covers such individual and, in certain instances, members of his family.
Individual Deductible: Amount that an insured and each person of his or her family covered by the policy must pay before the group or individual medical insurance policy begins to pay for medical expenses.
Individual Insurance: Policies which provide protection to the policyholder and/or his/her family. Sometimes called Personal Insurance as distinct from group and blanket insurance.
Individual Policy Pension Trust: A type of pension plan, frequently used for small groups, administered by trustees who are authorized to purchase individual level premium policies or annuity contracts for each member of the plan. The polices usually provide both life insurance and retirement benefits.
Individual Retirement Account (IRA): An account to which an individual can make save for retirement on a tax-favored basis. Contributions to a standard IRA are tax deductible for many workers; contributions to a Roth IRA are made with after-tax dollars but can be withdrawn tax-free at retirement.
Industrial Life Insurance: Life insurance issued in small amounts, usually less than $1,000, with premiums payable on a weekly or monthly basis. The premiums are generally collected at the home by an agent of the company. Sometimes referred to as debit insurance.
Industrial Life Insurance: A class of life insurance that is usually issued with protection amount of less than $1,000 and premiums usually payable weekly or at most, monthly.
Inflation-Guard Endorsement: Endorsement added at the insured's request to a homeowners policy to increase periodically the face amount of insurance of the dwelling and other policy coverages by a specified percentage.
Inherent vice: a defect or cause of loss arising out of the nature of the goods in question
Inheritance tax: A tax on the right of an heir to receive property at the death of another.
Initial Past Service Liability: The actuarial value (single sum) of the past service benefits as of the effective date of the establishment of the plan, or at the date of the latest liberalization. The maximum annual past service contribution allowable for tax deduction is the amount necessary to amortize past service liabilities and other supplementary pension or annuity credits over 10 years. Funding of the past service liability over a period of 30 years (40 in some cases) is required by the Internal Revenue Service under ERISA.
Initial Reserve: In life insurance, the reserve at the beginning of any policy year.
Injury Independent of All Other Means: An injury resulting from an accident, provided that the accident was not caused by an illness.
Inland Marine Insurance: A broad form of insurance, generally covering articles in transit as well as bridges, tunnels and other means of transportation and communication. Besides goods in transit (generally excepting trans-ocean), it includes numerous "floater" policies, such as those covering personal effects, personal property, jewelry, furs, fine arts, and other items.
Inland Marine Insurance: A broad type of insurance, generally covering articles that may be transported from one place to another as well as bridges, tunnels and other instrumentalities of transportation. It includes goods in transit (generally excepting trans-ocean) as well as numerous "floater" polices such as personal effects, personal property, jewelry, furs, fine art and others.
Inspection Report: A report (usually written) of an investigation of an applicant, conducted by an independent agency that specializes in insurance investigations. The report covers such matters as occupation, financial status, health history, and moral problems.
Insolvent: Having insufficient financial resources (assets) to meet financial obligations (liabilities).
Insurability: Acceptability to the company of an applicant for insurance.
Insurable Risk: The conditions that make a risk insurable are (a) the peril insured against must produce a definite loss not under the control of the insured, (b) there must be a large number of homogeneous exposures subject to the same perils, (c) the loss must be calculable and the cost of insuring it must be economically feasible, (d) the peril must be unlikely to affect all insureds simultaneously, and (e) the loss produced by a risk must be definite and have a potential to be financially serious.
Insurance: A system under which individuals, businesses, and other organizations or entities, in exchange for payment of a sum of money (a premium), are guaranteed compensation for losses resulting from certain perils under specified conditions.
Insurance: Protection by written contract against the financial hazards (in whole or in part) of the happenings of specified fortuitous events.
Insurance Company: An organization chartered to operate as an insurer.
Insurance Company: Any corporation primarily engaged in the business of furnishing insurance protection to the public.
Insurance Commissioner: The top insurance regulatory official in a state.
Insurance Exchange: Term used to describe a facility that exists in a few states to provide a market for reinsurance and for the insurance of large and unusual domistic and foreign risks that are difficult ot insure in the normal markets. Examples are the New York Insurance Exchange, the Insurance Exchange of the Americas, and the Illinois Inurance Exchange.
Insurance Examiner: The representative of a state insurance department assigned to participate in the official audit and examination of the affairs of an insurance company.
Insurance Guaranty Funds: State Funds that provide for the payment of unpaid claims of insolvent insurers.
Insurance Services Offices (ISO): Major rating organization in property and liability insurance that drafts policy forms for personal and commercial lines of insurance and provides rate data on loss costs for property and liability insurance lines.
Insured: A person or organization covered by an insurance policy, including the "named insured" and any other parties for whom protection is provided under the policy terms.
Insured or Insured Life: The person on whose life the policy is issued.
Insurer: The party to the insurance contract who promises to pay losses or benefits. Also, any corporation engaged primarily in the business of furnishing insurance to the public.
Insuring Agreement: That part of an insurance contract that states the promises of the insurer.
Insuring Clause: The clause which sets forth the type of loss being covered by the policy and the parties to the insurance contract.
Integration: A coordination of pension, disability or other benefit with the other sources of income, such as Social Security benefit, through a specific formula designed to ensure reasonable income replacement.. Qualified plans must integrate so that total benefits are non-discriminatory between rank and file employees and owners, officers or highly compensated employees.
Inter vivos Trust: A trust created while the creator of the trust is living. Also known as a living trust.
Interest: Money paid for the use of money.
Interest-Adjusted Method: Method of determining cost to an insured of a life insurance policy that considers the time cost of money by applying an interest factor to each element of cost. See Also Net payment cost index; surrender cost index.
Interest Option: Life insurance settlement option in which the principal is retained by teh insurer and interest is paid periodically.
Intestate: Without a will.
Investment Income: The income generated by a company's portfolio of investments (such as in bonds, stocks, or other financial ventures).
Investment Income: The portion of a company's income which is derived from its investments, including interest and dividends on stocks and bonds.
Investment Only Contract: Type of funding instrument that uses only the investment services of an insurer.
Involuntary Costs: insurance company costs incurred as a result of participating in insurance pools (e.g., workers compensation). Insurance companies must participate in these pools as a condition of doing business.
IPG Plan: See Immediate Participation Guarantee Plan.
IRA: See Individual Retirement Account.
Irrevocable Beneficiary: Beneficiary designation allowing no change to be made in the beneficiary of an insurance policy without the beneficiary's consent.
Irrevocable Trust: A trust in which the creator does not reserve the right to reacquire the trust property.
ISO: See Insurance Services Office.
'J'
Joint-and-Several Liability: A legal principle that permits the injured party in a tort action to recover the entire amount of compensation due for injuries from any tort feasor who is able to pay, regardless of the degree of that party's negligence.
Joint-and-Survivor Annuity: A contract that provides income periodically, payable during the longer lifetime of two persons. The amount payable may decrease at the death of one or the other. (See Contingent Annuity Option)
Joint Tenants: A form of joint property ownership with right of survivorship, i.e., in which the survivors automatically own the share of a deceased co-owner.
Joint Underwriting Association: One of several types of "shared market" mechanisms used to make automobile insurance available to persons who are unable to obtain such insurance in the regular market. JUAs also have been created in some states to help alleviate availability problems in the fields of medical malpractice and commercial insurance.
Joint Underwriting Association: A device used to provide insurance to those who cannot obtain insurance in the voluntary market. Certain companies (called carriers) issue policies at one rate level and handle claims, but the ultimate costs are borne by all companies writing insurance in that state.
Judgment Rating: Rate-making method for which each exposure is individually evaluated and the rate is determined largely by the underwriter's judgment.
Judicial Bond: Type of surety bond used for court proceedings and guaranteeing that the party bonded willl fulfill certain obligations specified by law, for example, fiduciary responsibilities.
Jumbo Risk: A risk involving exceptionally high benefits.
Jumping Juvenile Insurance Policy : Life insurance purchased by parents for children under a specified age. Provides permanent life insurance that increases in face value five times at age twenty-one with no increase in premium.
'K'
Kenney Rule: Concept permitting a property liability insurer to write of new net premiums for each $1 of policyowners' surplus.
Keogh (HR 10) Account: An account to which a self-employed person can make annual tax deductible contribution of the lesser of 25% of income or ,000.
Key-Person Insurance: Insurance designed to protect a business firm against the loss of income resulting from the death or disability of a key employee.
'L'
Labor-Management Relations Act of 1947 (Taft-Hartley Act): This law controls conditions under which an employer may pay any money to a representative of employees.
Lapse: The termination or discontinuance of an insurance policy due to non-payment of a premium.
Lapsed Policy: A policy terminated for non-payment of premiums. The term is sometimes limited to a termination occurring before the policy has a cash or other surrender value.
Larceny-theft: The unlawful taking, carrying, leading or riding away of another person's property.
Last Clear Chance Rule: Statutory modification of the contributory negligence law allowing the claimant endangered by his or her own negligence to recover damages from a defendant if the defendant has a last clear chance to avoid the accident but fails to do so.
Law of Large Numbers: Concept that the greater the number of exposures, the more closely will actual results approach the probable results expected from an infinite number of exposures.
Legal Reserve: The minimum reserve which a company must keep to meet future claims and obligations as they are calculated under the state insurance code.
Legal Reserve Life Insurance Company: A life insurance company operating under state insurance laws specifying the minimum basis for the reserves the company must maintain on its policies.
Level Commission Scale: A commission scale providing for payment of commissions at the same rate every year the policy is in force.
Level Premium: A premium which remains unchanged throughout the life of a policy.
Level Premium Life Insurance: Life insurance for which the premium remains the same from year to year. The premium is more than the actual cost of protection during the earlier years of the policy and less than the actual cost in the later years. The building of a reserve is a natural result of level premiums. The overpayments in the early years, together with the interest that is to a earned, serve to balance out the underpayments of the later years.
Liability: Any legally enforceable obligation.
Liability Insurance: Insurance covering the policyholder's legal liability resulting from injuries to other persons or damage to their property.
Liability Insurance: Provides protection for the insured against loss arising out of legal liability to third parties.
Liability Limits: The stipulated sum or sums beyond which an insurance company is not liable to protect the insured.
Liability Without Fault: Principle on which workers compensation is based, holding the employer absolutely liable for occupational injuries or disease suffered by workers, regardless of who is at fault.
License and Permit Bond: Type of surety bond guaranteeing that the person bonded will comply with all laws and regulations that govern his or her activities.
Life Annuity: A series of payments under which payments, once begun, continue throughout the remaining lifetime of the annuitant but not beyond.
Life Annuity: A contract that provides an income for life.
Life Annuity With 10 Years Certain: An annuity which pays an income to the annuitant for as long as he or she lives, but if death occurs within 10 years after the annuity payments begin, payments are continued to a named beneficiary for the remainder of the 10 years.
Life Expectancy: The average number of years of life remaining for a group of persons of a given age according to a particular mortality table.
Life Income Option: Life insurance settlement option in which the policy proceeds are paid during the lifetime of the beneficiary. A certain number of guaranteed payments may also be payable.
Life Insurance: Insurance providing for payment of a specified amount on the insured's death, either to his or her estate or to a designated beneficiary; or in the case of an endowment policy, to the policy holder at a specified date.
Life Insurance in Force: The sum of the face amounts, plus dividend additions, of life insurance polices outstanding at a given time. Additional amounts payable under accidental death or other special provisions are not included.
Life Insurance Programming: Systematic method of determining the insured's financial goals, which are translated into specific amounts of life insurance, then periodically reviewed for possible changes.
Lifetime Disability Benefit: A benefit to help replace income lost by an insured person as long as he/she is totally disabled, even for a lifetime.
Lifetime Disability Benefit: Disability income payable for the life of the insured as long as he is totally disabled.
Limited Payment Life Insurance: Whole life insurance on which premiums are payable for a specified number of years or until death if death occurs before the end of the specified period.
Limited Policy: A contract which covers only certain specified diseases or accidents.
Limited Policy: One that covers only specified accidents or sicknesses.
Liquidation: Dissolving a company by selling its assets for cash.
Liquor Liability Law: See Dramshop Law.
Living Benefits Rider: A rider that allows insureds who are terminally ill or who suffer from certain catastrophic diseases to collect part of their life insurance benefits before they die, primarily to pay for the care they require.
Living Trust: A trust created while the creator of the trust is living. Also known as an inter vivos trust.
LLoyd's of London: insurance marketplace where brokers, representing clients with insurable risks, deal with Lloyd's underwriters, who in turn represent investors. The investors are grouped together into syndicates that provide capital to insure the risks.
Loading: The amount that must be added to the pure premium for expenses, profit, and a margin for contingencies. See Expense Loading
Long-Term Care: The continuum of broad-ranged maintenance and health services to the chronically ill, disabled, or retarded. Services may be provided on an inpatient (rehabilitation facility, nursing home, mental hospital), outpatient, or at-home basis.
Long-Term Disability Income Insurance: Insurance issued to an employer (group) or individual to provide a reasonable replacement of a portion of an employee's earned income lost through serious and prolonged illness or injury during the normal work career. (See also Integration.)
Loss: The happening of the event for which insurance pays.
Loss Adjustment Expense: expenses incurred in the process of evaluating, defending and paying claims.
Loss Avoidance: A risk management technique whereby a situation or activity that may result in a loss for a firm is avoided or abandoned.
Loss control: any conscious action (or decision not to act) intended to reduce the frequency, severity, or unpredictability of accidental losses.
Loss Expense - Allocated: Handling expenses, such as legal or independent adjuster fees, paid by an insurance company in settling a claim which can be definitely charged to that particular claim.
Loss Expense - Unallocated: Salaries and other expenses incurred in connection with the operation of a claim department of an insurance carrier which cannot be charged to individual claims.
Loss of use: value assigned to not having damaged property available, e.g., the cost of renting a replacement vehicle while one's car is being repaired
Loss Payable Clause: Means of protecting a mortgagee's interest in property by directing the insurer to make a loss payment to the mortgagee in the event of a loss.
Loss Prevention: Any measure which reduces the probability or frequency of a particular loss but does not eliminate completely all possibility of that loss
Loss Ratio: A ratio calculated by divinding claims into premiums. It may be calculated in several different ways, using paid premiums or earned premiums, and using paid claims with or without changes in claim reserves and with or without changes in active reserves.
Loss Reserve: The amount set up as the estimated cost of a claim. (See IBNR Reserve)
Loss Reserve Development: how the latest estimate of an insurance company's claim obligations compares to an earlier projection.
Lump-Sum Distribution: Payment within one taxable year of the entire balance payable to an employee from a trust which forms part of a qualified pension or employee annuity plan on account of that person's death, separation from service or attainment of age 59.
'M'
Mail Order Insurer: Type of insurance company that sells policies through the mail or other mass media, eliminating need for agents.
Major Medical Expense Insurance: A form of health insurance that provides benefits for most types of medical expense up to a high maximum benefit, such as ,000 or higher after a substantial deductible, such as or more. Such contracts may contain internal limits and are normally subject to coinsurance.
Major Medical Insurance: Health insurance to finance the expense of major illness and injury. Characterized by large benefit maximums ranging up to ,000 or no limit, the insurance, above an initial deductible, reimburses the major part of all charges for hospital, doctor, private nurses, medical appliances, prescribed out-of-hospital treatment, drugs, and medicines. The insured person as coinsurer pays the remainder.
Malingering: The practice of feigning illness or inability to work in order to collect insurance benefits.
Malpractice: Improper care or treatment by a physician, hospital, or other provider of health care.
Malpractice Insurance: Coverage for a professional practitioner, such as a doctor or a lawyer, against liability claims resulting from alleged malpractice in the performance of professional services.
Managed Care: Health care systems that integrate the financing and delivery of appropriate health care services to covered individuals by arrangements with selected providers to furnish a comprehensive set of health care services, explicit standards for selection of health care providers, formal programs for ongoing quality assurance and utilization review, and significant financial incentives for members to use providers and procedures associated with the plan.
Manual Rate: The premium rate developed for a group insurance coverage from the company's standard rate tables normally referred to as its rate manual or underwriting manual.
Manuscript Policy: Policy designed for a firm's specific needs and requirements.
Marine Insurance: A form of insurance primarily concerned with means of transportation and communication, and with goods in transit (see "Inland Marine Insurance" and "Ocean Marine Insurance").
Marital deduction: A reduction of an estate for estate tax purposes, which is available if the decedent is survived by his or her spouse, can be as large as the administrator or executor elects so long as it does not exceed the value of qualifying property passing to the surviving spouse.
Market Price (or Market Value): The price at which a security can be bought or sold at any particular time.
Mass Merchandising: Plan for insuring individual members of a group, such as employees of firms or members of labor unions, under a single program of insurance at reduced premiums. Property and liability insurance is sold to individual members using group insurance marketing methods.
Master Policy: A policy that is issued to an employer or trustee, establishing a group insurance plan for designated members of an eligible group.
Master Policy (or Master Contract): The policy issued to a group policyholder setting forth the provisions of the group insurance plan. The individuals insure under the policy are then issued certificates of insurance.
Material Damage: Insurance against damage to a vehicle itself. It includes automobile comprehensive, collision, fire and theft. Material damage and physical damage are terms that often are used inter- changeably.
Maximum family benefit: The largest amount in Social Security benefits that will be paid to any family unit.
McCarran-Ferguson Act: Federal law passed in 1945 stating that continued regulation of the insurance industry by the states is in the public interest and that federal antitrust laws apply to insurance only to the extent that the industry is not regulated by state law.
Medicaid: State programs of public assistance to persons whose income and resources are insufficient to pay for health care. Title XIX of the federal Social Security Act provides matching federal funds for financing state Medicaid programs, effective January 1, 1966.
Medical Examination: The examination given by a qualified physician to determine to the insurability of an applicant. A medical examination may also be used to determine whether an insured claiming disability is actually disabled.
Medical Expense Insurance: A form of health insurance that provides benefits for expenses incurred for medical care. This form of health insurance provides benefits for expenses of physicians, hospital, nursing, and related health services, and supplies. These benefits may be related to actual expense, specified sums, or services rendered. Such insurance sometimes includes benefits for prevention and diagnosis as well as treatment.
Medical malpractice: Improper care or treatment by a physician, hospital, or other provider of health care.
Medical Payments Insurance: A coverage, available in various liability insurance policies, in which their insurer agrees to reimburse the insured and others, without regard for the insured's liability, for medical or funeral expenses incurred as the result of bodily injury or death by accident under specified conditions.
Medicare: A program of Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) protection provided under the Social Security Act.
Medigap: A term sometimes applied to private insurance products that supplement Medicare insurance benefits.
Minimum Benefits: A provision that a minimum amount of annuity will be paid if the regular benefit formula produces less. This minimum is usually payable only if certain service requirements are met at retirement.
Minimum Group: The least number of employees permitted under a state law to effect a group for insurance purposes; the purpose is to maintain some sort of proper division between individual policy insurance and the group forms.
Minimum Premium Plan (MPP): An arrangement under which an insurance carrier will, for a fee, handle the administration of claims and insure against large claims for a self- insured group.
Miscellaneous Expenses: Expenses in connection with hospital insurance, hospital charges other than room and board, such as X-rays, drugs, laboratory fees, and other ancillary charges. (Sometimes referred to as ancillary charges.)
Miscellaneous Hospital Expense Benefit: A provision in a hospital expense policy providing for the payment of a benefit for expenses for necessary hospital services and supplies during a period of hospital confinement. Expenses commonly covered under this benefit include those for x-ray examinations, laboratory tests, medicines, surgical dressings, anesthetics (including administration thereof), and use of operating room.
Misrepresentation: A false, incorrect, improper, or incomplete statement of a material fact, made in the application for a policy.
Mode of Premium Payment: The frequency with which premiums are paid monthly, quarterly, semiannually, or annually.
Money purchase plan: a pension plan design in which a plan sponsor obligation is defined in terms of the contribution it makes on behalf of the employee
Moral Hazard: Hazard arising from any nonphysical, personal characteristic of a risk that increases the possibility of loss or may intensify the severity of loss for instance, bad habits, low integrity, poor financial standing.
Morbidity: The incidence and severity of sicknesses and accidents in a well-defined class or classes or persons.
Morbidity Tables: Actuarial statistics showing the frequency and duration of disability.
Mortality Table: A table showing how many members of a group, starting at a certain age, will be alive at each succeeding age. It is used to calculate the probability of dying in, or surviving through, any period, and for the valuation of an annuity. To be appropriate for a specific group, it should be based on the experience of individuals having common characteristics, such as sex or occupation.
Mortality Table: A statistical table showing the death rate at each age, usually expressed as so many per thousand.
Multi-Employer Plan: A plan maintained according to a collective bargaining agreement, to which more than one employer contributes. Under ERISA, at the beginning of the plan, no single employer may contribute as much as 50% of the total, and thereafter as much as 75%. An employee may change employers within the group without losing retirement benefits unless a break in service (under the plan) cancels credits earned before the break.
Multi-Peril Policy: A package policy which provides protection against a number of separate perils. Multi-peril policies are not necessarily multiple line policies, since the combined perils may be all within one insurance line.
Multiple Employer Trust (MET): A legal trust established by a plan sponsor that brings together a number of small, unrelated employers for the purpose of providing group medical coverage on an insured or self-funded basis.
Mutual Insurance Company: An insurance company in which the ownership and control is vested in the policyholders and a portion of surplus earnings may return to policyholders in the form of dividends. No capital stock exists.
MVR: motor vehicle report
'N'
Named Perils: Coverage in a property policy that provides protection against loss from only the perils specifically listed in the policy rather than protection from physical loss. Examples of named perils are fire, windstorm, theft, smoke, etc.
National Association of Insurance Commissioners (NAIC): The association of insurance commissioners of various states formed to promote national uniformity in the regulation of insurance.
Negligence: Failure to use the care that a reasonable and prudent person would have used under the same or similar circumstances.
Net Premium: The portion of the premium rate which is designed to cover benefits of the policy, but not expenses, contingencies, or profit. The term is also used to describe the portion of the premium remitted to the home office by an agent after deduction of the agent's commission.
Net written premiums: premium income retained by insurance companies, directly or through reinsurance, after payments made for reinsurance.
No-Fault: A type of auto insurance mechanism whereby the right to sue another party for damages caused by negligence is limited and, in exchange, expanded first party benefits are offered.
No-fault Automobile Insurance: A form of insurance by which a person's financial losses resulting from an automobile accident are paid by his or her own insurer regardless of who was at fault.
Non-admitted Insurance Company: An insurance company not licensed to do business in a particular state; such a company, however, may sell excess and surplus insurance in that state if admitted insurers lack the capacity or expertise.
Noncancellable: A contract that the insured has the right to continue in force by the timely payments of premiums set forth in the contract (1) until at least age 50 or (2) in the case of a policy issued after age 44 for at least five years from its date of issue, during which period the insurer has no right to make unilaterally any change in any provision of the contract while the contract is in force.
Noncancellable Guaranteed Renewable Policy: An individual policy which the insured person has the right to continue to force until a specified age, such as to age 65, by the timely payment of premiums. During this period, the insurer has no right to unilaterally make any changes in any provision of the policy while it is in force.
Nonconfining Sickness: A sickness that disables the insured person but does not confine him to his home or a hospital.
Noncontributory: A term applied to employee benefit plans under which the employer bears the full cost of the benefits for the employees. One hundred percent of the eligible employees must be insured.
Nondisabling Injury: An injury which may require medical care, but does not result in loss of working time or income.
Nondisabling Injury Benefit: A benefit in some disability income policies providing payment for medical expense due to injury when medical care is necessary but the insured is not totally disabled.
Nonforfeiture Option: One of the choices available if the policyholder discontinues premium payments on a policy with a cash value. This, if any, may be taken in cash, as extended term insurance or as reduced paid-up insurance.
Nonmedical Limit: The maximum face value of a policy that a given company will issue without the applicant taking a medical examination.
Nonoccupational Policy: Contract which insures a person against off-the-job accident or sickness. It does not cover disability resulting from injury or sickness covered by Workers' Compensation. Group accident and sickness policies are frequently non- occupational.
Nonoccupational Policy: One that provides off-the-job coverage only; it does not cover loss resulting from accidents or sickness arising out of or in the course of employment or covered under any workers' compensation law.
Nonparticipating Insurance: Plan of insurance under which the policy-holder is not entitled to share in the dividend distribution of the company.
Nonparticipating Policy: A life insurance policy in which the company does not distribute to policyholders any part of its surplus. Note should be taken that premiums for nonparticipating polices are usually lower than for comparable participating polices. Note should also be taken that some nonparticipating polices have both a maximum premium and a current lower premium. The current premium reflects anticipated experience that is more favorable than the company is willing to guarantee, and it may be changed from time to time for the entire block of business to which the policy belongs. (See also: Participating policy)
Nonparticipating Policy: One that does not provide for the payment of a dividend.
Nonprofit Insurers: Persons organized under special state laws to provide hospital, medical, or dental insurance on a nonprofit basis. The laws exempt them from certain types of taxes.
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Occupational Hazards: Occupations which expose the insured to greater than normal physical danger by the very nature of the work in which the insured is engaged, and the varying periods of absence from the occupation, due to the disability, that can be expected.
Occurrence: An accident, including continuous or repeated exposure to substantially the same general, harmful conditions, that results in bodily injury or property damage during the period of an insurance policy.
Occurrence policy: A liability insurance policy that covers claims arising out of occurrences that take place during the policy period, regardless of when the claim is filed.
Ocean Marine Insurance: Insurance for sea-going vessels, including liabilities connected with them, and their cargoes.
Ocean Marine Insurance: Coverage on all types of vessels, including liabilities connected with them, and on their cargoes.
Operating Ratio: The sum of expenses and losses expressed as a percent of earned premium.
Optionally Renewable Contract: A contract of health insurance in which the insurer reserves the right to terminate the coverage at any anniversary or, in some cases, at any premium due date, but does not have the right to terminate coverage between such dates.
Ordinary Life Insurance: Life insurance usually issued in amounts of $1,000 or more with premiums payable on an annual, semi-annual, quarterly or monthly basis.
Ordinary Life: Synonymous With Whole Life and Straight Life: The three terms are applied to the type of policy which continues during the whole of the insured's life and provides for the payment of amount insured at this death.
Overhead Expense Insurance: A special form of health insurance designed to help offset overhead expenses such as office rent, utilities, employees' wages, and auditors' fees, incurred during total disability. The monthly payments during disability is not a fixed amount of indemnity as on regular disability polices, but the amount of overhead expense actually incurred, or a percentage thereof, up to the limit specified in the policy.
Overhead Insurance: A type of short-term disability income contract that reimburses the insured person for specified, fixed monthly expenses, normal and customary in the operation and conduct of his/her business or office.
Over-the Counter Market: A means of buying and selling securities that are not listed on a stock exchange. Negotiations are carried out by telephone or computer network.
Overriding Commission (Overwrite): A commission paid to general agents or agency managers in addition to the commission paid the soliciting agent or broker.
'P'
Package Policy: A combination of two or more individual polices or coverages into a single policy. A homeowners policy, for example, is a package combining property, liability and theft coverages for the homeowner.
Paid-up Insurance: Insurance on which all required premiums have been paid. The term is frequently used to mean the reduced paid-up insurance available as a nonforfeiture option.
Paramedical Examination: Physical examination of an applicant by a trained person other than a physician.
Partial Disability: The result of an illness or injury which prevents an insured from performing one or more of the functions of his/her regular job.
Partial Disability: A benefit sometimes found in disability income policies providing for the payment of reduced monthly income in the event the insured cannot work full time and/or is prevented from performing one or more important daily duties pertaining to his occupation.
Participating Insurance: Insurance issued by an insurance company providing participation in dividend distribution.
Participating Policy: A life insurance policy under which the company agrees to distribute to policyholders the part of its surplus which its Board of Directors determines is not needed at the end of the business year. Such a distribution serves to reduce the premium the policyholder had paid. (See also: Policy dividend; Nonparticipating policy)
Participating Policy: One under which the policy owner is entitled to receive shares of the divisible surplus of the insurer. Such shares are commonly called dividends.
Pension Benefit Guaranty Corporation (PBGC): The Federal body responsible for administering the plan termination insurance program under ERISA.
Pension Benefits: A series of payments to be provided in accordance with the plan of benefits.
Pension Plan: A plan established and maintained by an employer, group of employers, union or any combination, primarily to provide for the payment of definitely determinable benefits to participants after retirement.
Percentage Participation: A provision in a health insurance contract that the insurer and insured will share covered losses in agreed proportions. Also see Coinsurance.
Peril: The cause of a loss insured against in a policy.
Peril: The cause of a possible loss, such as fire, windstorm, theft, explosion, or riot.
Permanent Life Insurance: A phrase used to cover any form of life insurance except term; generally insurance that accrues cash value, such as whole life or endowment.
Persistency: A term used to refer to the length of time insurance remains continuously in force.
Persistency: The degree to which policies stay in force through the continued payment of renewal premiums.
Personal Articles Floater: A form of coverage designed to meet the needs for insurance on property of a moveable nature. The coverage usually protects against all physical loss, subject to special exclusions and conditions. Examples of property covered include jewelry, furs, silverware, fine arts.
Personal Injury Protection (PIP): First-party no-fault coverage in which an insurer pays, within the specified limits, the wage loss, medical, hospital and funeral expenses of the insured.
Personal Lines: Those types of insurance, such as auto or home insurance, for individuals or families rather than for businesses or organizations.
Personal representative:A person appointed through the will of a deceased or by a court to settle the estate of one who dies.
Physical Damage: Damage to or loss of the auto resulting from collision, fire, theft or other perils.
Physician's Expense Insurance: Coverage which provides benefits toward the cost of such services as doctor's fees for nonsurgical care in the hospital, at home or in a physician's office, and X-rays or laboratory tests performed outside the hospital. (Also called Regular Medical expense Insurance.)
Plan Administrator: The person or persons controlling the money or property contributed to the plan, usually designated in the plan agreement.
Point-of-Service Plans: Often known as open-ended HMOs or PPOs, these plans permit insureds to choose providers outside the plan yet are designed to encourage the use of network providers.
Policy: The printed legal document stating the terms of the insurance contract that is issued to the policyholder by the company.
Policy: A contract of insurance.
Policy: The legal document issued by the company to the policyholder, which outlines the conditions and terms of the insurance; also called the policy contract or the contract.
Policy Dividend: A refund of part of the premium on a participating life insurance policy reflecting the difference between the premium charged and actual experience.
Policy Loan: A loan made by a life insurance company from its general funds to a policyholder on the security of the cash value of a policy.
Policy Reserves: The measure of the funds that a life insurance company holds specifically for fulfillment of its policy obligations. Reserves are required by law to be so calculated that, together with future premium payments and anticipated interest earnings, they will enable the company to pay all future claims.
Policy Term: That period for which an insurance policy provides coverage.
Policyholder: The person who owns a life insurance policy. This is usually the insured person, but it may also be a relative of the insured, a partnership or a corporation.
Policyholder: A person who pays a premium to an insurance company in exchange for the insurance protection provided by a policy of insurance.
Policyholders' Surplus: Sum left after liabilities are deducted from assets. Sums such as paid-in capital and special voluntary reserves are also included in this term. This surplus is an additional financial protection to policyholders in the event a company suffers unexpected or catastrophic losses. In effect, it is the financial base that permits a company to sell insurance.
Pollution Liability: Exposure to lawsuits for injury or cleanup costs that result from pollution damage
Pool: An organization of insurers or reinsurers through which particular types of risk are underwritten and premiums, losses and expenses are shared in agreed-upon amounts.
Pooling arrangement: An agreement to divide any losses that might occur equally among two or more people, typically with each paying the average loss.
Portability: The transfer of pension rights and credits when a worker changes jobs.
Preadmission Certification: Process in which a health care professional evaluates an attending physician's request for a patient's admission to a hospital by using established medical criteria.
Preexisting Condition: A physical and/or mental condition of an insured which first manifested itself prior to the issuance of his/her policy or which existed prior to issuance and for which treatment was received.
Preexisting Condition: A physical condition that existed before the effective date of coverage.
Preferred Provider Organization (PPO): An arrangement whereby a third-party payer contracts with a group of medical care providers who furnish services at lower than usual fees in return for prompt payment and a certain volume of patients.
Preferred Stock: Evidence of ownership which entitles the owners to receive dividends from the corporation before the common stockholders and which usually also provides a prior claim to corporate assets if the corporation is dissolved.
Premium: The sum paid by a policyholder to keep an insurance policy in force.
Premium finance: allows the insured to pay part of the premium when coverage takes effect and pay the rest during the policy period.
Premium Loan: A policy loan made for the purpose of paying premiums.
Premium Tax: A tax, imposed by each state, on the premium income of insurers doing business in the state.
Prepaid Group Practice Plan: A plan under which specified health services are rendered by participating physicians to an enrolled group of persons, with a fixed periodic payment in advance made by or on behalf of each person or family. If a health insurance carrier is involved, a contract to pay in advance for the full range of health services to which the insured is entitled under the terms of the health insurance contract. Such a plan is one form of Health Maintenance Organization (HMO).
Primary Beneficiary: See Beneficiary.
Primary Insurance: Insurance that pays compensation for a loss ahead of any other insurance coverages the policyholder may have.
Principal Sum: The amount payable in one sum in the event of accidental death and in, some cases, accidental dismemberment. When a contract provides benefits for both accidental death and accidental dismemberment, each dismemberment benefit is an amount equal to the principal sum or some fraction thereof.
Probate: The court-supervised process of validating or establishing a distribution for assets of a deceased including the payment of outstanding obligations.
Probate estate That portion of the assets and liabilities whose distribution is supervised by the courts in the probate process.
Probationary Period: A period from the policy date to a specified time, usually 15 to 30 days, during which no sickness coverage is effective. It is designed to eliminate a sickness actually contracted before the policy went into effect.
Product Liability: legal liability incurred by a manufacturer, merchant, or distributor because of injury or damage resulting from the use of its product.
Product Liability Insurance: Protection against financial loss arising out of the legal liability incurred by a manufacturer, merchant, or distributor because of injury or damage resulting from the use of a covered product.
Professional Review Organization (PRO): An organization in which practicing physicians assume responsibility for reviewing the propriety and quality of health care services provided under Medicare and Medicaid.
Proof of Loss: Documentation presented to the insurance company by the insured in support of a claim so that the insurer can determine its liability under the policy.
Proof of Loss: Documentary evidence required by an insurer to prove a valid claim exists. It usually consists of a claim form completed by the insured and the insured's attending physician. For medical expense insurance itemized bills must also be included.
Property Damage Coverage: An agreement by an insurance carrier to protect an insured against legal liability for damage by an insured automobile to the property of another.
Property Insurance: Insurance providing financial protection against the loss of, or damage to, real and personal property caused by such perils as fire, theft, windstorm, hail, explosion, riot, aircraft, motor vehicles, vandalism, malicious mischief, riot and civil commotion, and smoke.
Property Insurance: Provides financial protection against loss or damage to the insured's property caused by such perils as fire, windstorm, hail, etc.
Proration: The adjustment of benefits paid because of a mistake in the amount of the premiums paid or the existence of other insurance covering the same accident or disability.
Proscription: A claim not covered by an insurance policy because it is filed after the time required in the language of the contract.
Prospective Payment: An advancement of payment for health care charges that are likely to occur.
Prototype Plan: A standardized plan, approved and qualified as to its concept by the Internal Revenue Service, which is made available by life insurance companies, banks and mutual funds for employers' use.
Provision: A part (clause, sentence, paragraph, etc.) of an insurance contract that describes or explains a feature, benefit, condition, requirement, etc. of the insurance protection afforded by the contract.
Proximate Cause: The dominating cause of loss or damage; an unbroken chain of events between the occurrence and damage.
Punitive Damages: a court-awarded amount that exceeds the economic losses and general damages of a defendant and is intended solely to punish the plaintiff
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