Glossary of Terms

Agency - A company, usually specialized, that provides the insured with a plan on behalf of the carrier.

Agent - A licensed representative or salesperson of an insurance company who is able to advise and sell insurance to customers.

Appraisal - To assess the value of a claim.

Benefit Level - The maximum amount on a plan that an insurer will pay for a benefit.

Benefit Period - The time frame in which you are covered under a policy.

Benefits - The elected coverages included in a plan.

Blanket Policy - A single policy that covers a group of individuals. It can also mean a policy that covers multiple properties.

Carrier - An insurance company that provides the insurance and takes the underwriting risk.

Claim - A request made by the insured for the benefits provided by the policy.

Co-Insurance - The amount the insured is required to pay for services after the deductible has been reached.

Co-Pay - A pre-determined fee the insured pays for specified services in addition to covered costs.

Compulsory Plan - An insurance plan that is required by law.

Coverage Level - The maximum amount an insurer will pay for a benefit.

Covered Person(s) - The person or people eligible to receive benefits under a given plan.

Deductible - A set amount the insured is responsible for paying before the insurer will cover costs.

Dependent - Individuals named by the insured who rely on the policy holder for insurance benefits.

Disclaimer - Language that highlights limitations of services offered that the insured should be aware of in relation to the plan.

Eligible - If an individual qualifies for coverage under policy language, they are eligible for that particular insurance coverage.

Endorsements - An addition to a policy that contains language which can modify coverage.

Excess Insurance - An insurance policy set to cover expenses when losses exceed a specific amount, also referred to as Secondary Insurance.

Exclusions - Items not covered by an insurance policy.

Guaranteed Issue - The right to insurance without any underwriting requirements.

In-Network - In a health insurance plan, the discounted providers or services that are provided under the plan are considered in-network.

Indemnity - Payment, repair or replacement after a loss in order to make the policy holder whole.

Liability - When the insured is legally responsible for a loss.

Limits - Maximum amount of losses paid for a plan.

Loss - The loss of assets that is the basis for an insurance claim.

Mandated Benefits - Benefits that are required by law.

Mandated Minimum - Minimum amount of coverage required by law. These may vary by state.

Maximum Benefit - The maximum amount a plan will pay in benefits.

Period of Coverage - The time frame in which you are covered under a policy.

Policy - A written contract of insurance between the insurer and the insured.

Pre-Authorization - In a health plan, the requirement that your health plan provider gains approval for treatments.

Pre-Certification - In health insurance, approval by an insurance representative to be admitted to a hospital or in-patient facility.

Pre-Existing Condition - A coverage limitation where certain conditions that may already exist will not be covered under the insurance policy.

Premium - The amount the insurer charges for coverage.

Pro-Rata Refund - An insurance refund where the amount returned to the insured is based on the number of days remaining in the policy compared to the total number of days in the policy.

Renew - To re-establish or continue an insurance plan.

Replacement Cost - The cost associated with replacing a covered item rather than the actual cash value of the item.

Risk - The chance that a given activity or action will lead to a loss.

Subrogation - When another party is liable for a loss, the process by which the insurer recovers the amount of loss after payment to the insured.

Trigger - The event that must occur before a policy can cover a loss.

Underwriter - The insurer, who is trained in measuring risk and determining acceptable rates and pricing.

Waiting Period - Period of time following the start of coverage before the insured can make certain claims and receive insurance benefits.