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Learning Center
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Insurance Glossary
Insurance Glossary
HHealth Maintenance Organization (HMO) - Prepaid group health insurance plan which entitles members to services of participating physicians, hospitals and clinics. Emphasis is on preventative medicine. Home Service Life - Home service refers to a method of selling and servicing insurance, mostly life and health insurance, and does not identify the type or relative cost of the product that is sold. Some companies that market on a home service basis sell what is known as "industrial life insurance. " These are most often low death benefit policies with face amounts that may vary from $1,000 to $5,000 and which accumulate cash values at a very low rate. They are intended primarily to cover the expenses of a last illness and burial. The relative cost of industrial life insurance is extremely high compared to some other cash value policies and term life insurance policies. IIncontestability - A provision that places a time limit - up to two years - on a company´s right to deny payment of a claim because of suicide or a material misrepresentation on your application. Independent Adjuster - A person who charges a fee to the insurance company to adjust the company´s claim. Indexed Life Insurance - A whole life plan of insurance that provides for the face amount of the policy and, correspondingly, the premium rate, to automatically increase every year based on an increase in the Consumer Price Index (CPI) or another index as defined in the policy. Insurable Interest - A financial interest in the property insured, prerequisite to a valid contract of insurance. In life insurance, a person´s or party´s interest - financial or emotional - in the continuing life of the insured. Insured - The person or firm covered by an insurance policy. Insurer - The insurance company. Interpleader - This is a procedure when conflicting claims are made on a life insurance policy by two or more people. Using this procedure the insurance company pays the policy proceeds to a court, stating the company cannot determine the correct party to whom the proceeds should be paid. Irrevocable Beneficiary - A named beneficiary whose rights to life insurance policy proceeds are vested and whose rights cannot be canceled by the policy owner unless the beneficiary consents. J K LLapse - Termination of a policy due to non-payment of premiums. Liability - Responsibility to another for one´s negligence. Liability Insurance - Pays for injuries to the other party and damages to the other vehicle resulting from an accident you caused. It also pays if the accident was caused by someone covered by your policy, including a driver operating your car with your permission. Liability Limits - The maximum amount your liability policy will pay. Your policy must pay at least $20,000 per person for injuries and deaths, up to $40,000 for all victims of an accident, plus $15,000 for property damage. You can purchase higher liability limits for additional premium. Loss - The amount an insurance company pays on a claim. Loss History - Refers to an insured´s history of losses (claims) with other companies, or the company they are currently with. A company will consider "loss history" when underwriting a new policy or considering a renewal of an existing policy. Companies view "loss history" as an indication of an insured´s propensity for a claim in the future. MMaterial Misrepresentation - A significant misstatement in an application form. If a company had access to the correct information at the time of application, the company might not have agreed to accept the application. Medical Payments & Personal Injury Protection (PIP) - Both pay limited medical and funeral expenses if you, a family member, or a passenger in your car is injured or killed in a motor vehicle accident. PIP also pays lost-income benefits. Mortality Charge - The cost of the insurance protection element of a universal life policy. This cost is based on the net amount at risk under the policy, the Insured´s risk classification at the time of policy purchase, and the Insured´s current age. Mortality Expenses - The cost of the insurance protection based upon actuarial tables which are based upon the incidence of death, by age, among given groups of people . This cost is based on the amount at risk under the policy, the insured´s risk classification at the time of policy purchase, and the insured´s current age. NNamed Driver Exclusion - An endorsement that provides that a policy does not cover accidents when a specifically named person is the driver. Named Driver Policy - A policy that covers only the drivers specifically named in the policy. Generally, all other drivers are excluded from coverage under the policy. This type of policy is usually written by surplus lines companies. Net Cash Value - The cash value amount available to a policy owner after adjustments have been made to the cash surrender value to account for policy loans and dividends. Non-Owners Policy - Insurance coverage that offers liability, uninsured motorist, and medical payments to a named insured who does not own a vehicle. Nonparticipating Policy - A life insurance policy that does not grant the policy owner the right to policy dividends. Non-renewal - A decision by an insurance company not to renew a policy. O PPaid-Up - This event occurs when a policy will not require any further premiums to keep the coverage in force. Paid-Up Additions - Additional amounts of insurance purchased using dividends; these insurance amounts require no further premium payments.Peril - A cause of property losses. Usually used in the context of "a peril insured against." Policy - The contract issued by the insurance company to the insured. Policy Loan - An advance made by a life insurance company to a policy owner. The advance is secured by the cash value of the policy. Policy Owner - The person or party who owns an individual insurance policy. This person may be the insured, the beneficiary or another person. The policy owner usually is the one who pays the premium and is the only person who may make changes to a policy. Policy Period - The period a policy is in force, from the beginning or effective date to the expiration date. Preferred Provider Organization (PPO) - Hospital, physician, or other provider of health care which an insurer recommends to an insured. A PPO allows insurance companies to negotiate directly with hospitals and physicians for health services at a lower price than would be normally charged. Premium - The amount paid by an insured to an insurance company to obtain or maintain an insurance policy. Premium Expense Charges - An amount deducted from each premium payment, which reduces the amount credited to the policy. Property Damage (PD) - Physical damage to property. Providers - Usually references doctors or those who are providing a medical service. Public Adjuster - A person hired by you to settle the claim with the insurance company to settle the claim on your behalf. Q RRated Policy - A policy issued at a higher premium to cover a person classified as a greater-than-average risk, usually due to impaired health or a dangerous occupation. Redlining - Refusal by an insurance company to underwrite or to continue to underwrite questionable risks in a given geographical area. Refund - Amount of money being returned to the policyholder. Reinstatement - The process by which a life insurance company puts back in force a policy which had lapsed because of nonpayment of renewal premiums. Renewal Policy - A policy issued as a renewal of a policy expiring in the same company or agency; not new business. Rental Reimbursement Coverage - Pays a set daily amount for a rental car if your car is being repaired because of damage covered by your auto policy. Replacement Cost - The cost associated with replacing property at current market prices. Rescind - To take away or remove. To avoid so as to restore the involved parties to the positions they would have occupied had there been no contract. Return Premium - The premium returned to an insured for canceling or amending a policy. Rider - A written agreement attached to the policy expanding or limiting the benefits otherwise payable under the policy. Same as an "endorsement." Rule of 78 - This is a method for calculating the amount of unused premium which takes into account the fact that more insurance coverage is required in the early months of the loan, since the payoff of the loan is greater. As the loan is paid off, less coverage is being paid for, so the refund percentage decreases. Rule of Anticipation - This is a similar method to "Rule of 78" where the amount of unused premium takes into account the fact that more insurance coverage is required in the early months of the loan, since the payoff of the loan is greater. As the loan is paid off, less coverage is being paid for, so the refund percentage decreases. SSingle Interest Insurance - Insurance coverage for only one of the parties having an insurable interest in that property. Single-Premium Whole Life Policy - A type of limited-payment policy that requires only one premium payment. Staff Adjuster - Employee of the insurance company´s claim department. Subrogation - Assignment of rights of recovery from insured. Suicide Clause - Life insurance policy wording which specifies that the proceeds of the policy will not be paid if the insured takes his or her own life within a specified period of time after the policy´s date of issue. Surcharge - An extra charge added to your premium by an insurance company. For automobile insurance, a surcharge is usually added if you have at-fault accidents. Surplus Lines - Coverage from out-of-state companies not licensed in Texas but legally eligible to sell insurance on a "surplus lines" basis. Surplus lines companies generally charge more than licensed companies and often offer less coverage. Surrender Charges - Charges that are deducted if your life insurance policy or annuity is cashed in (surrendered). These charges also are deducted if you borrow money on your policy or if your policy lapses for non-payment. TThird Party Administrator (TPA) - An organization that performs managerial and clerical functions related to an employee benefit insurance plan by an individual or committee that is not an original party to the benefit plan. Third Party Loss - A situation involving a person other than the insurer and insured; i.e., a person making a liability claim against the insured. Towing and Labor Coverage - Pays for towing charges when your car can´t be driven. Also pays labor charges, such as changing a flat tire, at the place where your car broke down. UUnderwriter - The person who reviews an application for insurance and decides if the applicant is acceptable and at what premium rate. Underwriting - The process an insurance company uses to decide whether to accept or reject an application for a policy. Unearned Premium - The insured´s remaining premium equity in his policy; that part of the policy premium that has not been "used up." Uninsured/Underinsured Motorist (UM/UIM) Coverage - Pays for your injuries and property damage caused by a hit-and-run driver or a motorist without liability insurance. It will also pay when your medical and car repair bills are higher than the other driver´s liability coverage. Universal Life Insurance - The key characteristic of universal life insurance is flexibility. Within limits, you can choose the amount of insurance and the premium you wish to pay. The policy will stay in force as long as the policy value is sufficient to pay the costs and expenses of the policy. The policy value is "interest-sensitive," which means that it varies in accordance with the general financial climate. Lowering the death benefit and raising the premium will increase the growth rate of your policy. The opposite also is true. Raising the death benefit and lowering the premium will slow the growth of your policy. If insufficient premiums are paid, the policy could lapse without value before the maturity date is reached. (The maturity date is the time your policy ceases and cash surrender value would be payable if the policyholder is still living.) Therefore, it is your responsibility to pay consistently a premium that is high enough to ensure that your policy´s value will be adequate to pay the monthly cost of the policy. The company is required to send you an annual report and also to notify you if you are in danger of losing your policy due to insufficient value. Usual and Customary - these charges may be based on: rates usually charged by physicians and providers in your area; rate averages compiled by independent rating services; or rate averages compiled by the insurance company. VVariable Annuity - A form of annuity policy under which the amount of each benefit payment is not guaranteed and specified in the policy, but which instead fluctuates according to the earnings of a separate account fund. Variable Life Insurance - A type of whole life policy in which the death benefit and the cash value fluctuate according to the investment performance of a separate account fund that the policyholder selects. Because the investment account is regulated by the Securities and Exchange Commission, you must be presented with a prospectus before you purchase a variable life policy. Viatical Settlement Agreements - Viatical settlements involve the sale of an existing life insurance policy by a viator (person with a life threatening or terminal illness) to a viatical settlement company in return for a cash payment that is a percentage of the policy´s death benefit. WWhole Life Insurance - Whole life insurance policies are one type of cash value insurance. Whole life policies offer protection through a lifetime - that is, for a person´s "whole life." From the day you buy the policy, you pay a scheduled premium,. The scheduled premium may be level or may increase after a fixed time period, but it will not change from the amount(s) shown in the policy schedule. It is important that you look at the policy schedule to be sure you understand what your premium payments will be and that you can afford them over time. This premium is based on your age at the time of purchase. Initially, it will be higher than the premium paid for a term policy, but you are likely to end up paying less in premiums when you are older, if you keep the policy for a long time. Part of each premium payment will go to cash value growth, part for the death benefit and part for expenses (such as commissions and administrative costs). There is no need to renew whole life policies. As long as you pay your premium when due, your coverage will continue in force throughout your life. X Y ZDisclaimer: This information is intended to be a guide to understanding common insurance terms. InsuranceUSA does not intend this information to be official or legally binding. This list should be used as a basic guide to understanding these terms and should not be considered complete or definitive. Reference Information: Much of the information provided in this glossary comes from the Texas Department of Insurance, as of December 2001. We thank them for providing this helpful information to the public. |




