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Individual Annuities- Immediate Non-Variable - an annuity contract that provides for the fixed payment of the annuity at the end of the first interval of payment after purchase. Professional Errors and Omissions Liability - coverage available to pay for liability arising out of the performance of professional or business related duties, with coverage being tailored to the needs of the specific profession. Common Health Insurance Terminology 101 Many of the terms you encounter when dealing with health insurance are not familiar. Net Premiums Earned - premiums on property/casualty or health policies that will not have to be returned to the policyholder if the policy is cancelled. Errors and Omissions Liability | Professional Liability other than Medical - liability coverage of a professional or quasi professional insured to persons who have incurred bodily injury or property damage, or who have sustained any loss from omissions arising from the performance of services for others, errors in judgment, breaches of duty, or negligent or wrongful acts in business conduct. Incurred Claims - paid claims plus amounts held in reserve for those that have been incurred but not yet paid. health insurance | Germany |Munich, Nuremberg and Bavaria - europages Self-Insurance - type of insurance often used for high frequency low severity risks where risk is not transferred to an insurance company but retained and accounted for internally. Nationally Recognized Statistical Rating Organization (NRSRO) - refers to rating organizations so designated by the SEC whose status has been confirmed by the Securities Valuation Office. Credit Health Insurance - policy assigning creditor as beneficiary for insurance on a debtor thereby remitting balance of payment to creditor should the debtor become disabled. The employer self-funds a fixed percentage (e.g. Ocean Marine - coverage for ocean and inland water transportation exposures; goods or cargoes; ships or hulls; earnings; and liability. Health Excess/Stop Loss - this type of insurance may be extended to either a health plan or a self-insured employer plan. Centers for Medicare & Medicaid Services (CMS) - U.S. governmental agency responsible for the licensing of federally qualified HMOs. Named Peril Coverage - insurance for losses explicitly defined in the policy contract. Whole Life - life insurance that may be kept in force for a person's entire life and that pays a benefit upon the person's death, whenever that may be. Tel +49 221 5789- 4005 service@dkv.com www.dkv.com. Calculated on the basis of original cost adjusted, as appropriate, for accrual of discount or amortization of premium and for depreciation. Package Policy - two or more distinct policies combined into a single contract. Stock Insurance Company - business owned by stockholders. HDHPs are often paired with a health savings account (HSA), which allows you to pay for certain medical expenses with money exempt from federal taxes. (Bickelhaupt and Magee). Accidental Bodily Injury - unexpected injury to a person. A Affordable Care Act Collateral Loans - unconditional obligations for the payment of money secured by the pledge of an investment. Your doctor may suggest that you participate in a clinical trial as a treatment option. It's not a one-size-fits-all type of situation, and there are a lot of confusing . Raymond G. Farmer Award for Exceptional Leadership, System for Electronic Rates and Forms Filings, Market Regulation and Consumer Affairs (D), Financial Regulation Standards and Accreditation (F), Innovation, Cybersecurity, and Technology (H), Casualty Actuarial and Statistical (C) Task Force, Statutory Accounting Principles (E) Working Group, Big Data and Artificial Intelligence (H) Working Group, Group Capital Calculation (E) Working Group, Mutual Recognition of Jurisdictions (E) Working Group, Restructuring Mechanisms (E) Working Group, Reinsurance Financial Analysis (E) Working Group. Includes but is not limited to coverage for all obligations and liabilities incurred by a service contract provider, mechanical breakdown insurance and service contracts written by insurers. You, your employer, and others can put money into your HSA up to a certain yearly limit set by IRS guidelines. If a quoted market price is available, the fair value is the product of the number of trading units times market price. Investment Income Accrued - investment income earned as of the reporting date but not legally due to be paid to the reporting entity until subsequent to the reporting date. Group Credit Life - contracts sold in connection with loan/credit transactions or other credit transactions, which do not exceed a stated duration and/or amount and provide insurance protection against death. Convertible Term Insurance Policy - an insurance policy that can be converted into permanent insurance without a medical assessment. An EPO usually has lower out-of-pocket costs than a PPO plan. Nonadmitted Assets - assets having economic value other than those which can be used to fulfill policyholder obligations, or those assets which are unavailable due to encumbrances or other third party interests and should not be recognized on the balance sheet. For example, you may have a co-pay of $30 for a doctors visit, $20 for one kind of prescription, and $50 for another type of prescription. A glossary of insurance terms and definitions. Umbrella and Excess (Personal) - non-business liability protection for individuals above a specific amount set forth in a basic policy issued by the primary insurer; or a self-insurer for losses over a stated amount; or an insured or self-insurer for known or unknown gaps in basic coverages or self-insured retentions. Access public conference call documents and information. Agent - an individual who sells, services, or negotiates insurance policies either on behalf of a company or independently. Health insurance terms to know as open enrollment begins - NPR Protection and Indemnity (P&I) Insurance - a broad form of marine legal liability insurance coverage. Condos - homeowners insurance sold to condominium owners occupying the described property. Surety Bond - a three-party agreement whereby a guarantor (insurer) assumes an obligation or responsibility to pay a second party (obligee) should the principal debtor (obligor) become in default. Americans Confused By Basic Health Insurance Terms But Happy - Forbes The policyholder selects the accounts into which the premium payments are to be made. Combinations - a special form of package policy composed of personal automobile and homeowners insurance. It's OKwe know as well as anyone that the language of health insurance can be hard to understand. Furthermore, the mortgage must have originated from a regulated and authorized financial institution. Premiums Written - total premiums generated from all policies (contracts) written by an insurer within a given period of time. Rider - an amendment to a policy agreement. Federal Flood Insurance - coverage for qualifying residents and businesses in flood prone regions through the National Flood Insurance Act, a federally subsidized flood insurance program enacted in 1968. Losses Incurred - Includes claims that have been paid and/or have amounts held in reserve for future payment. 1. Capital and Surplus - a company's assets minus its liabilities. Many plans have specific forms that you must complete for your prior authorization request to be processed. Elevators and Escalators Liability - liability coverage for bodily injury or property damage arising from the use of elevators or escalators operated, maintained or controlled by the insured. Claims-made Form - A type of liability insurance form that only pays if the both event that causes (triggers)the claim and the actual claim are submitted to the insurance company during the policy term. What is health insurance? | healthinsurance.org JAMA Health Forum - Health Policy, Health Care Reform, Health Affairs Event Cancellation - coverage for financial loss because of the cancellation or postponement of a specific event due to weather or other unexpected cause beyond the control of the insured. Collar - an agreement to receive payments as the buyer of an Option, Cap or Floor and to make payments as the seller of a different Option, Cap or Floor. For example, if your deductible is $1,000, your plan wont pay anything in a given year until youve spent $1,000 on covered medical services, devices or medications. Missouri health insurance plans | UnitedHealthcare While these terms can be confusing, the better you understand them, the better you will be prepared to successfully gain coverage and access to the treatments that are right for you. If the coverage is as a rider, deductibles or out-of-pocket limits must be set separately from the medical coverage. Unauthorized Reinsurance - reinsurance placed with a company not authorized in the reporting company's state of domicile. An example would be provider-sponsored organizations where there is no coverage for other than provider (non-hospital) services. Thomas J. Catalano What Is Health Insurance? Excluded are losses resulting from fire, explosion, flood or tidal wave following the covered event. The list below includes definitions for some of the . Facultative Reinsurance - reinsurance for a specific policy for which terms can be negotiated by the original insurer and reinsurer. Face Amount - the value of a policy to be provided upon maturity date or death. Non-proportional Reinsurance - reinsurance that is not secured on individual lives for specific individual amount of reinsurance, but rather reinsurance that protects the ceding company's overall experience on its entire portfolio of business, or at least a broad segment of it. Your copay amount is listed on your health plan ID card. Health insurance companies usually require you to be formally admitted into a hospital for a stay for a service to be considered inpatient. Written Premium - the contractually determined amount charged by the reporting entity to the policyholder for the effective period of the contract based on the expectation of risk, policy benefits, and expenses associated with the coverage provided by the terms of the insurance contract. Access to every published model law, regulation, and guideline. Rebate - a refund of part or all of a premium payment. Because health insurance contracts last for one year, your monthly premium multiplied by 12 months is the minimum amount youll spend in a given year. Nonadmitted Insurer - insurance company not licensed to do business within a given state. Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of The Cigna Group, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (LINA) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (NYLGICNY) (New York, NY), formerly known as Cigna Life Insurance Company of New York. This page provides a glossary of insurance terms and definitions that are commonly used in the insurance business. Producer - an individual who sells, services, or negotiates insurance policies either on behalf of a company or independently. Short-Term Medical - policies that provide major medical coverage for a short period of time, typically 30 to 180 days. It permits financial services companies to merge and engage in a variety of new business activities, including insurance, while attempting to address the regulatory issues raised by such combinations. Other Liability - coverage protecting the insured against legal liability resulting from negligence, carelessness, or a failure to act resulting in property damage or personal injury to others. Environmental Pollution Liability - liability coverage of an insured to persons who have incurred bodily injury or property damage from acids, fumes, smoke, toxic chemicals, waste materials or other pollutants. Unearned Premium - amount of premium for which payment has been made by the policyholder but coverage has not yet been provided. Question How have out-of-pocket (OOP) costs for naloxone in the US changed between 2010 and 2018 overall and by drug brand and payer?. Medicare Supplement - Insurance coverage sold on an individual or group basis to help fill the "gaps" in the protections granted by the federal Medicare program. Salaries for postdocs and professors - Research in Bavaria Prescription drug coverage - Glossary | HealthCare.gov Contractual Liability - liability coverage of an insured who has assumed the legal liability of another party by written or oral contract. The Cigna names, logos, and marks, including THE CIGNA GROUP and CIGNA HEALTHCARE are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of The Cigna Group. Treaty - a reinsurance agreement between the ceding company and reinsurer. EDP Policies - coverage to protect against losses arising out of damage to or destruction of electronic data processing equipment and its software. The insurer is responsible for the rest of the reimbursement. You will pay less for services provided by an in-network health provider than one that is out-of-network. Replacement Cost - the cost of replacing property without a reduction for depreciation due to normal wear and tear. Owner Occupied - homeowners insurance sold to owners occupying the described property. Taking the time to understand what they are trying to say makes it easier to communicate, though, and ultimately saves my time by avoiding confusion between me, my doctor and my insurance company.T1D patient, NY. EBNR - Earned but not reported - premium amount insurer reasonably expects to receive for which contracts are not yet final and exact amounts are not definite. Risk Retention Group - group-owned insurer organized for the purpose of assuming and spreading the liability risks to its members. Loss Adjustment Expense (LAE) - expected payments for costs to be incurred in connection with the adjustment and recording of losses. Renters Insurance - liability coverage for contents within a renter's residence. Property - coverage protecting the insured against loss or damage to real or personal property from a variety of perils, including but not limited to fire, lightening, business interruption, loss of rents, glass breakage, tornado, windstorm, hail, water damage, explosion, riot, civil commotion, rain, or damage from aircraft or vehicles. . Important key words explained Other Accident and Health - accident and health coverages not otherwise properly classified as Group Accident and Health or Credit Accident and Health (e.g., collectively renewable and individual non-cancelable, guaranteed renewable, non-renewable for stated reasons only, etc.). Not more costly than alternative services that are at least as likely to produce equivalent therapeutic or diagnostic results for that patients illness, injury or disease. Fire - coverage protecting the insured against the loss to real or personal property from damage caused by the peril of fire or lightning, including business interruption, loss of rents, etc. Difference In Conditions (DIC) Insurance - special form of open-peril coverage written in conjunction with basic fire coverage and designed to provide protection against losses not reimbursed under the standard fire forms. Permanent Life Insurance - policy that remains active for the life of the insured. State Children's Health Insurance Program - policies issued in association with the Federal/State partnership created by title XXI of the Social Security Act. "Creditor Placed Home" means "Creditor Placed Insurance" on homes, mobile homes and other real estate. Find contact information for insurance departments and local insurance agents, or file a complaint. Once you get past the slick brochures, the terms that describe what health insurance actually does and doesnt cover, for me, were almost impossible to read! Limited Policies - health insurance coverage for a certain ailment, such as cancer. Insurance Holding Company System - consists of two or more affiliated persons, one or more of which is an insurer. Subsequent Event - events or transactions that occur subsequent to the balance sheet date, but before the issuance of the statutory financial statements and before the date the audited financial statements are issued, or available to be issued. Why is Health Insurance Important? | American Heart Association Homeowners Insurance - a package policy combining real and personal property coverage with personal liability coverage. Stop.Call.Confirm is a registered service markof the National Association of Insurance Commissioners. Financial Guaranty - a surety bond, insurance policy, or an indemnity contract (when issued by an insurer), or similar guaranty types under which loss is payable upon proof of occurrence of financial loss to an insured claimant, obligee or indemnitee as a result of failure to perform a financial obligation or any other permissible product that is defined as or determined to be financial guaranty insurance. The coverage reshuffle: Health insurance projections & health care Liability - a certain or probable future sacrifice of economic benefits arising from present obligations of a particular entity to transfer assets or to provide services to other entities in the future as a result of a past transactions(s) or event(s). An exclusive provider organization (EPO) health plan offers a local network of doctors and hospitals for you to choose from. Policyholders Surplus - assets in excess of the liabilities of a company or net income above any monies indebted to legal obligation. Fraternal Insurance - a form of group coverage or disability insurance available to members of a fraternal organization. Premiums are made for same time period. Cost. Earned Premium - portion of insured's prepaid premium allocated to the insurance company's loss experience, expenses, and profit year- to -date. If you want to enroll or make changes to a plan with an effective date of January 1, 2023, your period to do so would be November 1-December 15, 2022. We provide tools and resources to help regulators set standards and best practices, provide regulatory support functions, and educate on U.S. state-based insurance regulation. A Health Maintenance Organization (HMO) is the type of insurance plan with the most restricted provider network. Situs of Contract - the jurisdiction in which the contract is issued or delivered as stated in the contract. Security - a share, participation, or other interest in property or in an enterprise of the issuer or an obligation of the issuer. Morbidity risk excludes the potential for an individual's death, but includes the potential for an illness or injury that results in death. Hold-Harmless Agreement - A risk transfer mechanism whereby one party assumes the liability of another party by contract. Mobile Homes - Homeowners - homeowners insurance sold to owners occupying the described mobile home. An HMO insurance plan may not cover your medical costs if you see a doctor who is out-of-network. Modified Guaranteed - an annuity that contains a provision that adjusts the value of withdrawn funds based on a formula in the contract. Companies providing these cards offer discounts on any FDA-approved medication by leveraging the power of group purchasing to help negotiate lower costs for their customers. Personal Auto Policy - coverage designed to insure private passenger automobiles and certain types of trucks owned by an individual or husband and wife. Did we miss something? The state of domicile receives a schedule for each jurisdiction the company wrote direct business, or has amounts paid, incurred or unpaid. Premises and Operations - policies covering the liability of an insured to persons who have incurred bodily injury or property damage on an insured's premises during normal operations or routine maintenance, or from an insured's business operations either on or off of the insured's premises. To calculate coinsurance for a service, youll need to know how much in total you will be charged for the service. Depending on your plan, your coinsurance usually kicks in after you meet your deductible. The member or spouse can get some life insurance benefits as an early payment. Health insurance can pay for short-term medical care, including surgery, hospital stays and doctor's office visits. For glucose monitors. anything until you've met your $1000 deductible for covered health care services subject to the deductible. Investigational treatments or medications are those that are currently under review in a clinical study. Some words and/or phrases may be defined differently by other entities, or used in a context such that the definition shown may not be applicable. No waiting period for preventive care: 10% of score. Aetna Better Health of Oklahoma selected to support Medicaid members There can be limits on how much a patient is responsible for paying out-of-pocket, determined by each insurer. Mortgage - a note used to secure a loan for real property. Examples of items covered are pension plans, group life insurance, group health insurance, group disability income insurance, and accidental death and dismemberment. Conditions - requirements specified in the insurance contract that must be upheld by the insured to qualify for indemnification. Statement Value - the Statutory Accounting Principle book value reduced by any valuation allowance and non-admitted adjustment applied to an individual investment or a similar group of investments, e.g., bonds, mortgage loans, common stock. For example not taking proper care to protect insured property because the insured knows the insurance company will replace it if it is damaged or stolen. The Health Plans involved will often designate these contracted providers as "preferred" and will provide an incentive, usually in the form of lower deductibles or co-payments, to encourage covered individuals to use these providers. Many Medicare Advantage plans do not charge an additional premium. Reserve Credit - reduction of reserve amounts for reinsurance ceded. Whole Life Insurance - life insurance that may be kept in force for the duration of a person's life and pays a benefit upon the person's death. Copays cover your portion of the cost of a doctor's visit or medication. The definitions in this glossary are developed by the NAIC Research and Actuarial Department staff based on various insurance references. Loss Reserve - the amount that insurers set aside to cover claims incurred but not yet paid. Coordination of Benefits (COB) - provision to eliminate over insurance and establish a prompt and orderly claims payment system when a person is covered by more than one group insurance and/or group service plan. Municipal Bond Guarantee Insurance - coverage sold to municipalities to guarantee the principle payment on bonds issued. Common Health Insurance Terminology 101 - JDRF FAIR Plan - Fair Access to Insurance Requirements - state pools designed to provide insurance to property owners who are unable to obtain property insurance through conventional means. Term - period of time for which policy is in effect. I had never heard of many of those terms before. Individual Annuities- Deferred Non-Variable - an annuity contract that provides an accumulation based on funds that accumulate based on a guaranteed crediting interest rate or additional interest rate. FEMA - Federal Emergency Management Agency - an independent agency, tasked with responding to, planning for, mitigating and recovery efforts of natural disasters. Index Annuity - an interest bearing fixed annuity tied to an equity index, such as the Dow Jones Industrial Average or S & P 500. Its purpose is to insure against the risk that any one claim will exceed a specific dollar amount or that an entire plan's losses will exceed a specific amount. Individual Annuities Special - contracts with certain noteworthy attributes. With this type of account, you (along with your employer, in some cases) can make contributions up to a maximum of $2650 in 2018 (the cap on contributions changes every year). Individual Annuities- Deferred Non-Variable and Variable - an annuity contract that provides an accumulation based on both (1) funds that accumulate based on a guaranteed crediting interest rates or additional interest rate applied to designated considerations, and (2) funds where the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. Health insurance terms to know as open enrollment begins : Life Kit Picking health insurance takes a lot of work. Blue Cross and Blue Shield of Texas is the trade name of Dearborn Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. Casualty Insurance - a form of liability insurance providing coverage for negligent acts and omissions such as workers compensation, errors and omissions, fidelity, crime, glass, boiler, and various malpractice coverages. While these terms can be confusing, the better you understand them, the better you will be prepared to successfully gain coverage and access to the treatments that are right for you. Reserve - A portion of the premium retained to pay future claims. When I had to change plans, I felt like I was reading Greek! Premium - Money charged for the insurance coverage reflecting expectation of loss. The costs for an HMO plan copays and coinsurance are typically lower than for other types of health plans, as long as you stay in network. Protected Cell - an insurance-linked security retained within the insurance or reinsurance company and is used to insulate the proceeds of the securities offering from the general business risks of the insurer, granting an additional comfort level for investors of the securitized instrument. High or low risk candidates may qualify for extra or discounted rates based on their deviation from the standard. Pool - an association organized for the purpose of absorbing losses through a risk-sharing mechanism thereby limiting individual exposures. Health Care & Insurance Glossary of Terms | Aetna Glossary Click on a letter to jump to the glossary items beginning with that letter. The contract provides for the initiation of payments at some interval that may vary, however the annuity payouts must begin within 13 months. Long-Term Disability Income Insurance - policy providing monthly income payments for insureds who become disabled for an extensive length of time, typically two years or longer. Credit - Credit Default - coverage purchased by manufacturers, merchants, educational institutions, or other providers of goods and services extending credit, for indemnification of losses or damages resulting from the nonpayment of debts owed to them for goods or services provided in the normal course of their business. AARP Dental Insurance Review 2023 - Forbes Advisor All insurance policies and group benefit plans contain exclusions and limitations. Independent Adjuster - freelance contractor paid a fee for adjusting losses on behalf of companies. Loss Payable Clause - coverage for third party mortgagee in case of default on insured property, secured by a loan, that has been lost or damaged. Key Points. Insured - party(ies) covered by an insurance policy. How to understand your costs and key health insurance terms Occurrence - an accident , including injurious exposure to conditions, which results, during the policy period in bodily injury or property damage neither expected or intended from the standpoint of the insured. Coinsurance - A clause contained in most property insurance policies to encourage policy holders to carry a reasonable amount of insurance. Clinical studies, or trials, are part of the process by which new therapies receive approval by the FDA. Bulk provisions are reserves included with other IBNR reserves to reflect deficiencies in known case reserves.

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