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Insurance
Glossary
A-to-Z Index
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A
Accelerated Death Benefits - If your policy has an accelerated
death benefits provision, it will pay you - under certain conditions - all
or part of the policy death benefits while you are still alive. These conditions
include proof that the policyholder is terminally ill with a life expectancy
of less than 12 months, has a specified life-threatening disease or is in
a long-term care facility such as a nursing home. If you have a group term
life policy or certificate, the amount of accelerated benefit you may receive
is limited by law to: the greatest of $25,000 or 50% of the death benefit.
By accepting an accelerated benefit payment, a person could be ruled ineligible
for Medicaid or other government benefits. The proceeds also may be taxable.
Accident - An unforeseen, unintended event; something unexpected;
fortuitous.
Accidental Death Benefits - If a policy includes an accidental
death benefit, the cause of death will be examined to determine whether
the Insured´s death meets the policy´s definition of accidental.
Actual Cash Value (ACV) - The value of your property, based
on the current cost to replace it minus depreciation.
Adjuster - A person who investigates and settles insurance
claims.
Administrative Expense Charge - An amount deducted, usually
monthly, from the policy.
Agent - A person who sells insurance policies.
Annuitant - A person who receives the payments from an
annuity during his or her lifetime.
Annuity - A contract in which the buyer deposits money
with a life insurance company for investment. The contract provides for
specific payments to be made at regular intervals for a fixed period or
for life.
Annuity Certain - An annuity that provides a benefit amount
payable for a specified period of time regardless of whether the annuitant
lives or dies.
Annuity Period - The time span between the benefit payments
made under an annuity contract.
Application - A form you fill out with information about
you that an insurance company will use to decide whether to issue you a
policy and how much to charge.
Assignment - The transfer of all or part of a policy owner´s
legal title and rights to a policy to another person. It is possible to
change this type of transfer at a later date.
B
Bankdraft - Occurs when money is being automatically debited
from a banking account to for insurance coverage.
Benchmark Rate(s) - The rates set annually by the Commissioner
of Insurance that rate-regulated insurance companies use to reference their
rates. Rate-regulated insurance companies filing rates within a range of
30 percent above or below the benchmarks may use them immediately upon filing
without prior approval. A company that wants to set its rates outside this
range must receive the Commissioner´s prior approval.
Beneficiary - The person, persons or entity designated
to receive the death benefits from a life insurance policy or annuity contract.
Binder - A temporary insurance contract that provides proof
of coverage until you receive a permanent policy.
Bodily Injury (BI) - Physical injury to a person.
C
Cancellation - Termination of an insurance policy by the
company or insured before the renewal date.
Cash Surrender Option - Nonforfeiture option, which specifies
that the policy owner can cancel the coverage and receive the entire net
cash value in a lump sum.
Cash Value - The amount of money, which the policy owner
will receive as a refund if the policy owner cancels the coverage and returns
the policy to the company. Also known as cash surrender value.
Churning - Can occur when an agent persuades a consumer
to borrow against an existing life insurance policy to pay the premium on
a new one.
Claimant - A person who makes an insurance claim.
Co-insurance - The percent of each health care bill you
must pay out of your own pocket. Non-covered charges and deductibles are
in addition to this amount.
Collision Coverage - Pays for damage to your car without
regard to who caused an accident. The company must pay for the repair or
up to the actual cash value of your vehicle, minus your deductible.
Company Profile
- A synopsis of a company´s performance in the state of Texas. Includes
licensing data, a rating provided by A.M. Best Company, financial information
regarding the company´s assets and liabilities, complaint history
and a record of the companies activities as it pertains to the interests
it has in Texas.
Complaint
- The formal mechanism to start an investigation of potential wrongdoings
by insurers, agents and premium finance companies licensed and doing business
in the start of Texas.
Complaint History
- Information collected or maintained by the Texas Department of Insurance
relating to the number of justified, verified as accurate, and documented
as valid, complaints received against a particular insurer, agent or premium
finance company and the disposition of the complaints.
Comprehensive
Coverage (Physical Damage Other than Collision) - Pays for damage
to or loss of your automobile from causes other than accidents. These include
hail, vandalism, flood, fire, and theft.
Conditional
Receipt - A premium receipt given to an applicant which makes the
insurance effective only if or when a specified condition is met.
Contestable
Period - A period of up to 2 years that an insurance company may
deny payment of a claim because of suicide or a material misrepresentation
on your application.
Contingent
Beneficiary - Another party or parties who will receive the proceeds
if the primary beneficiary should predecease the person whose life is insured.
Contract
- In most cases, the term "contract" refers to an insurance policy.
A policy is considered to be a contract between the insurance company and
the policyholder.
Conversion
Privilege - The right to change (convert) insurance coverage from
one type of policy to another. For example, the right to change from an
individual term insurance policy to an individual whole life insurance policy.
Credit Life
Insurance - This is a special type of coverage usually designed
to pay off your loan or charge account balance if you die. Some lenders
or sellers may require credit life insurance before they will approve your
loan. If credit life is required, the lender or seller cannot require you
to purchase it from them or a particular insurance company. If you have
an existing life policy, the creditor has to accept an assignment of benefits
under your existing policy instead of requiring you to purchase a credit
life policy. Credit life insurance premium rates for loans of 10 years or
less are regulated by the Texas Department of Insurance, but premium rates
for loans that are more than 10 years old are unregulated.
D
Death Benefit - Amount paid to the beneficiary upon the
death of the insured.
Declarations
Page - - The page in your policy that shows the name and address
of the insurer, the period of time a policy is in force, a description of
the vehicle, the amount of the premium, and the amount of coverage.
Deductible
- The amount the insured must pay in a loss before any payment is due from
the company.
Deferred Annuity
- An annuity under which the annuity payment period is scheduled to begin
at some future date.
Depreciation
- The act of lowering an item´s value due to use or wear and tear.
Dividend
- The amount of money an insurance company may decide to distribute to policyholders.
E
Earned Premium - The portion of a policy premium that has
been used to actually buy coverage, or that the insurance company has "earned."
For instance, if you have a six-month policy that you paid for in advance,
two months into the policy, there would be two months of earned premium.
The remaining four months of premium is called unearned premium.
Effective Date
- The date on which an insurance policy becomes effective.
Endorsement
- A written agreement attached to a policy expanding or limiting the benefits
otherwise payable under the policy. Same as a "rider."
Escrow
- Money placed in the hands of a third party until specified conditions
are met.
Evidence of
Insurability - To qualify you for a particular policy at a particular
price, companies have the right to ask you for information about your health
and lifestyle. An insurance company will use this information - your evidence
of insurability - in deciding if your application for insurance is acceptable
and at what premium rate.
Exclusion
- Provision in an insurance policy that indicates what is denied coverage.
Experience
Period - The period of time that a company will reference when
making evaluations of an insuring policy. There is not a standardized amount
of time. See annotation for an example of an experience period.
Expiration
Date - The date on which an insurance policy expires.
Extended Term
Insurance Option - A nonforfeiture benefit under which the net
cash value of the policy is used to purchase term insurance for the amount
of coverage available under the original policy.
F
Face Value - The initial amount of death benefit provided
by the policy as shown on the face page of the contract. The actual death
benefit may be higher or lower depending on the options selected, outstanding
policy loans or premium owed.
First Party
Loss - A situation involving only the insurer and insured.
Free Examination
Period - Also known as "10-day free look" or "Free
Look," it is the time period after a life insurance policy or an annuity
is delivered during which the policy owner may review it and return it to
the company for a full refund of the initial premium. Variable life policies
are required to include a "free-look" provision. For other coverage,
it is at the company´s option.
G
Gap Insurance - Insurance that pays the difference between
the actual cash value of a vehicle and the amount still to be paid on the
loan, Some gap policies may also cover the amount of the deductible.
Grace Period(s) - The time - usually 31 days - during which
a policy remains in force after the premium is due but not paid. The policy
lapses as of the day the premium was originally due unless the premium is
paid before the end of the 31 days or the insured dies. This is not a "free-insurance"
period.
Group Life Insurance - This type of life insurance provides
coverage to a group of people under one contract. Most group contracts are
sold to businesses that want to provide life insurance for their employees.
Group life insurance also can be sold to associations to cover their members
and to lending institutions to cover the amounts of their debtor loans.
Most group policies are for term insurance. Generally, the business will
be issued a master policy and each person in the group will receive a certificate
of insurance.
Group of Companies - Several insurance companies under
common ownership and often common management.
H
Health 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.
I
Incontestability - 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
L
Lapse - 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.
M
Material 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.
N
Named 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
P
Paid-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
R
Rated 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.
S
Single 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.
T
Third 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.
U
Underwriter - 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.
V
Variable 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.
W
Whole 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
Z
Disclaimer: This information is
intended to be a guide to understanding common insurance terms. SOL Insurance
and its affiliates 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.
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