Term
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Definition
| Riders attached to life insurance policies which allow death benefits to be used to cover nursing or convalescent home expenses. |
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Term
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Definition
| An unplanned, unforeseen event which occurs suddenly and at a specific place. |
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Term
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Definition
| A type of insurance that protects the insured against loss due to accidental bodily injury. |
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Term
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Definition
| Unplanned, unforeseen traumatic injury to the body. |
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Term
| Accidental Death and Dismemberment (AD&D) |
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Definition
| An insurance policy which pays either a specified amount or a multiple of the insured's weekly disability benefit if the insured dies, loses his sight, or loses two limbs due to an accident. If the insured loses only one eye, arm, hand, leg, or foot, a smaller benefit is paid. |
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Term
| Accidental Death Insurance |
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Definition
| An insurance policy that provides payment if the insured's death is the result of an accident. |
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Term
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Definition
| The time before an annuitant's retirement during which the annuitant is making payments or investments in an annuity. |
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Term
| Acquired immunodeficiency Syndrome (AIDS) |
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Definition
| An infectious and incurable disease caused by the human immunodeficiency virus (llIV). |
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Term
| Activities of Daily Living (ADL's) |
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Definition
| Activities individuals must do everyday such as moving about, getting dressed, eating, bathing, etc. |
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Term
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Definition
| A person trained in the technical aspects of insurance and related fields, particularly in the mathematics of insurance; a person who, on behalf of the insurer, determines the mathematical probability of loss. |
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Term
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Definition
| A contract offered on a "take-it-or-leave-it" basis by an insurer. The insured's only option is to accept or reject the contract. Any uncertainty found in the contract is construed against the party who drew up the contract. |
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Term
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Definition
| Life insurance which permits changes on the face amount, premium amount, period of protection, and the duration of the premium payment period. |
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Term
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Definition
| An individual appointed by a court as a fiduciary to settle the financial affairs and estate of a deceased person. |
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Term
| Admitted (Authorized) Insurer |
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Definition
| An insurance company authorized and licensed to transact business in a particular state. |
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Term
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Definition
| A program for impaired adults that attempts to meet their health, social, and functional needs in a setting away from their homes. |
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Term
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Definition
| The tendency of more bad than good risks wanting to buy and maintain insurance~ |
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Term
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Definition
| An insurance sales office or company. |
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Term
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Definition
| An individual who is licensed to sell, negotiate, or effect insurance contracts on behalf of an insurer. |
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Term
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Definition
| The authority and special powers granted to an agent by his or her agency contract |
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Term
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Definition
| A contract in which the parties to the contract agree to exchange unequal amounts. Insurance contracts are aleatory in that the amount the insured will pay in premiums is unequal to the amount the insurer will pay in the event of a loss. |
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Term
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Definition
| A disease that causes the victim to become dysfunctional due to degeneration of brain cells and severe memory loss. |
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Term
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Definition
| Additional, miscellaneous services such as x-ray, anesthesia, and lab work provided by a hospital. Ancillary charges do not include hospital room and board. |
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Term
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Definition
| The person making application for, or offering themselves or another to be insured under an insurance contract. |
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Term
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Definition
| A document that provides information for underwriting purposes. |
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Term
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Definition
| The transfer of ownership rights of a life insurance policy from one person to another. |
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Term
| Attending Physician's Statement (APS) |
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Definition
| A statement usually obtained from the applicant's doctor. |
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Term
| Authorized (Admitted) Insurer |
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Definition
| An insurance company authorized and licensed to transact business in a particular state. |
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Term
| Basic Hospital Expense insurance |
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Definition
| Coverage providing benefits for room and board and miscellaneous hospital expenses for a certain number of days during a hospital stay. |
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Term
| Basic Medical Expense Insurance |
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Definition
| Coverage for doctor visits, x-rays, lab tests, and emergency room visits. Benefits limited to specified dollar amounts. |
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Term
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Definition
| Temporary contracts of insurance which put an insurance policy into force before the premium has been paid. |
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Term
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Definition
| The method of determining primary coverage for a dependent child that determines that the parent whose birthday is earliest will be considered as having the primary plan. |
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Term
| Blanket Medical Insurance |
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Definition
| Provision that provides benefits for all medical costs, including doctor visits, hospitalization, and drugs. |
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Term
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Definition
| An individual who represents an insured in the process of purchasing and negotiating a contract of insurance. |
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Term
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Definition
| Booklet that describes what type of coverage is being offered, and provides general information to help an applicant compare policies and decide which is best for his/her needs. |
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Term
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Definition
| A benefit that gives an employee a series health care benefits choices. |
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Term
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Definition
| In life insurance, the amount to which a policyowner is entitled if the policy is surrendered before maturity. |
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Term
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Definition
| A statement or booklet confirming that a policy has been written and stating the coverage in general. |
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Term
|
Definition
| A request for payment of the benefits provided by an insurance contract. |
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Term
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Definition
| An unfair trade practice in which an agent uses physical or mental force with the intent of inducing an applicant to purchase insurance. |
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Term
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Definition
| This provision states that the insurer and the insured will share the losses covered by the policy in a proportion agreed upon in advance. |
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Term
|
Definition
| A practice in which a person in a fiduciary capacity illegally mixes his/her personal funds with funds he/she is holding in trust. |
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Term
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Definition
| The payment made by insurers to agents or brokers for the sale and service of policies. |
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Term
| Commissioner (Director, Superintendent) |
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Definition
| The head of the state department of insurance. |
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Term
| Comprehensive Major Medical |
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Definition
| This is a combination of basic coverage and major medical coverage that features low deductibles, high maximum benefits, and coinsurance. |
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Term
|
Definition
| The withholding of known facts which, if material, can render a contract void. |
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Term
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Definition
| A contract in which both parties must perform certain duties and follow rules of conduct to make the contract enforceable. |
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Term
| Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 |
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Definition
| This law provides for the continuation of group health care benefits for up to 18 months if the insured person terminates employment or is no longer eligible and up to 36 months in cases of loss of eligibility due to death of the insured person, divorce, or attainment of the limiting age. |
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Term
|
Definition
| A plan of employee coverage that requires the employee to pay part of the premium. |
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Term
|
Definition
| Possessing a license solely for the purpose of writing business on one's own self, immediate family, relatives, employer or employees. |
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Term
|
Definition
| A policy that may be exchanged for another type of policy, by contractual provision, at the option of the policyowner, and without evidence of insurability (i.e. term life changed to a form of permanent life). |
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Term
|
Definition
| This provision helps to determine which provider is the primary provider in situations where an insured is covered by more than one policy thus avoiding claims overpayments. |
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Term
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Definition
| An arrangement in which a covered person must pay a specified amount for services "up front" and the provider pays the remainder of the cost. |
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Term
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Definition
| The act of signing an insurance policy by a licensed resident agent. |
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Term
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Definition
| The perils (causes of loss) which are covered in a policy. |
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Term
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Definition
| The Commissioner's Standard Ordinary Table. A mortality table used in life insurance that mathematically predicts the likelihood of death. |
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Term
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Definition
| Care that is rendered to help an insured complete his/her activities of daily living. |
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Term
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Definition
| The amount payable upon the death of the person whose life is insured. |
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Term
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Definition
| An unfair trade practice in which one agent or insurer makes an injurious statement about another with the intent of harming the person's or company's reputation. |
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Term
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Definition
| A person who relies on another for support and maintenance. |
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Term
| Director (Commissioner, Superintendent) |
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Definition
| The head of the state department of insurance. |
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Term
| Disability Income Insurance |
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Definition
| Health insurance that provides periodic payments to replace an insured's income when he/she is injured or ill. |
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Term
| Dread (Specified) Disease Policy |
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Definition
| Policy with a high maximum limit that covers certain diseases named in the contract such as polio and meningitis. |
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Term
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Definition
| By federal law, employers that have 25 or more employees who are within the service area of a qualified HMO, pay minimum wage, and offer a heath plan, must offer HMO coverage as well as an indemnity plan. |
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Term
|
Definition
| The amount of the premium for which the policy protection has been given. |
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Term
|
Definition
| The date when an insurance policy begins (also known as the inception date). |
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Term
|
Definition
| The period of time in which an employee may enroll in a group health care plan without having to provide evidence of insurability. |
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Term
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Definition
| An injury or disease which occurs suddenly and requires treatment within 24 hours. |
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Term
| Employee Retirement Income Security Act (ERISA) |
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Definition
| This act stipulates federal standards for private pension plans. |
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Term
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Definition
| A form changing the provisions of and attached to a life insurance policy (also known as a rider). |
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Term
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Definition
| The maturity date or time at which the face amount equals cash values. |
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Term
|
Definition
| The amount of time an employee has to sign up for a contributory group health plan. Errors and Omissions Policy (E&O) A type of insurance, purchased by the insurer, which protects the insured from errors or oversights on the part of the insurer. |
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Term
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Definition
| Prevents an individual from denying a fact, if the fact was admitted to be true by a previous action. |
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Term
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Definition
| Insurance that pays over and above or in addition to basic policy limits. |
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Term
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Definition
| Causes of loss, exposures, conditions, etc. listed in the policy which are not covered and with no benefits payable. |
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Term
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Definition
| A contract that promises action in the event of a specified future occurrence. |
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Term
| Explanation of Benefits (EOB) |
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Definition
| A statement that outlines what services where rendered, how much the insurer paid, and how much the insured was billed. |
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Term
| Explanation of Medicare Benefits |
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Definition
| A statement sent to a Medicare patient indicating how the Medicare claim will be settled. |
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Term
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Definition
| A facility which is licensed by the state to provide 24 hour nursing care. |
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Term
|
Definition
| This provision allows coverage to continue beyond the policy's expiration date for employees who are not actively at work due to disability or dependents who are hospitalized on that date. This coverage continues only until the employee returns to work or the dependent leaves the hospital. |
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Term
|
Definition
| The first page of a policy. |
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Term
|
Definition
| An agent/broker who handles insurer funds in a trust capacity. |
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Term
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Definition
| Premium the insured can vary in the amount of timing of payments. |
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Term
| Flexible Spending Account (PSA) |
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Definition
| A salary reduction cafeteria plan that uses employee funds to provide various types of health care benefits. |
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Term
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Definition
| Misrepresentation or deceit with the intent to induce a person to part with something of value. |
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Term
|
Definition
| A period of time, usually required by law, during which a policyowner may inspect a newly issued individual life or health insurance policy for a stated number of days and surrender it in exchange for a full refund of premium if not satisfied for any reason. |
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Term
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Definition
| A model of IIMO and PPO organizations that uses the insured's primary care physician (the gatekeeper) is the initial contact for the patient for medical care and for referrals. |
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Term
| Group Disability Insurance |
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Definition
| This type of insurance covers a group of individuals against loss of pay due to accident or sickness. |
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Term
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Definition
| Health insurance provided to members of a group. |
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Term
|
Definition
| Life insurance provided for members of a group. |
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Term
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Definition
| A circumstance that increases the likelihood that a peril will take place. |
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Term
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Definition
| The effect of a person's reputation, character, living habits, etc. on his/her insurability. |
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Term
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Definition
| The effect a person's indifference concerning loss has on the risk to be insured. |
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Term
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Definition
| A type of hazard that arises from the physical characteristics of an individual, such as a physical disability. The hazard may be a current condition or a condition present at birth. |
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Term
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Definition
| Protection against loss due to sickness or bodily injury. |
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Term
| Health Maintenance Organization (HMO) |
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Definition
| A prepaid medical service plan in which medical service providers, who must be used be used by plan members, contract with the HMO to provide services. The focus of the HMO is preventive medicine. |
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Term
|
Definition
| A facility which provides services under contract that is certified by the insured's health plan. |
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Term
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Definition
| Type of care in which part-time nursing or home health aide services, speech therapy, physical or occupational therapy services are given in the home of the insured. |
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Term
|
Definition
| A covered expense under Part A of Medicare in which a licensed home health agency provides home health care to an insured. |
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Term
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Definition
| A facility for the terminally ill that provides supportive care such as pain relief and symptom management to the patient and his/her family. Hospice care is covered under Part A of Medicare. |
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Term
| Hospital Confinement Rider |
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Definition
| This optional disability income rider waives the elimination period when an insured is hospitalized as an inpatient. |
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Term
|
Definition
| To restore the insured to the same condition as prior to loss with no intent of loss or gain. |
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Term
|
Definition
| The ability of an individual to meet an insurance company's underwriting requirements. |
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Term
|
Definition
| Proven by love and affection for family members, economic or fmancial loss. In life and health insurance it is required at the time of policy issue. |
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Term
|
Definition
| A contract whereby one party (insurer) agrees to indemnit~ or guarantee another party (insured) against a loss by a specified future contingency or peril in return for payment of a premium. |
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Term
|
Definition
| The person or organization that is protected by insurance; the party to be indemnified. |
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Term
|
Definition
| The party who undertakes to indemnity for losses, provides other benefits, or renders services (also known as insurance company). |
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Term
|
Definition
| This rider is added to a life insurance policy to pay LTC benefits; the benefits paid toward LTC will reduce the life insurance policy's benefits. The amount of benefits available for LTC depends upon the life insurance benefits available. |
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Term
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Definition
| An act that is intended to cause injury. Self- inflicted injury is not covered under accident insurance. Intentional injuries inflicted on the insured by another are covered. |
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Term
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Definition
| A level of care that is one step down from skilled nursing care. Intermediate Care provides nursing care under the supervision of physicians or registered nurses. |
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Term
|
Definition
| The individual's age when a policy is issued. |
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Term
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Definition
| Termination of a policy because the premium has not been paid by the end of the grace period. |
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Term
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Definition
| The accounting measurement of an insurer's future obligations to pay claims to policyowners. |
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Term
|
Definition
| The premium in a policy that remains the same over the period of time premiums are paid. |
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Term
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Definition
| Average number of years remaining for a person of a given age to live, as shown on the mortality table. |
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Term
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Definition
| This rider is attached to a life insurance policy and provides LTC benefits or benefits for the terminally ill using available life insurance benefits. |
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Term
|
Definition
| The amount of money an insured can borrow using the cash value of his/her life insurance policy as collateral. |
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Term
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Definition
| Health and social services provided under the supervision of physicians and medical health professionals for persons with chronic diseases or disabilities. Care is usually provided in a Long-Term Care Facility which is a state licensed facility that provides services. |
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Term
| Long-Term Disability Insurance |
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Definition
| This type of insurance provides coverage for illness until the insured reaches age 65 and for life in the case of an accident. This insurance is can be written as group or individual. |
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Term
|
Definition
| The reduction, decrease, or disappearance of value of the person or property insured in a policy, by a peril insured against. |
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Term
|
Definition
| Pays benefits for inability to work because of disability resulting from accidental bodily injury or sickness. |
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Term
|
Definition
| Settlement method that pays the beneficiary the entire proceeds of a life insurance policy in one "lump sum" rather than in installments. |
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Term
|
Definition
| A type of health insurance that pays covered expenses up to a high limit whether the insured is in or out of the hospital. This type of insurance usually carries a large deductible. |
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Term
|
Definition
| The date when the face amount of the life insurance becomes payable. |
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Term
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Definition
| A medical benefits program jointly administered by the individual states and the federal government. |
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Term
| Medical Expense Insurance |
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Definition
| This type of insurance pays benefits for medical, surgical, and hospital costs. |
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Term
| Medical Information Bureau (MIB) |
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Definition
| An information database that stores the health histories of individuals who have applied for insurance in the past. Most insurance companies subscribe to this database for underwriting purposes. |
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Term
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Definition
| The United States federal government plan for paying certain hospital and medical expenses for persons who qualify. |
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Term
| Medicare Supplement Insurance |
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Definition
| This type of insurance fills the gaps in the protection provided by Medicare. It is sold on an individual or group basis and cannot duplicate any benefits provided by Medicare. |
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Term
|
Definition
| A false statement in the application that can render the contract void if material to acceptance of the risk. |
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Term
|
Definition
| The method of premium payment, whether annually, semiannually, quarterly, or monthly. |
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Term
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Definition
| The ratio of the incidence of sickness to the number of well persons in a given group of people over a given period of time. |
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Term
|
Definition
| A table showing the incidence of sickness at specified ages. |
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Term
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Definition
| A table showing the probability of death at specified ages. |
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Term
| Nonadmitted (Nonauthorized) |
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Definition
| An insurance company that has not applied, or has applied and been denied a Certificate of Authority and may not transact insurance in a particular state. |
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Term
| Nonauthorized (Nonadmitted) |
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Definition
| An insurance company that has not applied, or has applied and been denied a Certificate of Authority and may not transact insurance in a particular state. |
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Term
|
Definition
| When an insurer terminates a policy on the anniversary or renewal date. |
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Term
|
Definition
| A health insurance contract that the insured has a right to continue in force by payment of prem'.ms that remain the same for a substantial period of time. The premium amount and time period are both spelle~ out in the contract. While the contract is in force, the insurer may not make any changes to the provisions of the contract. |
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Term
|
Definition
| Those values in a life insurance policy that the owner does not forfeit even if he or she ceases to pay premium. |
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Term
| Non-participating Policies (Non-par) |
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Definition
| Insurance that does not pay dividends. Nonresident Agent An agent licensed in a state in which he or she is not a resident. |
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Term
| Omnibus Budget Reconciliation Act |
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Definition
| A federal law which extends the minimum COBRA continuation of group health care coverage from 18 to 29 months for qualified beneficiaries who are disabled at the time of qualification. |
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Term
|
Definition
| A choice of ways of receiving policy dividends, nonforfeiture values, death benefits, or cash values. |
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Term
|
Definition
| Amounts a covered person must pay for things such as coinsurance and deductibles before the insurer will pay its portion. |
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Term
|
Definition
| When there is more insurance in force that the insured has the potential to lose, the insured will be paid the excess amount. |
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Term
|
Definition
| A policy on which all premiums have been paid but has not matured due either to death or endowment. |
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Term
|
Definition
| Legal term that distinguishes oral statements from written statements. |
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Term
|
Definition
| States that a contract may not be altered without written consent of both parties; in other words, the contract may not be altered by an oral agreement. |
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Term
|
Definition
| An insured is considered to be partially disabled when he or she can perform some, but not all, of the duties of his/her occupation as a result of injury or sickness. |
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Term
|
Definition
| Insurance that pays dividends to policyholders. |
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Term
|
Definition
| A rider found in juvenile policies which waives the premiums if the person paying them (often the parent) is disabled or dies while the child is still a minor. |
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Term
|
Definition
| The cause of a possible loss. |
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Term
| Permanent and Total Disability |
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Definition
| Total disability from which the insured does not recover. |
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Term
|
Definition
| The staying quality of life insurance policies (renewals). |
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Term
|
Definition
| This states that insurance policies cover the insurable interest of the insured. The insured cannot transfer or assign any policy except life insurance. |
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Term
| Physical Exam and Autopsy |
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Definition
| A provision that allows an insurer, at its own expense, to have an insured examined when a claim is pending or to have an autopsy performed in the event of death where one is not prohibited by law. |
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Term
|
Definition
| A nonforfeiture value in which an insurer loans a part of all of the cash value of the policy assigned as security for the loan to the policyowner. |
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Term
|
Definition
| The person who as possession of the policy, usually the insured. |
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Term
|
Definition
| The person who has the right to exercise the rights and privileges in the policy. This person may or may not be the insured. |
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Term
|
Definition
| A physical condition that existed before the effective date of the policy. Many health insurance policies will cover preexisting conditions until after a stated amount of time has passed. |
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Term
| Preferred Provider Organization (PPO) |
|
Definition
| An organization of medical professionals and hospitals who provide services to an insurance company's clients for a set fee. The insured is given a list of these "preferred providers," and the insured may chose from any of the physicians or hospitals on this list. Coverage in a PPO is 100%, with a minimal copayment for each office visit or hospital stay. |
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Term
|
Definition
| A risk that is better than the standard risk on which the premium rate was calculated. |
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Term
|
Definition
| Basic, fundamental; an insurance policy which pays first with respect to other outstanding policies. |
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Term
|
Definition
| The person who is named as first to receive benefits from a policy. |
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Term
|
Definition
| Insurance furnished by nongovernmental insuring organizations. |
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Term
|
Definition
| Adjusting the premium charge in proportion to the exact coverage that has been in force. |
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Term
|
Definition
| The period of time between the effective date of a health insurance policy and the date coverage for all or certain conditions begins. |
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Term
|
Definition
| The amount payable by a policy, usually in reference to the face amount of a life insurance policy, payable at the death of the insured. |
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Term
|
Definition
| Insurance agent or broker. |
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Term
|
Definition
| Any group or individual who provides health care services. |
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Term
|
Definition
| Insurance whereby premiums are paid for protection in the event of death or disability. There is no cash value in the policy. Term insurance is an example of pure protection. |
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Term
| Rate Service Organization |
|
Definition
| Rate service organizations are formed by, or on behalf of, a group of insurers to develop rates for those insurers. The service organization files the rates with the insurance department on behalf of their members. They may also act as a collection point for actuarial data. |
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Term
|
Definition
| The termination of an insurance contract due either to material misrepresentation by the insured or by fraud, misrepresentation, or duress on the part of the agent/insurer. |
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Term
|
Definition
| an amount representing actual of potential liabilities kept by an insurer in a separate account to cover debts to policyholders. |
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Term
|
Definition
| Care provided either by paid workers who come to the home for short periods of time or by a nursing facility when a patient stays for a short period of time to give family members a rest. |
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Term
|
Definition
| Any supplemental agreement attached to and made a part of the policy whether the policy's conditions are expanded and additional coverage added, or coverage or condition is waived. |
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Term
|
Definition
| Uncertainty as to the outcome of an event when two or more possibilities exist. |
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Term
|
Definition
| The uncertainty or chance of a loss occurting in a situation that can only result in a loss or no change. |
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Term
|
Definition
| The uncertainty or chance of a loss occurring in a situation that involves the opportunity for either loss or gain. |
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Term
|
Definition
| The person who is named to receive benefits upon the death of the insured if the first-named beneficiary is no longer alive or does not collect all the benefits due to his/her own death. |
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Term
|
Definition
| Insurance plans where the health care services rendered are the benefits instead of monetary benefits. |
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Term
|
Definition
| Choices available to the insured/owner for distribution of insurance proceeds either to the insured or the insured's beneficiary, instead of an immediate cash lump-sum payment. |
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Term
|
Definition
| Canceling the policy with a less that proportionate return of premium. |
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|
Term
| Short-Term Disability Insurance |
|
Definition
| A group or individual policy that covers disabilities of 13 or 26 weeks. It is not uncommon for the policy to cover an insured for a period of up to two years. |
|
|
Term
|
Definition
| Physical illness, disease, and pregnancy are all considered sicknesses. Mental illness is not considered sickness. |
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Term
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Definition
| Daily nursing care or skilled care, such as administration of medication, diagnosis, or minor surgery that is performed by or under the supervision of a skilled professional. |
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Term
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Definition
| Prevents the debtors of a beneficiary from collecting the benefits before he/she receives them. |
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Term
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Definition
| Requirements approved by state law that must appear in all insurance policies. |
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Term
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Definition
| A risk that is considered the average on which the rate of premium has been based. |
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Term
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Definition
| The legal process by which an insurance company seeks recovery of the amount paid to the insured from a third party who may have caused the loss. The insured cannot collect twice. |
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Term
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Definition
| A risk that does not meet the "average" standard set by the underwriting department. |
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Term
| Superintendent (Commissioner, Director) |
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Definition
| The head of the state department of insurance. |
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Term
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Definition
| To give up a whole life policy. In the case of surrender, the insurer will pay the insured the cash value the policy has built up. |
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Term
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Definition
| Insurance that provides protection for a specific period of time. |
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Term
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Definition
| A patient who will normally die within 6 months of a specific illness or sickness. |
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Term
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Definition
| The third in line to receive the benefits of a life insurance policy. |
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Term
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Definition
| An insured is considered totally disabled if he or she cannot perform the duties of any occupation for payment as a result of injury or sickness. |
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Term
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Definition
| A misrepresentation which persuades an insured/owner to his of her detriment to cancel, lapse, or switch policies from one to another. |
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Term
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Definition
| A home office person who performs the underwriting process to accept or reject risks on behalf of the insurer. An agent is classified as a field underwriter and collects necessary data. |
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Term
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Definition
| The portion of premium for which policy protection has not yet been given. |
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Term
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Definition
| When only one party is legally bound to contractual obligations after the premium is paid. |
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Term
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Definition
| A combination of flexible premium and adjustable life insurance policy. |
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Term
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Definition
| When both parties bargain in good faith in forming the contract. Applicant must make full disclosure of risk to the company. Company must be fair in underwriting the risk. |
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Term
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Definition
| A contract the pays a stated amount in the event of a loss (disability insurance/life insurance). |
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Term
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Definition
| Time between the beginning of a disability and the start of disability insurance benefits. |
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Term
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Definition
| The voluntary abandonment of a known or legal right or advantage by an insurer. |
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Term
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Definition
| Continuation of life insurance coverage if the insured becomes totally disabled and is unable to pay the premiums. |
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Term
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Definition
| A material stipulation in the policy that if breached may void coverage. |
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Term
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Definition
| Insurance that is kept in force for a person's entire life and pays a benefit upon the person's death, whenever that may be. |
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