Glossary

Term
Definition
Accidental Death Benefit
A benefit in addition to the face amount of a life insurance policy, payable if the insured dies as the result of an accident or, depending upon the policy definition of the term, as a result of accidental means. Sometimes referred to as “double indemnity”.
Agent
A person who represents a life insurance company for the purpose of soliciting applications, collection initial premiums, and servicing insurance contracts.
Age of Majority
The age at which a person has the legal capacity to enter into a contract.
Amendment
A formal document changing the provisions of an insurance policy.
Assignee
The party to whom all or certain rights are transferred under an absolute or collateral assignment.
Assignor
The person who executes an assignment.
Assignment of Benefits
A provision in a health benefits claim form by which the insured directs the insurance company to pay any benefits directly to the provider of care on whose charge the claim is based.
Basic Coverage
Refers to base plan benefits over which major medical benefits may be superimposed.
Benefit
The amount payable by the insurer to a claimant, assignee, or beneficiary when the insured suffers a loss covered by the policy.
Beneficiary
The person to whom the proceeds of a life insurance policy are payable at the death of the insured.
Certificate of Insurance
The document delivered to an individual that summarises the benefits and principal provisions of a group insurance contract. May be distributed in booklet form.
Claim
A demand to the insurer by, or on behalf of, the insured person for the payment of benefits under a policy.
Claimant
The insured or beneficiary exercising the right to receive benefits.
Contingent Beneficiary
The person designated under a life insurance contract to receive the proceeds payable on the death of the insured if there is no primary beneficiary living at the insured’s death. Sometimes referred to as “secondary beneficiary”.
Contract
A binding agreement between two or more parties. A contract of insurance is a written document called the policy.
Co-Payment
The amount of money that you will be responsible for paying. With insurance your co-payment is typically 20%, which means you will be paying 20% of the cost while your insurance company will pay 80% of the cost.
Coverage
A major classification of benefits provided by a policy (e.g., short-term disability, major medical), or the amount of insurance or benefit stated in the policy for which an insured is eligible.
Covered Expenses
Those specified health care expenses that an insurer will consider for payment under the terms of a health insurance policy.
Convertible Term Insurance Policies
Term insurance policies that gives the policyholder the right to convert the term policy to a permanent plan such as Whole of Life Insurance or endowment Insurance without supplying evidence of insurability.
Credit Life Insurance
Life insurance, usually group, purchased as protection to one who has loaned money or extended credit to the insured. The amount of the insurance at any point in time is the amount of the unpaid balance of the loan.
Dependent
An insured’s spouse (wife or husband), not legally separated from the insured, and unmarried child(ren) who meet certain eligibility requirements and who are not otherwise insured under the same group policy. The precise definition of a dependent varies by insurer.
Deductible
The amount you pay for covered health care services before your insurance plan starts to pay. For example, if you have a $500 deductible, you will pay the first $500 of medical expenses before your insurance company will supply a co-payment.
Effective Date
The date that insurance coverage goes into effect.
Eligibility
The provisions of the group policy that state the requirements members of the group and/or their dependents must satisfy to become insured.
Eligibility Date
The date on which a member of an insured group may apply for insurance.
Eligible Medical Expense
A term describing the various types of expense the policy covers. The provision that describes these expenses commonly contains limitations applicable to certain of these expenses.
Endowment Insurance
An insurance contract that pays the sum assured (fixed sum) after a specified period (fixed period) or the sum assured is paid to beneficiary should the insured die prior to the maturity date.
Evidence of Insurability
Any statement or proof of a person’s physical condition and/or other factual information affecting acceptability for insurance.
Extended Term Insurance
Term life insurance granted under the non-forfeiture section of a life insurance contract, where the cash value will be applied to purchase term insurance in the face amount of the original policy, less indebtedness, for as long a period as the cash value will provide. Under endowment contracts, any excess of the Cash Value not used to purchase term insurance for the remaining term of the policy will be used to purchase a pure endowment payable on the date the contract matures.
Face Amount
The amount stated is the policy that is payable at the death of the insured or at the maturity of the contract, subject to adjustments for indebtedness, divided additional, additional benefits, etc. Also called “amount of insurance”.
Family Life Policy
A policy that provides insurance on the lives of all members of a family. A typical form provides permanent insurance on the life of the husband and a lesser amount of term insurance on the lives of the wife and children. Children born or legally adopted after the policy is issued are automatically insured under the policy with no increase in premium.
First-Dollar Coverage
A hospital or surgical policy with no deductible amount.
Fixed Amount Option
A settlement option under which the insurance company uses the policy proceeds plus interest to pay a specified sum at selected intervals for as long as the proceeds last.
Fraudulent Statement
A statement that was made with the intent to deceive.
Grace Period
A specified time (usually 30 or 31 days) following the premium due date during which the insurance remains in force and a policyholder may pay the premium without penalty.
Health Insurance
A form of insurance benefits in the event of economic loss resulting from sickness or injury. It thus includes loss-of-time and all medical expenses reimbursement coverage. Sometimes referred to especially in legislative language, as “accident and health insurance”.
Insurability
Refers to the physical, moral, occupational, and financial status of a risk and its acceptability to the insurer.
Insurance Agent
A Sales person who represents a life insurance company for the purpose of soliciting applications, collecting initial premiums and servicing insurance contracts.
Insured
The person and dependent(s) who are covered for insurance under a policy and to whom, or on behalf of whom, the insurer agrees to pay benefits.
Insurer
The party to the insurance contract that promises to pay losses or benefits. Also, any corporation primarily engaged in the business of furnishing insurance protection to the public.
Lapse
Termination of a life insurance contract because of non-payment of premiums. If there are non-forfeiture values, the policy lapses but may remain effective as extended term or educed paid-up insurance.
Liability
The probable cost of meeting an obligation.
Lump Sum
One amount of money paid one time.
Major Medical Insurance
A form of health insurance that provides benefits for most types of medical expense up to a high maximum benefit. Such contracts may contain internal limits and usually are subject to deductibles and coinsurance.
Maturity Value
The amount payable under an endowment insurance contract if the insured person is living at the end of the specified endowment period. Also, the amount payable under a whole life insurance policy if the insured lives to the last age of the mortality table on which the values of the contract were based.
Maximum Daily Hospital Benefit
The maximum amount payable for hospital room and board per day of hospital confinement.
Non-Cancelable Policy
A health insurance policy which the policy owner has the right to continue in force to a specified age, such as 60 or 65, by paying premiums as they fall due or within the grace period, and with respect to which the insurer has not reserved the right to increase premium rates.
Ordinary Life Insurance
One of the broad classes of life insurance (the others are group and industrial). The term “ordinary” is also used to refer to continuous premium, whole of life contracts.
Out-of-Pocket Expense
Those medical expenses that an insured must pay that are not covered under the group contract.
Policy
The written instrument issued to the applicant, which expresses the insurance contract between the company and the applicant.
Policy Mature Date
The date at which the amount of the life insurance policy becomes payable by either death or other contract agreement.
Policyowner/Policyholder
The person or party who owns an individual insurance policy.
Pre-Existing Condition
A mental or physical problem suffered by an insured prior to the effective date of insurance coverage.
Pre-Existing Conditions Provision
A restriction on payments for those charges directly resulting from an accident or illness for which the insured received care or treatment within a specified period of time (e.g. three months) prior to the date of insurance.
Premium
The payment, or one of several payments, establishing and keeping a life insurance policy in force.
Primary Beneficiary
The person who has first rights to receive policy proceeds when they become payable.
Principal
In agency law, the party to a contract who authorizes an agent to act on its behalf.
Proceeds
The amount of money payable under a policy at the death of an insured or at the maturity of a policy.
Proof of Loss
Documentary evidence required by an insurer to prove a valid claim exists, usually consisting of a claim form completed by the insured and the insured’s attending physician. Medical expense insurance claims also require itemised bills.
Reinsurer
An insurance company that accepts the risk transferred from another insurance company in a reinsurance transaction.
Renewable Term Insurance
Term insurance that may be renewed for another term of the same length usually subject to an upper age limit beyond which renewal will not be permitted.
Renewal Premium
Premium payable after the initial premium.
Rider
A special policy provision or group of provisions which may be added to a policy to expand or limit the benefits otherwise payable. Examples of benefits often added to basic policy by rider are the accidental death benefit and waiver of premiums for disability benefit.
Standard Premium Rate
The premium rate changed for insuring a person classified as having an average or less-than-average likelihood of a loss.
Term
The period of time
Term Insurance
Life insurance under which the benefit is payable only if the insured dies during a specified period of time or term, nothing being payable if he survives to the end of the term.
Valid Contract
A contract that is enforceable by law.
Waiting Period
The time a person must wait from the date of entry into an eligible class or application for coverage to the date the insurance is effective.
Whole of Life Insurance
Life insurance under which the coverage remains in force during the insured’s entire life time, provided premiums are paid as specified in the policy.
Yearly Renewal Term (YRT)
Term Life Insurance that allows the policyholder the right to continue the coverage at the end of each year for a specified number of years or until the insured reaches the age specifies in the contract.