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MI Pre-Insurance Lic
C - Vocabulary Words
| Term | Definition |
|---|---|
| Cafeteria Plan | Employee Benefit Plan. Employees select among various group programs & insurance plans that best meet their needs. |
| Cancellable | A renewability provision with a health insurance contract that allows the insurance company, at its option, to terminate or renew the policy. |
| Capital Sum | The benefit provided for accidental dismemberment or accidental blindness. |
| Capitation | A method of payment for health services, the medical provider is paid a fixed amount for each patient without regard to the actual number or nature of services provided. Common payment method for HMO primary care physicians. |
| Carrier | Another term for insurer or insurance company. |
| Cash Refund Annuity | A settlement option that offers an additional guarantee to pay a beneficiary if not all premiums were returned to the annuitant as income payments. |
| Cash Surrender option | A nonforfeiture option that allows the policyowner to receive the cash value when surrendering or giving up their permanent life insurance. |
| Cash Surrender Value | The amount of equity (cash value) available if the policyowner surrenders their permanent life insurance. |
| Cash Value | The amount of equity (ownership) or cash accumulation in a permanent life insurance policy. |
| Catastrophe (Catastrophic) Insurance | A health policy that provides substantial benefits if the insured has a prolonged, serious and expensive diseability or illness |
| Certificate of Creditable Coverage | Documentation issued by a group health care plan to an employee for presentation to a new group plan to verify previous coverage especially for a preexisting condition. |
| Certificate of Insurance | Issued by group contracts (typically employer groups) that summarizes coverage to insured employees. AKA Group Certificate |
| Chronic Condition | A treatable but incurable illness such as arthritis or high blood pressure. |
| Claim | A request for payment of a loss which may be covered by the insurance contract. |
| Class Designation | A beneficiary designation that does not specify beneficiaries by name, but rather by a group or class. e.i. "all my children" named as beneficiaries |
| Class Rate | A premium calculation for a group or class of persons with similar risks. AKA - rating |
| Coinsurance | The insurance company pays a percentage and the insured pays a percentage. i.e. 80/20 |
| Collateral Assignment | A type of policy assignment in which the assignee receives partial control over the policy and also partial rights to its benefits. Used to secure a loan. AKA temporary assignments |
| Commercial Health Insurers | Private health insurance companies offering traditional reimbursement policies such as major medical expense insurance. |
| Commission | A percentage of premium paid by the insurance company to the agent as compensation for selling an insurance policy. |
| Common Disaster Provision | A policy condition designed to protect the contingent beneficiary or provide an alternative beneficiary in the event that both the insured and primary beneficiary die as a result of a common accident. |
| Competent Party | Requires both parties understand the contract and agree to it for the contract to be enforceable. A policyowner must be of legal age |
| Major Medical Expense | A traditional medical expense insurance designed to reimburse the policy owner for out-of-pocket expenses. Typically has low deductibles, coinsurance & Stop loss limits. |
| Concealment | The deliberate withholding of information in order to financially gain, such as obtaining an insurance policy or receiving payment on a claim under false pretense. |
| Conditional Contract | A contract that is inforce only if certain obligations are met or events have occurred. |
| Conditional Receipt | Given to potential policyowners at time of application & initial premium payment. It allows for the earliest possible coverage if the policy is approved subject to underwriting and any other stated conditions on the receipt. |
| Conditionally Renewable | A health insurance provision that allows renewability if certain stated conditions are met by the insured, such as full-time employment to age 65. |
| Conditions | Another term for policy provisions or terms |
| Consent | Written approval or permission to be insured by another party. |
| Consideration | Exchange of values between parties to complete a contract. With an insurance contract, premium is paid by the policyowner, and the insurer promises to pay according to the policy. |
| Consideration Clause | The part of the insurance contract that sets forth the amount, renewal and frequency of premium payments by the policyowner. |
| Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) | A law that extends group health insurance coverage for terminated employees and assume more control in protecting their health. |
| Consumer-Driven Health Plan | A type of health benefit plan in which the insureds select their health care providers, manage their health expenses and assume more control in protecting their health. |
| Contestable Period | A period of time, usually the first two years the policy is in force, in which the insurance company can contest a claim based on misstatements or omissions on the application. |
| Contingent Beneficiary | Recipient of life or accident policy payable upon death of the insured & no primary beneficiary is named or alive. AKA - secondary or tertiary bene's |
| Contract | An agreement (offer & acceptance) between two parties that have the legal capacity to do so and have exchanged valuable consideration. |
| Contributory Plan | A group insurance policy were the policyowner (an employer) and insureds (employees) share the cost of the plan. Generally, insurance companies will require 75% or more of all eligible employees to participate. |
| Convertible Term | A term life policy that may be exchanged to a permanent life policy without evidence of insurability. |
| Coordination of Benefits Provision | It prevents duplication of benefits with multiple group health insurance coverage. It limits coverage to 100% of thee expenses covered and designates the order of benefits payable by the group carriers. |
| Co-payment | A set amount of money that a managed care plan member must pay at the time of medical services. |
| Corridor Deductible | With supplemental major medical expense, it is an amount that is paid by the policyowner after the insurer first pays the basic plan portion when covered expenses are submitted. |
| Cost of Living Rider (COLA - cost of living adjustment) | A rider that automatically increases the benefit of a policy (typically linked to the CPI - consumer Price Index) to offset the effects of inflation. |
| Counteroffer | An initial offer that is not accepted, but negotiated by the second party. With insurance, the alternate offer usually involves additional premium to be paid for the coverage requested. |
| Credit Accident & Health Insurance | A policy that will pay an outstanding debt if the insured becomes totally disabled. |
| Credit Life Insurance | A policy that will pay the outstanding loan balance of a debt if the insured dies. |
| Critical Illness Insurance | A supplemental health policy - pays a lump sum in the event the insured is diagnosed with a critical illness. Can be used to pay for medical care, daily living expenses, etc. |
| Currently Insured | A status of limited eligibility under Social Security that provides only death benefits. |
| Custodial Care | A level of care assisting someone with the activities of daily living. The caregiver does not need medical training, but a doctor orders the care. AKA - Personal or residential care. |
| Customary & Reasonable Expense | Medical expenses paid by the insurance company, no specific dollar amount, payment based on similar charges for like service in same geographic area. Charges in excess can be denied. AKA - usual, customary & reasonable expenses. |
Created by:
Rosemj42
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