Car Insurance–Glossary (Part 1 of 2) - January 10, 2010
In considering an insurance policy, individual health insurance policy, small business health insurance plan, or self-employed health insurance benefits program, it is imperative to create an understanding of the insurance industry terms and jargon. We offer this guide to help better understand and gain knowledge of the terms and policy labels being used by the major insurance companies, agents, and brokers offering a full spectrum of insurance coverage to consumers in all 50 states.
Accidental Death Coverage: Accidental death coverage is sometimes a part of your auto insurance policy’s Personal Injury Protection or First Party Benefits plans. If someone who’s covered dies from accident-related injuries, this type of auto insurance coverage may provide a payment to the insured’s designated beneficiary.
Actual Cash Value: Frequently used in most auto insurance policy papers especially in claim forms. Most consumers only receive insurance proceeds for the actual cash value of their vehicle. Determining a vehicle’s cash value is usually the result of subtracting any depreciation from the original price of the vehicle.
Admitting Privileges: authority granted to a health care professional to admit patients to a particular medical facility, hospital or medical care treatment facility.
Advocacy: to encourage or support an activity that helps a consumer, company, or organization to secure health care coverage designed to best meet their unique needs.
Agent/Broker: Persons that market and coordinate insurance policy programs for consumers. Agents can represent a single insurance company or multiple providers. Brokers represent consumers seeking to purchase insurance policy programs and coverage.
Annuity: A legal policy provided by an insurance company that enables consumers to allocate money annually that earns interest at a guaranteed rate, tax-deferred, for a specific period of time. These annuity dollars provide policyholders with additional annual income stipends for a designated length of time in the later years. Annuity policy programs are popular because of the tax benefits, guaranteed annual income, and security benefits that they provide.
Association: An affiliation or an alliance. A brotherhood, club, fraternity or fellowship offering group or individual health insurance plans customized to meet the needs of their membership body.
Auto Insurance: An Auto insurance policy is a safe guard for consumers that shields private passenger carrying automotive vehicle owners from monetary losses if a vehicle they own is involved in any type of accident. An agreement, contract, or policy formed when a consumer and an insurance company establish specific protections involving vehicle ownership. Consumers agree to allocate funds call premiums and the insurance company agrees to provide benefits that cover setbacks from an accident involving a vehicle. Damages can include property, physical injury, medical treatments, or death as established in the auto insurance policy.
Benefit: to be useful or profitable to better, improve, or help. In the Health insurance industry a benefit is the actual amount made payable by the health insurance company to a claimant, assignee, or beneficiary when the insured party incurs a loss.
Bodily Injury Liability Coverage: Clauses that help protect insurance policy holders that injure or maim a person in an auto accident. The stipends are usually capped at pre determined fixed amounts when the insurance policy is written.
Car Insurance: A Car insurance policy is a safe guard for consumers that shields private passenger carrying automotive vehicle owners from monetary losses if a vehicle they own is involved in any type of accident. An agreement, contract, or policy formed when a consumer and an insurance company establish specific protections involving vehicle ownership. Consumers agree to allocate funds call premiums and the insurance company agrees to provide benefits that cover setbacks from an accident involving a vehicle. Damages can include property, physical injury, medical treatments, or death as established in the car insurance policy.
Capitation: the fixed or set dollar payment cap that a consumer or employer pays to a health maintenance organization (HMO), for the services being offered by a health maintenance provider regardless of usage levels. Providers are health care professionals who assist patients. Typically providers select doctors, physicians, hospitals, or professional health care givers. The term can also be applied to nurses, nurse practitioners, chiropractors, psychologists, and other health care professionals who practice in specialized fields of medicine.
Case Management: a process enlisted by employers and health insurance companies that result in individuals or groups receiving premium health care and health insurance services.
Claim: the real or assumed right to demand something as one’s own. In the health insurance industry a claim is usually an appeal by an insured individual or his health care provider to the individual or group health insurance company requesting said health insurance company to assume costs for services rendered by a health care professional. An insurance claim is a policyholder’s demand to be compensated for financial losses in the event of an accident or loss.
Claims Adjuster: An insurance company employee responsible for researching and substantiating the settlement of an insurance claim.
Co-Insurance: to guard, protect, safeguard, or shield, co-insurance designates the set amount of money that an insured individual is asked to pay for health care services, after the insurance company has met the deductible. Usually a group health insurance policy also outlines co-insurance or “co-payment.” Co-insurance is normally listed as a percentage. For example, an employee pays 10 percent of total fees for any healthcare service and the employer or designated health insurance provider covers the remaining balance.
Co-Payment: a set or flat fee that a consumer is obligated to pay for specific healthcare service. This amount is separate from the fees being covered by the health insurance company. For example, most Health Maintenance Organizations – HMO’s use a ten-dollar co-payment for every doctor office visit, regardless of the type or level of medical services received during the actual stay.
Collision Coverage: Language that defines how much money will be provided to the policyholder to help cover the cost of repairs or replacements that result in a vehicular accident.
Comprehensive Coverage: This language provides payment for vehicle repair following a vandalism, fire, or theft. Caps are usually set to cover car repair or vehicle replacement when consumers purchase an auto insurance policy.
Continuously Insured: Number of consecutive years a consumer has been covered by a major insurance company.
Deductible: to take away one quantity from another or subtract. The actual dollar amount an insured individual is asked to pay for healthcare expenses prior to any health insurance, or self-insured health insurance company payments. Many health insurance and Group health Insurance rates are based on annual deductible figures.
Denial Of Claim: Refusal by a health insurance company to recognize a claim by an insured individual or his health insurance provider, to cover the fees for health care services received from a registered medical professional.
Dependent Worker: A worker or member in a family or company that does not have a large personal income.
Depreciation: Depreciation is the loss or reduction in value of a specific item due to erosion or degradation, or disfavor.
Effective Date: The actual date that your insurance policy and coverage terms take effect.
Employee Assistance Programs (Heaps): Specialized health care services such as mental health counseling being offered by health insurance companies or corporate employers. Usually individuals or employers do not have to pay directly for health care services provided through an established employee assistance program.
Endorsements: Endorsements are revisions to the original insurance policy agreement. Also known as riders, endorsement revisions often times are used to change deductible amounts or possibly to bring an additional vehicle into an existing auto insurance coverage program.
Exclusions: Having or exercising the power or limit inclusion. In the Medical services industry exclusions represent insured health care items not paid for or covered by an individual health insurance policy.
Fixed Annuity: Provides insurance consumers with an ensured amount of principal or interest on their assets. The amount of annual interest earned is guaranteed at a specific level set forth in the annuity policy agreement.
Full Coverage: An insurance policy that lists all coverage factors, as legally required in a designated state. This term does not guarantee full coverage to a policyholder.
Guaranteed Annuity: There are two types of annuities, fixed and variable. A fixed annuity provides you with a guaranteed of principal and interest. Your principal earns a current level of interest that can’t fall below the specified minimum in your annuity contract. A variable annuity provides you the opportunity to invest in separate contracts that are run similar to mutual funds and offer you the opportunity to have professional money management with current tax-deferral. Fixed annuities are not subject to any market risk while variable annuities are subject to market risks.
Health Care Decision Counseling: Specialized Services, usually provided by health insurance companies or employers, that meet with individual insurance consumers to clarify benefits, risks and real dollar costs of specific medical tests and treatments. Health care decision counseling is usually discreet. Service offers assistance to consumers creating more informed selections of health insurance, medical care, and reassurance that decisions made were appropriate for the medical program required of the circumstances.
Health Maintenance Organizations (HMO’s): represent a group of health insurance policy holders in which individuals or their employers allocate a monthly fee for medical services, instead of per service pricing. The monthly HMO dues usually remain fixed, regardless of the type or level of medical service received. Professional Medical Services are performed by certified practitioners and physicians employed by, or under service contract with the Health Maintained Organization. Several types of HMO Insurance companies are available with guidelines on medical facilities and the health treatment services they offer.
Indemnity: An established amount of money or compensation to be paid that covers an insured loss.
Indemnity Health Plan: known as fee for service health insurance programs, indemnity programs were very popular before the establishment of HMO, IPA, and PPO plans. With indemnity plans, the health insurance consumer pays a set percentage of the total costs of the health care treatment, and the health insurance company pays the remaining percentage. The costs of medical treatment are defined by the health insurance provider and vary by doctor. Indemnity health plans allow health insurance consumers an opportunity to become actively involved in selecting the actual medical care professional or physicians.
Independent Practice Associations: IPA coverage resembles traditional HMO plans, except consumers receive medical treatment in a doctor’s office, rather than a large treatment facility or hospital.
Insurance Claim Report: These reports list details of an insurance claim that have been issued with most insurance companies. These reports are usually compilations from consumer reporting agencies or underwriting exchange organizations that gather insurance claim data from a host of insurance companies.
Insurance Score: Calculations designed to help determine the level of future insurance claims based on a consumer’s personal credit rating and history.
Insured: A consumer or policyholder covered by an insurance policy.
Judgment: A legally binding determination or ruling set froth by a legal jurisdiction or court. Judgments usually determine who is financially responsible to cover any monetary costs as a result of an accident involving an insured consumer.
Source: NebraskaInsurannceZone.com