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Accident:
An event or occurrence which is unforeseen and unintended.
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Accident
and Health Insurance: A type of coverage that
pays benefits, sometimes including reimbursement for
loss of income, in case of sickness, accidental injury,
or accidental death.
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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. Sometimes
referred to as "double indemnity."
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Accounting:
The process of recording, summarizing, and allocating
all items of income and expense of the company and
analyzing, verifying, and reporting the results.
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Accumulation
period: 1) The time between the first premium
payment and the first benefit payout under a deferred
annuity; 2) A specified period of time, such as 90
days, during which the insured person must incur eligible
medical expenses at least equal to the deductible
amount in order to establish a benefit period under
a major medical expense or comprehensive medical expense
policy.
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Accumulation
units: The mechanism used to account for your
"deposits" in a variable annuity contract during the
premium paying period. The number of units purchased
depends upon the current valuation of a unit in dollars.
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Acquisition
Costs: The insurer's cost of putting new business
in force, including the agent's commission, the cost
of clerical work, fees for medical examinations and
inspection reports, sales promotion expense, etc.
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Activities
of Daily Living: A list of activities, normally
including mobility, dressing, bathing, toileting,
transferring, and eating which are used to assess
degree of impairment and determine eligibility for
some types of insurance benefits.
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Actual
Cash Value (ACV): 1) The cost of replacing
or restoring property at prices prevailing at the
time and place of the loss, less depreciation, however
caused; 2) replacement cost minus.
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Actuarial
Cost Method: One of several systems for determining
either the contributions to be made under a retirement
plan, or level of benefits when the contributions
are fixed. In addition to forecasts of mortality,
interest and expenses, some of the methods involve
estimates of future labor turnover, salary scales
and retirement rates.
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Actuarial
Equivalent: If the present values of two series
of payments are equal, taking into account a given
interest rate and mortality according to a given table,
the two series are said to be actuarially equivalent
on this basis. For example, a lifetime monthly benefit
of $67.60 beginning at age 60 (on a given set of actuarial
assumptions) can be said to be the actuarial equivalent
of $100 a month beginning at age 65. The actual benefit
amounts are different but the present value of the
two benefits, considering mortality and interest,
is the same.
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Actuarially
Fair: The price for insurance which exactly
represents the expected losses
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Actuary:
A person professionally trained in the technical aspects
of pensions, insurance and related fields. The actuary
estimates how much money must be contributed to an
insurance or pension fund in order to provide future
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Adhesion,
Contract of: A contract that is drafted by
one party and accepted or rejected by the other, with
no opportunity to bargain with respect to its terms.
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Adjustable
Life Insurance: A type of insurance that allows
the policyholder to change the plan of insurance,
raise or lower the face amount of the policy, increase
or decrease the premium and lengthen or shorten the
protection period.
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Adjusted
gross estate: Approximately the net worth
of the deceased--the beginning point for the computation
of estate taxes.
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Adjuster:
A person who investigates and settles losses for an
insurance carrier.
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Adjusting:
The process of investigating and settling losses with
or by an insurance carrier.
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Adjustment
Bureau: Organization for adjusting insurance
claims that is supported by insurers using the bureau's
services.
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Administrative
Services Only (AS0) Plan: An arrangement under
which an insurance carrier or an independent organization
will, for a fee, handle the administration of claims,
benefits and other administrative functions for a
self-insured group.
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Advance
Funding: Pension-funding method in which the
employer systematically and periodically sets aside
funds prior to the employee's retirement.
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Advance
Premium Mutual: Mutual insurance company owned
by the policyowners that does not issue assessable
policies but charges premiums expected to be sufficient
to pay all claims and expenses.
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Adverse
Selection: The tendency of persons who present
a poorer-than-average risk to apply for, or continue,
insurance to a greater extent than do persons with
average or better-than-average expectations of loss.
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Age Limits:
Stipulated minimum and maximum ages below and above
which the company will not accept applications or
may not renew policies.
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Agent: An
insurance company representative licensed by the state
who solicits, negotiates or effects contracts of insurance,
and provides service to the policyholder for the insurer.
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Aggregate
Deductible: Deductible in some property and
health insurance contracts in which all covered losses
during a year are added together and the insurer pays
only when the aggregate deductible amount is exceeded.
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Aggregate
Indemnity: The maximum dollar amount that
may be collected for any disability or period of disability
under the policy.
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AIDS: Acquired
immune deficiency syndrome. A fatal, incurable disease
caused by a virus that can damage the brain and destroy
the body's ability to fight off illness.
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Allied Lines:
A term for forms of property insurance allied with
fire insurance, covering such perils as windstorm,
hail, explosion, and riot.
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Allocated
Benefits: Benefits for which the maximum amount
payable for specific services is itemized in the contract.
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All-risks
Policy: Coverage by an insurance contract
that promises to cover all losses except those losses
specifically excluded in the policy. See also: Risks
of direct loss to property.
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Alternate
Delivery Systems: Health services provided
in other than an in-patient, acute-care hospital.
Examples include skilled and intermediary nursing
facilities, hospice programs, and home health care.
Alternate delivery systems are designed to provide
needed services in a more cost-effective manner.
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Ambulatory
Care: Medical services that are provided on
an outpatient (nonhospitalized) basis. Services may
include diagnosis, treatment, and rehabilitation.
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Amendment:
A formal document changing the provisions of an insurance
policy signed jointly by the insurance company officer
and the policy holder or his authorized representative.
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Amortization:
Paying an interest-bearing liability by gradual reduction
through a series of installments, as opposed to one
lump-sum payment.
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Annual
Statement: The annual report, as of December
31, of an insurer to a state insurance department,
showing assets and liabilities, receipts and disbursements,
and other financial data.
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Annuitant:
The person during whose life an annuity is payable,
usually the person to receive the annuity.
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Annuity:
A contract that provides an income for a specified
period of time, such as a number of years or for life.
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Annuity
Certain: A contract that provides an income
for a specified number of years, regardless of life
or death.
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Annuity
Consideration: The payment, or one of the
regular periodic payments, an annuitant makes for
an annuity.
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Antiselection:
The tendency of persons who present a poorer-than-average
risk to apply for, or continue, insurance to a greater
extent than do persons with average or better-than-average
expectations of loss.
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Application:
A signed statement of facts made by a person applying
for life insurance and then used by the insurance
company to decide whether or not to issue a policy.
The application becomes part of the insurance contract
when the policy is issued.
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Arbitration:
A form of alternative dispute resolution where an
unbiased person or panel renders an opinion as to
reponsibility for or extent of a loss.
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Arson: The
willful and malicious burning of, or attempt to burn,
any structure or other property, often with criminal
or fraudulent intent.
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Assessment
Association: An insurer that does not charge
a fixed premium for insurance, but rather assesses
its members periodically to pay its losses. Assessment
insurers usually collect an advance premium which
is estimated to cover losses and expenses, but reserve
the right to make additional assessments whenever
the premium collected is insufficient.
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Assessment
Mutual: Mutual insurance company that has
the right to assess policyowners for losses and expenses.
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Assets:
All funds, property, goods, securities, rights of
action, or resources of any kind owned by an insurance
company. Statutory accounting, however, excludes non-admitted
assets, such as deferred or overdue premiums, that
would be considered assets under generally accepted
accounting principles (GAAP).
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Assignment:
The legal transfer of one person's interest in an
insurance policy to another person.
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Association
Captive: Type of captive insurer owned by
members of a sponsoring organization or group, such
as a trade association.
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Association
Group: A group formed from members of a trade
or a professional association for group insurance
under one master health insurance contract.
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Association
Group Plan: Health insurance plans designed
for members of a professional association or trade
association. Members may be protected under a group
health insurance policy or by individual franchise
policies.
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Assumption
certificate: an endorsement to an insurance
contract stating that reinsurance proceeds will be
paid directly to the named payee in the event of an
insurer's insolvency.
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Assumption
of Risk Doctrine: Defense against a negligence
claim that bars recovery for damages if a person understands
and recognizes the danger inherent in a particular
activity or occupation.
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Assumptions:
Conditions and rules underlying the calculation of
a pension benefit, including expected interest, mortality
and turnover.
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Assurance
Insurance: These terms are today generally
accepted as synonymous, although not originally so.
The term "assurance" is used more commonly in Canada
and Great Britain than in the United States.
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Attachment
point: the dollar amount of loss
where an insurance begins to provide coverage.
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Attractive
Nuisance: Condition that can attract and injure
children. Occupants of land on which such a condition
exists are liable for injuries to children.
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Automatic
Premium Loan: Cash borrowed from a life insurance
policy's cash value to pay an overdue premium after
the grace period for paying the premium has expired.
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Automatic
Reinsurance: An agreement that the insurer
must cede and the reinsurer must accept all risks
within certain explicitly defined limits. The reinsurer
undertakes in advance to grant reinsurance to the
extent specified in the agreement in every case where
the ceding company accepts the application and retains
its own limit.
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Automobile
Insurance Plan: One of several types of "shared
market" mechanisms where persons who are unable to
obtain such insurance in the voluntary market are
assigned to a particular company, usually at a higher
rate than the voluntary market. Formerly called "Assigned
Risk."
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Automobile
Liability Insurance: Protection for the insured
against financial loss because of legal liability
for car-related injuries to others or damage to their
property.
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Automobile
Reinsurance Facility: One of several types
of "shared market" mechanisms used to make automobile
insurance available to persons who are unable to obtain
such insurance in the regular market.
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Automobile
Shared Market: A program in which all automobile
insurers in each state and the District of Columbia
participate to make coverage available to car owners
who are unable to obtain auto insurance in the voluntary
market. Except in Maryland, which operates a state-funded
mechanism whose losses are subsidized by private insurers,
each state uses one of three systems (an automobile
insurance plan, a joint underwriting association,
or a reinsurance facility) to guarantee the availability
of automobile insurance.
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Aviation
Insurance: Aircraft insurance including coverage
of aircraft or their contents, the owner's liability,
and accident insurance on the passengers.Beneficiary:
The person designated or provided for by the policy
terms to receive any benefits provided by the policy
or plan upon the death of the insured.
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