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Cafeteria
Plan: Generic term for an employee benefit
plan that allows employees to select among the various
group life, medical expense, disability, dental, and
other plans that best meet their specific needs. Also
called flexible benefit plans.
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Calendar-year
Deductible: Amount payable by an insured during
a calendar year before a group or individual health
insurance policy begins to pay for medical expenses.
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Cancelable:
A contract of health insurance that may be canceled
during the policy term by the insurer or insured.
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Cancellation:
The discontinuance of an insurance policy before its
normal expiration date, either by the insured or the
company.
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Capacity:
The amount of capital available to an insurance company
or to the industry as a whole for underwriting general
insurance coverage or coverage for specific perils.
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Capital Gain:
Profit realized on the sale of securities. An unrealized
capital gain is an increase in the value of securities
that have not been sold.
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Capital
Retention Approach: A method used to estimate
the amount of life insurance to own. Under this method,
the insurance proceeds are retained and are not liquidated.
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Capitation:
A method of payment for health services in which a
physician or hospital is paid a fixed, per capita
amount for each person served regardless of the actual
number of services provided to each person.
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Captive
Insurance Company:A company owned solely or
in large part by one or more non- insurance entities
for the primary purpose of providing insurance coverage
to the owner or owners.
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Captive
Insurer: Insurance company established and
owned by a parent firm in order to insure its loss
exposures while reducing premium costs, providing
easier access to a reinsurer, and perhaps easing tax
burdens. See also Association captive; Pure captive.
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Cargo
Insurance: Type of ocean marine insurance
that protects the shipper of the goods against financial
loss if the goods are damaged or lost.
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Career
average formula: A pension plan formula that
bases retirement benefits on earnings during all years
of service to the employer.
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Cash
Surrender Value: The amount available in cash
upon voluntary termination of a policy by its owner
before it becomes payable by death or maturity.
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Casualty
Insurance: Insurance concerned with the insured's
legal liability for injuries to others or damage to
other persons' property; also encompasses such forms
of insurance as plate glass, burglary, robbery and
workers' compensation.
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Catastrophe:
Event which causes a loss of extraordinary magnitude,
such as a hurricane or tornado.
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Causes-of-loss
Form: Form added to commercial property insurance
policy that indicates the causes of loss that are
covered. There are four causes-of-loss forms: basic,
broad, special, and earthquake.
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Cede: To transfer
all or part of a risk written by an insurer (the ceding,
or primary company) to a reinsurer.
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Certificate
of Insurance:A statement of coverage issued
to an individual insured under a group insurance contract,
outlining the insurance benefits and principal provisions
applicable to the member.
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Cession:
Amount of the insurance ceded to a reinsurer by the
original insuring company in a reinsurance operation.
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Change
of Occupation Clause: Provision in a health
insurance policy stipulating that if the insured changes
to a more hazardous occupation, the benefits are reduced
based on the amount of benefits the premium would
have purchased for the more hazardous occupation.
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Chartered
Financial Consultant (ChFC): An individual
who has attained a high degree of technical competency
in the fields of financial planning, investments,
and life and health insurance and has passed ten professional
examinations administered by The American College.
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Chartered
Life Underwriter (CLU): An individual who
has attained a high degree of technical competency
in the fields of life and health insurance and who
is expected to abide by a code of ethics. Must have
minimum of three years of experience in life or health
insurance sales and have passed ten professional examinations
administered by The American College.
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Chartered
Property and Casualty Underwriter (CPCU):
Professional who has attained a high degree of technical
competency in property and liability insurance and
has passed ten professional examinations administered
by the American Institute for Property and Liability
Underwriters.
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Choice
No-Fault: Allows auto insureds the choice
of remaining under the tort system or choosing no-fault
at a reduced premium.
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Claim: A
request for payment of a loss which may come under
the terms of an insurance contract.
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Civil law:
The portion of law that deals with interactions between
individual.
The two branches of civil law are Contract
law and tort law .
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Claims
Adjustor: Person who settles claims: an agent,
company adjustor, independent adjustor, adjustment
bureau, or public adjustor.
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Claim-made
policy: A liability insurance policy under
which coverage applies to claims filed during the
policy period.
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Class Rating:
Rate-making method in which similar insureds are placed
in the same underwriting class and each is charged
the same rate. Also called manual rating.
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Cliff
vesting: a pension design in which an employee
becomes entitled to full retirement benefits after
participating in the plan for the specified period,
e.g., five years.
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CLU: See
Chartered Life Underwriter.
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Coinsurance:
1) A provision under which an insured who carries
less than the stipulated percentage of insurance to
value, will receive a loss payment that is limited
to the same ratio which the amount of insurance bears
to the amount required; 2) a policy provision frequently
found in medical insurance, by which the insured person
and the insurer share the covered losses under a policy
in a specified ratio, i.e., 80 percent by the insurer
and 20 percent by the insured.
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Collateral
Source Rule: Under this rule, the defendant
cannot introduce any evidence that shows the injured
party has received compensation from other collateral
sources.
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Collision
Insurance: Protection against loss resulting
from any damage to the policyholder's car caused by
collision with another vehicle or object, or by upset
of the insured car, whether it was the insured's fault
or not.
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Combined
Ratio: Basically, a measure of the relationship
between dollars spent for claims and expenses and
premium dollars taken in; more specifically, the sum
of the ratio of losses incurred to premiums earned
and the ratio of commissions and expenses incurred
to premiums written. A ratio above 100 means that
for every premium dollar taken in, more than a dollar
went for losses, expenses, and commissions.
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Commercial
Lines: Insurance for businesses, organizations,
institutions, governmental agencies, and other commercial
establishments.
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Commercial
Package Policy (CPP): A commercial policy
that can be designed to meet the specific insurance
needs of business firms. Property and liability coverage
forms are combined to form a single policy.
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Commission:
The part of an insurance premium paid by the insurer
to an agent or broker for his services in procuring
and servicing the insurance.
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Commissioner:
A state officer who administers the state's insurance
laws and regulations. In some states, this regulator
is called the director or superintendent of insurance.
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Common law:
the law that has evolved over time as a result of
previous court decisions, rather than having been
enacted by a legislative body
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Common Stock:
Securities that represent an ownership interest in
a corporation.
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Community
Property: A special ownership form requiring
that one-half of all property earned by a husband
or wife during marriage belongs to each. Community
property laws do not generally apply to property acquired
by gift, by will, or by descent.
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Commutation function: a notation
as defined by actuaries to combine various elements
of an actuarial computation in a manner that makes
a formula look simpler.
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Commutation table: a table that
combine elements (e.g., interest and mortality) into
a single value to facilitate further computations.
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Company
Adjustor: Claims adjustor who is a salaried
employee representing only one company.
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Comparative
Negligence: Under this concept a plaintiff
(the person bringing suit) may recover damages even
though guilty of some negligence. His or her recovery,
however, is reduced by the amount or percent of that
negligence.
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Completed
Operations: Liability arising out of faulty
work performed away from the premises after the work
or operations are completed. Applicable to contractors,
plumbers, electricians, repair shops, and similar
firms.
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Comprehensive
Major Medical Insurance: A policy designed
to give the protection offered by both a basic and
a major medical health insurance policy. It is characterized
by a low deductible amount, a coinsurance feature,
and high maximum benefits.
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Comprehensive
Medical Expense Insurance: A form of health
insurance which provides, in one policy, protection
for both basic hospital expense and major medical
expense coverages. The major medical part of a comprehensive
policy is characterized by a deductible amount, coinsurance,
and high maximum benefits.
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Comprehensive
Personal Liability Insurance: Protection against
loss arising out of legal liability to pay money for
damage or injury to others for which the insured is
responsible. It does not include automobile or business
operation liabilities.
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Compulsory
Insurance Law: Law protecting accident victims
against irresponsible motorists by requiring owners
and operators of automobiles to carry certain amounts
of liability insurance in order to license the vehicle
and drive legally within the state.
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Concealment:
Deliberate failure of an applicant for insurance to
reveal a material fact to the insurer.
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Concurrent
Causation: Legal doctrine that states when
a property loss is due to two causes, one that is
excluded and one that is covered, the policy provides
coverage.
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Conditional
Receipt: A receipt given for premium payments
accompanying an application for insurance. If the
application is approved as applied for, the coverage
is effective as of the date of the prepayment or the
date on which the last of the underwriting requirements,
such as a medical examination, has been fulfilled.
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Conditionally
Renewable: Continuance provision of a health
insurance policy under which the company cannot cancel
the policy during its term but can refuse to renew
under certain conditions stated in the contract.
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Conditions:
Provisions inserted in an insurance contract that
qualify or place limitations on the insurer's promise
to perform.
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Conservation:
The attempt by the insurer to prevent the lapse of
a policy.
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Consideration:
One of the elements for a binding contract. Consideration
is acceptance by the insurance company of the payment
of the premium and the statement made by the prospective
policyholder in the application.
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Consideration
Clause: The clause that stipulates the basis
on which the company issues the insurance contract.
In health policies, the consideration is usually the
statements in the application and the payment of premium.
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Consequential
Loss: Financial loss occurring as the consequence
of some other loss. Often called an indirect loss.
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Constructive Total Loss:
an insurance claim where the value to repair the property
exceeds the market value of that property
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Contingent
Annuity Option:An option under which an employee
may elect to receive, under certain conditions, a
reduced amount of annuity with the same income, or
a specified fraction, to be paid after his death to
another person designated as his contingent annuitant,
for that person's lifetime. The contingent annuitant
is usually the husband or the wife. (See Joint and
Survivor Annuity)
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Contingent
Beneficiary: The person or persons designated
to receive the benefits of a policy or plan if the
primary beneficiary dies while the insured is living.
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Contingent Employers
Liability Insurance: provides payment on behalf
of the employer for bodily injury to an employee if
that person is ineligible to receive workers compensation
benefits, e.g., an "occasional" employee.
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Contingent
Liability: Liability arising out of work done
by independent contractors for a firm. A firm may
be liable for the work done by an independent contractor
if the activity is illegal, the situation does not
permit delegation of authority, or the work is inherently
dangerous.
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Contingent
Owner: The person to succeed as owner of a
life insurance policy if the original owner dies.
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Contract:
A binding agreement between two or more parties for
the doing or not doing of certain things. A contract
of insurance is embodied in a written document called
the policy.
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Contract
law: the portion of civil law that
interprets written agreements between parties and
resolves disputes between them.
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Contract
Holder: The group, entity or person to whom
a group annuity contract is issued.
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Contract of adhesion: occurs when
one party to the contract writes it and offers other
parties only the option of acceptance or rejection.
In such a circumstance the law interprets any
ambiguities in the contract against the party writing
it.
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Contractual
Liability: Legal liability of another party
that the business firm agrees to assume by a written
or oral contract.
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Contribution
by Equal Shares: Type of other-insurance provision
often found in liability insurance contracts that
requires each company to share equally in the loss
until the share of each insurer equals the lowest
limit of liability under any policy or until the full
amount of loss is paid.
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Contributory:
A group insurance plan issued to an employer under
which both the employer and employee contribute to
the cost of the plan. Seventy-five percent of the
eligible employees must be insured. (See Noncontributory.)
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Contractual risk transfer:
a major method of loss financing through which a legal
agreement is used to transfer risk to another party
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Contributory
Negligence:Negligence of the damaged person
that helped to cause the accident. Some states bar
recovery to the plaintiff if the plaintiff was contributorily
negligent to any extent. Others apply comparative
negligence.
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Conversion Privilege: A privilege
granted in an insurance policy to convert to a different
plan of insurance without providing evidence of insurability.
The privilege granted by a group policy is to convert
to an individual policy upon termination of group
coverage.
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Conversion
Privilege: The right given to an insured person
to change insurance without evidence of medical insurability,
usually to an individual policy upon termination of
coverage under a group contract.
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Convertible
Bond: A bond that offers the holder the privilege
of converting the bond into a specified number of
shares of stock.
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Convertible
Term Insurance:Term insurance which can be
exchanged, at the option of the policyholder and without
evidence of insurability, for another plan of insurance.
Credit life insurance. Term life insurance issued
through a lender or lending agency to cover payment
of a loan, installment purchase, or other obligation,
in case of death.
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Coordination
of Benefits (COB): The mechanism used in group
health insurance to designate the order in which the
multiple carriers are to pay benefits and to prevent
duplicate payments.
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Corridor
Deductible: Major medical plan deductible
that excludes benefits provided by a basic plan if
both a basic and a supplemental group major medical
expense policy are in force.
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Cost Basis:
An amount attributed to an asset for income tax purposes;
used to determine gain or loss on sale or transfer;
used to determine the value of a gift
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Cost Containment:
The controller reduction of inefficiencies in the
consumption, allocation, or production of health care
services that contribute to higher than necessary
costs.
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Cost-of-Living
Rider: Benefit that can be added to a life
insurance policy under which the policyowner can purchase
one-year term insurance equal to the percentage change
in the consumer price index with no evidence of insurability.
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Cost of pure risk: all costs
related to pure risk which includes, from the perspective
of shareholders, retained risk, loss prevention costs,
insurance costs, and more.
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Cost of risk: the reduction
in business value that arises as a result of risk
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Coverage:
The scope of protection provided under a contract
of insurance; any of several risks covered by a policy.
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Coverage
for Damage to Your Auto: That part of the
personal auto policy insuring payment for damage or
theft of the insured automobile. This optional coverage
can be used to insure both collision and other-than-collision
losses.
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Covered:
A person covered by a pension plan is one who has
fulfilled the eligibility requirements in the plan,
for whom benefits have accrued, or are accruing, or
who is receiving benefits under the plan.
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Covered
Expenses: Hospital, medical, and miscellaneous
health care expenses incurred by the insured that
entitle him/her to a payment of benefits under a health
insurance policy. Found most often in connection with
major medical plans, the term defines, by either description,
reasonableness, or necessity to specify the type and
amount of expense which will be considered in the
calculation of benefits.
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Covered
Participant: A person covered by a pension
plan is one who has fulfilled the eligibility requirements
in the plan, for whom benefits have accrued, or are
accruing, or who is receiving benefits under the plan.
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CPCU: See
Chartered Property and Casualty Underwriter.
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Credibility:
A statistical measure of the degree to which past
results make good forecasts of future results.
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Credibility
Factor: The weight given to an individual
insured's past experience in computing premiums for
future coverage.
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Credit
Health Insurance:A form of health insurance
on a borrower, usually under an installment purchase
agreement. The benefits cover the obligations of the
borrower and are payable to the creditor.
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Credit
Insurance: A guarantee to manufacturers, wholesalers,
and service organizations that they will be paid for
goods shipped or services rendered. Applies to that
part of working capital which is represented by accounts
receivable.
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Crop-hail
Insurance: Protection against damage to growing
crops as a result of hail or certain other named perils.
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Cross
Purchase Agreement: specifies the terms for
the surviving partners or shareholders to buy a deceased's
share of the business's ownership.
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CSR: Customer
service representatives support the work of insurance
agents with a variety of tasks that must be done within
a company or agency to deliver services to and handle
requests from clients.
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Current
Assumption Whole Life Insurance: Nonparticipating
whole life policy in which the cash values are based
on the insurer's current mortality, investment, and
expense experience. An accumulation account is credited
with a current interest rate that changes over time.
Also called interest-sensitive whole life insurance.
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Currently
Insured: Status of a covered person under
the Old-age, survivors, and Disability Insurance (OASDI)
program who has at least six quarters of coverage
out of the last thirteen quarters, ending with the
quarter of death, disability, or entitlement to retirement
benefits.
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Cut-through
endorsement: 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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