Package
Policy: A combination of two or more individual
polices or coverages into a single policy. A homeowners
policy, for example, is a package combining property,
liability and theft coverages for the homeowner.
Paid-up
Insurance: Insurance on which all required
premiums have been paid. The term is frequently used
to mean the reduced paid-up insurance available as
a nonforfeiture option.
Paramedical
Examination: Physical examination of an applicant
by a trained person other than a physician.
Partial
Disability: The result of an illness or injury
which prevents an insured from performing one or more
of the functions of his/her regular job.
Partial
Disability: A benefit sometimes found in disability
income policies providing for the payment of reduced
monthly income in the event the insured cannot work
full time and/or is prevented from performing one
or more important daily duties pertaining to his occupation.
Participating
Insurance: Insurance issued by an insurance
company providing participation in dividend distribution.
Participating
Policy: A life insurance policy under which
the company agrees to distribute to policyholders
the part of its surplus which its Board of Directors
determines is not needed at the end of the business
year. Such a distribution serves to reduce the premium
the policyholder had paid. (See also: Policy dividend;
Nonparticipating policy)
Participating
Policy: One under which the policy owner is
entitled to receive shares of the divisible surplus
of the insurer. Such shares are commonly called dividends.
Pension
Benefits: A series of payments to be provided
in accordance with the plan of benefits.
Pension
Plan: A plan established and maintained by
an employer, group of employers, union or any combination,
primarily to provide for the payment of definitely
determinable benefits to participants after retirement.
Percentage
Participation: A provision in a health insurance
contract that the insurer and insured will share covered
losses in agreed proportions. Also see Coinsurance.
Peril: The
cause of a loss insured against in a policy.
Peril: The
cause of a possible loss, such as fire, windstorm,
theft, explosion, or riot.
Permanent
Life Insurance: A phrase used to cover any
form of life insurance except term; generally insurance
that accrues cash value, such as whole life or endowment.
Persistency:
A term used to refer to the length of time insurance
remains continuously in force.
Persistency:
The degree to which policies stay in force through
the continued payment of renewal premiums.
Personal
Articles Floater: A form of coverage designed
to meet the needs for insurance on property of a moveable
nature. The coverage usually protects against all
physical loss, subject to special exclusions and conditions.
Examples of property covered include jewelry, furs,
silverware, fine arts.
Personal
Injury Protection (PIP): First-party no-fault
coverage in which an insurer pays, within the specified
limits, the wage loss, medical, hospital and funeral
expenses of the insured.
Personal
Lines: Those types of insurance, such as auto
or home insurance, for individuals or families rather
than for businesses or organizations.
Personal
representative:A person appointed through
the will of a deceased or by a court to settle the
estate of one who dies.
Physical
Damage: Damage to or loss of the auto resulting
from collision, fire, theft or other perils.
Physician's
Expense Insurance: Coverage which provides
benefits toward the cost of such services as doctor's
fees for nonsurgical care in the hospital, at home
or in a physician's office, and X-rays or laboratory
tests performed outside the hospital. (Also called
Regular Medical expense Insurance.)
Plan
Administrator: The person or persons controlling
the money or property contributed to the plan, usually
designated in the plan agreement.
Point-of-Service
Plans: Often known as open-ended HMOs or PPOs,
these plans permit insureds to choose providers outside
the plan yet are designed to encourage the use of
network providers.
Policy:
The printed legal document stating the terms of the
insurance contract that is issued to the policyholder
by the company.
Policy:
The legal document issued by the company to the policyholder,
which outlines the conditions and terms of the insurance;
also called the policy contract or the contract.
Policy
Dividend: A refund of part of the premium
on a participating life insurance policy reflecting
the difference between the premium charged and actual
experience.
Policy Loan:
A loan made by a life insurance company from its general
funds to a policyholder on the security of the cash
value of a policy.
Policy
Reserves: The measure of the funds that a
life insurance company holds specifically for fulfillment
of its policy obligations. Reserves are required by
law to be so calculated that, together with future
premium payments and anticipated interest earnings,
they will enable the company to pay all future claims.
Policy Term:
That period for which an insurance policy provides
coverage.
Policyholder:
The person who owns a life insurance policy. This
is usually the insured person, but it may also be
a relative of the insured, a partnership or a corporation.
Policyholder:
A person who pays a premium to an insurance company
in exchange for the insurance protection provided
by a policy of insurance.
Policyholders'
Surplus: Sum left after liabilities are deducted
from assets. Sums such as paid-in capital and special
voluntary reserves are also included in this term.
This surplus is an additional financial protection
to policyholders in the event a company suffers unexpected
or catastrophic losses. In effect, it is the financial
base that permits a company to sell insurance.
Pollution
Liability: Exposure to lawsuits for injury
or cleanup costs that result from pollution damage
Pool: An organization
of insurers or reinsurers through which particular
types of risk are underwritten and premiums, losses
and expenses are shared in agreed-upon amounts.
Pooling arrangement:
An agreement to divide any losses that might occur
equally among two or more people, typically with each
paying the average loss.
Portability:
The transfer of pension rights and credits when a
worker changes jobs.
Preadmission
Certification: Process in which a health care
professional evaluates an attending physician's request
for a patient's admission to a hospital by using established
medical criteria.
Preexisting
Condition: A physical and/or mental condition
of an insured which first manifested itself prior
to the issuance of his/her policy or which existed
prior to issuance and for which treatment was received.
Preexisting
Condition: A physical condition that existed
before the effective date of coverage.
Preferred
Provider Organization (PPO): An arrangement
whereby a third-party payer contracts with a group
of medical care providers who furnish services at
lower than usual fees in return for prompt payment
and a certain volume of patients.
Preferred
Stock: Evidence of ownership which entitles
the owners to receive dividends from the corporation
before the common stockholders and which usually also
provides a prior claim to corporate assets if the
corporation is dissolved.
Premium:
The sum paid by a policyholder to keep an insurance
policy in force.
Premium finance: allows the
insured to pay part of the premium when coverage takes
effect and pay the rest during the policy period.
Premium
Loan: A policy loan made for the purpose of
paying premiums.
Premium Tax:
A tax, imposed by each state, on the premium income
of insurers doing business in the state.
Prepaid
Group Practice Plan: A plan under which specified
health services are rendered by participating physicians
to an enrolled group of persons, with a fixed periodic
payment in advance made by or on behalf of each person
or family. If a health insurance carrier is involved,
a contract to pay in advance for the full range of
health services to which the insured is entitled under
the terms of the health insurance contract. Such a
plan is one form of Health Maintenance Organization
(HMO).
Primary
Insurance: Insurance that pays compensation
for a loss ahead of any other insurance coverages
the policyholder may have.
Principal
Sum: The amount payable in one sum in the
event of accidental death and in, some cases, accidental
dismemberment. When a contract provides benefits for
both accidental death and accidental dismemberment,
each dismemberment benefit is an amount equal to the
principal sum or some fraction thereof.
Probate:
The court-supervised process of validating or establishing
a distribution for assets of a deceased including
the payment of outstanding obligations.
Probate
estate: The portion of the assets and liabilities
whose distribution is supervised by the courts in
the probate process.
Probationary
Period: A period from the policy date to a
specified time, usually 15 to 30 days, during which
no sickness coverage is effective. It is designed
to eliminate a sickness actually contracted before
the policy went into effect.
Product
Liability: legal liability incurred by a manufacturer,
merchant, or distributor because of injury or damage
resulting from the use of its product.
Product
Liability Insurance: Protection against financial
loss arising out of the legal liability incurred by
a manufacturer, merchant, or distributor because of
injury or damage resulting from the use of a covered
product.
Professional
Review Organization (PRO): An organization
in which practicing physicians assume responsibility
for reviewing the propriety and quality of health
care services provided under Medicare and Medicaid.
Proof of
Loss: Documentation presented to the insurance
company by the insured in support of a claim so that
the insurer can determine its liability under the
policy.
Proof of
Loss: Documentary evidence required by an
insurer to prove a valid claim exists. It usually
consists of a claim form completed by the insured
and the insured's attending physician. For medical
expense insurance itemized bills must also be included.
Property
Damage Coverage: An agreement by an insurance
carrier to protect an insured against legal liability
for damage by an insured automobile to the property
of another.
Property
Insurance: Insurance providing financial protection
against the loss of, or damage to, real and personal
property caused by such perils as fire, theft, windstorm,
hail, explosion, riot, aircraft, motor vehicles, vandalism,
malicious mischief, riot and civil commotion, and
smoke.
Property
Insurance: Provides financial protection against
loss or damage to the insured's property caused by
such perils as fire, windstorm, hail, etc.
Proration:
The adjustment of benefits paid because of a mistake
in the amount of the premiums paid or the existence
of other insurance covering the same accident or disability.
Proscription: A claim not
covered by an insurance policy because it is filed
after the time required in the language of the contract.
Prospective
Payment: An advancement of payment for health
care charges that are likely to occur.
Prototype
Plan: A standardized plan, approved and qualified
as to its concept by the Internal Revenue Service,
which is made available by life insurance companies,
banks and mutual funds for employers' use.
Provision:
A part (clause, sentence, paragraph, etc.) of an insurance
contract that describes or explains a feature, benefit,
condition, requirement, etc. of the insurance protection
afforded by the contract.
Proximate
Cause: The dominating cause of loss or damage;
an unbroken chain of events between the occurrence
and damage.
Punitive
Damages: a court-awarded amount that exceeds
the economic losses and general damages of a defendant
and is intended solely to punish the plaintiff
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