Glossary of Insurance Terms

Major health insurance which meets or exceeds the minimum requirements of the Affordable Care Act is referred to as ACA-compliant coverage. All health insurance plans sold on healthcare.gov and on state marketplace exchanges are ACA-compliant. (Key ACA protections include coverage for pre-existing conditions and preventive care).

For more details: HEALTH INSURANCE → Major Medical Health Insurance.

An unintended, non-deliberate, and unforeseen injury resulting from an injury, and not from sickness.

ACV is the method of property valuation, where the current insured value is determined by taking the original purchase price and depreciating it based on its age and use. ACV is usually compared with RCV (Replacement Cost Value)

Insurance actuaries analyze the likelihood of loss occurrence and the resulting financial risk to the insurer.

An insurance professional licensed to assess the validity of the insurance claim, verify what the insurance policy covers, and authorize the claim payout. Adjusters working for the insurance company can be employees, contractors, or independent. (see Public Adjuster for more)

A person or organization licensed by the state’s department of insurance to sell insurance to the residents of the state. During the purchase of coverage, an insurance agent represents the insurance company chosen by the client. The client can be an individual or an organization.

An agent can be captive or independent:

• Captive agents can represent only the products of their employer (insurance company or agency). Some insurers choose to work only with their own employee (captive) agents,
• Independent agents sign up to represent various competing insurance companies, which offer products through independent representation.

All risk insurance contracts are a type of policy which covers any loss, unless it is explicitly excluded from the coverage.

Annuities are financial products which create a stream of income, typically during retirement. Social Security is the most common example of an annuity.

Assignment refers to identifying and documenting the temporary or permanent change of the life insurance ownership and beneficiaries. You can temporarily assign a life insurance policy to secure the repayment of a personal or business debt by doing a collateral assignment of the death benefit in favor of the lender. If you sell your life insurance policy in a Life or Viatical Settlement, you must do an absolute assignment in favor of the new owner. Absolute assignment is irreversible without the approval of the new owners of the policy.

In states that follow an At-Fault law, when a driver is at-fault in an accident (auto or motorcycle) - the guilty party and their insurance company are responsible for paying for the damages. (See opposite meaning: No-Fault State)

Auto insurance pays to repair or replace damaged or stolen vehicles and the medical bills associated with the accidents. Auto insurance can be private or commercial.

Behavioral condition in insurance is any behavior that can affect the insurability. Undisclosed behavioral conditions may be grounds for policy cancellations and denial of claims:

• In Auto insurance, a history of traffic accidents and prior at-fault claims is a behavioral condition that leads to higher premiums.
• In Health and Life insurance, smoking, excessive alcohol consumption, and other unhealthy habits increase the likelihood of a claim, and therefore can lead to higher premiums.
• In Commercial insurance, behavioral conditions are the reflection of a business, how it operates, and what risks it is exposed to.
• In Pet insurance, behavioral condition refers to conditions or illnesses that originate from behavioral causes (aggression, vocalization, excessive licking, hiding, etc.).

(Also See: Behavioral Condition, Bilateral Condition, Congenital Condition, Hereditary Condition)

Person or organization named on the life insurance policy to receive the death benefit at the insured’s death. Beneficiaries are listed as primary, secondary, and so on - determining the priority in line to receive the money. Beneficiaries can be revocable (can be replaced at any time), or irrevocable (can be changed only with the beneficiary’s approval).

Benefit schedule is a comprehensive list provided by your insurance plan, detailing the specific services and treatments that are covered, as well as their respective costs. Benefit schedule is commonly used in:

• Dental insurance
• Disability insurance
• Health insurance
• Life Insurance
• Long-Term Care insurance
• Pet insurance
• Travel insurance
• Vision insurance

Bilateral condition across insurance typically refers to a mutual agreement of both the insurer and the insured to fulfill their side of the deal. The main bilateral condition of insurance is the exchange of the payment for insurance coverage:

• In some Health insurance, the insured is required to disclose pre-existing conditions as a requirement to get coverage.
• In Auto insurance, the insured is expected to maintain a valid driver’s license in order to insure and then operate the insured vehicle,
• In Residential insurance, the insured must continuously take care of the property and its upkeep in order for the insurer to provide coverage if the home becomes damaged.
• In Pet insurance, bilateral conditions can refer to two instances: 1. Payment of premium in exchange of coverage, and 2. Health conditions that affect both sides of the pet’s body. (Also See: Behavioral Condition, Congenital Condition, Hereditary Condition)

A physical injury to a person (typically part of the Liability coverage)

Body system refers to a group of physical structures and organs in the body that work together to performs specific functions. Insurance companies categorize coverage and exclusions according to body systems in: Health insurance and in Pet insurance.

An insurance broker represents the client during the purchase of insurance from an insurance company. The client can be an individual or an organization.

A group of coverages, also referred to as commercial insurance, that provide protection to businesses based on the needs:

• Commercial liability insurance
• Commercial property insurance
• Commercial health insurance
• Commercial life insurance,
• Business interruption,
• Business auto, etc.

For more details see: COMMERCIAL INSURANCE Category.

Cash surrender value is the amount of money that is paid out if you cancel your permanent life insurance policy before you die. Cash surrender value = cash value of the insurance policy minus any surrender fees that are imposed by the insurer.

CV is a savings element of the permanent life insurance policy. (Note: Term life insurance does not have a CV component)

Also see Actual Cash Value (ACV) and Replacement Cash Value (RCV)

A formal request from the insured party to the insurance company for compensation for damage or loss covered under the policy. A claim can be for Liability (when you are at-fault), Property repair or replacement, Medical expenses, and other covered events.

Here are some examples of claims for different types of insurance:

• Health insurance: A claim is filed to cover all or some of the incurred medical expenses.
• Auto insurance: A claim can be filed when a policyholder's car is involved in an accident or stolen, and the insurance company covers the repair costs or provides compensation for the vehicle's total loss.
• Homeowners insurance: If a residence is damaged by a fire, wind, hail, or if there was a break-in and theft, the owner can file a claim to receive funds for the repair or rebuilding of the damaged structure, and to replace the stolen items.
• Renters insurance: A claim can be filed by the renter for damaged or lost personal property and liability, if someone gets hurt while visiting the rented property.
• Commercial insurance: A business can file a claim for damage to the property and the associated loss of business income, while the repairs are ongoing.
• Disability insurance: The insured individual can file a claim if they become unable to continue to work due to illness or injury.
• Life insurance: When the insured individual passes away, the designated beneficiary files the claim to receive death benefits.
• Pet insurance: The owner of the insured pet submits a claim to be reimbursed for eligible veterinary costs.

Grouping of people or property under the same identifier, in order to simplify the pricing model. Class rating can be established based demographics, location, occupation, property type, etc.

The percentage of medical bills which must be covered by the insured after annual deductible has been met. The percentage is based on the plan type. Note: Just like copayment and deductible, coinsurance counts towards the annual MOOP (Maximum Out-of-Pocket).

Auto insurance coverage which covers damage to your own insured vehicle from any type of collision.

An insurance policy which covers most types of typical expenses of the type. Examples:

• ACA-compliant health insurance (which provides the most comprehensive coverage package),
• Full coverage auto insurance (Auto insurance coverage which protects your insured vehicle in case of any direct or indirect loss other than collision (theft, fire, flood, etc.).

Condo insurance is for the owners of condo units. Condo association pays for the building coverage using the fees collected from the unit owners. Meanwhile, the owner of the unit buys Condo insurance to cover property and liability inside their unit.

Copay: The dollar amount the insured must pay per medical event or service after meeting the annual deductible. The percentage is based on the plan type. Note: Just like coinsurance and deductible, copayments count towards the annual MOOP (Maximum Out-of-Pocket).

Commercial insurance protects the insured business from financial losses due to insurable events, such as: Property damage, Employee or professional liability, Commercial vehicle insurance, and Business interruption coverage - for when the business cannot operate as usual after a covered event.

A percentage of the insurance policy sale that the agent receives from the insurer in return for aligning the customer with the insurer’s product and helping to process the application. Even if the agent is not employed by the insurer (independent agent), by selling the policy to the consumer, an agent acts as the representative of the insurer.

A unique condition or defect in a human or a pet during birth. (Also See: Hereditary Condition, Bilateral Condition, Behavioral Condition)

In health insurance, the insured individual shares the cost of medical bills with the insurer. The insured is responsible for a portion of the total medical costs (as outlined in the purchased policy). The maximum amount of the required cost sharing is defined by the annually adjusted federal Maximum Out Of Pocket (MOOP) amount.

Cost sharing includes: Coinsurance, Copayment, and Deductible.

Cost sharing excludes: Premiums, Out-of-Network charges, and Non-Covered services.

Insurance coverage is the protection of the insured asset or person. Coverage typically outlines the types of covered perils, events, or circumstances that are insured against, as well as the limits, deductibles, and exclusions that may apply.

(Also see: LIMIT)

Federal crop insurance program (FCIP), overseen by the USDA, is a way for farmers to protect their business from weather events that can damage the crops, and from price fluctuations on their product.

An amount of life insurance coverage that is paid out to the beneficiaries upon the death of the insured individual. Death Benefit can be paid as: Lump Sum, Installment plan, Life income option, and Interest Income Option.

A specified amount of money that the insured must pay out of pocket before the insurance plan starts coverage. Deductible is common in property and health insurance. It can be a percentage of the value of the insured item (Homeowners and Commercial property insurance), or a certain dollar amount per event, as typically seen in Health insurance and at-fault Auto insurance claims.

Note: For health insurance: deductible, just like coinsurance and copayments counts towards the annual MOOP (Maximum Out-of-Pocket).

An insurance type that covers dental routine care and other dental maintenance expenses

A decrease in value of the insured items based on the time and the amount of use. (Typically associated with Actual Cash Value - ACV).

If the director, an officer, or a key employee of a company is accused of breaching their fiduciary duties, a D&O (Directors & Officers) liability policy is used to pay the damages.

Disability can be Short Term, Long Term, Total, Partial, Residual, and Recurrent:

• Short Term disability is any disability lasting less than 2 years
• Long Term disability is any disability lasting over 2 years
• Total disability is the inability to perform your occupation
• Partial disability is the inability to perform one or more duties required for your occupation
• Residual disability is the inability to perform work at the pre-disability level after the recovery and returning to work
• Recurrent disability is when you suffer a total disability, go through the recovery process, return back to work, and within 3-6 months become disabled from the same cause.

Disability income insurance provides a set of payments if you are injured or too ill, and are not expected to be able to return to work for a while.

Disaster insurance includes all types of insurance that can be purchased by individuals and businesses to insure against events that are typically not covered by the regular insurance policy: Flood insurance, Earthquake insurance, etc.

In insurance, a discount refers to a reduction in the overall cost (premium) of an insurance policy. In some cases, the full cost of insurance may be discounted by over 50%. Discounts are offered by insurers to encourage policyholders to take certain actions, exhibit specific characteristics, or meet certain criteria. Typical insurance discounts are offered for:

• Multiple policies under the same insurance company (bundling discount)
• Claims-Free policies (the longer you stay claims-free - the less you will typically pay for coverage)
• Installation of additional security and safety features on the insured property
• Paying policy in full

Additional Type-Specific Typical Insurance Discounts

Besides the standard discounts, all types of insurance have additional “type-specific” discounts. Here are a few:

• Health insurance: Wellness program discount.
• Auto insurance: New car discount, Defensive driver discount, Safe driver discount, Good student discount, and Usage-based discount.
• Residential insurance: New home construction discount, Impact-Resistant roofing, Storm shutters, Fire sprinkler system, etc.
• Flood Insurance: Elevation discount.
• Life insurance: Non-smoker discount, Healthy lifestyle discount.
• Commercial insurance: Business experience length discount.
• Pet insurance: Microchipping discount.

Discuss the discounts with a trusted state-licensed insurance agent.

An insurance company which is domiciled in the same state where it sells its policies.

Earthquake coverage is typically excluded from regular residential and commercial property insurance, and must be purchased through private insurers.

For more details see: DISASTER INSURANCE.

Covers the injuries sustained by employees while on the job.

EPLI protects the insured business from lawsuits from employees, alleging inappropriate or unfair acts from the company towards them. This can include sexual harassment, wrongful terminantion, breach of employment contract, and discrimination.

Any modification of the policy, done though riders or amendments.

Endowment life insurance policy provides regular term life insurance coverage with an additional savings element. When the insured individual does not die during the policy’s term (outlives the policy) - the insurer pays a lump sum amount to be insured at maturity of the policy.

In this healthcare plan, insurers contract with hospitals or specific healthcare providers. Insured members can only benefit from this plan when using contracted hospitals or healthcare providers. Under the EPO plan, there is coverage for emergency services regardless of the network status of the medical provider or facility.

If a business’ actions or professional advice cause a client to lose money - E&O insurance pays for the damages.

If an event is canceled, Event Cancellation Insurance can help the hosts of the event recoup some of the non-refundable costs, such as down payments for services and entertainment.

For businesses that are able to self-insure workers compensation for their employees, Excess Workers Compensation insurance is a way to limit their exposure to the potential unlimited losses. Similar to any other umbrella policy, it limits the maximum exposure of the policy that it protects.

(See Marketplace)

A section in the insurance policy which identifies anything that is excluded from coverage under the policy. Examples of typical insurance exclusions are: war, flooding, earthquakes, mold, cosmetic medical expenses, and certain types of aggressive dog breeds on the liability side.

Note: Always read the exclusion of the policy before signing it.

The dollar amount stated on the front page of the life insurance as a death benefit.

Specialized coverage built for protecting farms and ranches. It combines the aspects of homeowners insurance and private property with commercial coverages to protect the business side.

Federal Poverty Level is an annually updated measurement of income of the population. FPL allows to determine the boundaries of income that qualify for health insurance government assistance. If income falls within the range of 100% to 400% of FPL, the person qualifies for some discount for the price of the Individual or family plan purchased on the health insurance marketplace. The closer you are to 400%, the higher is your portion of the premium. Lower pay results in more subsidies. (Example: 2023 individual poverty guideline is $14,580, so any individual making $14,450 to $58,320 per year qualifies for subsidies)

NOTE: Some states offer programs with a higher percentage of FPL qualifying for discounted coverage. For example, New Jersey’s residents can receive subsidies with income of up to 600% of FPL ($86,700 per year).

As a coverage that is typically excluded from regular property insurance, flood insurance is purchased from the federally-sponsored National Flood Insurance Program (NFIP) and through private insurers. NFIP provides the primary coverage up to a federal limit, while private insurers can insure without limits - as supplementary coverage.

For more details see: DISASTER INSURANCE.

An insurance company that is operated from another state from where it sells their policies. (Opposite of Domestic Insurer)

The amount of time provided by law for the newly insured to cancel a life insurance policy after the start of coverage, in order to get all of the money paid-in back (typically 10-30 days).

When you owe more on the vehicle than it is worth - the bank requires you to buy GAP insurance. In case of a total loss accident, GAP insurance covers that difference and helps pay off the loan in full.

A broad commercial insurance policy, which protects business from claims and lawsuits stemming from bodily injury, property damage, or personal injury.

The amount of time the insured has to pay the policy premium past the due date, in order for the policy to remain active. Grace period can be as short as 1 day or as long as 30 days, depending on the type of insurance. ACA-compliant health insurance typically has grace periods of up to 90 days. Grace period is regulated by the department of insurance.

Gross premium is the total amount of money an insured has paid for a policy. Gross premium includes the net premium (which keeps the policy alive), plus other policy expenses and operating costs.

A guarantee that an insured with a life or health insurance policy can purchase additional (supplementary) amounts of insurance coverage without having to prove insurability and undergo a medical exam.

HDHP is a designation which allows the insured to participate in additional health savings plans like the HSA (Health savings Account). To be considered high-deductible, a health plan must have an annual deductible above the annually-set limit (2023: $1,500 for individuals, $3,000 for a family) (see Qualified High-Deductible Health Plan)

An insurance policy designed to provide coverage for medical bills.

In Pet insurance: Some breeds of animals are predisposed to certain illnesses and diseases. Such know conditions may be excluded by the insurer from coverage or will cost extra to insure. (Also See: Congenital Condition)

Members of this type of healthcare plan pay fixed amounts monthly to access a wide range of medical services, depending on their particular HMO plans. Members are only allowed to use doctors, pharmacies, and hospitals within the HMO's specific network of providers. There is coverage for emergency services regardless of the network status of the healthcare provider or facility.

An HMO will cover the costs of in-network benefits and may sometimes necessitate preauthorization or a referral, barring life-threatening circumstances wherein network restrictions would be waived

Insurance coverage for the owner of the residence if they reside in the home.

Hospital indemnity insurance helps pay for the cost of a hospital stay. It is typically purchased as a supplementary policy, to help cover the deductible in case of a hospitalization. It can also be purchased as a stand-alone plan.

Commercial insurance which provides coverage to the structure of the hull for waterborne vessels and airborne aircraft. Hull insurance covers cargo and passenger vessels.

Helps pay for the costs associated with restoring your identity after a theft.

An annuity, the growth performance of which is tied to a particular stock market index.

Commercial insurance policy that covers property and goods during transportation. The insured items may be owned or being transported “in-care of” another party.

In order to be able to insure anything or anyone, an insurable interest must be established. Insurable interest is a way to show that the insured will be financially affected in case if the insured item or a person is damaged or lost. Examples:

• Homeowner has an insurable interest in their home. If the home is financed, so does the bank.
• Spouses have an insurable interest in each other and may purchase life insurance on each other.

A financial instrument that in return for a premium payment helps a person or a business to recoup their losses from certain “insurable” events”. Insurance coverage is meant to bring the insured party as close to being “whole”, after an insurable event.

The party listed on the insurance policy as the insured. An insured is any person or organization that obtains insurance coverage from an insurance company (insurer). Insurance coverage remains intact while the insured makes premium payments to the insurer. Once the coverage ends or if the insured stops paying the premium, the insured stops being insured.

An insurance company providing insurance coverage, is an organization that pays out the claims to the insured. The insurer furnishes the policyholder with financial protection in the event of a covered loss. The insurer designs the insurance policy and sets out the relevant terms, conditions, and exclusions that bind both parties, once the contract is signed. Note that the term “insurer” is also used interchangeably with an “insurance carrier”. So, when you see the words: insurance carrier, it means the insurance company that sells policies like home, auto, and life insurance, to you.

When the payout is broken down into a set of payments that are made based on a predetermined schedule.

When the death benefit payout is kept by the life insurance company as an investment, and the beneficiary collects the interest.

Similarly to a regular annuity, which allows setting up a recurring income payment, Joint Life Annuity is used to set up such income payment for both spouses.

A business life insurance policy designed to cover the life of the company personnel, whose death can significantly affect the company. The proceeds of the policy are meant to help cover the costs of replacing the lost key person and the resulting company transition.

Kidnap and ransom insurance helps cover the funds demanded by kidnappers.

Insurance coverage that lets homeowners protect their home if they decide to let tenants move in. Landlords insurance can be purchased as a stand-alone policy or as a rider to the homeowners insurance.

Note: Check RESIDENTIAL INSURANCE → Insurance for Property Owners for more details.

An insurance policy terminates (lapses) if the renewal premium payment is not made within the outlined grace period.

Refers to a type of life insurance premium, where the payment remains the same through the duration of the life insurance policy.

Liability insurance protects the insured individual or business from claims alleging that they were at fault in causing bodily injury, property damage, or personal injury to a third party. Liability insurance typically covers medical payments for the treatment of injuries and to pay for the repairs or replacement of damaged property.

Typical examples of liability insurance are:

• Homeowners liability
• Landlord’s liability
• Renters liability
• Auto liability
• Commercial liability
• Pet owner liability

When the payout (typically of the life insurance death benefit) is set on a schedule and lasts for the rest of the life of the person who is receiving it. This is typically seen when the surviving spouse receives the death benefit as a set amount of money every month until they die.

Insurance with the main goal of providing coverage for an individual's life. Besides the death benefit, life insurance offers a wide range of uses while the insured is still alive: tax-advantaged cash value growth accounts, tax free loans, and other living benefits (speak with a licensed life insurance agent for more)

Life settlement is the process of selling your own life insurance to a person or an organization in return for a one-time payment of a portion of the death benefit. The buyer becomes both the owner of the policy (and takes over the responsibility of paying monthly premiums) and the beneficiary of the death benefit after you die. (Life Settlement is used by healthy individuals who are not expected to die any time soon, as opposed to Viatical Settlement, which is a similar arrangement for the insured who are terminally ill)

Maximum value of benefit allowable under the policy, during the policy term.

A commercial liability coverage for businesses engaging in selling alcoholic beverages. The policy covers a business in case if the patron leaves the insured establishment intoxicated and causes bodily injury and/or property damage to another party. If the injured party sues the alcohol establishment - liquor liability coverage steps in.

In life insurance a living benefit is the opposite of a death benefit (an amount of money that is paid out to the beneficiaries after the insured’s death). A living benefit is the ability by the insured to use their life insurance while they are still alive. Most common living benefits are:

• Ability to pay for the treatment of a terminal or chronic condition,
• Cover a critical illness,
• Pay for Long Term Care,
• Cover life insurance premium if the insured becomes disabled and unable to work, etc.

If a living benefit of the life insurance policy is used by the insured, after they pass away the insurance company deducts the used up benefits from the death benefit - before it is paid out to the beneficiary.

Long term care includes both medical non-medical care, provided to individuals who are unable to perform daily activities unassisted. LTC can be administered at home, or a nursing home. LTC insurance helps cover the associated costs. LTC insurance coverage can be obtained from:

• Life insurance and Annuities (using Riders and Accelerated death benefits)
• Medicare
• Medicaid
• Long Term Care insurance

Loss of use is home insurance coverage for both homeowners and renters alike. It helps cover the costs you may incur while your damaged home is being repaired and you live elsewhere. Loss of Use is part of the Additional Living Expenses (ALE) coverage.

An option in life insurance payout, where the whole amount of the benefit is paid out in one payment to the beneficiary.

Major medical insurance is any health plan that can cover major medical expenses without the need for supplementary coverage. Examples of major medical insurance are: ACA group, ACA-individual, Medicare, and Self-insured plans.

Health insurance marketplace / Health insurance exchange (can be used interchangeably). State-operated and federal health insurance marketplaces are two ways how health insurance exchanges are implemented under the Affordable Care Act (ACA):

• State-operated exchanges are run and managed by individual states, providing them more control over design, implementation, and management. For example, state-based exchanges can choose to extend the Open Enrollment Period past the federal deadlines.
• Federal health insurance exchanges (Federally Facilitated Marketplace (FFM)), are managed by the U.S. Department of Health and Human Services, and are used by states that choose not to establish their own marketplace or cannot meet the federal requirements.

Mechanical breakdown insurance helps pay for the cost of repairing the vehicle if it breaks down. MBI is not a replacement of standard auto insurance. MBI is a supplementary insurance coverage, which can be purchased in addition to the standard auto liability and comprehensive insurance.

Medical malpractice insurance is a type of professional liability coverage for healthcare professionals. Malpractice insurance protects medical professionals from claims arising from their professional performance.

Medicare is a federally-ran program that provides health insurance coverage to seniors aged 65 or older. Medicare can be offered through Original Medicare, with or without the assistance of Medigap, or through Medicare Advantage, as a private insurance alternative.

Medicare Advantage is an alternative to Original Medicare. Medicare Advantage typically provides more coverage than the Original Medicare.

Medigap is a supplementary plan, which helps cover some of the items that the Original Medicare may not. Medigap is available only for Original Medicare users, and cannot be used with Medicare Advantage.

Maximum out-of-pocket amount is the maximum amount the insured individual can expect to pay for medical expenses in the course of the policy year in case they need treatment and must use insurance extensively. MOOP is set by the federal government every year as the upper “maximum” possible amount.

Anything above that is paid by the insurance company at 100%.

• MOOP includes: Coinsurance, Copay, and Deductible.
• MOOP excludes: Premiums, Services not covered by the plan, Out-of-network care, and Balance billing.

In 2023 MOOP was $9,100 for an individual and $18,200 for a family.

Mortgage Insurance protects the bank from a possible loan default on the home loan. Private mortgage insurance (PMI) is typically required from homeowners who finance more than 80% of the home’s value. PMI is usually included in the monthly mortgage payment.

The person or organization listed in the insurance policy as the insured party.

Named perils are the cause of damage that are covered by the policy. Typical perils of insurance are: Fire, Lighting, Windstorm and Hail, Explosions, Riots, Smoke, Vandalism, Theft, Accidental discharge of water or steam, Freezing, etc.

In a no-fault state, after a car or motorcycle accident, the driver uses their own insurance coverage - regardless of who was actually at fault. If you are uninsured in the no-fault state, you have no insurance protections even if you get hit by someone else. Their insurance will not pay for your damages if you are uninsured. (See At-Fault States for opposite meaning)

No-Fault states are: Florida, Hawaii, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Dakota, Pennsylvania, Utah

Non-admitted insurers are the ones who are not licensed by the department of insurance to operate in the state. Non-admitted insurers can still offer their products to the residents of the state but only as a Surplus Line insurer.

Nonrenewal is the termination of coverage by the insurer at the end of the policy term. A policy is considered non renewed if the insurance company chooses not to provide further coverage after the expiration of the current policy.

In order to start the claim process after a loss, the insured must notify the insurer about the fact of the loss. This can be done by asking your insurance agent to do it for you or contacting the insurance company yourself.

Ocean marine insurance protects the cargo while it is being transported on board of a shipping vessel.

Time period when one can purchase health insurance from a state-operated and/or federal government-operated health insurance marketplace. Typically occurs from 1 November to 15 January. The purpose of open enrollment is to prevent people from waiting to get coverage until they get sick. The coverage is selected based on the anticipated medical expenses and is locked in for the duration of the next year. (Also see: Special Enrollment Period - SEP)

(see Maximum Out-of-Pocket)

Homeowners insurance can be sold only to the owners of residence who also occupy it.

Package policy is created when multiple independent coverages are placed under one policy, typically resulting in cost savings.

Peril is the exposure to an occurrence of a risk. (See Named Peril).

A life insurance which lasts until it is either canceled or the insured person dies. All permanent life insurance has a Cash Value savings component.

Pet diagnostics refers to any test with the purpose of checking your pet’s health (Labs, X-Rays, MRIUs, CT scans, etc.).

Pet insurance separates pet health conditions into categories, based on how and when the illness or a disease occurs: Accident, Illness, Behavioral condition, Bilateral condition, Congenital condition, Hereditary condition.

Pet insurance helps pet owners cover medical treatment of their insured pets.

An insurance policy is an official document stating who is being covered, the duration of coverage, and detailing the coverages and exclusions.

All insurance policies require to list the following information:

• Insurance policy number
• Duration of coverage
• Cost of coverage for the mentioned duration
• **Deducible **(if any)
• What is covered
• The amount of coverage for the insured item
• Definition of terms
• Exclusions to the coverage

The owner of the policy. The policyholder is the person or an organization buying the policy. They make premium payments and can make changes to the policy at will.

These health care plans have an out-of-network option. At the point of service, the insured can choose whether to receive care from a healthcare provider within or outside the plan's network. Healthcare expenses provided outside the network are covered at lower percentages and with a higher deductible and coinsurance than expenses incurred within the network.

PPO offers a network of providers to meet the insured's medical needs. The insurer contracts with a group of healthcare providers to regulate the price of providing benefits to its insureds. The fees charged by these providers are usually cheaper than the regular rate.

Refers to conditions that existed prior to the start of the insurance coverage (most commonly in health insurance). For certain insurance policies, some or all pre-existing conditions may be excluded from coverage.

Pet insurance does not cover pre-existing conditions, but may cover curable illness or disease after a waiting period.

The payment to the insurance company in exchange for insurance coverage. Typically paid monthly, bi-annually, annually, or financed using premium financing. If you do not pay your premium on time, the underlying insurance coverage gets canceled.

Premium financing is the process of funding the cost of the insurance premium using borrowed money. Typically seen in commercial insurance, which is paid up front in-full, the insured engages the services of a 3rd party finance company, which charges 3%-15% for the use of their funds. This allows businesses to get insurance coverage right away and spread the costs of the coverage over a period of time (usually a year).

A list of medications that are covered by the plan. (Note: If your medication is not on the list, ask your health insurance agent if it can be added)

Primary insurance is the policy which covers the bills first. If there are more than one insurance policies providing the same coverage, the primary policy pays up to its limits first, and the additional policies act as supplementary (umbrella) coverage - stepping in after the primary limit is exhausted.

Product liability insurance protects the manufacturers and resellers of the goods from claims of damages and injuries stemming from their products.

After notifying the insurer of the intention to file the claim, the insurer will request that you file a proof of loss, where all damages and losses are listed along with their values. This document justifies the amount of money you are claiming. If required by the insurer, proof of loss must be submitted within a certain timeframe, based on the policy language (typically 15 days - 60 days).

Damage to the property belonging to others (typically part of the Liability coverage)

A list of doctors and hospitals which have pre negotiated contract rates with the insurer (in-network). Using medical services out-of-network typically costs more.

Provisions are contractual conditions outlined in the policy, which place limitations on how the policy performs based on whether those conditions are met or not. If the conditions are not met, the insured may cancel the policy or the insurer may deny the claim.

An independent licensed insurance professional who can be hired by the consumer to help settle the claim with the insurance company’s adjuster. Public adjuster gets paid by the consumer who hires them (typically a portion of the received claim amount).

A health insurance plans which meets the requirements of the current year’s High-Deductible Health Plan (See HDHP)

An insurance quote is an estimate of costs for insurance coverage, given by the insurance company or its representatives to the prospective client to give an idea of what the particular coverage may cost.

The quote is based on the information provided by the applicant and covers the details about the terms of the policy: proposed coverages, coverage limits, applicable deductibles, copayments, the corresponding costs, and the frequency of payment.

Always compare multiple quotes from various sources, side by side. Do not concentrate just on the cheapest price. Compare the actual coverages the policy provides. (Use the Quote Comparison Worksheets - available at the bottom of every category page.)

Note: Seek the advice of a licensed insurance agent to help you obtain and compare the quotes. Agent’s assistance is free for the insured.

Insurance rate is the exact amount of money an insured pays to receive a specific amount of coverage for losses and expenses. Insurance companies use the rate charged to earn profit. The rate used in the different types of insurance policy varies; for instance, in a health insurance policy it is known as the base rate and when the policyholder pays the premium for the coverage, the premium is calculated from the base rate. Similarly, in homeowners and renter insurance policies, the rate is called the exposure unit, which is the cost the insured pays the insurer for a particular quantity of property coverage for a time frame, usually a month or annually.

What is the difference between premium and rate in insurance?

Premium is the actual dollar amount you pay to the insurance company to provide the coverage. The rate is the cost of a specific policy’s benefit usually adjusted to risk characteristics like smoking, age, family size, business type, etc. of the particular insurance applicant.

Return of part or all of the paid in premium.

(See: Replacement Cost Value (RCV))

A process of an insurer purchasing insurance coverage from another insurance company. While the original insurer receives the claims from their insured, the reinsurer assumes responsibility for covering those payments.

Renewable term life insurance policy allows the insured to renew the coverage at the end of the current policy, without the need to medically requalify for coverage. Term life insurance is typically no longer renewable once you turn 70 years old.

Provides property coverage for tenants in rental residential properties. Renters insurance covers the items that the tenants own, while the landlord’s insurance protects the structure of the building itself.

Note: Check RESIDENTIAL INSURANCE → Insurance for Renters for more details.

RCV is the method of property valuation, where the current insured value of the item is determined by the cost it will take to replace the insured item with an item of similar quality. Insurance policies based on RC valuation typically pay out enough to purchase a brand new replacement of the lost/damaged item.

RCV is usually compared with ACV (Actual Cost Value).

Replacement cost valuation is important for policies where the value can fluctuate, such as a homeowners insurance - where the cost to rebuild your home can flex based on the cost of building supplies, lumber, current contractor labor costs, and many others.

RCV policies are typically structured based on the cost of reconstruction (See: Reconstruction Costs):

Additional Definition

• Replacement Cost does not include expenses such as site improvements, demolition, debris removal, fees, premium material costs, and other construction-related expenses.
• Reconstruction Cost (Rebuild Cost) includes expenses on repairs and restoration, costs associated with the construction process, demolition, debris removal, and other construction-related expenses.

Residential insurance includes all types of insurance that provide coverage for residential dwellings. Residential insurance can be for the owners of the property (Homeowners insurance, Condo insurance, Mobile Home insurance, and Landlords insurance), and for temporary tenants (Renters insurance).

Riders, also known as Endorsements, are optional modifiers of the standard policy, which allow the insured to get coverage specifically tailored for their needs. A rider stipulation may add, modify, or remove coverages from the policy. Examples of riders:

• Homeowners insurance offers optional protection for jewelry, specialty items, identity theft, landlords, etc.
• Life insurance offers multiple riders which allow you to use the policy as a living benefit.
• Commercial insurance riders allow protection of business property and employees, which are typically excluded from the standard policies.

Salvage vehicle is a vehicle which was announced as a total loss by the insurance company. After a total loss accident, the insurance company pays out the policy and keeps the vehicle, to sell it through a network of salvage yards and recoup some of its losses.

Self insurance (a.k.a. Self Funded insurance) is a way for businesses to finance health insurance using company funds, instead of using a health insurance company. Self insurance can be self-administered (where the company employees run the program), or contracted to insurers and third-party administrators.

Temporary medical coverage is not available in every state. Where available, short term health insurance offers a temporary solution while you are waiting for the ACA enrollment to open or in between jobs.

When premiums for a life insurance policy are paid-in as a one single payment and the coverage lasts until the insured turns 100 years old or passes away.

SOAP (Subjective, Objective, Assessment, and Plan) notes is a standardized format used by the doctors and veterans alike, to fill out medical records.

Pet insurance: SOAP notes are typically required as part of a claim with pet’s insurance.

Any time outside of the Open Enrollment Period (OEP), when you qualify to purchase health insurance from a state or federal marketplace, based on special qualifications, such as: job loss and the subsequent loss of health insurance coverage, getting married, having a baby, or experiencing a drop in income.

Specified disease is a supplemental insurance which pays out if the insured is diagnosed with any of the diseases specifically named as covered by the policy. Typically, the policy covers cancer and other diseases like: diabetes, heart disease, multiple sclerosis, ALS, and more, Specified disease insurance can be purchased as stand-alone coverage or as an optional rider to a policy.

The state where a business is formed and the official address is listed.

In insurance, a subsidy is a financial benefit meant to assist the insured to lower costs of insurance coverage. Generally seen in health insurance, subsidies (discounts) are typically given if the insured earns between 100% and 400% of the federal poverty level. (Check your Adjusted Gross Income on line 11 of your IRS Tax Form 1040)

States that run their own health marketplaces can offer expanded subsidies (Example: New Jersey offers subsidies up to 600% of FPL).

A process when the insurer pays out a claim to the insured and then seeks to recoup the money from the at-fault party’s insurer. Most common example of subrogation is in auto insurance, when the insurance company covers the damages to their client's vehicle and then goes after the at-fault driver’s insurer for reimbursement.

Surplus insurance is a secondary-market for insurance, which gets used when regular insurance cannot provide the needed coverage. Surplus insurance companies do not have to be licensed by states other than their home state. Examples of Surplus insurance:

• Private flood insurance can be provided by a surplus insurer, as an umbrella coverage, in addition to the NFIP Policy maximum limit,
• Property that is hard to replace or to restore, if damaged: art, boats, old historical homes, etc.

The period of time during which the insurance policy is in-force.

Title insurance insures that the title given by the seller of the home is clean and does not have issues, such as liens, forged documents, and undisclosed easements. Title insurance can be purchased for both the bank and the home owners.

A vehicle is generally considered a total loss if it will cost over 75 percent of its value to repair.

An underinsured person or organization whose insurance coverage is not sufficient to make them “whole” again, in case of a sudden loss.

An optional car insurance coverage which protects from bodily injuries and property damages caused by a driver with insufficient coverage limits. Depending on the severity of an accident, state-mandated minimum limits are frequently not enough.

A process an insurance company undertakes to gauge the risk of insuring the applicant.

A life insurance where the death benefit (face value) and duration are reflective of the underlying invested securities. An insurance agent selling variable life insurance must also have a securities license.

Life settlement is the process of selling your own life insurance if you are terminally ill. You can sell the policy to a person or an organization in return for a one-time payment. The buyer becomes both the owner of the policy and the beneficiary after your death, while you get the cash in hand. You can typically get more for your policy through Viatical settlements than by just surrendering it. (Viatical Settlement is used by terminally-ill individuals, as opposed to Life Settlement, which is a similar arrangement for the insured who are healthy)

Limited benefit policies, which provide predetermined dollar amounts per activity: annual eye exams, eye injury treatments, and the purchase of glasses.

Some insurance policies include a waiting period before some benefits become available:

• Dental insurance,
• Disability insurance,
• Health insurance,
• Homeowners and Renters insurance,
• Life insurance,
• Pet insurance.

In Business interruption insurance there is typically a waiting period of 2-3 days before the policy starts providing coverage to the business. During the waiting period the business relies on the company's cash reserves.

A warranty is a guarantee from the manufacturer, seller, or reseller that a product will work properly for a certain time. A warranty covers repairs or replacements for manufacturing defects and stipulates the process and conditions for repairs or exchanges, if the product does not perform according to the expectations. Warranties, unlike insurance, are limited to the product, often included in the purchase price, and have specific conditions. Insurance, on the other hand, offers broader coverage for various risks and provides financial support in unexpected situations.

See Permanent Life insurance

Workers Comp is a state-regulated insurance program which pays medical bills and lost wages of employees with work-related injuries and illnesses - for companies that participate in this coverage.