Our insurance terms glossary is divided alphabetically by insurance terms in a quick reference guide to assist understanding the language commonly used by insurance companies. Policy documents contain a number of insurance terms because they typically define the limitations of risk and liability on the insured and any exclusions of coverage.
If you plan to start a new policy or renew your current policy with a carrier or agency, it is important to review and understand the policy differences behind individual quotes from multiple carriers. Lower policy premiums may be the result of decreased payout benefits, higher deductibles, or maximum damages allowed. It is important to identify these unique features in any policy comparison, otherwise a lower price may come at a much higher cost when you have to file a claim for loss or damages in the future.
Mail Order Insurer
Type of insurance company that sells policies through the mail or other mass media, eliminating need for agents.
Major Medical Expense Insurance
A form of health insurance that provides benefits for most types of medical expense up to a high maximum benefit, such as $250,000 or higher after a substantial deductible, such as $500 or more. Such contracts may contain internal limits and are normally subject to coinsurance.
Major Medical Insurance
Health insurance designed to finance the expense of major illness and injury. Characterized by large benefit maximums ranging up to $250,000 or higher above an initial deductible, which reimburses the major part of all charges for hospital, doctor, private nurses, medical appliances, prescribed out-of-hospital treatment, drugs, and medicines. The insured person pays the remainder.
Deliberate or willful destruction of another person’s property for vicious purposes.
The practice of feigning illness or inability to work in order to collect insurance benefits.
Coverage for a professional practitioner, such as a doctor or a lawyer, against liability claims resulting from alleged malpractice in the performance of professional services.
Health care systems that integrate the financing and delivery of appropriate health care services to covered individuals by arrangements with selected providers to furnish a comprehensive set of health care services.
The premium rate developed for a group’s insurance coverage from the company’s standard rate tables normally referred to as its rate manual or underwriting manual.
Policy designed for a firm’s specific needs and requirements.
A form of insurance primarily concerned with means of transportation and communication, and with goods in transit See Inland Marine Insurance and Ocean Marine Insurance.
A reduction of an estate for estate tax purposes, which is available if the deceased is survived by his or her spouse.
Market Price (Or Market Value)
The price at which a security can be bought or sold at any particular time.
A policy that is issued to an employer or trustee, establishing a group insurance plan for designated members of an eligible group.
Automobile insurance designed to provide financial protection against damage to an insured vehicle. It includes automobile comprehensive, collision, fire and theft. Material damage and physical damage are terms that often are used interchangeably.
Maximum Family Benefit
The largest amount in Social Security benefits that will be paid to any family unit.
Federal law passed in 1945 stating that continued regulation of the insurance industry by the states is in the public interest and that federal antitrust laws apply to insurance only to the extent that the industry is not regulated by state law.
Intervention in a dispute in efforts to resolve it. Often referred to as ‘arbitration.’
State programs of public assistance to persons whose income and resources are insufficient to pay for health care. Title XIX of the Federal Social Security Act provides matching federal funds for financing state Medicaid programs, effective January 1, 1966.
The examination given by a qualified physician to determine to the insurability of an applicant. A medical examination may also be used to determine whether an insured claiming disability is actually disabled.
Medical Expense Insurance
A form of health insurance that provides benefits for expenses incurred for medical care. This form of health insurance provides benefits for expenses of physicians, hospital, nursing, and related health services, and supplies. These benefits may be related to actual expense, specified sums, or services rendered. Such insurance sometimes includes benefits for prevention and diagnosis as well as treatment.
Medical Expense Liability Insurance
A general liability coverage in which the insurer reimburses, without regard to the insured’s liability, the insured and others (as specifically provided in the policy) for medical and funeral expenses incurred by such persons as a result of bodily injury or death sustained by accident under the conditions specified in the policy.
Medical Information Bureau (MIB)
An association of over 500 U.S. and Canadian life insurance companies providing information and database management services to the financial services industry. Organized in 1902, MIB’s core fraud protection services protect insurers, policyholders and applicants from attempts to conceal or omit information material to the sound and equitable underwriting of life, health, disability, and long term care insurance. Fair pricing of insurance products is largely dependent on accurate “risk assessment”, “risk classification”, and “risk selection”. A determination of these factors begins with the assurance of accurate health information supplied on the insurance application concerning the proposed insured.
Medical Loss Ratio (MLR)
The percent of premium insurers spend on claims and expenses.
Improper care or treatment by a physician, hospital, or other provider of health care.
Medical Payments Insurance
A coverage, available in various liability insurance policies, in which their insurer agrees to reimburse the insured and others, without regard for the insured’s liability, for medical or funeral expenses incurred as the result of bodily injury or death by accident under specified conditions.
The use of medical and health information to analyze coverage for a potential customer.
National health insurance program for people age 65 and older. A program of Hospital Insurance (Part A) and Supplementary Medical Insurance
(Part B) protection provided under the Social Security Act.
Medicare Advantage (Part C)
Health insurance that provides coverage within Part C of Medicare, and is based on a monthly fee, instead of a fee-for-service model.
Medicare Part D
Often called Medicare Prescription Drug Benefit, is an optional program intended to help Medicare recipients pay for prescription drugs through premiums.
A term sometimes applied to private insurance products that supplement Medicare insurance benefits.
A provision that a minimum amount of annuity will be paid if the regular benefit formula produces less. This minimum is usually payable only if certain service requirements are met at retirement.
The least number of employees permitted under a state law to effect a group for insurance purposes; the purpose is to maintain some sort of proper division between individual policy insurance and the group forms.
Minimum Premium Plan (MPP)
An arrangement under which an insurance carrier will, for a fee, handle the administration of claims and insure against large claims for a self-insured group.
Expenses in connection with hospital insurance, hospital charges other than room and board, such as X-rays, drugs, laboratory fees, and other ancillary charges. (Sometimes referred to as ancillary charges.)
Miscellaneous Hospital Expense Benefit
A provision in a hospital expense policy providing for the payment of a benefit for expenses for necessary hospital services and supplies during a period of hospital confinement. Expenses commonly covered under this benefit include those for x-ray examinations, laboratory tests, medicines, surgical dressings, anesthetics (including administration thereof), and use of operating room.
A false, incorrect, improper, or incomplete statement of a material fact, made in the application for an insurance policy.
Mode Of Premium Payment
The frequency with which premiums are paid monthly, quarterly, semiannually, or annually.
Modified Endowment Contract (MEC)
A life insurance policy where the premiums paid to it exceed what is allowed under federal tax laws.
Hazard arising from any nonphysical, personal characteristic of a risk that increases the possibility of loss or may intensify the severity of loss, for instance, bad habits, low integrity, poor financial standing.
The incidence and severity of sicknesses and accidents in a defined class or classes or persons.
Actuarial statistics showing the frequency and duration of disability.
The rate at which members of a group die in a specified period of time. Actual mortality rates are compared to the mortality table.
A chart showing how many members of a group, starting at a certain age, will be alive at each succeeding age. It is used to calculate the probability of dying in, or surviving through, any period, and for determining the value of an annuity. To be appropriate for a specific group, it should be based on the experience of individuals having common characteristics, including such variables as sex and occupation.
A plan maintained according to a collective bargaining agreement, to which more than one employer contributes (eg., multiple school districts). Under ERISA, at the beginning of the plan, no single employer may contribute as much as 50% of the total, and thereafter as much as 75%. An employee may change employers within the group without losing retirement benefits unless a break in service (under the plan) cancels credits earned before the break.
A package policy which provides protection against a number of separate perils. Multi-peril policies are not necessarily multiple line policies, since the combined perils may be all within one insurance line.
Multiple Employer Trust (MET)
A legal trust established by a plan sponsor that brings together a number of small, unrelated employers for the purpose of providing group medical coverage on an insured or self-funded basis.
Mutual Insurance Company
An insurance company in which ownership and control is vested in the policyholders and a portion of surplus earnings may return to policyholders in the form of dividends. No capital stock (e.g.., common stock) exists.
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