| A | B |
|---|
| Risk | Uncertain, unpredictable factors that can lead to losses or damages |
| Insurance | An arrangement in which an insured pays money to an insurer to gain protection against risks and compensation for losses |
| Policy | A written contract stating the arrangement between insured and insurer |
| Policyholder (insured) | A consumer who has purchased an insurance policy |
| Coverage | Potential risks and losses against which an insured is protected by a policy |
| Premium | Fee paid to an insurance company on a regular basis for coverage |
| Claim | Request submitted to insuracne company describing injury or accident & requesting payment to policyholder (reimbursement for costs incurred) |
| Deductible | Initial amount paid by insured for a loss before insurance compensation begin |
| Health insurance | Provides compensation for losses due to injury, illness, or disability |
| Basic medical | Pay a large part of hospital and medical care, may also pay part of some other expenses (e.g. doctor’s visits) |
| Major medical | Pays for long-term illness expenses after basic medical benefits limits have been reached (e.g. cancer). |
| HMO | Health management organizaiton---a health care group that provides health care services to members for a set fee and a small co-pay. |
| HSA | Health savings account---you contribute pre-tax dollars to account for expected medical expenses for coming year-often set up through your employer-submit claims & receipts for reimbursement up to amount deposited. |
| PPO | Preferred providers organization---an agreement between health providers with empoloyers or insurers to provide services at a reduced rate to employees. |
| POS | Point of service---members use a primary physician who refers them as needed to participating specialists or members can see non-participating specialist members. But, members pay more to use non-participating health providers. |
| Fee-for-services plan | Plan in which insured can select his/her own doctors and hospitals, pay costs at time of visit, & file form with insurer for reimbursement of covered expenses |
| CHIP-Childrens Health Insurance Program | Federally funded health insurance for children under 18 whose parents earn too much to qualify for Medicaid, but not enough to afford private insurance |
| Disability | An illness or injury that leaves a person unable to work |
| Long term care | Pays for care when a person with a serious illness or injury cannot care for themselves for an extended period of time |
| Worker’s compensation | Covers medical care, rehabilitation, & portion of wages from injuries/illness caused by the workplace. Required by every state in some form. Employer paid |
| Medigap insurance | May be purchased by Medicare recipients to cover part/all expenses not covered by Medicare |
| Pre-existing condition | Illness or injury that a person has at the time he/she enrolls in a health care plan |
| COBRA | A federal law that someone who leaves employment may be eligible to keep insurance coverage at his/her own expense up to six months |
| Medicare | Federal government sponsored health care for individuals over the age of 65 |
| Medicaid | Federal government sponsored health care program for low income individuals |
| Renewability | A patient’s right to restart coverage annually |
| Maximum benefit | A limit on the number of days one’s care will be covered, or the highest amount that can be paid in benefits for a specific procedure |
| Open enrollment period | A time period during which a person can enroll in a health care plan |
| Exclusion | A medical service that is not covered |
| Pre-authorization | Requirement to obtain approval from the plan before having certain treatments or procedures done |
| Primary care physician | A doctor who provides general medical care and coordinates other health care |
| Beneficiary | A group or individual selected to receive the assets of a person when he/she dies |
| Insurance benefits | Assets or gain received by having an insurance policy |
| Face value | The amount of money payable to a beneficiary as a death benefit when an insured dies |
| Maturity | The length of time it takes an insurance policy to reach its full value |
| Cash value | The amount of money a whole life policyholder would receive if the policy were surrendered before death or maturity |
| Term insurance | A type of insurance that provides coverage for a specific period of time with no investment benefits |
| Level term | premiums and death benefits stay the same for the life of the policy |
| Decreasing term | premiums stay the same but the benefits decrease over the life of the policy e.g. for home mortgage |
| Renewable term | the insured person can renew the policy without taking a physical |
| Convertible term | the insured person can change the policy from convertible to permanent without taking a physical, tends to be more expensive |
| Permanent life | (also called cash value life insurance) provides coverage the person’s entire life and includes an investment component |
| Whole life insurance | a type of insurance that provides coverage for a whole lifetime and grows in face value as premiums and cash accumulate |
| Limited payment life | coverage for entire life but premiums are higher than whole life because premiums are paid for a set number of years or until a set age |
| Universal life | allows adjustments of premium, face value, and level of protection |
| Variable life | premiums are fixed, but face amount varies with investment results |
