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ACCIDENT: An unexpected fortuitous event, unforeseen and unintended, not under the control of an insured and resulting in a loss.
ACCIDENT INSURANCE: A form of health insurance against loss by bodily injury.
ACCIDENTAL DEATH: Coverage in the event of death due to an accident, usually in combination with dismemberment insurance.
ADULT DAY CARE : a non-residential facility specializing in providing activities for elderly and/or handicapped individuals. Most centers operate 10 - 12 hours per day and provide meals, social/recreational outings, and general supervision.
AGENTS: Two types of agents sell insurance: (1) Independent Agents are self-employed business people who typically represent more than one insurance company and are paid on a commission basis; and (2) Exclusive Agents represent only one insurance company and may be salaried or work on a commission basis.
ANNUITY: A life insurance company contract that pays a periodic income benefit for a specified period of time.
ANOREXIA: an eating disorder in which people do not eat correctly due to the obsessive fear of weight gain.
APPLICATION: A signed statement by a prospective insured client which becomes a part of the insurance contract.
ASSISTED LIVING : Assisted living residences or assisted living facilities (ALF's) provide supervision or assistance with activities of daily living (ADL's); coordination of services by outside health care providers; and monitoring of resident activities to help to ensure their health, safety, and well-being. Assistance may include the administration or supervision of medication, or personal care services provided by a trained staff person.
BARBITURATE: drugs that act as central nervous system depressants, and by virtue of this they produce a wide spectrum of effects, from mild sedation to anesthesia.
BENEFICIARY: Designation by the owner of a life insurance policy indicating to whom the proceeds are to be paid upon the insured's death or when an endowment matures.
BENZODIAZEPINES: Benzodiazepines are useful in treating anxiety, insomnia, agitation, seizure, and muscle spasms, as well as alcohol withdrawal. They can also be used before certain medical procedures such as endoscopies or dental work where tension and anxiety are present, and prior to some unpleasant medical procedures in order to induce sedation and amnesia for the procedure. Another use is to counteract anxiety-related symptoms upon initial use of SSRI's and other antidepressants, or as an adjunctive treatment. Recreational stimulant users often use benzodiazepines as a means of "coming down". Benzodiazepines are also used to treat the panic that can be caused by hallucinogen intoxication.
CASH SURRENDER VALUE: Money the policyholder is entitled to receive from the insurance company upon surrendering a life insurance policy containing a cash value clause.
CLAIM: (1) A formal request for payment of a loss under an insurance contract or bond; (2) The actual amount of the final settlement.
CLAIMANT: One who seeks reimbursement for loss under the terms and conditions of the insurance contract.
COBRA (Consolidated Omnibus Budget Reconciliation Act): A federal law under which group health plans sponsored by employers with 20 or more employees must offer continuation of coverage to employees who leave their jobs, voluntarily or otherwise, and their dependents; gives individuals and their dependent families the right to continue their health care coverage for as long as 18 months.
COINSURANCE: (1) In property insurance, a clause under which the insured shares in losses to the extent that he is underinsured at the time of loss. (2) In health insurance, a provision that the insured and insurance company will shared covered losses in agreed proportion. In health insurance, the preferred term is "percentage participation."
CO-PAY: The portion, either a percentage or a fixed dollar amount, of a medical bill that a patient pays. The insurer pays the rest.
CONSUMER DRIVEN HEALTH PLAN: health insurance plans that allow members to use personal Health Savings Accounts (HSA's), Health Reimbursement Arrangements (HRA's), or similar medical payment products to pay routine health care expenses directly, while a high-deductible health insurance policy protects them from catastrophic medical expenses.
COVERAGE: The scope of protection provided under the contract of insurance.
DEDUCTIBLE: The amount of loss paid by the policyholder before the insurance policy benefits become payable.
DENTAL INSURANCE: Coverage for dental services under a group of individual policy.
DISABILITY: A condition that curtails to some degree a person's ability to carry on his normal pursuits. A disability may be partial or total, and temporary or permanent.
DISABILITY INSURANCE: A type of health insurance that pays a monthly income to the policyholder when he or she is unable to work because of illness or accident.
DISCLOSURE: The duty of the Assured and his broker to tell the Underwriter every material circumstance before acceptance of the risk.
DISCOVERY PERIOD: The time allowed the insured after termination of certain bond and policy provisions to discover that he has sustained a loss which occurred during the period covered by the contract.
EFFECTIVE DATE: The date on which an insurance policy or bond goes into effect, and from which protection is furnished.
EVIDENCE OF INSURABILITY: Any statement of a person's physical condition, occupation, etc., affecting his acceptance for insurance.
EXCLUSIONS: Specified hazards for which a policy will not provide benefit payments. (Often called Exceptions)
FOOD AND DRUG ADMINISTRATION : is an agency of the United States Department of Health and Human Services and is responsible for the safety regulation of most types of foods, dietary supplements, drugs, vaccines, biological medical products, blood products, medical devices, radiation-emitting devices, veterinary products, and cosmetics.
FORMULARY: In regards to health insurance, the formulary usually refers to a list of drugs that the insurance carrier covers.
HEALTH INSURANCE: Protection against the costs of hospital and medical care or lost income arising from an illness or injury (sometimes called Accident & Sickness Insurance).
HIGH DEDUCTIBLE HEALTH PLAN : a health insurance plan with lower premiums and higher deductibles than a traditional health plan. It is sometimes referred to as a catastrophic health insurance plan.
HMO (Health Maintenance Organization): An organization that provides health care for a monthly payment set in advance. In a traditional HMO, doctors and other providers are salaried employees and the facilities are owned by the organization. In recent years, however, other forms of HMO's have sprung up that contract with doctors and hospitals to care for members at set, negotiated fees. Many HMO's are hybrids, offering both kinds of care to members.
HOME CARE : (commonly referred to as domiciliary care), is health care or supportive care provided in the patient's home by healthcare professionals (often referred to as home health care or formal care; in the United States, it is known as skilled care) or by family and friends (also known as caregivers, primary caregiver, or voluntary caregivers who give informal care). Often, the term home care is used to distinguish non-medical care or custodial care, which is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel, whereas the term home health care, refers to care that is provided by licensed personnel.
HOSPICE CARE : is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than halting or delaying progression of the disease itself or providing a cure. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness.
INSURANCE: A system to protect persons, groups, or businesses against the risks of financial loss by transferring the risks to a large group who agree to share the financial losses in exchange for premium payments.
INSURED: The person whose risk is transferred and shared; the party to an insurance agreement whom the insurer agrees to indemnify for losses, provide benefits for, or render services to.
INSURER: The company or group offering protection through the sale of an insurance policy to an insured; the party to an insurance agreement who undertakes to indemnify for losses, provide pecuniary benefits, or render services.
JOINT LIFE POLICY: Pays the insurance amount when the first of two or more covered persons dies.
LIFE INSURANCE: Protection against the death of the Insured in the form of payment to a designated beneficiary, typically a family member or business.
LONG-TERM CARE INSURANCE: A type of insurance policy that covers the cost of long-term custodial care in a nursing facility or at home.
MANAGED CARE: A health plan that places limits on which treatments and which doctors, hospitals and other providers a member can use and still receive full coverage. Generally, under managed care an insurer negotiates lower fees with doctors, hospitals, or laboratories who join in a network that members of the plan are encouraged to use. Frequently, members of a managed care plan can use health care providers outside their network, but they must pay a greater share of the fees.
MEDICAID: A federal/state program that helps pay for health care for the needy, blind or disabled and for low-income families with children.
MEDICARE: A federal health care program for people age 65 and over, and for the disabled.
MEDICALLY NECISSARY: Activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care.
MEDIGAP: Insurance coverage sold by private insurers to supplement federal insurance benefits and expenses not covered under the federal Medicare program.
MINIMUM PREMIUM: The smallest premium which an insurance company will accept for writing a particular policy or bond for a designated period.
MISREPRESENTATION: An incorrect statement made about a material fact that, if made deliberately and with intent to deceive, could cause the insurance contract to become null and void.
NURSING HOME : A nursing home, skilled nursing facility (SNF), or skilled nursing unit (SNU), also known as a rest home, is a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living. Residents include the elderly and younger adults with physical disabilities. Adults 18 or older can stay in a skilled nursing facility to receive physical, occupational, and other rehabilitative therapies following an accident or illness.
NON-CANCELABLE POLICY: A policy which the insured has the right to continue in force by the timely payment of premiums set forth in the policy, during which period the insurer has no right to make unilaterally any change in any provision of the policy while the policy is in force. (See also "Guaranteed Renewable Policy".)
PHARMACOPOEIA: is a book containing directions for the identification of samples and the preparation of compound medicines, and published by the authority of a government or a medical or pharmaceutical society
POLICY: The written statement of a contract effecting insurance, or certificates thereof, by whatever name called and including all causes, riders, endorsements and papers attached thereto and made part thereof.
POLICY PERIOD: The period during which the policy contract affords protection.
PRE-CERTIFICATION AUTHORIZATION: A cost containment technique which requires physicians to submit a treatment plan and an estimated bill prior to providing treatment. This allows the insurer to evaluate the appropriateness of the procedures, and lets the insured and the physician know in advance which procedures are covered and at what rates benefits will be paid.
PRE-EXISTING CONDITIONS: A physical condition of an insured person which existed prior to the issuance of the policy.
PREMIUM: The payment for an insurance policy, usually paid periodically (annually, semi-annually, quarterly, or monthly).
QUALIFIED PLAN: A plan under which contributions by the employer are allowed as a deduction from taxable income, and which provides that the deposits for his employees' future benefits are not to be considered as taxable income to them in the year in which they are made.
REIMBURSEMENT: Payment of an amount of money related to the amount of loss to or on behalf of the insured upon the occurrence of a defined loss.
REINSTATEMENT: (1) Putting a lapsed policy back in force; (2) The payment of a claim under some forms of insurance reduces the principal amount of the policy by the amount of the claim. Provision is usually made for a method of reinstating the policy to its original amount.
RESPITE CARE : short-term, temporary relief to those who are caring for family members who might otherwise require permanent placement in a facility outside the home.
SCHEDULE: A list of specified amounts payable for, usually, surgical procedures, dismemberments, ancillary expenses or the like in Health Insurance policies.
TAX ADVANTAGE : The economic bonus which applies to certain accounts or investments that are, by statute, tax-reduced, tax-deferred, or tax-free. The most obvious examples are Retirement plans, but investments in many state or municipal bonds can also be exempt from certain taxes. Governments establish the tax advantaged status of these investments to encourage private individuals to contribute money when it is considered to be in the public interest.
TAX DEDUCTION : A tax deduction or a tax-deductible expense affects a taxpayer's income tax. A tax deduction represents an expense incurred by a taxpayer. It is subtracted from gross income when the taxpayer computes his or her income taxes. As a result, the tax deduction will lower overall taxable income and the amount of tax paid. The exact amount of tax savings is dependent on the tax rate and can be complicated to determine.
TAXABLE INCOME : the portion of income that is the subject of taxation according to the laws that determine what is income and the taxation rate for that income. Generally, taxable income refers to an individual's (or corporation's) gross income, adjusted for various deductions allowable by statute.
TERM INSURANCE: Life insurance issued for a stated temporary period of time.
UNDERWRITER: (1) A person trained in evaluating risks and determining the rates and coverage's that will be used for them; (2) An agent, especially a life insurance agent, who might qualify as a "field underwriter."
UNDERWRITING: The process of examining, accepting, or rejecting insurance risks, and classifying those selected in order to charge the proper premium for each.
UNIVERSAL LIFE INSURANCE: A flexible premium policy that combines protection against premature death with a savings account that typically earns a money market rate of interest.
USUAL AND CUSTOMARY CHARGES: also called reasonable and customary -- means the fee charged by most of the providers in a given geographical area for a particular service. Insurance companies may subscribe to an independent service which periodically surveys providers in a given area, or they may use their own claims experience to establish these allowances. Most companies pay claims based on a percentage of the usual and customary fee schedule.
WAITING PERIOD: A period of time between the beginning of a disability and the date benefits begin.
WHOLE LIFE INSURANCE: Life insurance payable to a beneficiary at the time of death of the insured, whenever that occurs.
Rodney McCarron, Authorized Independent Agent • Erin Wallen, Office Manager • Doug Thomas, Authorized Independent Agent
539 Oak Street • Farmington, MO 63640 • Phone: (573) 756-7982 • Fax: (573) 756-7142
Office Hours: Monday - Friday, 9:00am - 5:00pm CST