AGENT
A licensed person or organization authorized to sell Insurance by or on behalf of an Insurance company.

BENEFIT
Payments provided for covered services under the terms of the policy. The benefits may be paid to the insured, or on his behalf, to others.

Benefit Period
The maximum length of time for which benefits will be paid.

BROKER
A licensed person or organization paid by you to look for Insurance on your behalf.

CANCELLATION
The Termination of Insurance coverage during the policy period. Flat cancellation is the cancellation of a policy as of its effective date, without any premium charge.

CLAIM
A request for payment for benefits received or services rendered. A billing record as generated and submitted by a provider or subscriber using paper or electronic media.

COINSURANCE
An arrangement under which the covered person pays a fixed percentage of the cost of medical care after the deductible has been paid. For example, an Insurance plan might pay 80% of the allowable charge, with the insured individual responsible for the remaining 20%, which is then referred to as the coinsurance amount.

COVERED MEDICAL EXPENSE
Those expenses payable according to the terms of the member contract. The charges for these services are still subject to any cost sharing components or limits, such as deductibles, coinsurance, co-payments and maximums, included in the contract.

COVERED SERVICES
Hospital, medical and other health care expenses incurred by the covered person that entitle him/her to benefits under a contract. The term defines the type and amount of expense, which will be considered in the calculation of benefits.

DECLINE
The Company refuses to accept the request for insurance coverage.

DEDUCTIBLE
The amount of the loss which the insured is responsible to pay before benefits from the insurance company are payable. You may choose a higher deductible to lower your premium.

EMERGENCY
In general, a sudden, serious, and unexpected acute illness, injury, or condition (including without limitation sudden and unexpected severe pain) which the member reasonably perceives could permanently endanger health if medical treatment is not received immediately. More detailed or slightly different definitions may apply based on applicable law.

EXCLUSION
Certain causes and conditions, listed in the policy, which are not covered.

EXPIRATION DATE
The date on which the policy ends.

Hospital
An institution whose primary function is to provide inpatient services, diagnostic and therapeutic, for a variety of medical conditions, both surgical and non-surgical. In addition, most hospitals provide some outpatient services, particularly emergency care.

INSURED
The policyholder - the person(s) protected in case of a loss or claim.

INSURER
The insurance company.

LIMIT
Maximum amount a policy will pay either overall or under a particular coverage.

MEDICAL PAYMENTS

Will pay reasonable expenses incurred for necessary medical and /or funeral services because of bodily injury caused by accident and sustained by you or any other person.

NETWORK
The doctors, clinics, hospitals and other medical providers that a carrier contracts with to provide health care to its covered persons. Individuals are generally limited to network providers for full coverage of their health costs.

POLICY
The written contract of insurance.

POLICY LIMIT
The maximum amount a policy will pay, either overall or under a particular coverage.

PRE-EXISTING CONDITION
A health condition or medical problem that was diagnosed or treated before enrollment in a new health plan or insurance policy. Some pre-existing conditions may be excluded from coverage.

PREMIUM
The amount of money an insurance company charges for insurance coverage.

QUOTE
An estimate of the cost of insurance, based on information supplied to the insurance company by the applicant.

UNDERWRITING
The process of selecting applicants for insurance and classifying them according to their degrees of insurability so that the appropriate premium rates may be charged. The process includes rejection of unacceptable risks.

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