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  Insurance Terms

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Paid-up life Insurance
Insurance on which no further premiums are due.

Participating Insurance
Insurance that has the possibility of paying dividends to its policyholders. Also called a par policy.

Permanent Life
A phrase that covers any form of life insurance with the exception of term.

Permanent Life Insurance
Life insurance that provides coverage throughout the insured’s lifetime and also provides a savings element.

Physical Examination
Physical examination, as well as information about your medical history, may be required to qualify for health insurance. The requirements will vary for individual or group coverage, for different insurance companies, and for very large or very small groups.

PIP (Personal Injury Protection)
Commonly referred to as “no-fault” insurance. This was designed to pay promptly -- regardless of fault or negligence -- for actual economic losses (e.g., medical expenses, lost earnings, and other reasonable and necessary expenses related to injuries sustained) to a driver or passenger injured in the car and to pedestrians injured by your car, because of its use or operation. It applies to personal injuries only, not for physical damages to the vehicle.

Point-of-service (POS) Plans
These plans allow members the option of using services outside the HMO network without prior approval

Policy Anniversary
As a general rule, the date on which coverage under an insurance policy became effective. 

Policy Dividend
A partial premium refund on a participating life insurance policy

Policy Loan
A loan made by a life insurance company to the policyholder on the cash value of the policy.

Policy Period
the amount of time an insurance contract or policy provides coverage.

Policy Reserves
Funds held by a life insurance company specifically to fulfill its policy obligations.

Policy Rider
An amendment to an insurance policy that becomes part of the insurance contract and either expands or limits the benefits payable under the contract.

Policyholder
The person or party who owns an individual insurance policy. This person may be the insured, a relative, the beneficiary, a corporation, or another person.

Portability
Under HIPAA, workers with pre-existing medical conditions must receive credit for time in a previous health plan if they join an employer pla.

Pre-certification
A requirement that you notify the insurance company for its approval before you check into a hospital, have elective surgery, visit specialists, have expensive tests (e.g., MRI). Pre-certification does not guarantee the insurance company will pay the medical bills. Also called “utilization review”.

Pre-existing Condition
Health problem/condition/illness you had prior to applying for insurance and for which you received medical advice, diagnosis, care or treatment. Policies can exclude coverage of any medical condition for a period of time.

Preferred Provider Organization (PPO)
A network of doctors, hospitals, and suppliers (preferred providers) who agree to provide services to members of a health plan for discounted fees.

Preferred Risk
A proposed insured who presents a significantly less than average likelihood of loss and who is charged a lower than standard premium rate. 

Premium Waiver Provision
An optional provision that takes effect if the policy owner becomes disabled. The disabled person will not have to pay premiums for the duration of the disability, including lifetime disability.

Primary Care Physician (gatekeeper)
The physician selected by HMO members who serves as a personal doctor and provides all medical treatments and any referrals to medical specialists.

Primary Plan
This is the plan that pays first when you are covered by more than one insurance plan

Prior Qualifying Coverage
Health plan coverage that was in effect before the effective date of the current or new coverage

Proof of Loss
Documents that you give the insurer to support your request for payment of losses.

Property Damage Liability
This coverage protects you from claims and lawsuits by people whose property is damaged as a result of an accident you caused.

Pro-rata Cancellation
Revocation of a policy by an insurance company that returns the unearned premium to the policyholder.

Provider
A doctor, hospital, x-ray company, pharmacy, etc. that provides medical health care service.

 

 




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