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A policy issued at a higher than standard premium to cover a person classified as a greater than-average risk, usually due to impaired health or a hazardous occupation. Sometimes called an extra-risk policy.
Reasonable and Customary Fees
When a doctor or other provider of medical services submits a bill, the insurer will make an evaluation of whether the charges are reasonable and customary for that medical service provider and for the type of service performed. What is reasonable and customary depends on factors such as the specific medical service provided, the qualifications and skill level of the doctor (or other care provider), the geographic area (fees can vary widely in different areas) and anything else that the insurer may consider to be pertinent to the evaluation. Companies maintain large computerized databases of information and sophisticated computer programs to determine what is reasonable and customary in a specific situation.
The resumption of coverage under a policy that has lapsed because of nonpayment of the premium after the grace period has ended.
Group health insurance plans are normally 1 year term. Insurers generally review the claims experience of the group at each renewal date and make a renewal offer – often at a different premium. The company then decides whether to accept the renewal offer.
A term policy that guarantees the policy owner the right to renew coverage at the end of the term, without presenting evidence of insurability. Premiums increase at each renewal since the insured’s age increases.
The cost of replacing property without a reduction for depreciation. By this method of determining value, damages for a claim would be the amount needed to replace the property using new materials.
The company voids your policy back to the beginning. There is no coverage at all and the company will return the money you paid.
A specified maximum amount of insurance that a life insurer is willing to carry at its own risk on any one life without transferring some of the risk to a reinsurer.
A written addition or amendment to an insurance policy that adds or limits the benefits payable under the policy. Common riders are accelerated death benefits, accidental death benefits, automatic premium loan, guaranteed insurability, and premium waivers.
The likelihood that you will die while insured.
Things about you that affect your risk (e.g., older age, smoking, heart disease, occupation.)