Glossary of Commonly Used Insurance Terms

What is . . .?

Let‘s face it: Insurance is, for most people, a foreign language! Here are some important terms ‘translated’

List of Terms

Accident Insurance
Acute Care
Assignment of Benefits
Ambulatory Care
Ambulatory Setting
Basic Hospital Expense Insurance
Co Payment
Conditional Receipt
Coordination of Benefits
Covered Expenses
Covered Person
Dental Coverage
Dependent Coverage
Disability Insurance
Eligible Expenses
Explanation of Benefits
General Agent
Group Insurance
Health Maintenance Organization (HMO)
Health Savings Account (HSA)
Indemnity Health Plan
Individual Heath Insurance
International Heath Insurance
Inside Limits
Intermediate Care
Life Insurance
Long-term Care Insurance
Mandated Benefits
Maximum Lifetime Benefit
Maximum Lifetime Benefit (For each illness or injury)
Medically Necessary
Medical Information Bureau
Nursing Home
Medicare Supplement
Missionary Health Insurance
Office Visit
Out of Pocket Costs
Out of Pocket Limits
Pre-admission authorization
Pre-existing condition
Prescription Insurance
Preferred Provider Organization (PPO)
Registered Nurse
Short Term Medical
Second Surgical Opinion
Stop Loss
Student Medical
Ten Day Free Look
Vision Care Coverage


  • Accident Insurance
  • A form of insurance against loss by accidental bodily injury tzo the insured. For more information on Accident Plans go here
  • Acute Care
  • Skilled, medically necessary care provided by medical and nursing personnel in order to restore a person to good health.
  • Assignment of Benefits
  • A method where the person receiving the medical benefits assigns the payment of those benefits to a physician or hospital.
  • Ambulatory Care
  • Similar to outpatient treatment in that it is care which does not require hospitalization.
  • Ambulatory Setting
  • Institutions such as surgery centers, clinics, or other outpatient facilities which provide health care on an outpatient basis.
  • Ancillary
  • Additional services (other than room and board charges) such as X-rays, anesthesia, lab work, etc. Fees charged for ancillary care such as X-rays, anesthesia, and lab work. This term may also be used to describe the charge made by a pharmacy for prescriptions which exceed the health insurance plan‘s maximum allowable cost.
  • Basic Hospital Expense Insurance
  • Covers room, board and some miscellaneous expenses for a certain number of days.
  • Federal legislation that requires businesses of a certain size to keep former employees and their dependents on the group health plan for a limited period, provided the ex-employee pays the premiums.
  • Co-insurance
  • You and your health insurance company have agreed to share the cost of paying for procedures up to a certain dollar limit called a Stop-Loss. Once the Stop-Loss is exceeded, your health policy will pick up the bill for covered procedures. (I.e. Peter has an 80/20 % Coinsurance and a $5,000 Stop-Loss. This means that Peter is required to pay 20% or $1000 of $5,000 of procedures in a given calendar year above his deductible.) On most family plans each family member has co-insurance.
  • Co Payment
  • This is the amount of money you must pay for services rendered regardless of co-insurance and the deductible. (I.e. Peter goes to the doctor for a physical and is required to pay a co-payment of $15 for the services rendered.)
  • Conditional Receipt
  • This is the more exact terminology for what is often called a binding receipt. It provides that if a premium accompanies an application, the coverage will be in force from the date of application or medical examination, if any, whichever is later, provided the insurer would have issued the coverage on the basis of the facts revealed on the application, medical examination and other usual sources of underwriting information. A Life and Health Insurance policy without a conditional binding receipt is not effective until it is delivered to the insured and the premium is paid.
  • Coordination of Benefits
  • The adjustment of Health Insurance policy benefits by reason of the existence of other insurance covering the same contingency.
  • Covered Expenses
  • Health care expenses incurred by an insured or covered person that qualify for reimbursement under the terms of a policy contract.
  • Covered Person
  • A person who pays premiums into the contract for the benefits provided and who also meets eligibility requirements.
  • Declined
  • Most Individual and Family policies are medically underwritten. This means that health insurance companies look closely at an applicant’s medical records and turn down people whose conditions pose too much of a risk. When this happens, the application is declined.
  • Deductible
  • The deductible is the amount of money an insured needs to pay after making a claim before their insurance company pays any benefits With health insurance, deductibles usually range from $500.00 to $5,000. So if the insured has a $2500.00 deductible, for example, and has a $10,000 claim, he/she will be responsible to pay $2500 before the insurance company starts paying benefits.
  • Dental Coverage
  • Coverage for preventive, basic, and major dental services. To find out if you qualify and to get a quote and apply online follow this link.
  • Dependent Coverage
  • Insurance coverage on the head of a family which is extended to his or her dependents, including only the lawful spouse and unmarried children who are not yet employed on a full-time basis. "Children" may be step, foster, and adopted, as well as natural. Certain age restrictions on children usually apply.
  • Diagnosis
  • The process of identifying a disease.
  • Disability Insurance
  • A type of health insurance designed to compensate the insured person for a portion of the income they lose because of a disabling injury or illness. Benefits are generally are provided in the form of monthly payments. Sometimes called loss of time insurance. Click here for more information and here to request a quote.
  • Eligible Expenses
  • Expenses as defined in the health plan as being eligible for coverage. This could involve specified health services fees or "customary and reasonable charges.
  • Emergency
  • A disease or injury that occurs suddenly and requires immediate (usually defined as within 24 hours) treatment.
  • Explanation of Benefits
  • Paperwork sent by the insurer to the insured listing the cost of treatment, the charges paid by the plan and the remainder to be paid by the individual.
  • General Agent
  • An individual appointed by a Life or Health insurer to administer its business in a given territory. He is responsible for building his own agency and service force and is compensated on a commission basis, although he possibly has some additional expense allowances.
  • Group Insurance
  • Insurance coverage usually issued to an employer under a master policy for the benefit of employees. For more information on our group policies click here.
  • Health Maintenance Organization (HMO)
  • HMOs are also known as managed care plans. These plans typically offer a full selection of health-care benefits, including routine physicals and vision examinations. HMOs have a smaller selection of physicians. A primary care provider (PCP) is required to coordinate all your health-care needs.
  • Health Savings Account (HSA)
  • For Answers to questions most commonly asked about Health Savings Accounts, go here..
  • Indemnity Health Plan
  • A traditional fee for service Health Plan.
  • Individual Heath Insurance
  • For There are basically three types of Health Insurance plans available in the market today. Traditional Indemnity Policies, Health Maintenance Organization Policies (HMO), Preferred Provider Organization Policies (PPO). For more information on individual health care plans go to Individual Heath Insurance.
  • International Heath Insurance
  • Provides US citizen and non-US citizen with international coverage for a vacation, or group coverage for employees in locations around the world. Click here to learn more and buy online
  • Inside Limits
  • Limits placed on hospital expense benefits which modify benefits from the overall maximums listed in the policy. An inside limit when applied to room and board, limits the benefit to not only a maximum amount payable, but also limits the number of days the benefit will be paid.
  • Intermediate Care
  • A level of care associated with a skilled nursing facility which provides nursing care under the supervision of physicians or a registered nurse. The care provided is a step down from the degree of care described as skilled nursing care.
  • Life Insurance
  • Life Insuranceensures that your family and loved ones are protected against financial difficulties in the event of your death. Click here for more information about life insurance and for a free quote click here.
  • Long-term Care Insurance
  • Health insurance coverage designed to cover the cost of custodial care in nursing homes or extended care facilities. To request a quote click here.
  • Mandated Benefits
  • Benefits required by state or federal law.
  • Maximum Lifetime Benefit
  • This number is the maximum your health insurance policy will pay you for benefits throughout your lifetime. Please note that most plans have an individual maximum lifetime benefit, but some policies have a combined family Maximum Lifetime Benefit
  • Maximum Lifetime Benefit (For each illness or injury)
  • Some health insurance policies sold to-day has a maximum life time benefit for each illness or injury, check your policy very carefully.
  • Medically Necessary
  • Treatment that, if it were omitted, would negatively affect the patient‘s life.
  • Medical Information Bureau
  • Sort of like the credit bureau for medical information. This organization keeps health histories of people who have applied for life and health insurance and shares the information with subscribing insurers. For more information click Helpful Links.
  • Medicaid
  • A state and federal program providing some health care benefits for people who meet minimum income limits.
  • Medicare
  • Federal program that provides health benefits for people who qualify --usually those over 65 and the disabled. Medicare Part A covers hospitalization, and is funded by the government. Part B, also called Supplemental Medical Insurance, covers basic medical expenses, and is paid jointly by the government and the insured.
  • Medicare Supplement
  • Supplemental insurance designed to cover the health care cost that Medicare doesn‘t cover.
  • Missionary Health Insurance
  • Provides for the medical insurance needs of US citizens and foreign nationals who need temporary medical insurance for church or mission related travel anywhere outside of their home country. Click this link for more information and to purchase online: Travel & Health Insurance for Missionaries and Churches.
  • Nursing Home
  • Licensed facility that cares for those who are chronically ill or unable to care for themselves. Sometimes called a long-term care facility.
  • Office Visit
  • Services provided in the physician‘s office.
  • Out of Pocket Costs
  • The amounts the covered person must pay out of his or her own pocket. This includes such things as coinsurance, deductibles, etc.
  • Out of Pocket Limits
  • The maximum co insurance and deductible an individual will be required to pay, after which the insurer will pay 100% of covered expenses up to the policy limit.
  • Outpatient
  • ndividual receiving services in a facility but not staying overnight.
  • Pre-admission authorization
  • Also called pre-admission certification. In many plans, the insured must contact the company for permission to enter a hospital.
  • Pre-existing condition
  • A medical condition or problem diagnosed, treated, or needing treatment prior to the purchase of an insurance policy. Your application for Individual and Family insurance will ask about pre-existing conditions and medical history. Pre-existing conditions may be excluded for a specified period, as stated in the policy.
  • Prescription Insurance
  • Insurance program designed to save you money on your prescription drug costs. Go to Prescription Coverage to get a quote and apply directly online
  • Provider
  • Any individual or group of individuals that provide a health care service such as physicians, hospitals, etc.
  • Preferred Provider Organization (PPO)
  • A plan that offers discounted rates on services to members who use providers in the network. Often, if the individual seeks care outside the network, a smaller portion of the charges is reimbursed.
  • Registered Nurse
  • A licensed professional with a four-year nursing degree. Able to provide all levels of nursing care including the administration of medication.
  • Short Term Medical
  • Generally available for 30-185 days (depending on the state) and is designed to protect you from catastrophic medical bills. Visit Short Term Medical for more information.
  • Second Surgical Opinion
  • A cost containment technique to help patients and insurance companies determine whether a recommended procedure is necessary, or whether an alternative method of treatment could accomplish the same result. Some health policies require a second surgical opinion before specified procedures will be covered, and many policies pay for the second opinion.
  • Stop Loss
  • You and your health insurance company have agreed to share the cost of paying for procedures up to a certain dollar limit called a Stop-Loss. Once the Stop-Loss is exceeded, your health policy will pick up the bill for covered procedures. (I.e. Peter has an 80/20 % Coinsurance and a $5,000 Stop-Loss. This means that Peter is required to pay 20% or $1000 of $5,000 of procedures in a given calendar year above his deductible.) On most family plans each family member has co-insurance.
  • Student Medical
  • Is a permanent, renewable individual health insurance designed specifically for college students of all ages (up to age 63).see Student Medical for more information and a link to enrollment.
  • Ten Day Free Look
  • A notice, placed prominently on the face page of the policy, advising the insured of his or her right to examine a health policy, and if dissatisfied return the policy within ten days for a full refund of premium and no further obligation.
  • Underwriting
  • The process insurance companies use to evaluate the risks associated with an applicant for Individual and Family coverage.
  • Usual
  • A charge is considered “usual,” if it is a physician‘s usual charge for a procedure.
  • Customary
  • A charge is considered “customary,” if it is within a range of fees that most physicians in the area charge for a given procedure (often measured at a specific percentile of all charges submitted for a given procedure in that community).
  • Reasonable
  • ReasonableA charge is considered “reasonable,” if it‘s usual and customary or if it‘s justified because of special conditions.
  • Vision Care Coverage
  • A health care plan usually offered only on a group basis which covers routine eye examinations, and which may cover all or part of the cost of eyeglasses and lenses.