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KB Training
Terminology
| Term | Definition |
|---|---|
| Accident | An unforeseen event which occurs on or after the effective date of coverage for the Insured Person and while this Cert is in force that is the direct cause of an Accidental Injury to an Insured |
| Accidental Injury | Bodily injury to an Insured that is directly caused by an Accident and is the direct cause of a covered loss sustained on or after the effective date of coverage for the Insured |
| Activities of Daily Living | Physical & cognitive functional capacity to perform self-care such as, personal hygiene, dressing, eating, toileting, &transferring |
| Affidavit of Heirship | A document that declares the heirs of a deceased person |
| Beneficiary | The person who death benefits are paid to |
| Benefit | The payment made by the insurer |
| Benefit Year | The period of time when benefits are payable. IT starts on the effective date for an entire year and will renew and start over on the anniversary date of the effective date of the policy |
| Calendar Year | The period that starts with the Insured's Effective Date and ends on Dec. 31st of the first year. Each following Calendar Year will start on January 1st of any year and end on Dec. 31st of that yr |
| Claim | The demand for payment submitted by the insured to the insurer |
| Claimant | The individual requesting payment of policy benefits |
| Coinsurance | The insured and insurer each pay a percentage of eligible medical expenses, after the deductible is met |
| Common Carrier | Commercial airlines, train, bus, boat, ferry or ship, subway or streetcar, operated on a regularly scheduled basis between pre-determined points or cities. Taxis & privately chartered vehicles not common carriers |
| Contingent Beneficiary | The person or entity designated to receive the death benefit if the beneficiary is not alive at the time of the insured’s death |
| Coverage | Contractual agreement that outlines what the insurer will pay when a certain event occurs |
| Deductible: | A portion of covered medical expenses that the insured must pay before payable benefits are payable. |
| Elimination Period: | The number of continuous days the policyholder must be Totally Disabled before benefits are payable. |
| Indemnity Plans: | Policies that pay a pre-determined amount, regardless of total charges; no network discounts apply. |
| Insurer: | The entity, usually an insurance company, who sells coverage to an individual or organization. |
| Insured / Policyholder: | The party who coverage is sold to. |
| Letters Testamentary: | A document issued by a court or public official authorizing the executor of a will to take control of a deceased person's estate. |
| Lien: | A record that there has been an advancement of funds extended on a plan. |
| Loan: | An agreement between two parties where the first provides money to a second and the second agrees to pay the money back to the first. |
| Major Medical Benefit Plan: | Benefits based on actual charges incurred and require the insured to pay part of the expenses through a deductible and coinsurance. |
| Out of Pocket: | Payments required by coverage; deductible, co-insurance, co-pays and over maximum allowable. |
| Portability: | The ability for the insured to continue active coverage with them once retired or change in jobs. |
| Premiums: | The payment made by the insured to the insurer for coverage. |
| Policy / Contract / Certificate: | Legal document that identifies the terms of agreement between the insurer and the insured. |
| Rider: | Additional benefits that are made part of the Policy/Certificate to which it is attached. |
| Schedule of Benefits: | The page which gives basic information regarding eligible services referenced in the Certificate. |
| Underwriter: | The insurer who accepts liability and guarantees payment in case of damages or loss. |
| Whole Life Insurance: | Life insurance that provides guaranteed coverage at a fixed premium for the lifetime of the active policy; pays a benefit upon the death of the insured. |
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