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Gatekeeper Model: Under this model of HMO and PPO organizations, the primary care physician, known as the gatekeeper, is the initial contact for the patient for medical care and for referrals.
General Agent (GA): An individual appointed by a Life or Health insurer to administer its business in a given territory, who is responsible for building his own agency and service force and is compensated on a commission basis.
Generic Drug: A drug which is exactly the same as a brand name drug and which is allowed to be produced after the brand name drug's patent has expired.
Gift: The transfer of an asset, such as a life insurance policy, without requiring any form of payment.
Gift Tax: State and/or Federal taxes levied on the transfer of gifted property.
Grace Period: The period of time between a premium's due date and the date the policy will lapse if the premium is still unpaid (usually 31 days). If the insured dies during the grace period, the unpaid premium is deducted from the policy proceeds.
Group: Coverage of a number of individuals under one contract. The most common group is employees of the same employer
Group Insurance: Insurance purchased for a group of people which must provide coverage to all people who qualify on a class basis, regardless of individual considerations.
Group Contract: A contract of insurance made with an employer or other entity that covers a group of persons identified by reference to their relationship to the entity buying the contract. The group contractual arrangement is generally used to cover employees of a common employer, members of a trade association or trusteeship, members of a welfare or employee benefit association, members of a labor union, or members of a professional or other association not formed only for the purpose of obtaining insurance.
Group Disability Insurance: Coverage provided for a group of individuals for loss of compensation due to accident or sickness.
Group Long-Term Disability Insurance (Group LTD): A master disability insurance contract issued to an employer. It covers some or all employees, and provides long-term benefits on a group basis. Benefits are usually paid to age 65. These plans typically provide 50% to 60% of salary, and are reduced by income from other sources.
Group Model HMO: A health plan where a group of physicians is reimbursed for services they provide at a negotiated rate. The HMO also contracts with hospitals for the care of the patients of the physicians who belong to the group.
Grievance Procedure: A procedure which allows a member of a health plan or a provider of benefits to express complaints and seek remedies.
Group Specialist: An expert in the group health or disability insurance market
Health Benefits Package: The coverage's offered by a health plan to an individual or group.
Health Care Financing Administration (HCFA): Part of the Department of Health and Human Services, responsible for administration of the Medicare and Medicaid programs. The HCFA establishes standards for medical providers which must be complied with if the provider is to meet certification requirements.
Health History: A form used by underwriters to assist in evaluating groups or individuals to determine whether they are acceptable risks.
Health Plan: This refers to any kind of plan that covers health care services such as HMOs, insured plans, preferred provider organizations, etc.
Health Insurance: Insurance against loss by sickness or bodily injury. The generic form for those forms of insurance that provide lump sum or periodic payments in the event of loss occasioned by bodily injury, sickness or disease, and medical expense.
Health Insurance Association of America: An association supported by Life and Health insurers to provide the research, public relations, education, and legislative base for the promotion of voluntary private Health Insurance.
Health Maintenance Organization (HMO): An HMO is a prepaid medical service plan which provides services to plan members. Medical providers contract with the HMO to provide medical services to plan members. Members must use contracted providers. The emphasis is on preventive medicine, and it is an alternative to employee benefit plans. Employers of more than 25 persons are required to offer the alternative of HMO to employees, but not if the cost exceeds that of present employee benefit plans.
Home Health Agency: A certified facility approved by a health plan to provide services under contract.
Home Health Care: Care received at home as part-time skilled nursing care, speech therapy, physical or occupational therapy, part-time services of home health aides or help from homemakers.
Home Health Services: Health care services provided by a licensed home health agency in the patient's home which is a covered expense under Part A of Medicare.
Hospice: An organization which is primarily designed to provide pain relief, symptom management and supportive services for the terminally ill and their families. Hospice care is covered under Part A of Medicare.
Hospital Affiliation: A contract whereby one or more hospitals agree to provide benefits to members of a specific health plan.
Hospital Alliances: A group of hospitals that work together to share common services and thereby reduce health costs.
Hospital Benefits: Benefits payable for hospital room and board, plus miscellaneous charges resulting from hospitalization.
Hospital Income Insurance: A type of insurance that provides a stated weekly or monthly payment while the insured is hospitalized, regardless of expenses incurred and regardless of whether or not other insurance is in force. The insured can use the weekly or monthly benefit as the choose, for hospital or other expenses.
Hospital Indemnity: Coverage that pays based on daily, weekly, or monthly limits regardless of the amount of actual hospital expenses.
Hospital Insurance: Provides inpatient hospital care, home health skilled nursing care and hospice care subject to a benefit period deductible and co-payments for certain services.
Hospitalization Expense Policy: A policy which covers daily hospital room and board charges and also covers miscellaneous hospital expenses. It also often covers emergency treatment charges and many times will also include a surgical benefit.
Hospitalization Insurance: A form of insurance that provides reimbursement within contractual limits for hospital and specific related expenses arising from hospitalization caused by injury or sickness.
House Confinement: A provision in n some Health Insurance contracts which requires an insured to be confined to the house in order to be eligible for benefits. This provision is most commonly found in policies providing loss of income benefits.
Identification Card: A card given to each insured under the plan which identifies him or her as being eligible for benefits.
Identification of Benefits: A provision that the cost of putting a disabled insured in touch with and in the care of relatives will be reimbursed, usually up to a maximum amount.
Illustration: A sales ledger or proposal showing a product's guaranteed and non-guaranteed future payments, cash values and death benefits. Non-guaranteed values are based on the company's current rates of interest, mortality and expenses. The illustration is simply an example of how the policy might perform under one specific set of assumptions. It is neither an estimate or guarantee of future results. While illustrations may be helpful in showing how a policy might perform, they are not a prediction of policy performance.
Immediate Annuity: An annuity product under which life income or specified period payments begin at the start of the next period following premium payment (for example, one month or one year).
Individual Contract: A contract made with an individual that covers that individual and perhaps also specified members of his family for benefits as described in the policy.
Inflation Factor: A premium loading to provide for future increases in medical costs and loss payments resulting from inflation.
Inflation Protection: Provisions in a health insurance policy that increase benefit levels to account for anticipated increases in the cost of covered services.
Initial Eligibility Period: The time period during which prospective members can apply for coverage without providing evidence of insurability.
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.
Insurance In Force: The annual premium payable on current contracts of insurance.
Intermediate Care: A level of care associated with a skilled nursing facility which provides nursing care under the supervision of physicians or a registered nurses. The care provided is a step down from the degree of care described as skilled nursing care.
Intermediate Care Facility: A health care facility licensed by the state, which provides nursing care to persons who do not require the degree of care which a hospital or skilled nursing facility provides.
Individual Retirement Account/ Annuity (IRA): A retirement savings plan which allows individuals to contribute toward an account on a tax-deferred basis. The contributions and earnings are taxable as income only when withdrawn or paid out after retirement.
Insurability: Those qualifications of age, health, occupation, etc., which enable the applicant to meet the requirements of an insurance company for the issuance of insurance.
Insurance: A system whereby individuals and companies who are concerned about the potential for loss pay premiums to an insurance company which, in turn, will reimburse those individuals and companies in the event the loss occurs.
Insured: The person whose life is covered by the insurance contract.
Interest Rate: The rate of interest credited on a policy's cash or account value. The stated rate includes the policy's guaranteed interest rate and the excess interest currently being paid by the insurance company. The declared rate may be net of any expenses or taxes that the company deducts from its gross rate of return.
Irrevocable Beneficiary: A beneficiary whose interest cannot be canceled without his or her consent.
Irrevocable Trust: A trust that cannot be revoked or amended by the party who establishes it. This type of trust is often established when life insurance is purchased to protect an estate.
Issue Date: The date from which suicide and incontestability periods are calculated.
Joint and Last Survivor Annuity: A type of annuity settlement option which guarantees a lifetime income for two or more persons.
Joint and Survivor Option: A life insurance or annuity settlement option that allows the beneficiary to have the death proceeds paid out in the form of a joint and last survivor annuity.
Joint Survivorship Life Insurance: Second-to-die life insurance. Benefits become payable upon the second insured's death, typically when estate taxes come due.
Juvenile Insurance: Life insurance placed on the life of a child, typically 0 to 18 years old. It is advantageous for several reasons: premiums are never lower (since they are based on age), whole life premiums are guaranteed to remain at that level, the cash value also has longer to build and, with the Additional Purchase Benefit, juvenile insurance can be used to ensure future insurability. Premiums are typically paid by the parents, and, very often, by grandparents. Life insurance policies are often gifted to the insured child upon reaching adulthood, marriage, or some other significant event.
KEOGH Act: See Self-Employed Individual's Retirement Act.
Key Person Insurance: Insurance placed on an important person in a business to indemnify the business for loss of profits, goodwill and the increased expenses of having to replace the individual in the event of death or disability.
Lapse: On traditional life products, a change in policy status caused by the policy owner's failure to pay the premium by the end of the grace period. The policy will either terminate without value or fall under one of the non-forfeiture options. On universal life contracts, termination of the policy is caused by insufficient value in the policy to pay the next month's mortality and expense charge.
Life Annuity: An annuity in which payments are guaranteed to be paid at regular intervals for the life of the annuitant.
Life Annuity with Period Certain: A life annuity that guarantees payments will continue for a specified number of years. If the annuitant dies before the period certain has expired, payments will be made to a beneficiary for the duration of the period certain.
Level Premium: A premium that remains the same, not increasing with the insured's age, throughout all the premium payment year s of the contract.
Life Expectancy: The average number of years of life remaining to a number of people of a given age according to a given mortality table.
Life Income: A settlement option, or payment plan, that guarantees the beneficiary of a life insurance policy or annuity contract regular payments for life
Life Insurance: A product which provides indemnification for the economic loss caused by a person's death. The indemnification is made possible by spreading the cost of the financial loss over a large group of people who are exposed to the same risk.
Loan: Borrowing from the insurer and securing the amount of the loan by the cash value in the life insurance policy. If the insured dies when there is an outstanding loan balance, the amount of the loan and any unpaid interest will be deducted from the proceeds.
Lump Sum: A one-time deposit to purchase additional paid-up insurance. Can be made at issue and/or after issue on certain life insurance policies. Evidence of insurability may be required for after-issue lump sum purchases.
Legend Drug: A drug which has on its label "caution: federal law prohibits dispensing without a prescription."
Length of Stay: The total number of days a participant stays in a facility such as a hospital.
Living Benefits Rider: A rider attached to a life insurance policy which provides LTC benefits or benefits for the terminally ill. The benefits provided are derived from the available life insurance benefits.
Living Need Benefits: A combination of life insurance and long-term care insurance which allows life insurance benefits to generate long-term care benefits. Up to a certain percentage of the life insurance policy's death benefit may be used in advance to offset nursing home or medical expenses, reducing the face amount of the life policy.
Long Term Care: Care which is provided for insured's with chronic diseases or disabilities. The term includes a wide range of health and social services provided under the supervision of medical professionals.
Long Term Care Facility: Usually a state licensed facility which provides skilled nursing services, intermediate care and custodial care.
Long-Term Disability Insurance: A group or individual policy which provides coverage for longer than a short term, often until the insured reaches age 65 in the case of illness and for the remainder of his lifetime in the case of accident.
Loss of Income Insurance: Insurance paying loss of income benefits.
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