A health insurance contract that provides coverage on a group basis, e.g., employees within a business organization. A form of insurance that covers multiple items of property.
A method of settling a claim in which the parties to the dispute agree to accept something different than was originally expected. See Comprehensive Major Medical Insurance and Major Medical Insurance. Among applicants for a given group or individual program, the tendency for those with an impaired health status, or who are prone to higher-than-average utilization of benefits, to be enrolled in disproportionate numbers and lower deductible plans. Most contracts between insurers and reinsurers contain an arbitration clause. Life insurers are required to establish statutory reserves for mortgage loans, equity, real estate and joint ventures, as well as for those investments (fixed maturities and equity) previously subject to MSVR.
The period of time during which an insured must incur medical expenses up to the deductible in order to become eligible for reimbursement under a comprehensive major medical or major medical insurance policy. Unlike chronic care, acute care often is necessary for only a short time. One or more insureds, in addition to the principal named insured, referred to in an insurance policy as one enjoying protection under the policy. The additional amount of federal income tax payable by mutual life insurers due to the disallowance as a deduction of a portion of policyholder dividends. Businesses or self-funded health plans may use an ASO. Assets of an insurer permitted by insurance regulatory authorities to be taken into account in determining the insurer's financial condition under statutory accounting practices. An insurer licensed to write certain types of insurance within a given state; also known as an authorized insurer. Adverse selection may be attributable to improper underwriting and risk selection by the insurer or by superior knowledge of the risk by the insured. These associations have no legal or other relationship with Lloyd's of London. "Any Willing Provider Laws." Legislation that requires managed care plans to accept into their networks any provider willing to agree to the network's terms and conditions. A form of surety bond that guarantees to the court that the party against whom a judgment was rendered will pay the judgment if the appeal fails. A building or other structure on the same premises as the primary structure that also is insured under a property or homeowners insurance policy. A procedure to resolve a dispute between two parties without resorting to litigation. A provision in a contract in which the parties agree to arbitrate disputes. AVR was established as a liability on life insurance statutory financial statements beginning in 1992. Also refers to any person eligible as either a subscriber or a dependent for a managed care service in accordance with a contract.
An event that occurs without human intervention or culpability. Acute care usually is given in a hospital by specialized personnel using complex and sophisticated technical equipment and materials. Services usually include claims processing, but also may include other services, such as actuarial analysis, utilization review, etc. Particularly common in the life and health lines, adverse selection can occur when higher-than-expected claims experience leads an insurer to raise rates, which in turn causes the migration of "good" risks to companies charging less. Purchasers of goods and services, including insurance, with common characteristics. These entities provide insurance protection in competition with traditional insurance companies. This term is used to refer to the federal income tax liability of insurers, without regard to whether the insurer has taxable income using standard calculations. A Kansas City, Missouri-based trade organization representing managing general agents. A Washington, DC-based trade organization representing primarily the larger life insurers. A Washington, DC-based trade organization representing primarily the larger property-casualty insurers. Associations of individual underwriters permitted to operate within a limited number of states within the United States. An annuity may be bought by means of installments, or it may be bought by means of a single lump sum payment. Legislation designed to prohibit or restrict the business activities of managed care plans, or that undermines the principles of managed care. A mutual insurance company that may assess additional premiums from its insureds in the event losses exceed expectations. This term refers to (1) an additional payment that may be required of policyholders of an assessable mutual insurer in the event losses exceed expectations and (2) a charge levied upon insurers by state guaranty funds or other regulatory authorities. An investment strategy particularly appropriate for insurers in which the asset manager attempts to match the maturities of fixed-income securities to the schedule of claims and other payments anticipated by the insurer. A reserve adopted in interim form by the National Association of Insurance Commissioners in December, 1991, to replace the Mandatory Securities Valuation Reserve (MSVR). For example, if a reinsurer providing catastrophe reinsurance has earned $100,000 in premiums and incurred no losses, there would exist a $100,000 bank. A form of GIC issued only by a bank, these are the primary noninsurance competition for GICs, and are particularly popular for maturities of less than three years. The minimum limits of liability that may be purchased by an insured. Small mutual insurance companies, usually operating within a single geographic region, that underwrite medical malpractice insurance. The person named in an insurance policy as the recipient of the proceeds of the policy.
The principle that a person may be held liable for damages even without a finding of fault or negligence.
The ease of access is determined by such components as the availability of medical services and their acceptability to the patient, the location of health care facilities, transportation, hours of operation and cost of care.
The transfer is intended to extinguish the assignor's liabilities under the contracts being assigned. Audit premiums are generated in workers' compensation and other lines of insurance where premiums are based on payroll and other data relating to actual exposures. A form of insurance covering death or personal injury by accident, as well as sickness or bodily injury. The twelve-month period during which losses occurred, regardless of when they are reported. Also may refer to premiums accepted by an individual company under a pooling arrangement. A legal doctrine that provides a defense for a claim of negligence based upon the plaintiff's knowledge and voluntary assumption of risk associated with a particular activity. A transaction in which one insurer transfers its liabilities under existing or in-force contracts to an assuming insurer. Upon such a finding, the owner of such property can be held liable for resulting injuries. Premiums developed from an audit of an insured's records. The certification by an actuary as to the reasonableness of an insurer's reserves. A person who uses mathematical analysis of past loss data and other statistics to determine rates and estimate an insurer's future liabilities. A pattern of health care in which a patient is treated for an acute (immediate and severe) episode of illness, for the subsequent treatment of injuries related to an accident or other trauma, or during recovery from surgery. All the costs incurred by an insurer in the conduct of its business other than policy acquisition costs, loss adjustment expenses and investment expenses. Costs related to utilization review, insurance marketing, medical underwriting, agents' commissions, premium collection, claims processing, insurer profit, quality assurance programs and risk management. A fee-based program in which an insurance company or other third-party administrator performs administrative, clerical or managerial services only and does not assume any risk. The process by which an insurer is left with a disproportionate share of unwanted, higher-risk business. For example, Alexander and Alexander was known as "A&A". Health care providers other than acute-care hospitals, e.g., neighborhood clinics, treatment centers and visiting nurses. Self-insurers, captive insurers and risk retention groups. American Association of Managing General Agents (AAMGA). For a more detailed discussion of the provisions of the annual statement, see Chapter 10. A person who receives payment pursuant to an annuity contract. A contract that provides for a fixed or variable periodic payment to a person (the annuitant), made from a stated or contingent date and continued for a specified period, such as for a number of years or for life. A form of insurance that provides liability and physical damage protection for aircraft and their contents. The bail bond guarantees the person's appearance in court and is forfeited if this obligation is breached. Within the context of reinsurance, this term is used to refer to the profits earned by a reinsurer during the life of a program. Best Company, Inc., a company that publishes reports on the financial condition and history of individual insurers and provides ratings on most of the insurers doing business in the United States. A person who solicits insurance on behalf of an insurer. An insurer's written premiums minus commissions due and payable; also known as uncollected premiums. The aggregate losses occurring within a given policy period that must be exceeded before an insurer becomes liable for losses. The maximum amount payable by an insurer upon all claims arising within a single policy period. A federal cash assistance entitlement program; states are required to cover its beneficiaries under Medicaid. Earthquake insurance can be sold as a separate line, and data on earthquake insurance are tracked separately from allied lines in the annual statutory statement. Expenses directly related to a particular claim, including claims investigation and legal expenses, but excluding loss payments. A small number of national insurance brokerage organizations usually referred to by their initials. Larger HMOs tend to keep ancillary services in-house, while smaller ones typically contract with third parties. Also known as a convention blank or statement, statutory statement, yellow book (for property-casualty insurers) and blue book (for life insurers). Such claims may give rise to punitive damages far in excess of the actual damages suffered by the claimant. A form of surety bond furnished by a person seeking release from incarceration. Includes data processing insurance, demolition insurance, earthquake insurance, increased cost of construction clause, radioactive contamination insurance, sprinkler leakage insurance, standing timber insurance, vandalism and malicious mischief insurance and water damage insurance. Medical management of such services as pharmacy programs, mental health, EAP and dental care. The report includes a balance sheet, as well as detailed schedules and exhibits. The large group of 76 million Americans born between 19. A claim based upon wrongful conduct, usually asserted by an insured against an insurer. An insurer domiciled outside the United States that transacts business within the United States. Insurance in which coverage is not limited to specific events or named perils. A Downers Grove, Illinois-based trade organization representing primarily the smaller property-casualty insurers. A form of insurance coverage, often written in conjunction with fire insurance, covering perils not included in the basic policy. A report of an insurer's financial operations filed annually with the insurance regulatory authorities of each jurisdiction in which the insurer is licensed to transact business. An instrument provided by the surety guaranteeing that the surety will deliver a contract performance bond if a contractor's bid is accepted. Temporary authorization of coverage issued prior to the issuance of an insurance policy.