TERMS

 

 

ADL = Activities of Daily Living.

 

 

AMBULATORY:

 

Of or concerning walking, movable, not confined to a bed.

 

 

ANCILLARY SERVICES:

 

Services, other than those provided by a physician or hospital, which are related to a patient’s care, such as laboratory work, x-rays and anesthesia.

 

 

ANCILLARY BENEFITS:

 

Health insurance coverage for miscellaneous medical expenses associated with a hospital stay.

 

 

AVERAGING:

 

In some annuities, the average of an index’s value is used rather than the actual value of the index on a specified date.  The index averaging may occur at the beginning, the end, or throughout the entire term of the annuity.

 

 

BUY SELL – it takes about 3 weeks to process the paperwork.

 

 

CARVE OUT CLASSES:

 

An employer may elect to define only certain categories of employees as being eligible to enroll for coverage, for medical coverage, employers with 51 or more full-time employees (see Human Agent Sales Guide pamphlets).

 

 

CASH REFUND ANNUITY - Dictionary Page 76

 

 

CAVEAT – a warning or caution.

 

 

CERTIFICATE OF COVERAGE:

 

A document given to an insured that describes the benefits, limitations and exclusions of coverage provided by an insurance company.

 

 

 

 

 

 

COINSURANCE: (As used by BC&BS)

 

If you have a 80-20 plan, with a deductible, and you are sent outside of the Doctor’s office where you had paid a co-pay,  First you pay your deductible, then you pay 20% of the bill (Coinsurance) up to a maximum out-of-pocket maximum, or another term that is used is “Stop Loss”.

 

COINSURANCE: #2

 

The portion of covered health care costs for which the covered person has a financial responsibility, usually a fixed percentage. Coinsurance usually applies after the insured meets his/her deductible. (ex: 20/80%)

 

 

 

CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA):

 

A federal law that, among other things, requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance has been terminated if they undergo a triggering event

 

 

CONTINENCE:

 

The ability to maintain control of bowel and bladder function, or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene, including caring for a catheter or colostomy bag without substantial assistance.

 

 

CO-PAYMENT: (As used by BC&BS)

 

If you have a co-pay and you make your co-pay, anything you do in that Doctor’s office is covered with that co-pay.  An office visit includes the office visit, lab and X-Rays performed and billed in the Doctor’s office. 

 

CO-PAYMENT: #2

 

A cost-sharing arrangement in which an insured pays a specified charge for a specified service, such as $10 for an office visit. The insured is usually responsible for payment at the time the service is rendered. This charge may be in addition to certain coinsurance and deductible payments.

 

 

CSA = Certified Senior Advisor

 

 

DEDUCTIBLE: (As used by BC&BS)

 

A Deductible will pay towards you Major Medical needs, not anything in the Doctor’s office.  It does not apply to your prescriptions either.  So if you have major medical hospitalization, or outpatient or some of those issues, you pay your deductible first.  If you have a co-pay and you make your co-pay, anything you do in that Doctor’s office is covered with that co-pay.  An office visit includes the office visit, lab and X-Rays performed and billed in the Doctor’s office. 

 

 

 

 

 

 

DEDUCTIBLE: #2

 

The amount of eligible expenses a covered person must pay each year from his/her own pocket before the plan will make payment for eligible benefits.

 

 

EARLY CARE = adult that is buying the insurance for a minor.

 

EED = Early Enrollment Discount Program (Medicare for Supplement Plans)

 

ELIGIBLE EXPENSES:

 

The lower of the reasonable and customary charges or the agreed upon health services fee for health services and supplies covered under a health plan.

 

 

EXPLANATION OF BENEFITS (EOB):

 

The statement send to an insured by their health insurance company listing services provided, amount billed, eligible expenses and payment made by the health insurance company.

 

FBDE:

Full Benefit Dual Eligible – Payment of the consumers Medicare Part A premiums, in some cases Medicare Part B premiums and Full Medicaid Benefits

.

 

FEE-FOR-SERVICE:

 

With a fee-for-service plan an individual will pay a fixed amount of the health-care expenses before the coverage becomes applicable

 

 

FLEXIBLE SPENDING ACCOUNTS:

 

Medical Reimbursement (SEC 125), Dependent Care (SEC 129).

 

 

 

FLEXIBLE PREMIUM ANNUITIES:

 

Useful as a tool for accumulating a sum of money that will provide

benefits at some time in the future.

 

 

FIS = Fixed Interest Strategy – one year guaranteed interest rate, reset annually

 

 

FIXED DOLLAR ANNUITY  = Dictionary Page 190

 

 

FORMULARY = relating to formulas.

 

 

FSA = Flex Spending

 

 

FNS = Freedom Network Select

 

 

GATEKEEPER = a person in charge

 

GIS:

 

Guaranteed Index Strategy – Annual reset, point-to-point, equity index strategy.  No averaging, Lower Cap.  As least 2% index increase credited each year.

 

 

HRA = Health Reimbursement Arrangement

 

 

HSA – HEALTH SAVINGS ACCOUNT:

 

A tax benefit that is 100% tax deductible on premiums, money in account

 

 

 

INSTALLMENT REFUND ANNUITY = Dictionary Page 242

 

MAC = Medicare Allowable Charge

 

MIB = Medical Insurance Bureau

 

 

MEDIGAP:

 

Medicare supplemental insurance.  A Medigap policy often leads to the sale of Long-Term Care insurance and other products.

 

 

NACA = North American Consumer Alliance

 

 

INDEMNITY:

 

Or fee for service Insurance.  Coverage for the percentage of the health care costs paid by the health insurance company, which is usually 80% above the insured’s deductible up to a dollar amount of approximately $5000.  The company then pays 100% of the cost up to the policy limits.  The insured may select a physician of his or her choice.

 

 

LEVERAGE – borrowed money

 

 

LIFE ANNUITY CERTAIN = Dictionary Page 278

 

 

MET – Multiple Employer Trust

 

 

MEDIGAP:

 

Medigap refers to Insurance policies that are sold by private insurance companies. These policies are designed to supplement (fill the gaps in) Medicare Part A and Part B coverage by paying for expenses that would otherwise be paid out of one's own funds. Medigap policies are not government sponsored, but they are regulated as to form and content to make it easier for consumers to compare pricing. There is a wide range in coverage between the least expensive policy type and the most comprehensive one.

 

NAIC – National Association of Insurance Commissioners

 

 

OUT-OF-POCKET MAXIMUM:

 

The total payments that must be paid by a covered person (i.e., deductibles and coinsurance) as defined by the contract. Once this limit is reached, covered health services are paid at 100% for health services received during the rest of that calendar year.

 

 

OOP = Out of pocket

 

 

PARTICIPATION RATE:

 

The rate decides how much of the increase in the index will be used to calculate index-linked interest.  Ex: If the calculated change in the index is 9% and the participation rate is 70%, the index linked interest rate for your annuity will be 6.3% (9% x 70%)

 

 

PCP:

 

Primary Care Physician - a physician that is responsible for providing, prescribing, authorizing and coordinating all medical care and treatment.

 

 

POINT-TO-POINT:

 

The index-linked interest, if any, is based on the difference between the index value at the end of the term and the index value at the start of the term.  Interest is added to your annuity at the end of the term.

 

 

PPO:

 

Preferred Provider Organization - a health care delivery arrangement which offers insureds access to participating providers at reduced costs. PPOs provide insureds incentives, such as lower deductibles and copayments, to use providers in the network. Network providers agree to negotiated fees in exchange for their preferred provider status.

 

 

PRIMARY CARE PHYSICIAN (PCP):

 

A physician that is responsible for providing, prescribing, authorizing and coordinating all medical care and treatment.

 

 

PURE ANNUITY = Dictionary Page 411

 

 

 

QMB:

 

Payment of the consumers Medicare Part A & B premiums, deductibles, cost –sharing (excluding

Part D copayments).

 

 

QMB+:

 

Payment of the consumers Medicare Part A & B premiums, deductibles, cost –sharing (excluding

Part D copayments) and Full Medicaid benefits.

 

 

QDWI:

 

Qualified Disabled and working individual – Payment of the consumer’s Medicare Part A premiums.

 

 

QI:

 

Qualifying Individual – Payments of the consumer’s Medicare Part B premiums.

 

 

 

RIDERS:

 

Modifies clauses of a contract (adding or excluding).

 

Riders or supplementary benefits are additions to an insurance policy which expand or limit the benefits payable and which become a part of the insurance contract. Riders are usually attached to insurance policies in order to provide additional benefits. Some life insurers package different type of benefits as separate riders so that they can have the flexibility of combining these riders to form contracts with different set of benefits to suit different customers without having to go through the process of designing a new policy.

 

 

SCHEDULED BENEFIT PLANS:

 

This is where you have X amount of dollars for each medical issue, not an aggregate of 1 or 2 million like you would have with BC&BS, AMS, etc., that would cover everything.  We do not sell Scheduled Benefit Plans. 

 

 

 

SECTION 125 = Cafeteria Plan

                   129 = Dependent Day Care     

 

 

SIC = Standard Industry Code (For Name of Business)

 

 

SLMB:

 

Specified Low Income Medicare Beneficiary Payment of the consumer’s Medicare Part B premiums.

 

(Per SMS) Specified Low Income Medicare Beneficiary or QI (Qualifying Individual).  Consumers may qualify for programs that pay only Part B premiums.  Better option may exist for consumers.  Consumers in programs that pay premiums, deductibles, and co-pays are generally called QMB, (Qualified Medicare Beneficiaries), QMB+ or “Full Duals”

 

 

 

SLMB Plus:

 

Payment of the consumer’s Medicare Part B premiums and full Medicare Benefits.

TABLE RATES:

 

    .  1 thru 5 are OK,

    .  6 thru 11 means you have physical problems (most insurance won’t take – exception  see  Shenandoah)

    .  12 means you are critically ill.  

 

                       

TIS:

 

Traditional Index Strategy – Annual reset, point-to-point, equity index strategy.  No averaging.  High Cap.  Index credit guaranteed never to be negative.

 

 

TOILETING:

 

Getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene without substantial Assistance.

 

 

TRANSFERRING:

 

Moving into or out of a bed, chair, or wheelchair without substantial assistance.

 

 

 

 

 

 

UNIVERSAL LIFE (UL):
 

Adjustable Life Insurance – Flexible Term Life – Life insurance that stays in effect for only a specified limited period.  A type of whole-life insurance.  Whole life insurance can be described as term insurance with a forced savings plan (what is called the “cash value”  of the policy).  This means that part of each premium payment goes toward insurance (paying the insurance company to take on the risk of someone dying) and part goes toward the cash value.  With traditional whole-life insurance, the cash value grows at a set rate of return.  With universal life, the cash value is invested in a money market account, wherein the interest rate is constantly changing, reflecting the then-current level of short-term interest rates.  Universal life also allows the contract owner more flexibility in premium payments and loans.

 

A type of whole-life insurance.  Whole-life insurance an be described as term insurance with a forced savings plan (what is called the “cash value” of the policy).  This means that part of each premium payment goes toward insurance (paying the insurance company to take on the risk of someone dying) and part goes toward the cash value.  With traditional whole life insurance, the cash value grows at a set rate of return.  With Universal life, the cash value is invested in a money market account, wherein the interest rate is constantly changing , reflecting the then-current level of short term interest rates. Universal life also allows the contract owner more flexibility in premium payments and loans.

 

 

 

 

 

UNDERWRITING:

 

The act of reviewing and evaluating prospective insureds for risk assessment and appropriate premium.

 

 

VARIABLE DOLLAR ANNUITY = Dictionary Page 548