This is a common rider with life insurance policies.

When you have been diagnosed with a terminal illness, you can claim part of your life insurance money to help get the ball rolling with your final expenses.

Accidental death and dismemberment (AD&D) insurance is a type of insurance that is usually added as a rider to a health or life insurance policy.

It allows a policy to pay (or pay extra) if you die in a way that is considered accidental (trip and falling) or if you lose a body part or bodily function (loss of hearing, or loss of limb).

This is similar to AD&D, but it does not include the ‘dismemberment’ part.  It is usually added as a rider to life insurance and can include provisions that pay extra if you die from an accident.

Adjustable Life Insurance is a hybrid between Term Life and Whole Life.

This type of insurance allows you to change features after signing up, such as cash value amounts and premiums.

They require more work to set up than either straight whole life or term life, but offer the flexibility that some people desire.

The Affordable Care Act (also known as the ACA or Obamacare) was a healthcare law passed in 2010 that overhauled how healthcare was accessed.  It completely redefined how people can purchase health insurance and how companies can charge those people.

You can read more the ACA here.

This is the maximum amount that an insurance company will pay for any given service.

The purpose of the allowed amount is to standardize health cost so that patients are not overcharged.

The Annual Election Period (AEP), also known as Medicare’s Open Enrollment Period, is a time when eligible people can change or sign up for a Medicare plan. 

It usually takes place from October 15 to December 7, and during this time, people can make an unlimited number of plan changes. New plans become effective on January 1 of the following year.

The annual gross income (AGI) is the total amount of money earned BEFORE taxes and other deductions are taken out.

The Annual Notice of Change is a notice that you get in the mail from your Medicare Advantage or Part D plan in late September.

It gives a summary of any changes to your plan take effect January 1 of the next year.

This is the formal process that you go through when you ask your insurance company to change their mind about a decision they made about paying medical cost.

You can read more about that process here.

When talking about LIFE INSURANCE, this refers to an agreement where the patient authorizes the provider  to directly receive payments for services from the insurance company.  This would be most common with Indemnity plans.

When talking about LIFE INSURANCE, it refers to transferring the policy rights to someone else (or even a company).  This is most often used when you have a large debt that you want covered if you die.  If you were to die, the person or company with the right to policy would be paid first up the amount of the debt, then the beneficiary would be paid the rest.

This is when the provider bills the patient for the extra amounts not covered by the insurance company.  It is also called Surprise Billing.

The No Surprise Act of 2021 bans balance billing in certain circumstances, such as emergencies and at out-of-network facilities.

This is the person who receives the death benefit from a life insurance policy. 

You may have more than one where the benefit is split evenly or at a pre-determined percentage. 

You may set up secondary beneficiaries (person who get the money if the first person is also dead) or even tertiary beneficiary (person who is third in line to receive the money).

When referring to Medicare, this is the time period having gotten all better from an illness or injury, that you cannot be charged again if you need to go back to hospital.  It last for 60 days and interacts with your Medicare Part A cost.  You can read more about that here.

When referring to Health Insurance, it refers to the period of time when you can file a claim and receive payment from the insurance company.

When referring to Income Protection, it is the maximum amount of time that someone can receive income protection payments for a disability claim.

This is the name for a Section 125 plan.  It is a pre-tax benefit offered by certain employers that allows employees to pick and chose the benefits they want.

These plans are highly flexible and allow for pre-tax dollars to be used, but require a significant amount of work on the employer’s end.

This is another name for the insurance company.

This is amount of money that the insurance company would pay you if you voluntarily canceled your life insurance policy.

This is a type of health insurance categorized by very low monthly premiums and very high deductibles.

They are designed to be an affordable way to protect yourself from the worst-case scenarios, like getting seriously sick or injured.  You will need to pay for more routine healthcare yourself.

Unless you are given a hardship exemption, you may not have one of these plan if you are over 30 years old.

CHIP is a free or low cost health coverage designed for children in families that make too much to qualify for Medicaid.  Each state runs their own CHIP coverage.  Both CHIP and Medicaid work closely together.

WHen you apply for insurance through the Marketplace, if the system determines that you are eligible based on your household size and income, your information will automatically be sent to your states agency, who will contact you about enrollment.

The other way to apply is call 1-800-318-2596.

You may apply for CHIP anytime of the year and do not need to wait for an enrollment period.

Co-insurance is a type of cost-share.  It is represented in a percentage shows the portion of a procedure that you will need to pay.

As an example, if your policy shows an 80/20 coinsurance, and a procedure was $1000, you would pay $200, or 20%, of the procedure’s cost.

Copayment, or copay, is a fixed amount of money that a person will pay for a service.  Along with deductibles & coinsurance, it is one of the three main types of cost-shares.

Copayment amount are listed on the Summary of Benefits & Coverage and often times on the insurance cards.  It is rare to have a copay for anything more than prescription medication, emergency room visit, and seeing the doctor or specialist.

COBRA is the name of a federal that grants people the right to continue their job-based health insurance for up to 36 months after they leave their job.

There are stipulations to the duration you can have COBRA and the cost of the insurance can be expensive.

For more information on COBRA, check here.

After you sign a life insurance policy, this is the period of time (typically two years) that the insurance company can dispute the information you gave and refuse to pay the death benefit if you die.

For example, if you said you did not smoke cigarettes and died of lung cancer during those two years, the insurance company could legally dig through social media images of you to find a picture of you smoking and say that you lied on your application so they would pay your death benefit.

After the contestability period, the insurance company can not back out of payment of the death benefit for any reason other than what is stated in the policy

This is a clause added to a life insurance policy that allows a person to change the types of insurance without needing to undergo a medical exam.

This is really beneficial when a term policy expires and you want a small amount of whole life for burial expenses.  By adding this rider on to your term policy when you were young, and healthy, you will not need to worry about being rated poorly due to medical reasons brought on by age.

This is a process that determines which insurance plan pays first and which pays second.  When you have two different health insurance policies, the companies want to make sure they are paying the correct amount.  The Coordination of Benefits (COB) ensures this.

You can read more about Coordination of Benefits here and here.

A Cost Plan is a type of health coverage available for some people on Medicare that want an alternative to Medicare Part C plans and Medigap plans.

With a Cost Plan, while you still pay some of the cost-share amounts of Original Medicare, the majority of services have a pre-negotiated price within a network.

Cost Plans are not available to everyone is all areas.

A cost sharing reduction (CSR) is one of the subsidies offered through the Marketplace.  The subsidy reduces the amount you would pay for deductibles, copayments, and coinsurance on covered health services.

Eligibility is based on income and only Silver tier plans are eligible for CSRs.  The exception to this is if you are  American Indian or Alaskan Native you may receive a CSR on any plan.

Cost sharing included all of the deductibles, coinsurance, and copayments that you will have to pay using your health coverage.  It is a way that the insurance company gets you to share some of the cost of medical care.

The coverage gap was a period that your insurance would pay very little for your prescription medication, resulting in you needing to pay a higher than normal percentage.  It only applied to Part-D coverage, either as a standalone plan or attached to a Medicare Advantage plan.

The Coverage Gap has been eliminated from all Part-D plans starting 2025.  You can read more about those changes here.

This is the period of time you are covered by an insurance policy.  It starts on the policy’s effective date and ends on its expiration date (assuming you continue to pay your premiums).

The length of the coverage period can vary depending on the type of insurance and whether it is an individual or group plan.

Covered Employee refers to not only current employees that are eligible for group health insurance, but also terminated employees that are eligible for COBRA coverage and for retired employees that may receive retiree benefits.

It is an important designation in group insurance as the total number of Full Time Employees may not correctly list how many people can receive benefits. 

Creditable Coverage is any health insurance or prescription drug plan that meets a minimum set of qualifications.

The importance of Creditable Coverage comes when you become eligible for Medicare but choose to postpone enrollment due to having other insurance.

You can read more about Creditable Coverage here.

This is the amount of money that a life insurance policy will pay when you die.

This is a specified amount of money that you need to pay before your insurance company will start to pay it’s portions of covered medical services.

Normally, you pay 100% of all cost until you reach your deductible amount.  Once you reach your deductible amount you start to pay your co-insurance and co-pay amounts.

This is insurance coverage for family members of a policyholder.  It can include spouses, children, and domestic partners.

The ACA requires that plans offer dependent coverage to all dependents until they are age 26.

As a definition pertaining to insurance, disability is any condition of the body or impairment of the mind that makes it more difficult to do certain activities.

This definition is used for a number of insurance products.

Life insurance riders can include provisions that, if disabled, you do not have to pay premiums.

Disability insurance is a type of insurance that will provide income in the event you become unable to perform your work.

The stipulations and severity regarding a disability can vary depending in the policy.

This is a rider that can be added on to some life insurance policies that, if you become disabled and unable to make your premium payments, will ensure that you policy does not become canceled due to lack of payment.

This is a relationship between two people who live together and share a life together, but are not married.

Some companies allow for domestic partners to be added as dependents on health plans.

You can read more about Domestic Partnerships here.

This is payment by a life insurance policy of two times the face value when death results from an accident as opposed to health problems.

This is usually part of an Accidental Death and Dismemberment rider.

This is a complete list of all drug that are included on an insurance plan’s formulary.

Dual eligibility refers to people who have, or are eligible to have, both Medicare and Medicaid benefits.

With dual eligibility, when you receive medical care, Medicare pays first.  The remainder of the bill is sent to Medicaid, who will then also pay a portion or the remainder of the left over charges.

This is an insurance term for equipment and supplies ordered by a provider for everyday or extended use.

Durable Medical Equipment (DME) can include things like wheelchairs, oxygen tanks, crutches, or even blood test strips for diabetics.

An elimination period is a waiting period that occurs before you can receive payment for services or benefits. It’s similar to a deductible, but measured in time instead of money. Elimination periods can vary by type of insurance policy, but they typically range from 30 days to two years.

Elimination periods are common with Disability insurance and extended care insurance.

This is any injury, illness, or pain so severe that any reasonable person would seek care right away to avoid severe harm.

This is another term for a group health insurance.  It is a health insurance plan that an employer or employee organization offers to their members.

These are a list of services that all health insurance plans must cover to be considered qualifying coverage.  

Under the ACA, the essential health benefits include services such as prescription drug coverage, pregnancy and childbirth, and mental health.

You can read more about essential health benefits here.

This is a written document that describes how a plan works.  It is similar to a Summary of Benefits, but more detailed.

This is a statement that provides information about your health.  These can be needed sometimes for certain types of insurance.

If you are being asked for Evidence of Insurability, speak with your current insurance company and they can provide it for you.

The Exchange is the name of the online marketplace where people can look at and buy different health insurance plans.

Exchanges can be run federally or state-wide.  The federal Exchange is called the Marketplace.

Excluded services are health care services that a health insurance plan or health insurer does not cover or pay for. If a service is excluded, the plan will not pay benefits for medical or hospital costs, and the person receiving the service is responsible for paying out-of-pocket. Excluded costs do not count towards the plan’s total out-of-pocket maximum.

This is a provision in some types of insurance that eliminate coverage for certain acts that the insurance company feels is too risky to insure.

Life insurance policies typically have exclusions for things like bungee jumping or scuba diving.  If you die while participating in one of these excluded activities, the policy will not pay out.

A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).

These plans are not as restrictive as an HMO, but are more restrictive than a PPO.

The face amount of a life insurance policy, also known as the death benefit, is the amount of money the policy’s beneficiaries receive when the insured person dies. The face amount is stated in the policy contract and is chosen when the policy is purchased.

A measure of income issued every year by the Department of Health and Human Services.

Federal poverty levels are used to determine your eligibility for certain programs and benefits, including savings on Marketplace health insurance, and Medicaid and CHIP coverage.

This is another term for the arrangements needed after someone dies.

Depending on the person’s wishes, it can be a simple cremation or a lavish burial.

A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.

This a period of time where you are able to return a life insurance policy and receive your initial payment back.

Under law, the Free Look Period is at least 10 days, but often extends to 30 days.

Any employee who works an average of at least 30 hours per week for more than 120 days in a year. Part-time employees work an average of less than 30 hours per week.

This become important when looking at group health insurance.

An insurance grace period is a set amount of time after a premium is due when a policyholder can make a late payment and keep their coverage active. 

Grace periods can vary depending on the type of insurance, the policy, and the state, but can be as short as 24 hours or as long as 90 days with Marketplace plans.

This is a health insurance plan that was purchased before the Affordable Care Act was signed in 2010.

Grandfathered plans are not required to adhere to the stipulations and rules of the ACA, though no new granfathered plans can be sold.

A grievance is any complaint or dissatisfaction expressed about a health insurance plan or provider to the insurer or plan. 

Grievances can be filed verbally or in writing, and can include issues such as problems with customer service, difficulty understanding written materials, disrespectful behavior from staff, and long wait times for appointments.

This is a requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services.

Except in some states, guaranteed issue doesn’t limit how much you can be charged if you enroll.

Guaranteed renewable is a feature of some insurance policies that requires the insurer to continue coverage as long as premiums are paid on time. 

This means that the insurer can’t cancel the policy unless the policyholder doesn’t pay their premiums.

Habilitation services are healthcare services that help people maintain, learn, or improve their skills and functioning in daily life.

Habilitation= Learn/improve skills you do not have.

Rehabilitation=restore skills that have been lost

This is an exemption that’s needed when applying for Catastrophic coverage for people 30 and older who faced a “hardship” that prevented them from getting insurance.

Hardship exemptions are one type of exemption that someone can claim to qualify for Catastrophic coverage, along with affordability exemptions.

A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium.

A HMO is a health insurance plan that provides health services through a network of doctors for a monthly or annual fee.

The plans are characterized by lower premiums compared to a PPO, but with more restrictions on where you can seek care.

Marketplace plans are placed into 4 different categories, Bronze, Silver, Gold, and Platinum.

The different categories describe how the insurance plan splits cost and have nothing to do with quality of care.

For each plan category, you’ll pay a different percentage of total yearly cost of your care, and your insurance company will pay the rest.

You can read more about plan categories here.