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30 of 30 terms

Beneficiary

A person or entity designated to receive a life insurance death benefit, subject to the policy terms and applicable law. Keep primary and contingent designations current.

Cash value

A feature of some permanent life policies. Access through loans or withdrawals can reduce benefits, create costs, affect policy performance or have tax consequences. It is not the same as the death benefit.

Coinsurance

Your share of a covered service’s allowed cost, usually expressed as a percentage. When it applies depends on the plan.

Copayment

A defined dollar amount you pay for a covered service, under your plan’s rules. Different services can have different copayments.

Death benefit

The amount a life policy pays upon an insured person’s death when contract conditions are met. Loans, exclusions or other policy provisions can affect payment.

Deductible

The amount you pay for certain covered services before the plan begins sharing those costs. Some services may be covered before the deductible; separate deductibles can apply.

Elimination period

A waiting period before certain disability or long-term-care benefits can begin. How days count and which conditions must be met vary by policy.

Exclusion

A situation, service or condition that a policy does not cover. Read exclusions alongside the benefits summary.

Formulary

A plan’s covered prescription drug list, usually organized into cost tiers and subject to coverage rules. Check the exact medication, dose and coverage year.

Guaranteed issue

Availability of a policy without medical underwriting in a defined circumstance or product. It does not mean every benefit is payable immediately or without limits.

HMO

A health maintenance organization. These plans generally focus on a defined provider network; referral and out-of-network rules vary. Read the specific contract.

ICHRA

An individual coverage health reimbursement arrangement: an employer-funded arrangement that can reimburse eligible individual coverage expenses when its requirements are met. It is not a stand-alone insurance policy.

In-network

A provider or facility that participates in the specific plan’s contracted network. Participation can differ between plans offered by the same insurer.

Independent agency

An agency that can work with more than one insurer where appointed. It does not necessarily represent every company or plan available in a market.

Medicaid

A joint federal and state program providing health coverage for eligible people. Eligibility and program details are state-specific; it is different from Medicare.

Medicare Advantage

A Medicare-approved private-plan alternative for receiving Part A and Part B benefits, generally with Part D included. Costs, networks and coverage rules depend on the plan.

Medigap

Private Medicare Supplement Insurance that helps pay certain out-of-pocket costs under Original Medicare. It does not supplement a Medicare Advantage plan.

Open enrollment

A defined period when eligible people can enroll or change certain coverage. The dates and permitted changes differ by program; one program’s window is not another’s.

Out-of-pocket maximum

The most you pay for specified covered costs during a plan year under the plan’s rules. Premiums, noncovered services and many out-of-network costs generally do not count toward an in-network maximum.

PPO

A preferred provider organization. These plans commonly offer some out-of-network benefits, often at higher cost. Network, referral and authorization details remain plan-specific.

Premium

The amount required to keep coverage in force, usually paid monthly or on another scheduled basis. It is separate from deductibles and other costs when care is used.

Prior authorization

A plan review that may be required before certain services or medications are covered. Approval requirements and payment conditions are plan-specific.

Qualifying life event

A change that may allow a special enrollment period, such as certain losses of coverage or household changes. Eligibility rules, documentation and deadlines apply.

Rider

An addition that changes a policy’s benefits or conditions. Some riders cost extra and may have their own limitations or eligibility requirements.

Special enrollment period

A time outside a standard enrollment window when an eligible person may enroll or make certain changes because of qualifying circumstances. It is not automatic in every life change.

Surrender charge

A charge that may apply when ending or withdrawing value from certain permanent policies during a specified period. Review the schedule and any tax implications.

Term life insurance

Life coverage for a specified period, subject to policy terms. It generally has no cash value; renewal or conversion features vary.

Underwriting

An insurer’s evaluation of information to decide whether and on what terms it will offer coverage, where underwriting is permitted. Requirements vary by product.

Waiting period

A period before coverage or certain benefits begin. The meaning and effect depend on the product; do not confuse it with an enrollment deadline.

Whole life insurance

A permanent life product with contract-defined guarantees when required premiums are paid and conditions are met. Dividends, when applicable, are generally not guaranteed.

Definitions are educational drafts, not contract language or individual advice. For more detail, explore the official resources and content standards.