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A
Additional insured: A person, company or entity
protected by an insurance policy in addition to the insured.
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B
Benefits: The amount payable by the insurance company to a claimant,
assignee or beneficiary under each coverage.
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C
Certificate of Insurance: A statement of coverage
issued to an individual insured under a group insurance contract, outlining the
insurance benefits and principal provisions applicable to the member.
Claim: A request for payment of a loss which may come under the
terms of an insurance contract.
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D
Deductible: An amount which a
policyholder agrees to pay, per claim or per accident, toward the total amount
of an insured loss.
Dismemberment: Loss of body members (limbs), or use thereof, or loss
of sight due to injury.
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E
Effective Date: The date on which the insurance under a policy begins.
Exclusions: Specific conditions or circumstances listed in the policy
for which the policy will not provide benefit payments.
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I
In-Home: Any
activity occurring in or on a property intended for residential use.
Injury Independent of All Other Means: An injury resulting from an
accident, provided that the accident was not caused by an illness.
Insured: A person or organization covered by an insurance policy,
including the "named insured" and any other parties for whom protection is
provided under the policy terms
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L
Liability Insurance: Insurance covering the policyholder's legal
liability resulting from injuries to other persons or damage to their property.
Loss: The happening of the event for which insurance pays.
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M
Master Policy (or Master Contract): The policy issued to a group
policyholder setting forth the provisions of the group insurance plan. The
individuals insure under the policy are then issued certificates of insurance.
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N
Negligence: Failure to use the care that a reasonable and prudent
person would have used under the same or similar circumstances.
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O
Occurrence: An accident, including continuous or repeated exposure to
substantially the same general, harmful conditions, that results in bodily
injury or property damage during the period of an insurance policy.
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P
Policy: The legal document issued by the company to the policyholder,
which outlines the conditions and terms of the insurance; also called the policy
contract or the contract.
Policyholder: A person who pays a premium to an insurance company in
exchange for the insurance protection provided by a policy of insurance.
Premium: The sum paid by a policyholder to keep an insurance policy in
force.
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R
Reasonable and Customary Charge: A charge for health care, which is
consistent with the going rate or charge in a certain geographical area for
identical or similar services.
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S
Special Risk Insurance: Coverage for risks or hazards of a special or
unusual nature.
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