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The amount of money paid or due to be paid when a person insured under a life
insurance policy dies. This amount does not include adjustments for outstanding
policy loans, dividends, paid-up additions, or late premium payments. See also
basic death benefit and policy proceeds.
A request for payment under the terms of a life insurance policy.
In the numerical rating system, debits represent underwriting factors that have an
unfavorable effect on an individual's mortality rating. Debits are assigned positive
values. See also credits and numerical rating system.
A group composed of lending institutions—banks, credit unions, savings and loan
associations, finance companies, retail merchants, and credit card companies—
and their debtors. See also group creditor life insurance.
decreasing term insurance
A type of term life insurance in which the amount of coverage decreases during
the term of coverage.
A reduction in the number of participants in a pension plan caused by factors
such as retirement, disability, death, or termination.
A flat amount that an insured must pay before the insurance company will make
any benefit payments under a health insurance policy. Also called the deductible
amount or initial deductible. See also calendar year deductible, corridor
deductible, family deductible, integrated deductible and per cause deductible.
A date some time after the first anniversary of a group insurance policy to which
an insurance company defers the payment of the policy's first renewal premium.
An insurance company might defer this payment so that it could use the full first
year's experience to help calculate the new premium.
(1) A series of payments in which the first payment is postponed (deferred) for one
or more periods. (2) An annuity contract under which premiums are accumulated
at interest but the annuity payment period is postponed (deferred) for one or
more periods. See also deferred life annuity and group deferred annuity.
deferred compensation plan
A plan established by an employer to provide benefits to an employee at a later
date, such as after the employee's retirement.
deferred life annuity
A deferred annuity that provides a series of payments, each of which is made
only if a designated person is alive.
deferred premium arrangement
In group insurance, an agreement between an insurer and a policyholder to
lengthen a group insurance policy's grace period, on a permanent basis, usually
by 30, 60, or 90 days. This arrangement allows the policyholder to use the
deferred premium amounts for the length of time by which the grace period is
extended. The arrangement is usually only granted to companies with excellent
credit ratings. Also called a premium-delay arrangement.
Premiums that are due after a policy's statement date but before the next policy
defined benefit formula
A formula used to determine the periodic payment amounts that each participant
in a defined benefit pension plan will receive at retirement. The benefit amount is
often related to number of years of participation in the plan.
defined benefit pension plan
A pension plan that specifies the benefits that the plan promises to pay to a
participant upon retirement, with the benefits determined according to a specified
formula. Contrast with defined contribution pension plan.
defined contribution formula
A formula that describes the amount of money that will be deposited into a
pension plan each year on behalf of each plan participant. Usually, the
contribution is a specified percentage of the participant's compensation.
defined contribution pension plan
A pension plan that specifies the amount of annual contributions that the plan
sponsor will make on behalf of a plan participant. A defined contribution plan
does not guarantee a specific amount of retirement benefits. A participant's
benefits at retirement are based on the amount that has been contributed to the
participant's account, plus investment earnings. Contrast with defined benefit
dental maintenance organization
An organization like an HMO which provides only dental care.
A licensed dentist who understands the underwriting intent of dental plan
language as well as the accepted standards of dental practice, and who advises
insurers as to the appropriateness of dental treatment.
dependent life insurance
Group life insurance made available to group members, usually on an optional
and contributory basis, to cover the spouse, children, or other dependents of the
group member. It is usually sold in small amounts which are intended to pay
deposit administration contract
A funding vehicle for a pension plan in which the plan sponsor places plan assets
in an insurance company's general account. When a plan participant retires, the
insurer withdraws sufficient funds from the general account to buy an immediate
annuity for the plan participant. A deposit administration contract usually protects
the plan sponsor against investment loss and guarantees minimum investment
returns. See also immediate annuity and immediate participation guarantee (IPG)
deposit term insurance
A type of level term insurance that requires a substantially larger premium
payment in the first year than the amount of level annual premiums payable in
In the United States, a ruling by the Internal Revenue Service (IRS) as to
whether the design of a pension plan satisfies the criteria necessary for the plan
to be a qualified plan.
In group creditor insurance in the United States, a premium rate for a contributory
plan which is higher than the prima facie rate and based on the group's actual
claims experience. Insurers can charge a deviated rate only after the prima facie
rate has been in effect for a certain period of time and only after being granted
permission by the state insurance commissioner. Contrast with prima facie rate.
diagnostic related groups (DRGs)
In the United States, a prospective payment method used in the Medicare
Program, in which payment is not based on the number and kinds of medical
services that a patient receives, but instead is based on the diagnosis of each
direct response distribution system
In insurance, a distribution system that relies on advertisements, telephone
solicitations, and mailings to generate sales. No agents visit customers to induce
direct response marketing
A method of selling insurance products directly to the consumer, usually through
direct mail, advertising in print and broadcast media, or by telephone solicitation,
without the use of insurance agents.
Inability to work due to an injury or sickness. See also partial disability,
presumptive disability, and total disability.
Benefits that are payable periodically while an insured continues to be disabled.
"Being disabled" is generally defined in terms of inability to work. See also total
disability buy-out insurance
Insurance that provides cash funds to a business or professional partnership so
that the business interests of a totally disabled partner or stockholder may be
purchased if the disability is long-term or permanent.
disability income insurance
A type of health insurance designed to compensate insured people for a portion
of the income they lose because of a disabling injury or illness. Generally,
benefits for disability income insurance are provided for the disabled person in
the form of monthly payments. Sometimes called loss of time insurance. See
also long-term disability income insurance and short-term disability income
(1) A tabulation of the probabilities of becoming disabled at each age, plus certain
related figures. (2) A tabulation of the number of persons who are still disabled at
each age and the duration of disability, plus certain related figures.
disabled life annuity
A series of payments, each of which is contingent on a person being alive and
Part of a small estates statute which releases an insurance company from liability
under an insurance contract if it pays the proceeds to the deceased insured's
estate. See small estates statutes.
A test required by the NAIC Model Life Insurance Disclosure Regulation and
designed to disclose instances in which policy illustrations have been
manipulated so that they present an unrealistic progression of premiums,
dividends, and benefits.
The process of removing money from a financial intermediary in order to earn a
higher yield somewhere else, usually with another financial intermediary.
Historically, disintermediation, through policy loans or surrendered policies, has
been a major problem for life and health insurers during periods of economic
depression and high inflation.
In pension and employee-benefit plans, the curtailment of a plan which does not
have sufficient funds to cover all the benefits to which the plan's participants are
entitled. Contrast to standard plan termination. See also involuntary plan
termination and voluntary plan termination.
Expenses involved in making insurance products available to the general public.
These expenses include agent compensation, group sales representatives'
salaries, and postal, printing, and telecommunications expenses for those
companies that use direct response marketing.
In an insurance company, the network of organizations and individuals that
performs all the marketing activities required to convey a product from an insurer
to its customers.
(1) A refund of excess premium paid to the owner of an individual participating life
insurance policy. Such a dividend is paid out of an insurer's divisible surplus.
Also called a policy dividend or a policyowner dividend. See also divisible
surplus. (2) The portion of a group insurance premium that is returned to a group
policyholder whose claims experience is better than had been expected when the
premium was calculated. Also called experience rating refund, experience
refund, and retroactive rate reduction. (3) A periodic payment paid by a business
to a stockholder. Dividends paid in cash are called cash dividends. Dividends
paid in the form of additional shares of stock are called stock dividends.
Amounts that result when a policyowner decides to leave the policy dividends
owed to him or her on deposit with the insurer. Also called dividend credits.
When an insurer calculates policyowner dividends, dividend expenses represent
the amount of money that it costs the insurer to maintain each policy in force for
the current year.
dividend interest rate
The interest rate that represents the actual rate being earned on an insurer's
present investments. The dividend interest rate is used to calculate policyowner
Several alternatives that participating policyowners can choose from to indicate
the manner in which they want to receive their share of the insurance company's
divisible surplus. See accumulation at interest option, additional term insurance
option, automatic dividend option, cash payment option, dividend accumulations,
enhancement type policy, paid-up additions, and premium reduction option.
dividend rate of mortality
The rate of mortality (for a given age) that an insurer chooses to use in
calculating policyowner dividends. The dividend rate of mortality is the mortality
rate currently experienced by the insurer on the policies it has sold.
The portion of an insurance company's earnings that is available for distribution
to the owners of the company's participating policies. See also surplus.
doctrine of reasonable expectations
A doctrine applied by some courts under which the reasonable expectations of
policyowners and beneficiaries will be honored, even though the language of the
policy does not literally support these expectations.
From the point of view of a particular state in the United States, a company
incorporated under the laws of that state. Compare to alien corporation and
Death benefit coverage that pays an additional benefit equal to the basic death
benefit of the policy if the insured's death is accidental. See also accidental death
benefit (ADB) rider.
dread disease policy
See limited coverage policy.
An underwriting term for evidence of alcohol abuse or alcoholism.
In the United States, part of the Health Maintenance Organization Act of 1973
which requires employers that meet certain specifications to offer health
insurance through a federally qualified HMO as an alternative to a traditional
health insurance plan.
The licensing of registered representatives with more than one broker-dealer.
duplicate coverage inquiry (DCI) form
In the United States, a form filled out by a health insurance company claim office
and sent to another company in order to ascertain whether an accident or injury
for which the first company has received a claim is also insured by the second
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early retirement age
An age specified in a pension plan that is earlier than the plan's normal
retirement age but at which a plan participant can still receive an immediate
pension benefit. The benefit received at early retirement is usually actuarially
reduced from the amount that would have been received had retirement occurred
at the normal retirement age. See also late retirement age and normal retirement
A 60-day period following notification of an insured's eligibility for COBRA
continuation coverage, during which the individual can accept or decline the
elective contributions or elective deferrals
In the United States, contributions to an employee's Section 401(k) plan (cash or
deferred arrangement) that are made by the employer on the employee's behalf.
The contributions are made using before-tax dollars obtained through a voluntary
reduction of the employee's salary. The contributions are tax-deferred to the
employee. See also matching contributions and nonelective contributions.
In contributory group insurance plans, the period of time, usually 31 days, during
which a new employee may apply for group insurance coverage.
The conditions a person must meet in order to be a participant in a group life
insurance, group health insurance, or retirement plan.
See waiting period.
See percentage contribution.
Employee Retirement Income Security Act of 1974 (ERISA)
A United States federal law establishing (a) the rights of pension plan
participants, (b) standards for the investment of pension plan assets, and (c)
requirements for the disclosure of plan provisions and funding. ERISA also
established the Pension Benefit Guaranty Corporation (PBGC).
employee's cost basis
In the United States, an amount that is subtracted from the total amount of a
distribution to a pension plan participant, in order to determine the portion of the
distribution that is subject to federal taxation. The cost basis is the amount on
which an employee has already been taxed. It includes the amount of the
nondeductible contributions made to the plan by the participant, any cost of plan-
provided life insurance that was reported as taxable income by the participant,
and other factors, including the amount of any employer contributions previously
taxed as income to the participant.
employee stock ownership plan (ESOP)
Generally, any qualified employee-benefit plan, which invests some, or all plan
assets in employer stock. In the United States, ERISA further defines an ESOP
as either a qualified stock bonus plan or a combination qualified stock bonus plan
and defined contribution pension plan designed to invest primarily in employer
securities. The employer's contributions are tax deductible for the employer and
tax deferred for the employee.
A method of changing the beneficiary of a life insurance policy. The change may
be made in one of two ways: (a) The policyowner returns the policy to the
insurance company, and the insurer attaches the endorsement with the name of
the new beneficiary to the policy, or (b) the policyowner does not send the policy
to the insurer but only requests the change by letter or telephone, and the insurer
sends an endorsement with the change to the policyowner. Contrast with
A type of life insurance that provides a benefit (a) if death occurs during a
specified number of years or (b) if, at the end of the specified number of years,
the insured is alive.
enhancement type policy
A life insurance policy in which part of each dividend provides paid-up additions,
while the other part provides one-year term insurance to produce a
predetermined total death benefit.
In the United States, a pension actuary who meets the standards of and is
enrolled by the federal agency known as the Joint Board for the Enrollment of
entire contract provision
A life insurance policy provision which states that the policy itself, along with a
copy of the application for insurance, if attached, constitutes the entire
agreement between the insurer and the policyowner.
An assignment that does not meet the requirements of a legal assignment but
which will be enforced in an equitable action if fairness so requires.
equity-based insurance product
A life insurance or annuity product in which the cash value and benefit level
fluctuate according to the performance of a portfolio of equity investments. The
owners of this type of insurance product accept the risk of sharing in the insurer's
investment gains and losses. Equity investments are investments by virtue of
which investors gain part ownership in a corporation. The primary type of equity
investment is corporate stock. See also variable annuity, variable life insurance,
and variable universal life insurance.
A pension which provides benefit amounts that, at least in part, vary in
accordance with the investment results of a portfolio of common stocks and other
investment vehicles. The equity portion of the pension benefit is meant to provide
retirees with benefits that increase as inflation rises.
equivalent level annual dividend (ELAD)
One amount presented to consumers as part of the interest-adjusted method of
comparing the costs of life insurance policies. The equivalent level annual
dividend is meant to represent the part of the interest-adjusted payment and the
cost that is, in effect, not guaranteed by the insurer, because dividends will
change in the future as the insurer's experience changes. This amount gives the
buyer an indication of the extent to which these nonguaranteed amounts affect
the interest-adjusted payment and the cost of a policy.
equivalent single payment
One payment that can replace several other payments, because it equals the
value of the other payments.
An apparent suicide in which there is doubt about whether the deceased
intended to die as a result of an apparently self-destructive act.
See Employee Retirement Income Security Act of 1974 (ERISA).
error and omissions (E&O) insurance
Insurance designed to cover claims that result from the negligent acts or
mistakes of an agent, including (1) his or her vicarious liability stemming from
negligent acts or (2) mistakes committed by individuals for whom the agent is
See employee stock ownership plan (ESOP).
An insurance program designed not only to provide funds for the prospect's
dependents upon the death of the prospect, but also to conserve, as much as
possible, the personal assets that the prospect wants to bequeath to heirs.
Estate planning usually involves accountants, lawyers, and the trust officers of
banks, as well as insurance agents.
evidence of insurability
Proof that a person is an insurable risk.
The amount of interest above the guaranteed amount, that an insurance
company pays on a settlement option when interest rates are high.
A program that allows a proposed insured who is replacing a policy to obtain the
new policy on the basis of little or no evidence of insurability if his or her
insurability has recently been established by the company that issued the original
See impairment rider.
Losses for which an insurance policy does not provide benefits. For accidental
death benefit coverages, exclusions describe causes of death which do not
qualify as accidental. In health insurance policies, exclusions describe losses not
covered, such as those related to pre-existing conditions, cosmetic surgery or
Career agents who are under contract with one insurance company only and who
are not permitted to sell the products of other insurers. Also known as captive
Under the general agency distribution system, a territory in which no individual
other than the general agent is permitted to offer the insurer's products. Compare
to nonexclusive territory and overlapping territory.
Legislation in community-property states that allows an insurer to pay the
proceeds of a life insurance policy in accordance with the terms of that policy
without fear of double liability.
Statutes that excuse the insurer from liability if a party claims policy proceeds
which the insurer has already paid to a third party in good faith and without
knowledge of any conflicting claim.
The process of using a group's own premium and claims experience to calculate
premium rates. If the claims experience for the previous year was favorable, the
insurer considers reducing the premium rates for the coming year. If the
experience was unfavorable, the insurer attempts to discover the reason and
may propose higher premium rates for the next year. See also blended rates and
(1) The portion of a group insurance premium that is returned to a group policyholder
whose claims experience is better than had been expected when the premium
was calculated. Also called a dividend, an experience rating refund, and a
retroactive rate reduction. See also dividend. (2) The portion of a reinsurance
premium that is returned to the ceding company when claims experience is better
than had been expected when the premium was calculated.
The practice of cautiously accepting specific types of risk that are considered
uninsurable according to the insurer's normal underwriting guidelines.
The authority that a principal explicitly confers on an agent. See agent and
principal. Compare to apparent authority and implied authority.
extended term insurance option
A nonforfeiture option in which the cash value of a policy is applied as a net
single premium to purchase paid-up term insurance. The amount of term
insurance is equal to the death benefit of the policy being surrendered less any
outstanding policy loans. The insured maintains the same amount of coverage
but usually for a shorter period of time than the original coverage. See also
extra-percentage tables method
A commonly used plan for rating substandard risks. Under this method, each
substandard class is charged a premium rate that is a certain percentage above
the standard premium rate. Contrast with flat extra premium method.
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In a life insurance policy whose benefit is not variable, the amount stated as
payable at the death of the insured or (in the case of an annuity) at the maturity
of the contract. It is generally shown on the first page of the policy. Also called
the face value. See also basic death benefit, death benefit, and policy proceeds.
The first page of an insurance policy. The face page normally includes the
insured's name and age, the name of the policyowner (if different from the
insured's name), the amount of premiums, the policy number, the date on which
the policy was issued, and the signatures of the insurance company's president
A life insurance policy provision that permits an insurer to pay all or part of the
policy proceeds either to a blood relative of the insured or to anyone who has a
valid claim to those proceeds. The facility-of-payment clause enables the insurer
to pay benefits in a timely manner when such benefits cannot be made to the
beneficiary identified in the insurance contract.
A table used by insurance underwriters to determine an applicant's net worth by
specifying what an applicant's annual income should be multiplied by to arrive at
the maximum allowable amount of insurance.
Fair Credit Reporting Act (FCRA)
A United States federal law designed to help ensure that consumer reporting
agencies act fairly, impartially, and with respect for the consumer's right to
privacy when preparing consumer reports on individuals. See also consumer
A life insurance policy rider that provides term insurance coverage on the
insured's spouse and children.
A single deductible which, when satisfied, relieves a family of the burden of
satisfying a deductible for each individual family member.
family income insurance
A specialized individual policy that commonly combines whole life insurance with
decreasing term insurance. The whole life insurance portion of the policy is
usually paid as a lump sum when the insured dies. The decreasing term
insurance portion of the policy provides an income for a predetermined period to
help support the insured's family.
family insurance policy
A life insurance policy that covers all the members of a family under one contract.
federally qualified HMO
In the United States, a Health Maintenance Organization which satisfies specific
requirements set forth in the Health Maintenance Organization Act of 1973.
Federally qualified HMOs are entitled to certain grants and loans from the federal
government and are eligible to be used by employers to satisfy the dual choice
A schedule or list of maximum benefits that will be paid under a group medical
contract for certain listed procedures. See also relative value schedule. May
simply be called a schedule.
fee schedule basis
A compensation plan used in health maintenance organizations (HMOs) and
preferred provider organizations (PPOs) in which a physician is paid a
predetermined amount for each service that the physician provides. See also
A person or organization who holds, manages and has discretionary authority
and control over money belonging to an other person or organization, or who
renders investment advice in exchange for compensation. When an insurance
company manages pension funds, the insurance company is acting as a
Those insurance agents who work out of an insurer's field offices.
An insurance company's local sales offices.
See insurance agent.
The first step in the risk selection process. Field underwriting occurs when an
agent gathers pertinent information about the proposed insured and reports that
information on the application blank so the home office underwriter can make an
final average (final earnings) benefit formula
A type of defined-benefit formula in which the retirement benefit amount is
derived on the basis of a participant's average compensation during a specified
period (usually the three to five years preceding retirement) during which the
participant was most highly compensated. Contrast with career average benefit
An organization that helps to channel funds through an economy by accepting
the surplus money of savers and supplying that money to borrowers, who pay to
use the money. Insurance companies are financial institutions.
A financial institution that borrows money on its own account and loans money to
other borrowers. Insurance companies are financial intermediaries.
A lump sum payment by an insurer to a disabled insured that extinguishes the
insurer's responsibility under the disability contract. Also known as a buy-out or
Medical expense insurance under which no deductible or coinsurance is
applicable to covered expenses.
An amount paid to an insurance agent based on a policy's first annual premium
In the United States, a type of trust that many self-insured groups establish to
fund their group insurance plans. All contributions to a 501©(9) trust are
deductible for federal income tax purposes, as are all investment gains made on
funds in the trust. The trust must meet certain federal government requirements.
Also called a voluntary employees' beneficiary association (VEBA). See also self-
insured group insurance.
fixed amount option
A life insurance settlement option under which the insurer uses the policy
proceeds plus interest to pay the beneficiary a sum of money in a series of
annual or more frequent installments for as long as the proceeds plus interest
last. Also called the fixed payment option.
fixed period option
A life insurance settlement option under which the insurer pays the beneficiary
the policy proceeds plus interest in a series of annual or more frequent
installments for a specified length of time.
flat amount formula
A method of determining the retirement benefit for participants in a defined
benefit pension plan. A flat amount formula provides the same periodic (e.g.,
monthly, annual) benefit amount, for example $500 per month, to each retiree.
See also flat percentage of earnings formula and unit-benefit formula.
flat extra premium method
A method for rating substandard risks used when the extra risk is considered to
be constant. The underwriter assesses a specific extra premium for each $l,000
of insurance. Contrast with extra-percentage tables method.
flat percentage of earnings formula
A method of determining the retirement benefit for participants in a defined
benefit pension plan. This method provides for each participant to receive a
certain percentage of pre-retirement compensation, for example 60%. The actual
payment amount under this formula depends on how compensation is defined.
See also career average benefit formula, final average benefit formula, flat
amount formula, and unit-benefit formula.
flexible benefit plan
See cafeteria plan.
flexible premium annuity
A deferred annuity that gives the purchaser the right to vary the amount of each
premium paid to the insurer during the accumulation period.
From the point of view of a particular state in the United States, a company that
is incorporated under the laws of another state. Compare to domestic corporation
and alien corporation.
The ability of an insured to have had a reasonable anticipation that harm or injury
would be a likely result of a certain act or an omitted act.
The unvested amount that remains in a pension or profit sharing plan when a
participant leaves the plan and withdraws the amounts which are vested.
Forfeitures may occur when an employee is terminated, for example. Forfeitures
must either be used to reduce the plan sponsor's future contributions to the plan
or be reallocated to other participants.
Premiums that are paid in installments during a year, such as semiannually,
quarterly, or monthly. Fractional premiums are so called because they are
fractions of the annual premium.
fraternal benefit society
An organization that exists to provide social and insurance benefits to its
members. In such a society, members often share a common religious, ethnic, or
vocational background, although some fraternals are open to the general public.
Insurance coverage issued by a fraternal benefit society. See also open contract.
A type of claim that occurs when a claimant/insured intentionally uses false
information in an attempt to collect policy proceeds.
According to common law, a false statement which meets the following three
criteria: (1) the party that makes the statement is aware that it is not true or
disregards whether it is true; (2) the party that makes the statement does so in
order to induce another party to enter into a contract; (3) the other party does
enter into a contract as a result of the statement and suffers a loss because of
free examination period
The period of time after delivery of an insurance policy during which the
policyowner may review the policy and return it to the company for a full refund of
the initial premium. Full coverage is in force during this period. Also called a ten-
day free look.
A life insurance policy (usually a universal life insurance policy) in which most of
the expense charges take the form of deductions from each premium payment.
Such deductions continue throughout the premium payment period. See also
back-loaded policy and universal life insurance.
A health insurance plan which pays in full the actual cost, if reasonable and
customary, of services received, rather than a specified maximum for each
An arrangement in which the insureds under a group policy pay the entire cost of
their insurance. Contrast with contributory group insurance and noncontributory
The party who holds the assets of a pension plan. Often an insurance company.
funding standard account
For qualified pension plans in the United States, a bookkeeping account which is
maintained in order to determine whether a defined benefit pension plan is
meeting minimum funding standards set by law. Many of the entries to the
account are derived actuarially. If at any time the plan's funding is inadequate,
then an accumulated funding deficiency is said to exist. Also known as a
minimum funding standard account. See also minimum funding standards.
The legal document which governs the management of pension funds by a
funding agency. When the funding agency is an insurance company, the funding
instrument is usually an insurance contract. Also called the funding instrument.
The prospective service that an employee will provide to an employer from the
date of entry into a pension, or from the current date, to the employee's normal
retirement date. Pension benefits provided for this service are known as future
service benefits. See also past service.