DB Claims 1 - intro terms

Question 1

Producers

Answer 1

Insurance agents (a.k.a. “producers”) sell policies for an insurance company. Some agents work exclusively for one company, others sell insurance for many different insurance companies (which are usually referred to as brokers).

Question 2

Agent of Record (AOR)

Answer 2

The name of the broker/producer who is making commissions from the sale of the group.

Question 3

Broker

Answer 3

This is the person or Agency that sold the case of our coverages. They usually make a commission on the premium paid.

Question 4

Regional Group Offices (RGO)

Answer 4

These are our sales offices that are spread out through the country. They handle the selling of our cases and have relationships with the Brokers.

Question 5

Policyholder

Answer 5

This is a general term used to identify our customers.

Question 6

Employer

Answer 6

Also known as the Group or Policyholder. The insurance company has a contract with the employer. not with the employee. The employer offers insurance coverage to employees.

Question 7

Direct Product

Answer 7

Whether or not a product is Direct depends on how each state files the contract. If a product is Direct, we will issue both a certificate (each product and class/plan) and a policy (each product).

Question 8

Trust Product

Answer 8

Whether or not a product is Trust depends on how each state files the contract. If a product is Trust, we will only issue a certificate for each product and class/plan.

Question 9

Traditional (Basic)

Answer 9

Term used to describe OneAmerica’s Life product that is usually a flat amount of coverage and one rate for all employees.

Question 10

Voluntary

Answer 10

Term used to describe OneAmerica’s Life product that is usually an incremental plan design and the rates are based on an employee’s age.

Question 11

Application

Answer 11

This is the name of the document used by a new client to select the benefits they desire for their Direct Product.

Question 12

Application Subscription Agreement (SubApp)

Answer 12

This is an abbreviate term for the application/subscription agreement. A formal request from a potential client outlining benefits, schedule and rates they are wishing to purchase. An application is used when applying for a true group product where the employer is the master policyholder. If accepted the application is made part of the group’s master policy. A subscription agreement is used when the employer is applying for a trust product. In this case the trust holds the master policy.

Question 13

Participating Unit

Answer 13

The term used to describe a Trust Policyholder in their certificate.

Question 14

Special Conditions Limitations

Answer 14

This applies when chosen by the Participating Unit on the Subscription Agreement. Benefits for Disability due to Special Conditions, whether or not benefits were sought because of the condition, will not be payable beyond [12][24] months as stated on the Subscription Agreement. Benefits payments for Disabilities due to Special Conditions are cumulative for the lifetime of the contract.

Question 15

Policy

Answer 15

An insurance policy is a legal agreement between the Employer (also known as the Policyholder or Group) and the insurance company which outlines what coverage will be extended to eligible employees and under what conditions.

Question 16

Contract

Answer 16

A contract, or “Policy,” is a legal agreement between the Employer (also known as the Policyholder or Group) and the insurance company which outlines what coverage will be extended to eligible employees and under what conditions.

Question 17

Certificate

Answer 17

This is a booklet containing contractual information for the benefits elected by the Policyholder. It is given for all products (Direct and Trust).

Question 18

Certificate Number

Answer 18

Used to identify an employee attached to a Policyholder on GAIN - typically synonymous with the employee’s Social Security Number.

Question 19

Class

Answer 19

A segment of the group that has been separated according to specific criteria in order to determine amounts of coverage that each segment is eligible for. Classes need to be well defined from one another. Examples of defining elements: occupation, salary, length of service, etc

Question 20

Premium

Answer 20

The amount paid for insurance every month.

Question 21

Contributory

Answer 21

This means an employee pays all or some of the premium for the coverages elected by them. It also means that they must request coverage by filling out an Enrollment form.

Question 22

Non-Contributory

Answer 22

An Employer pays all of the premium for the coverage.

Question 23

Effective Date

Answer 23

The date that a coverage is in-force or employee is covered under the group contract.

Question 24

Anniversary

Answer 24

The date on which the policy becomes effective and twelve month intervals following the original effective date. May be a time of the year in which several things may happen to a group. Rates may change, age brackets may change, Guaranteed Increase Benefits are effective, or employees may be effective. What happens depends on the coverages and benefits elected by the Group.

Question 25

Annual Enrollment

Answer 25

A scheduled period before each policy anniversary date, which allows employees’ to enroll for coverage under the policy.

Question 26

Guaranteed Increase in Benefit (GIB)

Answer 26

This benefit allows an employee to increase their coverage on the Policyholder’s anniversary by either 10% of their current volume or $10K whichever is greater. This benefit is not allowed for anyone who has been declined for coverage or has had an Accelerated Life Benefit claim paid.

Question 27

Provision

Answer 27

Insurance contractual provisions bestow certain rights and privileges, and impose duties on the policy owner and the beneficiary.

Question 28

Conversion

Answer 28

A provision in the insurance policy that allows individuals who through termination are no longer eligible for coverage under the group policy, to convert to an individual plan of insurance without providing evidence of insurability.

Question 29

Portability

Answer 29

A privelege which allows employees to take the coverage with them upon termination of employment.

Question 30

Rider

Answer 30

A rider is an add-on provision to an insurance policy that provides additional benefits to the policyholder at an additional cost.

Question 31

Amendment

Answer 31

A legal document changing the provisions of the policy that is signed jointly by the insurance company and an authorized representative of the policyholder.