General Terms

Question 1

Activities of Daily Living (ADL)

Answer 1

ADLs are basic actions that a normally functioning person performs every day. The six standard ADLs are: bathing, dressing, toileting, transferring (moving to and from a bed or chair), eating and continence.

Question 2

Adverse Selection

Answer 2

The tendency of persons with a medical condition(s) to seek or continue insurance to a greater extent than persons with average or better health expectations. It is when individuals with substandard risks select coverage when they know they need it, versus an individual who selects coverage because they may need it in the future.

Question 3

Anniversary

Answer 3

A Policy’s Anniversary Date (generally annually) is the time in which an opportunity to change the terms and/or pricing of a Policy can take place.

Question 4

Annual Enrollment

Answer 4

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

Question 5

Application

Answer 5

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

Question 6

Application Subscription Agreement

(SubApp or AppSub)

Answer 6

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 7

Automated Clearing House

(ACH)

Answer 7

The process of electronically transferring funds from a policyholder’s bank account to pay their bill.

Question 8

Bill Cycle

Answer 8

The interval of time from the end of one billing statement date to the next billing statement date.

Question 9

Bill Method

(Bill Type)

Answer 9

The type of billing a Policyholder has. OneAmerica has several different Bill Methods and they are: GAIN List billed, Summary Billed, iBill Home Office Administered, iBill Policyholder Administered – Self Billed, iBill Policyholder Administered – AUL Billed, or Desktop.

Question 10

Contributory

Answer 10

This means an employee pays all or some of the premium for the coverages elected by them.

Question 11

Deduction Amount

Answer 11

The amount of premium charged based on a certain time period. If a person has contributory insurance, premiums may be paid by the person by means of payroll deduction administered by the policyholder.

Question 12

Employer Contribution

Answer 12

The percentage of premium that will be paid by the employer.

Question 13

Enrollment Form

Answer 13

A form completed by an Eligible Employee for purposes of coverage under a Plan.

Question 14

Final Appeal Determination

(ERISA)

Answer 14

Second claim decision, after a claim has been appealed.

Question 15

Grandfathered

Answer 15

There are two types of Grandfathering. The first is when OneAmerica takes another carrier’s plan design and keep all existing enrolled employees in that plan – all new employees would be in our plan design. The other is when we keep existing coverage amounts for employees currently enrolled in the prior carrier’s plan. These employees may be over our Guaranteed issue amount but they won’t need to provide Evidence of Insurability.

Question 16

Initial Claim Decision

(ERISA)

Answer 16

First claim decision, where OneAmerica is accepting or declining liability for claim based on eligibility, and/or medical support.

Question 17

Non-Contributory

(Non-Contrib)

Answer 17

An Employer pays all of the premium for the coverage.

Question 18

Paid-Through Date

Answer 18

The date through which a benefit was paid, or a policyholder’s premiums has been paid.

Question 19

Plan Document

(ERISA)

Answer 19

Sets forth how the program works.

Question 20

Policy

(Contract)

Answer 20

An insurance policy, or contract, 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 21

Premium

Answer 21

The amount paid for insurance coverage for a predetermined period of time.

Question 22

Provision

Answer 22

Clauses in the Plan documents that lay out the exact conditions for which coverage is provided and for what amounts along with exclusions and other restrictions and/or limitations.

Question 23

Quality Assurance

(QA)

Answer 23

A process used to determine if a product or service meets certain standards.

Question 24

Renewal Dates

Answer 24

The dates at which a coverage is reviewed to see if the rate they are charged should be adjusted.

Question 25

Subscription Agreement

Answer 25

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

Question 26

Summary Billed

Answer 26

A billing type were a Policyholder reports number of lives per coverage, volume, and premium due on a monthly basis.

Question 27

Turnaround Time

(TAT)

Answer 27

The expected time for a process to be complete.