General Terms Flashcards
Amendment
A legal document changing the provisions of the policy that is signed jointly by the insurance company and an authorized representative of the policyholder.
Anniversary
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.
Application Subscription Agreement
(SubApp or AppSub)
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.
Bill Method
(Bill Type)
The type of billing a Policyholder has. OA 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.
Contributory
This means an employee pays all or some of the premium for the coverages elected by them.
Deduction Amount
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.
Employer Contribution
The percentage of premium that will be paid by the employer.
Enrollment Form
A form completed by an Eligible Employee for purposes of coverage under a Plan.
Final Appeal Determination
(ERISA)
Second claim decision, after a claim has been appealed.
Grandfathered
There are two types of Grandfathering. The first is when we take another carriers 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 plan. These employees may be over our Guaranteed issue amount but they won’t need to provide Evidence of Insurability.
Initial Claim Decision
(ERISA)
First claim decision, where OneAmerica is accepting or declining liability for claim based on eligibility, and/or medical support.
Non-Contributory
(Non-Contrib)
An Employer pays all of the premium for the coverage.
Paid-Through Date
The date through which a benefit was paid, or a policyholder’s premiums has been paid.
Plan Document
(ERISA)
Sets forth how the program works.
Policy
(Contract)
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.
