Louisiana Accident/Health Insurance

Accident

Activities of Daily Living

Actual Charge

Adhesion

A contract offered on a "take-it-or-leave-it" basis by an insurer, in which the insured's only option is to accept or reject the contract. Any ambiguities in the contract will be settled in favor of the insured.

Admitted (Authorized) Insurer

Adult Day Care

Adverse Selection

The tendency of risks with higher probability of loss to purchase and maintain insurance more often than the risks who present lower probability.

Agent

An individual who is licensed to sell, negotiate, or effect insurance contracts on behalf of an insurer.

Aleatory

Alien Insurer

An insurance company that is incorporated outside the United States.

Alzheimer's Disease

Apparent Authority

The appearance or the assumption of authority based on the actions, words, or deeds of the principal or because of circumstances the principal created.

Approved Amount

Assignment

Attained Age

Attending Physician's Statement (APS)

Avoidance

Beneficiary

Benefit Period

Boycott

An unfair trade practice in which one person refuses to do business with another until he or she agrees to certain conditions.

Buyer's Guide

Cafeteria Plan

Carriers

Cease and Desist Order

A demand of a person to stop committing an action that is in violation of a provision.

Certificate of Authority

Certificate of Insurance

Claim

Coercion

An unfair trade practice in which an insurer uses physical or mental force to persuade an applicant to buy insurance.

Coinsurance

An agreement between an insurer and insured in which both parties are expected to pay a certain portion of the potential loss and other expenses.

Coinsurance Clause

Commissioner

Concealment

The withholding of known facts which, if material, can void a contract.

Conditional Contract

A type of an agreement in which both parties must perform certain duties and follow rules of conduct to make the contract enforceable.

Consideration

The binding force in a contract that requires something of value to be exchanged for the transfer of risk. The consideration on the part of the insured is the representations made in the application and the payment of premium; the consideration on the par

Consideration Clause

Consumer Report

Contract

An agreement between two or more parties enforceable by law.

Coordination of Benefits

Copayment

Custodial Care

Death Benefit

The amount payable upon the death of the person whose life is insured.

Deductible

Defamation

An unfair trade practice in which one agent or insurer makes an injurious statement about another with the intent of harming the person's or company's reputation.

Director

Disability

A physical or mental impairment, either congenital or resulting from an injury or sickness.

Disability Income Insurance

Disclosure

An act of identifying the name of the producer, representative or firm, limited insurance representative, or temporary insurance producer on any policy solicitation.

Domestic Insurer

An insurance company that is incorporated in the state.

Domicile of Insurer

Insurer's location of incorporation and the legal ability to write business in a state.

Elimination Period

Emergency

Enrollment Period

Estoppel

A legal impediment to denying a fact or restoring a right that has been previously waived.

Excess Charge

Expiration

Exposure

A unit of measure used to determine rates charged for insurance coverage.

Express Authority

The authority granted to an agent by means of the agent's written contract.

Fair Credit Reporting Act

Fiduciary

An agent/broker who handles insurer's funds in a trust capacity.

Foreign Insurer

An insurance company that is incorporated in another state.

Fraternal Benefit Societies

Fraud

Free Look

Grace Period

Group Health Insurance

Hazard

A circumstance that increases the likelihood of a loss.

Hazard, Moral

The effect of a person's reputation, character, living habits, etc. on his/her insurability.

Hazard, Morale

The effect a person's indifference concerning loss has on the risk to be insured.

Hazard, Physical

A type of hazard that arises from the physical characteristics of an individual, such as a physical disability due to either current circumstance or a condition present at birth.

Health Insurance

Health Maintenance Organization (HMO)

Health Reimbursement Accounts (HRAs)

Health Savings Accounts (HSAs)

Hospice

A facility for the terminally ill that provides supportive care such as pain relief and symptom management to the patient and his/her family. Hospice care is covered under Part A of Medicare.

Implied Authority

Authority that is not expressed or written into the contract, but which the agent is assumed to have in order to transact the business of insurance for the principal.

Indemnify

Insurability

Insurance

A contract whereby one party (insurer) agrees to indemnify or guarantee another party (insured) against a loss by a specified future contingency or peril in return for payment of a premium.

Insured

The person or organization that is protected by insurance; the party to be indemnified.

Insurer

Insuring Clause

Intermediaries

Intermediate Care

Lapse

Law of Large Numbers

A principle stating that the larger the number of similar exposure units considered, the more closely the losses reported will equal the underlying probability of loss.

Limited Policies

Limiting Charge

Lloyd's Associations

Organizations that provide support facilities for underwriters or groups of individuals that accept insurance risk.

Long

Long Term Disability Insurance

Loss

The reduction, decrease, or disappearance of value of the person or property insured in a policy, by a peril insured against.

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Medicaid

Medical Information Bureau (MIB)

Medicare

Medigap

Misrepresentation

A false statement or lie that can render the contract void.

Morbidity Rate

Multiple

Mutual Companies

Insurance organizations that have no capital stock, but are owned by the policyholders.

Noncancelable

Nonrenewal

A termination of a policy by an insurer on the anniversary or renewal date.

Nonresident Agent

Notice of Claim

A provision that spells out an insured's duty to provide the insurer with reasonable notice in the event of a loss.

Omnibus Budget Reconciliation Act

Out

Payment of Claims

Peril

The cause of a possible loss.

Personal Contract

Policyholder

Policyowner

The person who is entitled to exercise the rights and privileges in the policy. This person may or may not be the insured.

Preferred Provider Organization (PPO)

Premium

A periodic payment to the insurance company to keep the policy in force.

Primary Policy

A basic, fundamental insurance policy which pays first with respect to other outstanding policies.

Private Insurance

Insurance furnished by nongovernmental insuring organizations.

Producer

Proof of Loss

Provider

Pure Risk

The uncertainty or chance of a loss occurring in a situation that can only result in a loss or no change.

Rebating

Any inducement offered in the sale of insurance products that is not specified in the policy.

Reciprocity

Reduction

Lessening the possibility or severity of a loss.

Reinsurance

A form of insurance whereby one insurance company (the reinsurer) in consideration of a premium paid to it, agrees to indemnify another insurance company (the ceding company) for part or all of its liabilities from insurance policies it has issued.

Representations

Statements made by the applicant on the insurance application that are believed to be true, but are not guaranteed to be true.

Rescission

Reserve

Respite Care

Rider

Risk

Uncertainty as to the outcome of an event when two or more possibilities exist.

Risk, Pure

The uncertainty or chance of a loss occurring in a situation that can only result in a loss or no change.

Risk, Speculative

The uncertainty or chance of a loss occurring in a situation that involves the opportunity for either loss or gain.

Short

Short

Sickness

Stock Companies

Companies owned by the stockholders whose investments provide the capital necessary to establish and operate the insurance company.

Subrogation

Substandard Risk

Superintendent (Commissioner, Director)

The head of the state department of insurance.

Terminally Ill

Twisting

A form of misrepresentation in which an agent persuades an insured/owner to cancel, lapse, or switch policies, even when it's to the insured's disadvantage.

Underwriter

A person who evaluates and classifies risks to accept or reject them on behalf of the insurer.

Underwriting

The process of reviewing, accepting or rejecting applications for insurance.

Unilateral Contract

A contract that legally binds only one party to contractual obligations after the premium is paid.

Utmost Good Faith

The fair and equal bargaining by both parties in forming the contract, where the applicant must make full disclosure of risk to the company, and the insurance company must be fair in underwriting the risk.

Waiting Period

Time between the beginning of a disability and the start of disability insurance benefits.

Waiver

The voluntary abandonment of a known or legal right or advantage.

Warranty

A material stipulation in the policy that if breached may void coverage.

Workers Compensation

Benefits required by state law to be paid to an employee by an employer in the case of injury, disability, or death as the result of an on-the-job hazard.