Accident and Sickness
Used interchangeably with weekly indemnity, weekly income and weekly disability to mean short-term income replacement because of disability due to accident or iIlness.
Actively at Work
A phrase used to define when coverage begins for an individual employee. Some contracts “tighten” the definition by requiring a period of being actively on the job and on the premises before coverage commences.
A person who becomes insured subsequent to the effective date of the group policy.
The manual of instructions provided by the insurer to the policyholder that outlines and explains those duties required of the plan administrator.
Administrative Service Only (ASO)
Services provided by an insurer or its subsidiary on a contract basis. Services may include actuarial, plan design, claim handling, benefit communications, financial advice, preparation of data for government reports or stop-loss coverage. The insurer provides these services for self-funded plans.
The tendency of persons with poorer than average health expectations to apply for or continue insurance coverage to a greater extent than persons with average or better-than-average health expectations.
Benefits with the maximum amount payable for specific services is itemized on the group contract.
Used to refer to the date one year (or more) following the effective date of the master contract. It is the target for renewal action such as rate increases and rate credits.
Pertains to the transfer of an insured's rights. In life insurance, it means conveying the benefits to a third party. Each carrier has its own rules for this. In the context of medical care, assignment means signing over reimbursement rights to a hospital or another supplier of care.
Association Group Insurance
Group insurance provided to a professional or trade association top rated eligible members under one master policy.
Automatic Restoration Provision
Generally included in a plan with maximum lifetime benefits. This provision reinstates all or a portion of used benefits each year.