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Accumulation
Period: A period of consecutive
months that begins on the first day of disability
and during which the elimination period
must be satisfied.
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Association
Coverage: Group insurance
issued to an association rather than to
the employees of a business or members of
a union.
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Attending
Physician Statement (APS):
A report, completed by the proposed insured's
(or, in a claim situation, the insured's)
physician, which documents current and prior
health history. Used in the evaluation process
of approving an application (or claim).
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Automatic
Increase Rider: An optional
benefit which provides automatic increases
each year at either a stated percentage
or the Consumer Price Index, despite changes
in health, income or occupation.
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Benefit
Period: The longest period
of time for which benefits are payable for
continuous disability. Typical benefit periods
are 2 year, 5 year, to age 65 or lifetime.
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Business
Overhead Expenses: A policy
that reimburses a business owner for the
day-to-day expenses of the business in the
event of a disability. This type of policy
usually has a one or two year benefit period.
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Buy-Sell
Agreement: An agreement made
by the owners of a business to purchase
the share of a disabled or deceased owner.
The value of each owner's share of the business
and the exact terms of the buying and selling
process are established before death or
the onset of a disability.
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Conditional
Receipt:
A receipt given for premium payment
accompanying an application for insurance.
If the application is approved as applied
for, the coverage is effective as of the
date of prepayment or the date on which
the last of the underwriting requirements,
such as medical examination, has been fulfilled.
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Consumer
Price Index:
The Consumer Price Index for All
Urban Consumers as published by the Federal
Department of Labor. That index shows the
rate of change in the cost of living (inflation)
in the United States.
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Conversion
Privilege:
The right given to an insured person
to change insurance without evidence of
medical insurability, usually to an individual
policy, upon termination of coverage under
a group contract.
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Cost
of living Rider:
An optional benefit which provides
for increases in the disability benefit
during periods of disability. The amount
of increase is based on a pre-set percentage
or inflation.
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Cross-Purchase
Arrangement: An arrangement
between two or more business owners that
in the event of an owner's death or disability,
the remaining owner or owners will purchase
the business interest of the deceased or
disabled owner.
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Cumulative
Benefit: In an overhead
expense policy, the monthly benefit times
the number of months the insured has been
disabled after the elimination period.
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Earned
Income: Gross salary,
wages, commissions, fees, etc., derived
from active employment. This does not include
investment income, rents, or amounts received
from annuities or insurance policies.
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Elimination
Period: The consecutive
number of days for which no benefits are
payable at the start of a claim. An insured
must be disabled all of those days before
benefits are payable. Typical elimination
periods are 30, 60, 90, 180 or 365 days.
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Exclusions:
Certain conditions and causes which are
not covered by the policy. These are listed
in the policy.
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Future
Increase Option: An optional
benefit in a disability income policy that
allows the insured future increases to the
policy monthly benefit at specified dates
(typically on insured's policy anniversary),
with a requirement of only financial (and
not medical) insurability.
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Graded
Premium:
A premium structure where premiums
start out low and increase each year. If
the insured starts with a graded premium,
they may change to a level premium on a
policy anniversary. Premiums will then be
based on attained age.
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| Group
Insurance:
A policy covering the employees of
a business or members of a union. |
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Guaranteed
Renewable: A type of insurance
which cannot be cancelled or altered by
the insurance company as long as the insured
continues to pay premiums on time. However,
the premium may be increased for classes
of insureds.
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Income:
Gross earned income, less business expenses,
but before any other deductions. Income
includes salaries, wages, fees, commissions,
bonuses, business profits or other payments
for personal services. It does not include
unearned income from savings, investments,
or real property.
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Indexing:
A provision which increases the insured's
pre-disability earnings every year according
to a given formula, so residual disability
benefits will not lose purchasing power
because of inflation.
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| Level
Premium:
A premium which remains the same through
the insured's age 65. |
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Lifetime
Disability Benefit: A benefit
that is payable for the lifetime of the
insured if continuously and totally disabled
before a specified age (i.e., 45 or 55).
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Loss
of Income:
The difference between an insured's
prior income and current income. In better
policies, if the loss of income is more
than 75% of prior income, the loss is deemed
to be 100% for purposes of the Residual
Disability Rider.
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| Loss
Payee: The individual or
entity named to receive all benefits. |
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| Monthly Indemnity:
The amount the insurer will pay for each month
of total disability. |
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Non-Cancelable:
A policy which cannot be cancelled or altered
by the insurance company as long as the
insured continues to pay premiums on time,
and whose premium will not increase up through
the insured's age 65.
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| Occupation:
An insured's regular occupation or profession
at the time of becoming disabled. |
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| Optional Benefit:
An additional benefit offered by the insurance
company to certain occupational classes which
may be included in a policy at the applicant's
request, for an additional premium. |
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| Owner:
As named in the policy schedule page, the
owner's rights include, but are not limited
to, the right to renew the policy and to request
any change in benefits. |
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| Own Occupation:
A term that defines the most liberal wording
of the total disability contractual
provision. The insured will be considered
totally disabled even if they are at work in
some other capacity so long as they are not
able to work in their occupation. |
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| Partial Disability:
An insured's physical inability to perform
some, but not all, of the duties of his or
her regular occupation due to sickness or
injury. |
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Participation
Limit: The total amount of coverage
which will be allowed by a company from
all carriers.
Policy:
All material which constitutes the contract
of insurance.
Policy Term:
The effective period of the policy,
usually the period for which premiums
are paid.
Pre-Disability Earnings:
The earnings level of the insured prior
to the onset of disability.
Pre-Existing Condition:
An injury, illness, or physical condition
which existed prior to the issue of the
disability policy.
Presumptive
Disability: The presumption
that the insured is totally disabled, even
if still at work, if sickness or injury
results in the total and complete loss of
sight in both eyes, hearing in both ears,
power of speech, or use of any two limbs.
The elimination period is waived from the
date of the loss and total disability benefits
are payable while such loss continues until
the end of the benefit period.
Prior
Expenses:
An insured's average monthly
expenses for the same tax year on which
his or her prior income is based for purposes
of the residual disability rider.
Prior
Income: The insured's
average monthly income for the tax year
with the highest earnings in the three years
just prior to the date on which he or she
became disabled.
Recovery
Disability Rider: A rider which
provides reduced benefits when and insured
returns to work following a compensable
period of total disability. Recurrent Periods
of Disability: In some policies, recurrent
periods of disability from the same cause
or causes will be considered one continuous
period of disability unless each period
is separated by a recovery of six months
or more.
Rehabilitation
Benefit: A benefit paid
to help meet some of the costs an insured
may incur by enrolling in a rehabilitation
program for the purpose of returning to
his or her occupation.
Residual
Disability: In better
policies, a disability that causes an
insured's income to fall more than 20%
below its pre-disability level. Some
companies include a loss of time
requirement or the inability to perform
some duties of the insured's regular
occupation.
Social Insurance Substitute
Rider: A rider which pays
a benefit if the insured is disabled under
the policy and not receiving social insurance
benefits.
State
Disability Benefit Insurance Laws:
Laws enacted in California, Hawaii, New
Jersey, New York and Rhode Island which
provide the payment of benefits for the
non-job-related sickness or injury.
Total
Disability: The physical
or mental inability to perform the major
duties of one's occupation because of sickness
or injury.
Transplant
Donor Benefit:
In some policies, the provision that the
insured will be considered disabled as a
result of complications incurred during
a transplant or donor surgery.
Waiting
Period: The consecutive
number of days for which no benefits are
payable at the start of a claim. An insured
must be disabled all of those days before
benefits are payable. Typical elimination
periods are 30, 60, 90, or 180 days.
Waiver
of Elimination Period:
In some policies, the elimination period
will be waived if an insured becomes disabled
within five years after the end of a period
of disability which lasted longer than six
months and for which benefits were paid.
Waiver
of Premium: In some policies,
a provision which relieves the insured of
having to make premium payments after he
or she has been disabled for 90 days, or
the elimination period, if shorter. In addition,
premiums paid during those 90 days are refunded
and premiums due during the 90 days after
recovery are waived.
Worker's
Compensation: Benefits
paid to a worker to compensate for losses
caused by a work-related injury or illness.
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