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Glossary | ADA-Sponsored Insurance Plans Resource Center - Great-West Life Financial

Glossary

Assignment
The legal transfer of total or partial ownership of an insurance policy, for purposes of benefit payment. See Collateral Assignment.

Beneficiary
The person (or entity) to whom the proceeds of an insurance policy are payable when the insured dies. In certain cases, a trust may be your designated beneficiary.

Benefit
The amount payable by the insurance company, as stipulated in your policy. Depending on the nature of the coverage, the benefit may be paid directly to you, your beneficiary or assignee, or the provider/institution that renders service.

Certificate
The written contract between a group and the insurance company that is issued to individual insured members of the group. The Certificate outlines the essential features of your coverage, along with the terms and provisions of the policy. Generally applies to group insurance only. See Policy and Policyholder.

Certificate holder
The person to whom a Certificate of Insurance is issued unless otherwise assigned.

Claim
A request or demand for payment of benefits under the terms of your insurance policy.

Coinsurance
A shared financial burden in which you and your insurer share the cost of claims by a predetermined ratio. For example, in an 80/20 coinsurance arrangement, 80% is paid by the insurance company, and 20% is paid by you. Generally applies to medical and dental insurance only.

Collateral assignment
The assignment of a policy to a creditor as security for a debt.

Coordination of Benefits (COB)
The cooperative method by which multiple insurance carriers manage benefits to avoid duplication in payment when an insured is covered by more than one policy. Generally applies to medical, dental, and disability insurance only.

Copay (or Co-pay)
An out-of-pocket payment, usually required by the insurance company, that you are required to make at the time service or treatment is rendered. Generally applies to medical and dental insurance only.

Deductible
An out-of-pocket amount you agree to pay before the policy provides benefits. In general, the larger your deductible, the lower your insurance premium.

Exclusion
Specific items or circumstances not covered by your insurance policy. For example, death from war, suicide, or self-inflicted injury are exclusions for cause of death in the Accidental Death Option for the Term Life Plan.

Guaranteed issue
Coverage that the insurance company will guarantee to issue, or for which you will qualify (pending eligibility), without providing proof of insurability. See Proof of Good Health and Proof of Insurability.

In force (or Inforce)
The status under which your insurance policy is “active” and legally binding.

Insurability
Personal conditions (such as your health, age, occupation, income, life expectancy, etc.) that determine your risk factor and ability to qualify for insurance coverage.

Lapse
Termination of your policy because of failure to pay the required premium. See Out of Force.

Level premium
A premium that remains the same throughout the life of your policy, or for an identified period of time.

Liability
Your legally enforceable obligations, which may include compensation for damages to someone else’s person or property.

Medical evidence
Any statements by you and/or your personal physician, laboratory test results, or medical records and reports that help the insurance company determine your insurability when applying for life, medical, or disability coverage, or your eligibility for a benefit when you file a claim.

Out of force
A policy that is no longer legally binding, usually because its time period has expired or because it has terminated due to failure to pay premiums. A policy may also go out of force if terminated at your request, upon your death, or if you fail to satisfy eligibility requirements.

Own occupation coverage
Disability coverage that is defined (and for which benefits are payable) relative to your specific occupation or profession. By contrast, “any occupation” coverage is payable only if you cannot work in any occupation for which you are reasonably suited by education, training, and/or experience. This is an important distinction in disability insurance.

Policy
An insurance contract.

Policyholder
You, or the person who holds (or owns) an insurance policy. In group insurance, the group holds the policy, and individual members of the group receive coverage (and a Certificate) that is based on the terms and provisions of the group contract. See Certificate; Certificate Holder; and Policy.

Premium
The periodic payment you make to keep an insurance policy in force. Premium, also known as the cost of insurance, is paid in advance of your coverage period. Payment frequency will vary by policy, but is typically monthly, quarterly, semi-annually, or annually.

Proof of good health
Written evidence that you are insurable according to the general underwriting standards of the insurance company. See Insurability and Medical Evidence.

Reimbursement coverage
Insurance policies that reimburse you (or a service provider) for the exact expenses you incur. For example, business overhead expense insurance will reimburse you for certain office expenses while you are totally disabled.

Reinstatement
The resumption of coverage (according to the same parameters) under a policy that had previously terminated or gone out of force. See Lapse and Out of Force.

Rider
An attachment or supplemental agreement that adds something to a standard insurance policy whereby the conditions of the coverage are expanded or some conditions of the coverage are waived and are therefore not covered. Issued on a case-by-case basis, a rider can be either restrictive (offered as a way for the insurance company to consider you an acceptable risk) or additive (offered to provide additional coverage for items/circumstances not generally insured).

Renewal guarantee
A clause that sets conditions under which you can automatically renew coverage. Many insurance policies offer guaranteed renewability as long as you satisfy its eligibility requirements and pay premiums when due.

Residual benefits
A term used in disability insurance to describe benefits that are paid when you are partially disabled.

Suspension of benefits
The status under which your insurance coverage will continue, but no benefits will be paid and perhaps no premiums will be due, usually after maximum benefits have been paid for a particular condition.

Underwriting
The process of evaluating your insurability, level of coverage, and/or premium rates based on a review of your medical evidence and/or financial status.

Waiver
An amendment or rider to a policy that excludes payment of benefits under certain conditions. For example, some homeowner’s insurance policies will exclude claims for property damage caused by flood.

Waiver of premium
An agreement that suspends or “waives” payment of premium during a period of disability or other defined event.

Waiting period
The time, typically counted in consecutive days, that must elapse from the date of incident (or first coverage) until you can begin to receive benefits. Your waiting period options will vary by insurance type, but in general, the longer the waiting period, the lower your premium.

Dentists:This website is not a contract. Benefits provided under respective Group Policy Nos. (104TLP Annually Renewable Term Life, 1105GDH-IPP Disability Income Protection, 1106GDH-OEP Office Overhead Expense Disability, 104GUL Universal Life, 104LTLP Level Term Life, 1117GH-HIP Hospital Indemnity, 1127GH-CIP Critical Illness, and 1107GH-MCP MedCASHSM) issued to the American Dental Association, underwritten by Great-West Financial, and filed in accordance with and governed by Illinois law. The ADA is entitled to receive royalties from the ADA Members Insurance Plans. Coverage is available to all eligible ADA members residing in any U.S. state or territory. Level Term Life premiums are fixed based on the selected duration of 10 or 20 years. Must maintain membership throughout selected term. Annually Renewable Term Life, Hospital Indemnity, Critical Illness, and MedCASH premiums increase annually based on age. Recommended premiums under the Term Plus® Universal Life plan consist of the cost of insurance (which may vary based on the member’s age and coverage amount), the amount chosen by the member for deposit into his/her Policy Value Account and a service charge. Premium deposits may fluctuate or remain level depending upon the amount maintained in the Policy Value Account. Disability Income Protection premiums increase every 5 years and Office Overhead Expense every 10 years based on age. Premium credit for Annually Renewable Term Life and Term Plus Universal Life is not guaranteed but reevaluated annually. Premium credit for Disability Income Protection, Office Overhead Expense, Hospital Indemnity, Critical Illness, and MedCASH is not guaranteed but reevaluated semi-annually. Each Plan participant will receive a Certificate of Insurance explaining the terms and conditions of the policy.


Dental Students: This website is not a contract. Student coverage is issued regardless of your medical condition if you are under 45, but benefits are not payable, as defined by the respective policy, for death or disability resulting from a sickness, disorder, physical condition, or symptom that existed or was treated 12 months prior to enrollment. Benefits are provided under respective Group Policy Nos. (104TLP Annually Renewable Term Life and 1108GDH-SDP Student Disability) filed in the state of Illinois in accordance with and governed by Illinois law, issued to the American Dental Association, and underwritten by Great-West Life & Annuity Insurance Company. If you are 45 or older, you can apply for the no-cost coverage and all student program features by providing proof of good health. Coverage renews automatically each academic year. Each insurance plan participant will receive a Certificate of Insurance explaining the terms and conditions of the respective policy. Individuals may convert coverage to the plans for practicing dentists after graduation according to policy guidelines by paying ADA member premiums and maintaining ADA membership. See legal information above for the ADA-sponsored insurance plans for practicing dentists.


ADA® is a registered trademark of the American Dental Association.


Great-West Financial® refers to products and services provided by Great-West Life & Annuity Insurance Company, Greenwood Village, CO, its subsidiaries and affiliates. The trademarks, logos, service marks, and design elements used are owned by Great-West Life & Annuity Insurance Company. © 2017 Great-West Life & Annuity Insurance Company. All Rights Reserved. For website issues, contact the Webmaster at ADA_WebMaster@greatwest.com.

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