The definitions in this glossary are developed by the NAIC Research and Actuarial Department staff based on various insurance references. These definitions represent a common or general use of the term. Some words and/or phrases may be defined differently by other entities, or used in a context such that the definition shown may not be applicable. naic.org
Accident – an unexpected event or circumstance without deliberate intent.
Accident Insurance – insurance for unforeseen bodily injury.
Accident Only – an insurance contract that provides coverage, singly or in combination, for death, dismemberment, disability, or hospital and medical care caused by or necessitated as a result of accident or specified kinds of accident.
Accident Only or AD&D – policies providing coverage, singly or in combination, for death, dismemberment, disability, or hospital and medical care caused by or necessitated as a result of accident or specified kinds of accidents. Types of coverage include student accident, sports accident, travel accident, blanket accident, specific accident or accidental death and dismemberment (AD&D).
Accidental Bodily Injury – unexpected injury to a person.
Accidental Death & Dismemberment – an insurance contract that pays a stated benefit in the event of death and/or dismemberment caused by accident or specified kinds of accidents.
Accumulation Period – period of time insured must incur eligible medical expenses at least equal to the deductible amount in order to establish a benefit period under a major medical expense or comprehensive medical expense policy.
Actual Cash Value – repayment value for indemnification due to loss or damage of property; in most cases it is replacement cost minus depreciation
Actuarial Report – (PC Insurance)a document or other presentation, prepared as a formal means of conveying to the state regulatory authority and the Board of Directors, or its equivalent, the actuary’s professional conclusions and recommendations, of recording and communicating the methods and procedures, of assuring that the parties addressed are aware of the significance of the actuary’s opinion or findings and that documents the analysis underlying the opinion. (In Life and Health) this document would be called an “Actuarial Memorandum.”
Actuary – business professional who analyzes probabilities of risk and risk management including calculation of premiums, dividends and other applicable insurance industry standards.
Adjuster – a person who investigates claims and recommends settlement options based on estimates of damage and insurance policies held.
Admission – hospital inpatient care for any medical condition.
Admitted Assets – insurer assets which can be valued and included on the balance sheet to determine financial viability of the company.
Admitted Company – an insurance company licensed to do business in a state(s), domiciled in an alternative state or country.
Advance Premiums – occur when a policy has been processed, and the premium has been paid prior to the effective date. These are a liability to the company and not included in written premium or the unearned premium reserve.
Adverse Selection – the social phenomenon whereby persons with a higher than average probability of loss seek greater insurance coverage than those with less risk.
Advisory Organization – a group supported by member companies whose function is to gather loss statistics and publish trended loss costs.
Affiliate – a person or entity that directly, or indirectly, through one or more other persons or entities, controls, is controlled by or is under common control with the insurer.
Agent – an individual who sells, services, or negotiates insurance policies either on behalf of a company or independently.
Aggregate – the maximum dollar amount or total amount of coverage payable for a single loss, or multiple losses, during a policy period, or on a single project.
Aggregate Cost Payments – method of reimbursement of a health plan with a corporate entity that directly provides care, where (1) the health plan is contractually required to pay the total operating costs of the corporate entity, less any income to the entity from other users of services, and (2) there are mutual unlimited guarantees of solvency between the entity and the health plan that put their respective capital and surplus at risk in guaranteeing each other.
Aircraft – coverage for aircraft (hull) and their contents; aircraft owners’ and aircraft manufacturers liability to passengers, airports and other third parties.
ALAE – an estimate of the claims settlement associated with a particular claim or claims.
Alien Company – an insurance company formed according to the laws of a foreign country. The company must conform to state regulatory standards to legally sell insurance products in that state.
Allied Lines – coverages which are generally written with property insurance, e.g., glass, tornado, windstorm and hail; sprinkler and water damage; explosion, riot, and civil commotion; growing crops; flood; rain; and damage from aircraft and vehicle, etc.
All-Risk – also known as open peril, this type of policy covers a broad range of losses. The policy covers risks not explicitly excluded in the policy contract.
Alternative Workers’ Compensation – other than standard workers’ compensation coverage, employer’s liability and excess workers’ compensation (e.g., large deductible, managed care).
Ambulatory Services – health services provided to members who are not confined to a health care institution. Ambulatory services are often referred to as “outpatient” services.
Annual Statement – an annual report required to be filed with each state in which an insurer does business. This report provides a snapshot of the financial condition of a company and significant events which occurred throughout the reporting year.
Annuitant – the beneficiary of an annuity payment, or person during whose life and annuity is payable.
Annuities – Immediate Non-variable – an annuity contract that provides for the fixed payment of the annuity at the end of the first interval of payment after purchase. The interval may vary, however the annuity payouts must begin within 13 months.
Annuity – a contract providing income for a specified period of time, or duration of life for a person or persons.
Appraisal – an estimate of value.
Arbitration – a binding dispute resolution tactic whereby a conciliator with no interest in the outcome intercedes.
Assessed Value – estimated value for real or personal property established by a taxing entity
Asset – probable future economic benefits obtained or controlled by a particular entity as a result of past transactions or events. An asset has three essential characteristics: It embodies a probable future benefit that involves a capacity, singly or in combination with other assets, to contribute directly or indirectly to future net cash inflows; A particular entity can obtain the benefit and control others’ access to it; and The transaction or other event-giving rise to the entity’s right to or control of the benefit has already occurred.
Asset Risk – in the risk-based capital formula, risk assigned to the company’s assets.
Assigned Risk – A governmental pool established to write business declined by carriers in the standard insurance market.
Assisted Living Care – a policy or rider that provides coverage only while a policyholder is confined to an assisted living facility and meets the policy requirements for coverage.
Assumed Reinsurance – the assumption of risk from another insurance entity within a reinsurance agreement or treaty.
Authorized Company – an insurer licensed or admitted to do business in a particular state.
Authorized Control Level Risk Based Capital – theoretical amount of capital plus surplus an insurance company should maintain.
Authorized Reinsurance – reinsurance placed with a reinsurer who is licensed or otherwise allowed to conduct reinsurance within a state.
Auto Liability – coverage that protects against financial loss because of legal liability for motor vehicle related injuries (bodily injury and medical payments) or damage to the property of others caused by accidents arising out of ownership, maintenance or use of a motor vehicle (including recreational vehicles such as motor homes). Commercial is defined as all motor vehicle policies that include vehicles that are used primarily in connection with business, commercial establishments, activity, employment, or activities carried on for gain or profit. No Fault is defined by the state concerned.
Auto Physical Damage – motor vehicle insurance coverage (including collision, vandalism, fire and theft) that insures against material damage to the insured’s vehicle. Commercial is defined as all motor vehicle policies that include vehicles that are used in connection with business, commercial establishments, activity, employment, or activities carried on for gain or profit.
Automobile Liability Insurance – coverage for bodily injury and property damage incurred through ownership or operation of a vehicle.