Glossary

Money paid to the beneficiary if the insured person dies due to an accidental injury

Provides a lump-sum payment to the insured in the event of a covered accident

Pays a benefit if the insured suffers a covered loss or death due to an Accidental Injury

Coverage that employers provide to employees; term insurance coverage usually paid for by the employer

Dental care such as fillings, root canals, non-surgical extractions, periodontics; sometimes referred to as Type II procedures

Person who receives money from an insurance policy or investment account

Back-up beneficiary; person who receives the money from the life insurance policy if the first beneficiary dies before the insured

A beneficiary who can’t be changed without his or her permission

Amount of replacement income you receive if you become Totally Disabled; determined either as a percentage of your current income or as a specific dollar amount to be paid per week (short-term disability) or per month (long-term disability)

Length of time you continue to receive benefits, assuming you remain totally disabled; normally 13 or 26 weeks (up to 52 weeks in certain selected plans) for short-term disabilities and from 2 years to Social Security Normal Retirement Age for long-term disabilities

The list of what is covered under your plan and the benefits payable for those covered conditions. Also known as schedule of benefits.

Maximum dollar amount of benefits your plan will pay toward the cost of dental care over the course of a calendar year (i.e., January 1 to December 31)

An insurance policy that pays you a lump sum benefit (up to a maximum and subject to exclusions, limitations, waiting periods, and pre-existing conditions) upon diagnosis of a covered cancer condition

The portion of the cost of care that your dental plan is responsible for paying (you pay the rest)

When you change, or "convert," your group coverage to an individual policy

Amount of protection you have purchased. The maximum amount of money an insurance company will pay you if you make a claim for a loss or event covered by your policy.

An accident covered by the policy. If you experience a covered accident, you will receive a cash benefit according to the schedule of benefits. The amount you receive depends on your injury and your corresponding treatment. You may use this money however you wish—for example, to pay for prescriptions, crutches, or other out-of-pocket expenses as a result of a covered accident.

An insurance policy that pays you a lump sum benefit (up to a maximum and subject to exclusions, limitations, waiting periods, and pre-existing conditions) upon diagnosis of a covered critical illness condition

An insurance policy that provides coverage for covered conditions that include critical illness and cancer diagnoses (see definitions for "critical illness insurance" and "cancer insurance")

Money paid to the beneficiary when the person covered by the life insurance dies or, in the case of AD&D, when the insured dies due to a covered Accidental Injury

Amount you pay to the dentist before the insurance company starts to pay benefits

Insurance that is designed to pay a portion of the costs associated with dental care, so you have lower out-of-pocket expenses when you or your family visits the dentist.

A child who is dependent on the insured for support. A dependent child can be the insured's child (either natural or adopted)or stepchild of a Spouse or Domestic Partner, a foster child, or a grandchild. The maximum age and marital status requirements for eligible dependents varies based on plan provisions and applicable law. In addition, handicapped adult dependents may also be eligible. For more information on dependent eligibility, please refer to your group policy or booklet.

Replaces a portion of your income if you are totally disabled and cannot earn an income yourself for a qualifying period of time. As with other types of insurance, you make scheduled payments (called premium payments) to keep the coverage in place. The income amount, waiting period, and maximum amount of time the benefit will be paid will vary by plan.

Loss of a body part

Date you become covered by benefits

Allowed or qualified to participate in benefits

Amount of time (or waiting period) during which you are Totally Disabled between the first day of disability and the date you begin receiving benefits; for short-term disabilities, normally 7 or 14 days, and for long-term disabilities, 60, 90, or 180 days

A statement, or proof, of an employee’s or dependent’s medical history. It is used to determine whether or not coverage will be provided. In some cases, it may be required that you submit to a paramedical or other physical examination, at our expense, as part of the Evidence of Insurability. Also known as "proof of good health."

Something that is not covered by the plan

Tax-advantaged savings account that allows employees to contribute a portion of their earnings to pay for qualified expenses, such as medical or dependent care expenses. Subject to guidelines and maximums. An FSA is not the same as a Health Savings Account (HSA).

Insurance purchased through a group, such as an employer, an association, or a union

The maximum amount of insurance coverage you may elect without answering medical questions (providing Evidence of Insurability).

Tax-advantaged medical savings account used to help employees enrolled in High Deductible Health Plans (HDHP) pay for or receive reimbursement for certain medical expenses. Eligibility criteria apply.

A health insurance plan with a relatively high deductible and a relatively low premium. In the U.S., an HDHP is a requirement for a Health Savings Account (HSA) (which helps people pay the premium and certain medical expenses). Eligibility criteria apply.

A dentist who participates in your plan's dental network and whose charges are based on amounts negotiated by the network.

The person(s) covered by the policy

An insurance policy that pays a set amount to those named in the policy (the beneficiaries) when the insured dies.

The highest benefit amount that will be paid in one person’s lifetime

A plan provision that limits coverage

Provides replacement income for long-term or chronic disabilities. Benefits can last from two years to Social Security Normal Retirement Age

Dental care for bridges, dentures, partial dentures, crowns; sometimes referred to as Type III procedures

The highest possible amount of a benefit that may be issued per covered condition

Any person born between 1980 and 1995

Additional coverage that an employee can add on to basic life coverage; paid through payroll deductions

Detection, prevention, and correction of abnormalities in the positioning of the teeth in their relationship to the jaw; usually braces; sometimes referred to as Type IV procedures

A dentist not in your PPO network—you may incur higher out-of-pocket costs

Expenses that are not covered by insurance

Disability benefits that supplement your income if you return to work part-time or on a modified schedule during a covered disability

Group coverage that you can take with you, or “port,” after employment ends

A pre-existing condition can include any condition for which you, prior to the effective date of the policy, sought medical treatment, consultation, advice, care, or services; for which you took prescribed medications for the condition; or for which you had symptoms that a prudent person would consider significant enough to consult a health care provider. The lookback period for a pre-existing condition can range from a couple of months to a year prior to the effective date of the policy and should be explicitly stated within the policy. Having a pre-existing condition could limit the benefits payable to you.

Dental care such as X-rays, exams, prophylaxis (cleanings), fluoride, sealants; sometimes referred to as Type I procedures

Provides an additional lump sum benefit to Insureds who are diagnosed with a covered condition for which we previously paid a benefit. The diagnosis must be for a new event while the rider is in effect (not a re-diagnosis of the covered condition that was previously paid for), and a certain number of months must pass between diagnoses.

Clause or term added to your insurance policy to provide additional protection, usually for an additional cost, for risks not covered in a basic policy.

Income replacement for typically 13 or 26 weeks if you are Totally Disabled and cannot work (up to 52 weeks in certain selected plans).

Issued to provide coverage for a specified period, or "term." If the insured dies during the period that the policy is in force, the insurance benefit is payable. At the end of the term, the insurance protection ends. Term life is usually the most economical form of life insurance. Term life has no cash value. Most group life insurance purchased is term life insurance.

The fee dentists usually charge for dental services and procedures in a given geographic area

Life insurance where the employee funds the premium, usually through payroll deductions

Provides an annual benefit to help promote healthy lifestyles and early detection. Employees and covered spouses (not children) can receive a benefit once per calendar year, when they send us proof of a health screening like a mammogram, electrocardiogram, or diabetes test.