Exclusive Provider Organization System
A network of medical care providers structured in a similar manner to a PPO but have many of the requirements of an HMO.
Exculpatory Agreement or Clause
Pre-event exoneration of the fault of one party that results in any loss or specified loss to another.
Expected Loss Rate
When computing workers compensation experience modifications, the factor taken from actuarial tables used to calculate total expected losses for the specific classification given the audited
Expected Losses
Projection of the frequency and/or severity of losses based on loss history, probability distributions, and statistics; the expected loss projection is commonly called a “loss
Expected Mortality
The expected incidence of death within a given group during a given period of time, as shown in a mortality table developed by actuaries.
Expense Constant
Expense factor (usually expressed as a dollar amount) added to the premium charged for a class of policies that would otherwise produce insufficient premium to
Expense Ratio
A ratio that indicates the percentage of premiums used to pay the insurers’ operating expenses.
Experience Account
An account held by an insurer funded through the initial premium and subsequent premium deposits, if any.
Experience Modifier
Factor developed by measuring the difference between the insured’s actual past experience and the expected experience of the class. The factor may be either a
Experience Rating
A rating that considers the individual loss experience of a particular insured. It applies loss experience to the present policy year. Describes any plan that
Experience-based Allocation Method
Each unit is assigned costs on an equitable basis based on the loss experience each unit presents.
Experienced Mortality
The mortality that actually occurs to a group of insureds in contrast to expected mortality.
Exposure
A situation, practice or condition that may lead to an adverse financial consequence; an activity or resource; people and assets
Exposure-based Allocation Method
Each unit is assigned costs on an equitable basis based on the exposures each unit presents.
Express (Actual) Authority
Authority expressly given by the insurer, either orally or in writing.
Extended Death Benefit
A group policy provision that pays a life benefit when (1) the insured is totally and continuously disabled at the time the policy owner stops
External Financing
Using other funds other than the organization’s funds for the financing of losses, e.g. insurance, borrowing and contractual transfer.
Face Amount
The amount of coverage provided by a life insurance policy, also referred to as coverage amount or death benefit.
Facultative Reinsurance
A form of reinsurance using offer and acceptance of individual risks, in which under a contract of reinsurance, the reinsurer retains the faculty to accept
Family and Medical Leave Act of 1993
A federal regulation that provides employees who have been employed at least 12 months and have worked at least 1,250 hours within that 12 month
Family Member
A person related to the insured by blood, marriage, or adoption who is a resident of the insured’s household.
Fiduciary
1) under common law, liability imposed upon a party who stands in a special relationship of trust with another party for a breach of that
FIFO
An accounting method used to value inventory and the cost of goods sold. Sales are considered to be made against the earliest-purchased or produced merchandise
Finance
Process of managing an organization’s assets, liabilities, and cash flows to maximize shareholder (or stakeholder) wealth.
Financial Risks
Risks related to an organization’s financial activities resulting in upside and downside outcomes.
Finite Risk Insurance
Used by primary insurance companies and large self-insurers; the accepted term used to describe a spectrum of loss financing concepts that combine internal and external
First In, First Out
An accounting method used to value inventory and the cost of goods sold. Sales are considered to be made against the earliest-purchased or produced merchandise
First To Die
Insurance policy on two lives, with a death benefit to be paid to the surviving insured upon the death of one of the insureds (also
Fixed Cost
Costs that do not vary with the level of output, especially fixed financial costs such as interest, lease payments, and sinking fund payments.
Fixed-Amount Installments
Fixed, periodic benefit payments are made until the principal and interest are exhausted.
Fixed-Period Installments
Benefits are guaranteed to be paid in equal installments for a specified period of time.
Fixed-Term Life Insurance
Insurance that pays out a death benefit when the life insured dies during the term of the policy.
Flexible Premium Variable Life
A whole life contract and a security vehicle that features flexible premium payments, non-guaranteed cash values and either a minimum guaranteed death benefit or no
FMLA
A federal regulation that provides employees who have been employed at least 12 months and have worked at least 1,250 hours within that 12 month
Force Majeure
In the law of insurance, a superior or irresistible force. Also common to construction contracts to protect parties in the event that a part of
Foreign Insurer
Insurer domiciled outside a state that operates in that state under a certificate of authority granted by that state’s insurance department. A foreign insurer may
Fraud
An intentional manipulation of the truth, and the act of getting someone to rely on that manipulation of the truth, which results in the person’s
Free Look
A period of time (usually 10, 20 or 30 days) during which a policy owner may examine a newly issued policy of life and surrender
Fronting
Use of one insurance company, usually a domestic, admitted carrier, to issue policies on behalf of the captive.
FSA
A healthcare reimbursement account that allows employees to set aside money through payroll deductions on a pre-tax basis to pay for anticipated eligible medical expenses,
Fully Insured Plan
A plan where the policyholder (individual or employer) pays a defined premium to an insurer and does not share in the risk associated with actual
Fully Self-insured
Used by larger organizations to assume management of all exposures; useful when losses for both frequency and severity are very predictable and often used in
Fully Self-Insured Plan
Employer retains 100% of the cost of claims. Because there is no reinsurance protection most employers choose a partially self-funded financial arrangement.
Functional Replacement Cost
Cost to repair or replace damaged or destroyed property with materials that are functionally the equivalent of the damaged or destroyed property.
Funded Reserves
The setting aside of sufficient sums of money to meet future liabilities.
GAAP
Principles in financial accounting that serve to assure consistency in financial reporting. GAAP is a type of self-regulation in that members of the financial accounting
General Damages
An award based on a measure of intangible damages inferred from the Special Damages and other facts and circumstances (e.g., pain and suffering).
General Partnership
A partnership in which each general partner may act on behalf of the partnership and is personally liable for the partnership’s obligations.
Generally Accepted Accounting Principles
Principles in financial accounting that serve to assure consistency in financial reporting. GAAP is a type of self-regulation in that members of the financial accounting
Good Faith
As related to the Business Judgment Rule, a decision must be made with an honest belief that the decision is in the best interest of
Goodwill
1) In accounting, the difference between the market price paid for an asset an organization and its book value; 2) in common usage, customer relationship
Government Accounting
Non-commercial accounting system that features accounts for budgets, encumbrances and restricted use assets. Also called “fund accounting.”
Grace Period
A prescribed period, usually 30 to 31 days after the premium due date, during which an insurance contract stays in force and the overdue premium
Graded Death Benefits
Death benefits that, in the early years of the contract for an otherwise uninsurable individual, are less than the face amount of the policy, but
Graded Premium
A modified life insurance policy for which the initial premium is low, and then increases in steps over a period of time (usually five years),
Gross Premium
The premium for participating life insurance. If an insured elects to use his dividends to pay premiums, the gross premium becomes the net premium when
Gross Written Premium
The annual premium showing on the policies, collected on a gross basis. For a captive, GWP is the annual pay-in of premium by the organization(s).
Group Captive
Owned by multiple, unrelated organizations who are the policyholders; owners may be either homogeneous or heterogeneous.
Group Model HMO
A single multi-specialty medical group contracted with an HMO to provide care to the HMO’s insureds.
Group Purchasing Arrangement
Any of a wide array of arrangements in which two or more small employers purchase health insurance collectively, often through a common intermediary who acts
Guaranteed Convertible
Insurer guarantees to convert into a different type of policy at the request of the policy owner.
Guaranteed Cost Plan
An insurance plan for which a fixed premium for the policy term, subject to audit, is paid by the insured regardless of the number and
Guaranteed Insurability Rider
Sometimes called Guaranteed Purchase Option, an option that allows an insured or owner to buy additional coverage at certain times even though he or she
Guaranteed Rates
Guarantees the premium rates will not change during the entire term of the policy.
Guaranteed Renewable
Guarantees an insurance policy will continue in force, provided the policy premiums are paid on time.
GWP
The annual premium showing on the policies, collected on a gross basis. For a captive, GWP is the annual pay-in of premium by the organization(s).
Hazard
A condition or circumstance that may give rise to a loss from a given peril; physical, moral, or morale characteristics that make the likelihood of
HDHP
A plan that requires employees to bear a greater financial burden in their healthcare by requiring a larger amount of expenses be paid by the
Health Insurance Portability and Accountability Act of 1996
A federal law that provides rights and protections for employees and their covered dependents in group health plans that limit exclusions for pre-existing conditions; prohibit
Health Maintenance Organization System
Provides a comprehensive benefits package including physician visits, laboratory services, hospitalization and surgery, and focuses on preventive care, early diagnosis and outpatient treatment. An HMO
Health Reimbursement Account
An account owned, maintained and funded by the employer to pay Qualified Medical Expenses for employees.
Health Savings Account
A tax-saving plan for individuals and employees participating in High Deductible Health Plans to save and pay for Qualified Medical Expenses. HSA funds may also
Healthcare Flexible Spending Account System
A healthcare reimbursement account that allows employees to set aside money through payroll deductions on a pre-tax basis to pay for anticipated eligible medical expenses,
High Deductible Health Plan
A plan that requires employees to bear a greater financial burden in their healthcare by requiring a larger amount of expenses be paid by the
HIPPA
A federal law that provides rights and protections for employees and their covered dependents in group health plans that limit exclusions for pre-existing conditions; prohibit
HMO
Provides a comprehensive benefits package including physician visits, laboratory services, hospitalization and surgery, and focuses on preventive care, early diagnosis and outpatient treatment. An HMO
Hold Harmless Agreement
Affirmative assumption of the financial consequences for liabilities of another through a contract. See Indemnification agreement.
Home Healthcare
Medical care provided by trained personnel in the patient’s home for patients who do not need the more extensive treatment provided by a hospital, skilled
HRA
An account owned, maintained and funded by the employer to pay Qualified Medical Expenses for employees.
HSA
A tax-saving plan for individuals and employees participating in High Deductible Health Plans to save and pay for Qualified Medical Expenses. HSA funds may also
IBNR
Represents the liability for unpaid claims not reflected in the case reserve estimates for individual losses. The two components to IBNR reserves are pure IBNR
Implementation
Implementing the desired actions and risk management plans; an element of the risk administration step of the Risk Management Process.
Implied Authority
Authority of the agent, which is not specifically expressed or communicated, but which is consistent with the agent fully exercising the express authority granted by
Incident
An event that disrupts normal activities and may become a loss, claim or business interruption.
Incidents of Ownership
Various rights a policy owner may exercise under the policy contract. Some of the incidents of ownership would be the rights to (1) cash in
Income Policy
A life insurance contract that provides income on a monthly basis, as opposed to a policy that pays proceeds in a lump sum.
Income Statement
A report of the organization’s financial performance for a stated time period.
Income Tax Expense
Tax treatment depends upon type of captive, premium volume, and investment income.
Incontestable Clause
A clause in a policy stating that after a policy has been in effect for a given length of time (generally one or two years),
Increased Limit Factors
Ratio applied to losses at one retention level (e.g. $1,000,000 per occurrence) to determine expected losses at another retention level (e.g., $5,000,000).
Incurred but Not Reported
Represents the liability for unpaid claims not reflected in the case reserve estimates for individual losses. The two components to IBNR reserves are pure IBNR
Incurred Expense
Expenses not yet paid. Can also include paid expenses in some accounting systems.
Incurred Loss Ratio
Portion of an earned premium dollar that is spent on incurred losses.
Incurred Losses
1) The total amount of paid claims and loss reserves associated with a particular period of time (usually a policy year). Generally, incurred losses are
Indemnification Agreement
Affirmative assumption of the financial consequences for liabilities of another through a contract. See Indemnification agreement.
Indemnify
To make compensation to an entity for incurred hurt, loss, or damage; restore to original position.
Indemnity
Restoring an injured party to the financial position they enjoyed prior to a loss; reimbursing an injured party suffering loss for the amount of the
Indemnity Plan
Also known as “fee-for-service plans”, provide a specified payment for medical services rendered regardless of the actual charges.
Independent Adjuster
Organization or a person hired by an insurer and paid a fee for settling claims.
Independent Agency System
A system of marketing insurance that involves self-employed parties (independent contractors (agents)) who enter into contracts with usually more than one insurer to represent the
Independent Contractor
Individual or entity that agrees to perform specific work for another but is not subject to direction or management by the person who contracted for
Independent Practice Association Model
Physicians that retain their individual practices and separate offices but belong to a legal entity for contracting purposes with HMOs.
Indexed Contracts
Contracts where the policy owner can share in a percentage of the growth of an indexed investment (a mutual fund tied to the Standard &
Indexed Ultimate Total Loss
What is an Indexed Ultimate Total Loss? Answer: Indexed Ultimate Total Loss are incurred losses that have been developed (trended) and indexed (adjusted) for inflation.
Indicated Retro Premium
Amount of premium calculated for any one period using the retrospective rating formula.
Indirect Loss
A loss or damage that results from an insured’s inability to use his/her property because of direct loss to the property of others.
Individual Health Insurance
Health insurance that is typically purchased by individuals who are self-employed, unemployed or work for a company that does not offer employee health benefits.
Individual Retirement Arrangement
A self-directed, tax-deferred retirement investment account established by employed workers who earn a salary, wage, or self-employment income. An individual may establish an IRA account
Inflation Index Factor
Premium loading to provide for future increases in claims costs and loss payments resulting from inflation.
Inflation Protection
A feature that increases the amount of an insurance benefit by a fixed percentage automatically every year, to adjust for inflation.
Insurability
General acceptability by an insurer of an applicant for insurance, based on underwriting review, which may include items such as the applicant’s current health status,
Insurable Interest
The existence of potential financial loss on the part of the policy owner and/ or beneficiary in the event of the death of the insured.
Insurance Agent
A person authorized by an insurer to solicit applications, collect premiums, and write policies on behalf of the insurer.
Insurance Broker
The insurance broker is an individual who acts or aids in the negotiation of insurance contracts, in placing risks, or in soliciting or effecting contracts.
Insurer
Insurance company that assumes risks for insureds and performs other insurance-related operations, such as loss control and claims settlements.
Intellectual Property
Property that has a value and lacks a physical existence, such as industrial property consisting of inventions, designs, or trademarks, or copyrights, such as artistic
Intentional Act
When an individual commits an act with the intent of causing injury, damages, or a private violation of another person’s rights.
Internal Financing
Using the organization’s funds for the financing of losses, e.g. deductibles, planned retentions, uninsured losses (planned or unplanned).
Internal Rate of Return (IRR)
The calculation of an “unknown” discount rate that makes the PV of future cash inflows exactly equal to the net investment at time zero; only
Internet
A global system of interconnected computer networks using a standard Internet protocol to access data and information available on the World Wide Web (www); a
Investment Income
Investment returns on invested funds (loss reserves, capital, and retained earnings).
IRA
A self-directed, tax-deferred retirement investment account established by employed workers who earn a salary, wage, or self-employment income. An individual may establish an IRA account
Irrevocable Beneficiary
A beneficiary that cannot be changed without the beneficiary’s consent.
Issue Date
The date an insurance policy is issued. This may also be the effective date of the policy coverage.
Joint and Several Liability
1) Legal doctrine applying in some states that allows an injured person to sue and recover the full amount from any one or more of
Joint Venture
Association of two or more individuals or organizations who engage in a specific or limited business transaction; a partnership between separate business organizations.
Joint-Life and Survivorship Annuity
An annuity that provides income to two or more people and continues in force as long as any one of them survives.
Joint-Life Annuity
Provides annuity payments to the annuitant until they die then to the named survivor for their life. Usually spouse, but could be anyone named.
Joisted Masonry Construction
Exterior walls of masonry material (adobe, brick, concrete, gypsum block, hollow concrete block, stone, tile, or similar materials) with combustible floor and roof.
Judgement Rate
A rate that is applied solely to individual insureds by the insurance company.
Juridical Risk
A general class of risk; risks arising from a jury or judge’s decision or from court or jury attitudes.
Kurtosis
In probability theory and statistics, a statistic that measures the degree of peakedness in a distribution; also known as a measure of the volatility of
Lapse
The point in time when the policy has been terminated or cancelled, usually due to non-payment of premium.
Last In, First Out
An accounting method used to value inventory and the cost of goods sold. Sales are considered to be made using the latest-purchased or produced merchandise
Law of Large Numbers
In probability and statistics, the larger the number of units independently exposed to loss, the more accurate the ability to predict loss results arising from
Layering
Building an insurance program in steps, utilizing the excess-of-loss approach, whereby one insurer writes in excess of lower limits accepted by other insurers.
Leading
The behavior from a risk manager to cause people to take action; an element of the managerial process.
Legal Risk
A general class of risk; risks inherent in compliance or arising from statutory liability.
Level Death Benefit Option
In Universal life insurance, an option that provides a level death benefit similar to a whole life policy. This option may also apply in some
Level Premium Insurance
Insurance where the premium remains the same throughout the life of the contract.
Level-Term Insurance
The face value remains the same from the effective date until the expiration date.
Leverage
Use of external fixed cost sources of capital for the organization, e.g., long-term debt and preferred stock.
Life Expectancy
As shown in the mortality or annuity table used as a reference, the average number of years remaining for a person of a given age
Life Expectancy Term Insurance
Provides protection for a person’s “expectation of life.” This becomes the term of the policy, as opposed to the ordinary term policies that are for
Life Income
A settlement option under which a life insurance policy pays equal installments as long as the beneficiary lives, even if the principal has been exhausted.
Life Insurance (Generic)
A contractual system of risk sharing under which contributions are accumulated and redistributed to meet the economic consequences of the uncertain duration of life.
Lifetime Maximum
The maximum amount the insurer would pay in benefits for an insured during the insured’s lifetime while covered under the policy.
Limit of Liability Clause
Pre-event limitation of the amount, type, or method of calculation of damages available by one or both parties to an agreement.
Limitations
Health insurance plans that contain certain limitations that impose internal limits or “caps” on specific types of medical care.
Limited Liability Company
A business organization possessing the pass-through tax nature of a partnership while creating a separate legal entity similar to a corporation.
Limited Partnership
A partnership in which the general partner is the managing partner who operates the business and the limited partners are not involved in the day-to-day
Limited Payment Life
A life insurance contract with premiums paid for an indicated number of years.
Liquidity
Ability of an organization to convert assets into cash quickly with little or no loss, such as selling or factoring accounts receivable and selling marketable
Liquidity Ratios
Financial ratios that measure the organization’s ability to pay bills over the short term. Includes the current ratio, quick ratio, and net working capital.
Liquor Liability
Arises from causing or contributing to another’s intoxication, or from furnishing alcohol to a minor
Living Benefits Rider
A rider attached to a life insurance policy that allows for the payment of a percentage of the death.
Lloyd’s of London
An association of private underwriters, each of whom underwrites (backs) insurance contracts on a basis of personal liability.
Loan Value
A term that refers to the amount of money an insured can borrow using the cash value of his or her life insurance policy as
Local Area Network (LAN)
A network of computers interconnected with one another within a limited area.
Long-Term Care
A blanket term for a wide range of services designed to meet medical, personal, and social needs in a variety of settings and locations.
Long-Term Care Coordinator or Care Manager
An individual who plans and coordinates long-term care and assists individuals with the details of housing, home care services, socialization programs, and financial and legal
Long-Term Care Daily Benefit Amount
An amount that will be available under a long-term care policy taking into consideration the expected daily cost of a chosen care facility at a
Long-Term Care Maximum Benefit Period
The maximum amount of time, expressed in years, that the insured will receive long-term care benefits.
Long-term Debt
Funds borrowed from external sources; the least expensive source of capital for an organization.
Long-term Liabilities
Liabilities that are expected to be paid after one year, such as long-term debt, mortgages or deferred income tax liability.
Loss Conversion Factor
In retrospective rating, a factor used to cover claim adjustment expenses and the cost of the insurer’s or third-party claim administrator’s services.
Loss Data Analysis
Application of various methods of analyzing loss data to identify and understand the potential impact those losses may have on the organization’s risk management program
Loss Development
Difference between the original loss frequency and/or severity as originally reported to an insurer and its subsequent evaluation at a later date or at the
Loss Development Factor (LDF)
Ratios applied to a current valuation of losses to determine an estimate of ultimate incurred losses. These factors are calculated by comparing the period-to-period changes
Loss Limit
Used in retrospective rating formulas, the maximum amount of any one loss included in the retrospective rating plan. In effect, this lessens the impact of
Loss Portfolio Transfers (LPT)
Portfolio of previously incurred losses that is transferred for a premium; addresses known losses.
Loss Rating
Rating technique that establishes the prospective rate based upon historical losses that will be applied to an exposure base to compute the premium.
Loss Ratio
Proportionate relationship of incurred losses to earned premiums expressed as a percentage.
Loss Report
Listing of reported claims providing such information as the date of occurrence, type of claim, amount paid and amount reserved for each as of the
Loss Reserve
Estimation of the liability for unpaid claims that have occurred as of a given date, including the IBNR claims, claims due but not yet paid,
Loss Trending
Adjusting historical losses to account for inflationary trends so that the ultimate value is more current or meaningful. Loss trend factors are multiplied by actual
Loss Triangulation
Study of changes, the relationship of one period to a previous period. The process involves graphs in which the data is displayed in an inverted
Lump Sum
Benefits paid to the beneficiary all at once rather than in installment payments.
Major Medical Policy
Provides greater benefits for services such as in-patient and out-patient hospital care, intensive care, physician charges and other medical services.
Managed Care Plan
A partnership between insurers and providers through contracts to provide care at discounted costs for benefits defined in the policy.
Managed Indemnity Plan
Incorporates basic utilization programs such as case management, pre-certification and recertification of certain services into a traditional indemnity plan.
Managerial Accounting
An internal accounting system that provides accurate and timely financial information for use by managers to make short-term and day-by-day financial decisions.
Managerial Model
Planning, organizing, leading and evaluating the resources of people, funds, materials, and time to protect the organization’s assets and positively affect the organization’s performance.
Managing General Agent (MGA)
A person or firm who has an independent business that performs for one or more insurers some or all of the functions typically attributable to
Manual Rates
Rates as promulgated by a rating bureau before application of any credits, discounts, surcharges or deviations. Such rates are referred to as “manual rates” because
Market Ratios
Measures of the value of a corporation’s common stock in the financial market.
Market/book Ratio
Measure of the market price of a share of common stock divided by its book value per share.
Marketable Securities
Highly liquid securities that have a low but positive yield, normally publicly traded stocks and bonds.
Masonry Noncombustible Construction
Exterior walls of masonry material (adobe, brick, concrete, gypsum block, hollow concrete block, stone, tile, or similar materials) with floor and roof of metal or
Mass Marketing
An attempt by insurance companies to provide some forms of insurance in a more economical fashion.
Maturity
The date cash value equals the face value of a whole life or endowment policy and becomes payable to the policy owner.
Maturity Value
The amount paid under a whole life insurance contract if the insured reaches the age of the mortality table on which the contract was based.
Maximum Premium
Maximum that can be charged under a retro plan regardless of the losses; maximum paid by the insured under a retro plan.
Maximum Retrospective Premium Factor
In retrospective rating, a factor established by agreement between the insured and the insurer to determine the maximum premium. Excess loss premiums may be included
Mean
Sum of all observations divided by the number of observations; the average (also known as the arithmetic mean).
Measure of Central Tendency
In statistics, a statistic that defines the center of a distribution, such as the arithmetic mean or average, the median, or the mode.
Measure of Dispersion
In statistics, a statistic that describes the spread of values about the mean of a distribution, such as range, variance, and standard deviation.
Median
Midpoint of the observations ranked in order of value; half the observations lie below and half above; the middle value (also known as the 50th
Medicaid
A jointly funded federal and state program that provides hospital expenses, medical expense coverage, and in some cases long-term-care-type coverage to the low-income population and
Medical Information Bureau (“MIB”)
A data pooling organization that maintains information on individuals who have applied for insurance with life and health insurance companies that subscribe to the bureau.
Medical Savings Account (“MSA”)
A trust created exclusively for paying qualified medical expenses of the account holder. Allowable contributions are tax-deductible and growth is tax- free if the account
Medicare
A federal government medical insurance plan originally for individuals age 65 and older or disabled. The age requirement has been raised based on year of
Medicare Supplement Insurance
Also known as “Medigap”, individual health insurance coverage designed to bridge coverage gaps in Medicare.
Mental Health Parity Act of 1996 (“MHPA”), as amended by the Mental Health Parity and Addiction Equity Act of 2008 (“MHPAE”)
A federal regulation that requires employers to provide coverage for the diagnosis and treatment of mental illness and substance abuse under the same terms and
Merger
Two or more organizations that create a new entity, agree to move forward as one and issue the appropriate ownership interests (common stock, memberships, partnerships,
Microschool
As a consequence of COVID-19 and the closing of schools, parents have started organizing “microschools,” or homeschooling pods, where groups of three to 10 students
Mini-tail
Automatic 60-day extended reporting period allowing for the making of claims after expiration of a “claims made” liability policy.
Minimum Life Insurance Premium
Also known as “minimum continuation premium”, the premium that is lower than the target premium. It is used in universal life policies to skip premiums
Minimum Premium
In retrospective rating, the minimum amount of premium to be paid by the insured, determined by multiplying the minimum retrospective premium factor by the standard
Minimum Premium Plan (“MPP”)
A self-insured health plan that includes a maximum dollar amount that an employer must pay for claims.
Minimum Retrospective Premium Factor
In retrospective rating, a factor established by agreement between the insured and the insurance carrier to determine the minimum premium.
Misrepresentations
A misstatement of facts regarding the subject of insurance (the item being insured).
Mitigation of Damages
Legal concept that imposes a duty on an injured party to exercise reasonable diligence and ordinary care in attempting to minimize damages after injury or
Mixed Model HMO
Also known as a “hybrid HMO”, are closed-panel HMOs that expanded their market by offering an open model product on a regional or national level
Modified Accelerated Cost Recovery System (MACRS)
Depreciation by IRS schedule according to the type of asset; ach MACRS class has a predetermined schedule used to determine the percentage of the asset’s
Monitoring
Examining and evaluating the results of risk management actions and plans; an element of the Risk Administration step of the Risk Management Process.
Morbidity
The measure of the probability of expected sickness or injury within a given group.
Mortality
The measure of the probability of dying at a certain age. Mortality rates usually reflect the actual experience of an insurer with its insureds, adjusted
National Alliance Difference Makers
National Alliance Difference Makers is a quarterly multimedia series highlighting insurance and risk management professionals who display excellence and make positive impacts on the industry
National Council on Compensation Insurance (NCCI)
Association of insurers selling workers compensation coverage that operates as a rating organization. NCCI collects statistics, develops rates and policy forms, and makes state filing
Negligence
Failure to exercise a degree of care which a reasonably prudent person would exercise under the same circumstances. The following four elements must be proven
Net Book Value
Value of an organization’s assets as carried on the balance sheet in accordance with applicable accounting system principals. Under financial accounting (GAAP), the historic or
Net Ceded Premium
Premium deposited in the captive. From the perspective of the fronting company, it is ceded reinsurance. From the captive’s perspective, it is assumed reinsurance.
Net Income
Operating income less interest expense and taxes; amount that can be distributed to an organization’s owners or kept as retained earnings.
Net Present Value (NPV)
The measurement of the PV of future cash inflows compared to the net investment of a project.
Net Present Value Cost-benefit Analysis
In financial management, the evaluation of a project or option by determining if the PV of expected inflows exceeds the PV of expected outflows.
Net Profit Margin
Measure of the amount of profit within sales; net income divided by sales.
Net Underwriting Income
Sum of underwriting profit (loss) and investment income from underwriting.
Net Working Capital
Measure of ability of an organization to quickly meet its current obligations; current assets less current liabilities.
Network Model HMO
Multiple groups of medical providers contracted with an HMO to provide services to HMO insureds.
Newborns’ and Mothers’ Health Protection Act of 1996 (“NMHPA”)
A federal regulation that requires group and individual plans that offer maternity benefits to provide coverage for a hospital stay following a normal delivery for
No Abuse of Discretion
Director or officer is protected against honest errors in judgment that can be justified by a rationale or that are not egregious on their face.
No-Load Policy
A policy sold directly to consumers from the insurer, thus minimizing sales expenses.
Non-admitted Asset
Assets of an insurer that are not permitted by the state insurance department or other regulatory authority to be taken into account when determining an
Non-admitted Insurer
Insurer authorized to operate in a state under a certificate of authority but not being subject to that state’s financial, form, and rate regulations.
Non-Cancelable
An insurance policy that the insured has the right to keep in force by paying the premium for a period (stated in the contract). The
Non-concurrency
A term used to describe a situation where there are two or more insurance policies not written with the same coverage, or effective dates.
Non-Contributory Plan
A group health plan that has no cost sharing – the employer pays the full cost of an eligible employee’s coverage under the plan.
Non-Forfeiture Benefit Options
Provision that ensures the insured cannot lose the equity of a whole life insurance policy. A policy owner can select from three options under the
Non-insurance Contractual Transfer
The transfer of risk through a contract other than an insurance contract.
Non-insurance Risk Transfer
Transfer of risk from one party to another party other than an insurance company. This risk management technique usually involves risk transfers by way of
Non-qualified Self-insurance Plans
Often combine general liability, automobile liability, workers compensation (with fronting carriers) and other miscellaneous lines with no per occurrence stop loss or loss limitation; works
Non-renewal
The action by the insurance company to terminate insurance coverage at the expiration date or anniversary date of the policy.
Non-subject Premium
A premium that is not a part of a loss sensitive rating formula. For example, in a retro plan, the non-subject premium usually purchases the
Non-waiver Agreement
In claims management, a bilateral agreement between an insurer and a claimant that permits the continued processing of the claim while preserving the insurer’s rights
Noncombustible Construction
Exterior walls, floor, and supports made of metal, asbestos, gypsum, or other noncombustible materials.
Normal Distribution
In statistics, a distribution in which the mean, median, and mode are the same; it has the same value at the high point of the
Notes to the Financial Statement
An accounting concept, the explanation of how specific transactions have been treated; the rules by which the financial statements are drawn.
Nuisance Value
Amount that an insurer will pay to settle a claim that may not be valid or may be of lesser value so as to avoid
Nursing Home
A licensed facility that provides 24-hour-a-day nursing care to assist individuals who need long-term care.
Obligee
Person, firm, or corporation protected by a surety bond; the party to whom the principal under the bond is obligated.
Occurrence
An accident with the limitation of time removed; an “accident” that is extended over a period of time rather than a single observable happening.
Occurrence
An accident with the limitation of time removed; an “accident” that is extended over a period of time rather than a single observable happening.
Off-shore Insurer
An insurer domiciled outside the US. By definition, all off-shore insurance companies are alien, in spite of ultimate ownership by a US corporation.