GLOSSARY

Open-Panel HMO Model

Insurers contract with individual or groups of physicians to provide services to the HMO insureds. Open-panel providers and facilities may also contract with other HMOs

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Organizing

The actions a risk manager takes to arrange and relate work to be done so that it can be performed most effectively by others.

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Out-of-Pocket Maximum

In Health Insurance, a stop loss provision that defines the maximum dollar amount an insured must pay in out-of-pocket expenses during the year. Once an

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Outstanding losses

On a loss run, the amount calculated by subtracting paid losses from incurred losses and representing the remaining liability to be paid on a loss

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Owner

The individual or entity controlling all rights, benefits, and privileges of a life insurance contract. This may or may not be the insured. Ownership may

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Paid Losses

Amount actually paid in losses during a specified period of time, not including estimates of amounts (i.e., reserves) that will be paid in the future

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Paid-in Capital

Amount actually paid in losses during a specified period of time, not including estimates of amounts (i.e., reserves) that will be paid in the future

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Paid-in Excess

Original cost of a newly issued share of common stock less its stated par value. Insurance company common stock (and commercial bank stock) often has

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Pandemic Pods

Question: What are Pandemic Pods? Answer: As a consequence of COVID-19 and the closing of schools, parents have started organizing “pandemic pods,” or homeschooling pods,

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Pareto Principle

In business management, the observation that 80% of effects come from 20% of the causes. Also known as “Pareto Efficiency” or the “80/20 Rule”.

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Parole Evidence

Legal concept describing oral or verbal evidence. In contract law, parole evidence relates to the inadmissibility of oral representations that would otherwise alter or defeat

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Payback

In financial management, the measurement of the length of time needed to recoup the cost of a capital investment.

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Planning

The process a risk manager takes to predetermine a course of action; an element of the managerial process.

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Political Risk

A general class of risk; risks arising from changes in the law, governmental reinterpretations or changes in government policy.

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Pooling

A self-insurance strategy used by two or more organizations that desire to share risks with each other. The organizations are not individually capable of self-insuring.

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Pre-admission Certification

A healthcare provider’s authorization, or pre-admission certification, for an insured’s non-emergency hospital admission and certain covered benefits prior to an insured receiving the care.

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Preferred Stock

Type of stock issued by a corporation that has ownership privileges with respect to payment of dividends and distribution of assets greater than those of

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Premium

Amount of money an insurance carrier charges to provide the coverage described in the policy.

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Premium Discount

1) A discount allowed on premiums paid in advance of one year based on projected interest to be earned. 2) a discount allowed on certain

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Premium Equivalent

Used in self-insured health plans, the cost per covered employee, or the amount the employer would expect to reflect the cost of claims paid, administrative

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Presumptive Disability

In a disability income policy, a percentage of disability that will be considered without a waiting period if the insured suffers the total and complete

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Primary Actual Losses

When computing workers compensation experience modifications, the actual loss amount (each loss equal to or less than $15,000) is included in the calculation at its

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Private Law

The organizational charter and its by-laws control what the executives can and cannot do. Violations of these “laws” are ultra vires acts, or acts beyond

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Probate

A court-supervised process by which a will is determined to be the deceased’s final statement regarding the disposition of his or her property.

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PROFocus Series

National Alliance PROFocus Series courses are open to all insurance and risk management professionals! Dues-paid National Alliance designees are eligible for update credit! PROFocus Series

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Promissory Estoppel

Legal concept holding that a false statement will be treated as a promise when the listener relied upon the false statement to his/her detriment. The

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Protection

As related to property, the safeguards, equipment and measures provided by the building owner or occupant to minimize hazards.

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Punitive Damages

Damages in excess of those required to compensate the plaintiff for the wrong done. Punitive damages, also called exemplary damages, are imposed to punish the

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Qualified Plan

Concerning the income taxation of contributions, plans that cannot discriminate and must comply with specific IRS codes and regulations. Contributions are deductible from income taxes

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Qualified Self-insurance

An insurance plan subject to state regulation, such as self-insured workers compensation plans or self-insured automobile liability plans, in which regulatory oversight is needed to

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Qualitative Analysis

The “what” analysis; identification and assessment of loss exposures that cannot be easily measured by traditional statistical or financial methods; helps management understand the potential

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Quantitative Analysis

The “how much” analysis; attempts to accurately measure risks by using acceptable traditional methodologies to calculate relative numerical values.

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Quick Ratio

A liquidity ratio that measures the organizations ability to pay bills over the short term; the remainder of current assets less inventory divided by current

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Quid Pro Quo

Latin for “this for that,” or “one thing for another.” In contract law, it refers to the legal consideration of values required by both parties

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Rate Class

The manner in which a life insurance premium is determined, based upon the individual’s health condition, family history, occupation, hobbies and other factors specific to

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Reciprocal

A group of individuals or organizations, called subscribers, who join together into an association for the purpose of insuring one another.

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Recusal

Act of abstaining from a discussion or decision because of a conflict of interest or the appearance of a conflict of interest.

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Regression

In statistics, a technique of modeling the relationship between variables by fitting a line to a scatter of dots.

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Reinsurance

The acceptance by one or more insurers of a portion of the risk underwritten by another insurer that holds a contract for the entire coverage.

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Reinsurance

A contractual agreement in which one insurer agrees to insure the assumed liabilities of another insurer, a self-insured firm, or another reinsurer.

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Rent-a-captive

A licensed offshore insurer owned by an outside organization, e.g., a broker, reinsurer, insurance company, or other business enterprise, which makes its services available to

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Request for Proposal (RFP)

Providers are “invited” or requested to provide a proposal for insurance coverages; typically, the providers are assigned markets from which they will obtain proposals and

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Res judicata

“The matter has been decided,” a legal concept of common law stating that the prior decisions of judges and juries have determined the outcome. See

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Reservation of Rights

In claims administration, a letter sent by an insurer to a claimant to preserve the insurer’s right to deny a claim following their investigation by

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Residual Income

A provision in a disability income policy that provides for benefits to be paid when the insured can do some, but not all, of his

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Resources Magazine

Resources Magazine is the official publication of the National Alliance Research Academy. Published three times a year it is an exclusive benefit for National Alliance

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Respite Care

Usually associated with a long-term care situation, and normally occurs when a family member of the patient who is providing a majority of the care

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Retention

1) Internal funds used to pay losses; 2) budgeted losses plus the “tolerance corridor.” See Tolerance corridor; 3) assumption of risk of loss as through

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Retention Level

Amount of loss that is self-insured. It is usually expressed on a per occurrence basis and is sometimes referred to as the self-insured retention (SIR).

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Retro Adjustment

Amount of additional premium or return premium for each successive period determined by comparing the current period’s indicated retro premium to the preceding period’s retro

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Retrocession

Transaction that transfers liability from the reinsurer to another insurer, perhaps even back to the primary insurer, in whole or in part.

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Retrospective Rating

Rating plan that adjusts the premium, subject to a certain minimum and usually a maximum, periodically to reflect the actual loss experience of the insured.

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Retrospective Rating

Rating plan that adjusts the premium, subject to a certain minimum and usually a maximum, periodically to reflect the actual loss experience of the insured. 

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Rider

A provision that an insurer attaches to a policy to expand or restrict the benefits of the policy.

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Risk

The chance of loss; the uncertainty of loss; the variation from the expected outcome over time; the difference between expected losses and actual losses.

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Risk

Uncertainty that may be either positive or negative arising from a given set of circumstances. Common definitions also include: 1) chance or probability of loss,

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Risk Mapping

Visual analytical tool utilized to communicate key risks; it presents the risks with the highest impact and probability; can range from simple to complex depending

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Risk Analysis

The assessment of the potential impact of various exposures on an organization; a step of the Risk Management Process.

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Risk Control

Any conscious action or inaction to minimize at the optimal cost, the probability, frequency, severity, or unpredictability of loss; a step of the Risk Management

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Risk Duplication

The use of back-ups for critical systems or operations; a risk control technique in which the goal is to reduce overall severity.

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Risk Financing

The acquisition of internal and external funds to pay losses at the most favorable cost; a step of the Risk Management Process.

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Risk Management

The practice of protecting an organization from financial harm by identifying, analyzing, and controlling risk at the lowest possible cost.

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Risk Management

Process of managing uncertainty of exposures that affect an organization’s assets and financial statements using five steps: identification, analysis, control, financing and administration.

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Risk Profiling

Measurement of expected losses for a finite period of time based on historical data including but not limited to, total losses, number of losses, average

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Risk Reduction

A risk control technique in which the goal is to reduce the severity or financial impact from losses that are not prevented.

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Risk Retention Group

A special type of group captive whose business is limited to liability coverage for owners/insureds. Formed under the Federal Liability Risk Retention Act of 1986,

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Risk Segregation

An isolation of an exposure from other exposures, perils, or hazards; a risk control technique in which the goal is to reduce overall severity.

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Risk Separation

The spread of exposures or activities over several locations; a risk control technique in which the goal is to reduce overall severity.

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Risk Transfer

Risk control technique that attempts to reduce or prevent loss by transferring some or all of the risk to another organization, either through a physical

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Roth IRA

A retirement savings account that allows an individual to deposit after-tax funds (not tax-deductible) up to specified annual contribution limits and accrue earnings income tax

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Salvage

1) Gross salvage is the total amount a company expects to recover from salvage, and 2) net salvage is the gross amount less costs associated

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Second To Die

A type of life insurance policy that insures two lives, also referred to as a survivorship policy, where the death benefit is payable at the

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Secondary Beneficiary

A person designated by the policy owner to receive policy proceeds if the primary beneficiary is deceased at the time benefits become payable, also known

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Self-insurance

An insurance plan in which an organization makes a conscious decision to not purchase insurance and pay certain claim amounts using 100% internal funding. Self-insured

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Settlement Options

The choices available for the payment of death benefits. The owner can select a settlement option before the insured’s death and the beneficiary has no

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Severity

The dollar amount of a given loss or the aggregate dollar amount of all losses for a given period.

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Shared Care

A long-term care plan that allows the insured to purchase an additional Daily Benefit that either spouse may use.

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Sharing

A method of handling risk that involves the potential loss exposure being distributed among a number of persons.

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Sinkhole Collapse

Damage caused by the sudden sinking or collapsing of land into an underground empty space typically caused by water on limestone or dolomite.

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Social Risk

A general class of risk; risks arising from public relations, loss of reputation, damage to brand, cultural issues, social direction or social media.

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Sole Proprietorship

A business organization in which a sole proprietor is entitled to all profits, and will bear all losses, generated by the business and free of

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Specific 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

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Staff Model HMO

The most restrictive type of HMO where insureds select his or her primary care physician within the model but the HMO may close a particular

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Standard Premium

Premium that is determined on the basis of authorized rates, any experience modification rating, applicable loss constants and minimum premiums; specifically excludes premium discounts and

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Stare decisis

“Let the decision stand,” a legal concept of common law stating that the prior decisions of judges and juries have determined the outcome. See Res

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Statute of Frauds

Legal concept that holds no suit or action shall be maintained on certain classes of contracts or engagements unless there is a note or memorandum

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Stockholder Equity

Net worth, retained earnings or total assets less total liabilities; sum of the book value of common stock less treasury stock, preferred stock, and additional

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Stop-Loss Coverage

A form of reinsurance for self-insured employers that limits the amount the employers will have to pay for each covered employee’s and dependents healthcare claims

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Strategic Risks

Risks related to an organization’s strategic plan and its mission resulting in upside or downside outcomes; most likely cause of failure of organizations.

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Strict Liability

Liability directed by law (statute or common law) without regard to the intention of the offender’s actions. Strict liability shifts the burden of proof; it

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Subject Premium

In retrospective rating plans, the portion of the premium applied to the retrospective rating formula. It is generally used to help calculate the basic premium,

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Subrogation

1) The legal right of one who has paid another’s obligation to collect from the party originally owing the obligation, e.g., the insurer’s right to

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Subrogation

The right of an insurance company to recover an amount of money paid to an insured for a loss when the loss is someone else’s

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Suicide Clause

A life insurance policy provision that states if the insured dies by suicide within a certain period of time from the date of issue (usually

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Surety

Promisor under a bond; the party that promises to fulfill the obligation of the bonded party or principal; a surety company.

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Surplus Share

The primary insurer or ceding company cedes to the reinsurer a pro rata share of risks, but the reinsurer only pays its percentage of losses

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Surrender Benefit

An annuity contract that allows the owner to surrender the contract if income payments have not yet started. Upon surrender, the contract terminates and the

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Survivorship Clause

A life insurance provision stating when the death of the insured and the primary beneficiary is at the same time, the benefits would skip the

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Tail Factor

When calculating loss development factors from historical data, a factor that recognizes that at some point, older data becomes unavailable or is no longer relevant

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Target Premium

A suggested premium used in universal life policies that does not guarantee there will be adequate funds to maintain the policy to any time, including

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Tax Multiplier

In retrospective rating plans, a factor applied to an insurance premium to cover licenses, fees, assessments, and premium taxes the insurance carrier must pay on

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Top-down Pricing

Commonly known as manual rating or scheduled rating; an experience modification factor, scheduled credits or debits, premium discounts and/or deductible credits are applied to a

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Tort

Private or civil wrong, other than a breach of contract, for which the courts will provide a remedy in the form of an action for

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Total Cost of Risk (TCOR)

Sum of all quantified costs and expenses associated with the risk management function of an organization. TCOR includes insurance costs, retained losses, risk management departmental

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Total Loss Ratio

Ratio of the losses incurred and the Allocated Loss Adjustment Expense (ALAE) for those losses in a given period to the earned premium during the

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Transfer

A technique involving one party transferring the uncertainty of loss to another party or parties.

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Treaty

A form of reinsurance in which a contract of reinsurance automatically establishes the terms for reinsuring a class or classes of business.

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Treaty Reinsurance

The ceding company agrees to cede certain classes of business to a reinsurer. The reinsurer agrees to accept all business qualifying under the reinsurance treaty

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Trend Factor

Used to adjust past loss experience to the current cost levels, generally taking into account inflation and other similar forces.

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Trust

An obligation that binds a person (trustee) to deal with property in a particular way for the benefit of another person or class of persons

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Underwriting

The process of selecting a risk and assigning a proper rating classification (to calculate the correct premium) in a manner that the insured obtains coverage

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Underwriting

The process by which the cost of the coverage is determined. Insurers (and self- funded plans) seek assistance from actuaries.

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Unearned Premium

Amount of premium remaining after deducting the earned premium from written premium; the portion of a premium representing the unexpired part of the policy period.

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Utilization Review

The process of reviewing the appropriateness and quality of health care provided to patients. Utilization review may take place before, during, or after the services

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Utmost Good Faith

A contract is considered to be a contract of “utmost good faith” when the parties to the contract rely heavily on the honesty and integrity

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Vacancy

Not enough business personal property to conduct normal operations. In a rather broad sense, it means no contents.

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Variable Annuity

An annuity with investments in separate accounts directed by the owner, such as growth, high-yield, or small cap mutual funds, etc.

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Variance

In statistics, the modified average of the squares of the deviation of each value from the arithmetic mean of those values. The “modified average” refers

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Vesting

A term that describes the process by which a participant earns ownership rights of a benefit funded by an employer. When fully vested, a participant

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Viatical

A general term referring to transactions in the viatical settlement marketplace. A viatical settlement is the proceeds from the sale of a life insurance policy

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Waiver

1) Legal concept that holds a party who intentionally or voluntarily relinquishes a known right, claim, privilege, or the opportunity from taking advantage of that

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Waiver

Waiver- 1) Legal concept that holds a party who intentionally or voluntarily relinquishes a known right, claim, privilege, or the opportunity from taking advantage of

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Waiver of Premium

An insurance policy rider that allows a policy owner to stop making premium payments if the insured suffers a disability. Premium payments will be waived

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Warranty

A statement that promises or guarantees that something is absolutely true or will be true in the future.

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Weighted Average

An accounting method used to value inventory and the cost of goods sold. This method applies the costs of individual items as items are sold

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Weighting Value

In workers compensation experience modifications, a percentage value taken from the same actuarial tables used above to determine the percentage of excess losses to be

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Weighting Value

In workers compensation experience modifications, a percentage value taken from the same actuarial tables used above to determine the percentage of excess losses to be

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Whole Life Insurance

Whole Life Insurance – A type of permanent life insurance that is characterized by guarantees such as fixed death benefit, guaranteed cash value, and fixed

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