texas insurance zone
texas insurance zone home page
about texas insurance zone contact texas insurance zone site map
texas auto insurance texas home owner insurance
texas life insurance texas health insurance
TEXAS INSURANCE GLOSSARY: In considering an insurance policy, individual health insurance policy, small business health insurance plan, or self-employed health insurance benefits program, it is imperative to create an understanding of the insurance industry terms and jargon. We offer this guide to help better understand and gain knowledge of the terms and policy labels being used by the major insurance companies, agents, and brokers offering a full spectrum of insurance coverage to consumers in all 50 states.
auto insurance menu:
Auto Insurance:
Find out more and get a quote on current auto insurance rates

Motorcycle Insurance:

Get a quote on motorcycle insurance.

additional information:
Texas Auto Insurance Basics:
Beginners Guide to Texas Auto Insurance.

Texas Auto Insurance Coverage Guide
What Every Texas Driver Should Know About Texas Auto Insurance.

Texas Auto Insurance Rate Guide:
How is my rate determined? How can I save money on Texas Auto Insurance?

Guide to Texas Insurance:

A Guide to all types of Texas Insurance provided by Texas Insurance Zone.


Texas Insurance Glossary

In considering an insurance policy, individual health insurance policy, small business health insurance plan, or self-employed health insurance benefits program, it is imperative to create an understanding of the insurance industry terms and jargon. We offer this guide to help better understand and gain knowledge of the terms and policy labels being used by the major insurance companies, agents, and brokers offering a full spectrum of insurance coverage to consumers in all 50 states.

Accidental Death Coverage: Accidental death coverage is sometimes a part of your auto insurance policy's Personal Injury Protection or First Party Benefits plans. If someone who's covered dies from accident-related injuries, this type of auto insurance coverage may provide a payment to the insured's designated beneficiary.

Actual Cash Value: Frequently used in most auto insurance policy papers especially in claim forms. Most consumers only receive insurance proceeds for the actual cash value of their vehicle. Determining a vehicle's cash value is usually the result of subtracting any depreciation from the original price of the vehicle.

Admitting Privileges: authority granted to a health care professional to admit patients to a particular medical facility, hospital or medical care treatment facility.

Advocacy: to encourage or support an activity that helps a consumer, company, or organization to secure health care coverage designed to best meet their unique needs.

Agent/Broker: Persons that market and coordinate insurance policy programs for consumers. Agents can represent a single insurance company or multiple providers. Brokers represent consumers seeking to purchase insurance policy programs and coverage.

Annuity: A legal policy provided by an insurance company that enables consumers to allocate money annually that earns interest at a guaranteed rate, tax-deferred, for a specific period of time. These annuity dollars provide policyholders with additional annual income stipends for a designated length of time in the later years. Annuity policy programs are popular because of the tax benefits, guaranteed annual income, and security benefits that they provide.

Association: An affiliation or an alliance. A brotherhood, club, fraternity or fellowship offering group or individual health insurance plans customized to meet the needs of their membership body.

Auto Insurance: An Auto insurance policy is a safe guard for consumers that shields private passenger carrying automotive vehicle owners from monetary losses if a vehicle they own is involved in any type of accident. An agreement, contract, or policy formed when a consumer and an insurance company establish specific protections involving vehicle ownership. Consumers agree to allocate funds call premiums and the insurance company agrees to provide benefits that cover setbacks from an accident involving a vehicle. Damages can include property, physical injury, medical treatments, or death as established in the auto insurance policy.

Benefit: to be useful or profitable to better, improve, or help. In the Health insurance industry a benefit is the actual amount made payable by the health insurance company to a claimant, assignee, or beneficiary when the insured party incurs a loss.

Bodily Injury Liability Coverage: Clauses that help protect insurance policy holders that injure or maim a person in an auto accident. The stipends are usually capped at pre determined fixed amounts when the insurance policy is written.

Car Insurance: A Car insurance policy is a safe guard for consumers that shields private passenger carrying automotive vehicle owners from monetary losses if a vehicle they own is involved in any type of accident. An agreement, contract, or policy formed when a consumer and an insurance company establish specific protections involving vehicle ownership. Consumers agree to allocate funds call premiums and the insurance company agrees to provide benefits that cover setbacks from an accident involving a vehicle. Damages can include property, physical injury, medical treatments, or death as established in the car insurance policy.

Capitation: the fixed or set dollar payment cap that a consumer or employer pays to a health maintenance organization (HMO), for the services being offered by a health maintenance provider regardless of usage levels. Providers are health care professionals who assist patients. Typically providers select doctors, physicians, hospitals, or professional health care givers. The term can also be applied to nurses, nurse practitioners, chiropractors, psychologists, and other health care professionals who practice in specialized fields of medicine.

Case Management: a process enlisted by employers and health insurance companies that result in individuals or groups receiving premium health care and health insurance services.

Claim: the real or assumed right to demand something as one's own. In the health insurance industry a claim is usually an appeal by an insured individual or his health care provider to the individual or group health insurance company requesting said health insurance company to assume costs for services rendered by a health care professional. An insurance claim is a policyholder's demand to be compensated for financial losses in the event of an accident or loss.

Claims Adjuster: An insurance company employee responsible for researching and substantiating the settlement of an insurance claim.

Co-Insurance: to guard, protect, safeguard, or shield, co-insurance designates the set amount of money that an insured individual is asked to pay for health care services, after the insurance company has met the deductible. Usually a group health insurance policy also outlines co-insurance or "co-payment." Co-insurance is normally listed as a percentage. For example, an employee pays 10 percent of total fees for any healthcare service and the employer or designated health insurance provider covers the remaining balance.

Co-Payment: a set or flat fee that a consumer is obligated to pay for specific healthcare service. This amount is separate from the fees being covered by the health insurance company. For example, most Health Maintenance Organizations - HMO's use a ten-dollar co-payment for every doctor office visit, regardless of the type or level of medical services received during the actual stay.

Collision Coverage: Language that defines how much money will be provided to the policyholder to help cover the cost of repairs or replacements that result in a vehicular accident.

Comprehensive Coverage: This language provides payment for vehicle repair following a vandalism, fire, or theft. Caps are usually set to cover car repair or vehicle replacement when consumers purchase an auto insurance policy.

Continuously Insured: Number of consecutive years a consumer has been covered by a major insurance company.

Deductible: to take away one quantity from another or subtract. The actual dollar amount an insured individual is asked to pay for healthcare expenses prior to any health insurance, or self-insured health insurance company payments. Many health insurance and Group health Insurance rates are based on annual deductible figures.

Denial Of Claim: Refusal by a health insurance company to recognize a claim by an insured individual or his health insurance provider, to cover the fees for health care services received from a registered medical professional.

Dependent Worker: A worker or member in a family or company that does not have a large personal income.

Depreciation: Depreciation is the loss or reduction in value of a specific item due to erosion or degradation, or disfavor.

Effective Date: The actual date that your insurance policy and coverage terms take effect.

Employee Assistance Programs (Heaps): Specialized health care services such as mental health counseling being offered by health insurance companies or corporate employers. Usually individuals or employers do not have to pay directly for health care services provided through an established employee assistance program.

Endorsements: Endorsements are revisions to the original insurance policy agreement. Also known as riders, endorsement revisions often times are used to change deductible amounts or possibly to bring an additional vehicle into an existing auto insurance coverage program.

Exclusions: Having or exercising the power or limit inclusion. In the Medical services industry exclusions represent insured health care items not paid for or covered by an individual health insurance policy.

Fixed Annuity: Provides insurance consumers with an ensured amount of principal or interest on their assets. The amount of annual interest earned is guaranteed at a specific level set forth in the annuity policy agreement.

Full Coverage: An insurance policy that lists all coverage factors, as legally required in a designated state. This term does not guarantee full coverage to a policyholder.

Guaranteed Annuity: There are two types of annuities, fixed and variable. A fixed annuity provides you with a guaranteed of principal and interest. Your principal earns a current level of interest that can't fall below the specified minimum in your annuity contract. A variable annuity provides you the opportunity to invest in separate contracts that are run similar to mutual funds and offer you the opportunity to have professional money management with current tax-deferral. Fixed annuities are not subject to any market risk while variable annuities are subject to market risks.

Health Care Decision Counseling: Specialized Services, usually provided by health insurance companies or employers, that meet with individual insurance consumers to clarify benefits, risks and real dollar costs of specific medical tests and treatments. Health care decision counseling is usually discreet. Service offers assistance to consumers creating more informed selections of health insurance, medical care, and reassurance that decisions made were appropriate for the medical program required of the circumstances.

Health Maintenance Organizations (HMO's): represent a group of health insurance policy holders in which individuals or their employers allocate a monthly fee for medical services, instead of per service pricing. The monthly HMO dues usually remain fixed, regardless of the type or level of medical service received. Professional Medical Services are performed by certified practitioners and physicians employed by, or under service contract with the Health Maintained Organization. Several types of HMO Insurance companies are available with guidelines on medical facilities and the health treatment services they offer.

Indemnity: An established amount of money or compensation to be paid that covers an insured loss.

Indemnity Health Plan: known as fee for service health insurance programs, indemnity programs were very popular before the establishment of HMO, IPA, and PPO plans. With indemnity plans, the health insurance consumer pays a set percentage of the total costs of the health care treatment, and the health insurance company pays the remaining percentage. The costs of medical treatment are defined by the health insurance provider and vary by doctor. Indemnity health plans allow health insurance consumers an opportunity to become actively involved in selecting the actual medical care professional or physicians.

Independent Practice Associations: IPA coverage resembles traditional HMO plans, except consumers receive medical treatment in a doctor's office, rather than a large treatment facility or hospital.

Insurance Claim Report: These reports list details of an insurance claim that have been issued with most insurance companies. These reports are usually compilations from consumer reporting agencies or underwriting exchange organizations that gather insurance claim data from a host of insurance companies.

Insurance Score: Calculations designed to help determine the level of future insurance claims based on a consumer's personal credit rating and history.

Insured: A consumer or policyholder covered by an insurance policy.

Judgment: A legally binding determination or ruling set froth by a legal jurisdiction or court. Judgments usually determine who is financially responsible to cover any monetary costs as a result of an accident involving an insured consumer.

Liability: An obligation reflecting legal indebtedness or possible financial exposures.

Liability Coverage: Protects consumers from financial obligations to cover physical injury or property damages that occur in an accident. Most insurance quotes include bodily injury and property damage clauses.

Long-Term Care Policy: health Insurance coverage that specifies designated services for an exact period of time. Long-term care Health Insurance programs and fee structures vary significantly. Some LTC insurance programs cover medical services such as: nursing home stays, in-home health care service, and long term custodial healthcare.

LOS: length of stay health insurance coverage is used by insurance companies and employers to establish the designated length of stay an individual can claim for a hospital or in-patient treatment facility.

Managed Care: A medical service system designed to better manage the cost and quality of medical services that insurance policy holders receive. Many managed care health insurance programs work with HMO and PPO boards to promote use of specific health treatment procedures. Managed care health insurance plans also educate and work with consumers to improve overall health by addressing disease prevention.

Maximum Dollar Limit: The cap or highest amount of money that a health insurance company will pay for claims processed in a specific time period. These could be based on or described in terms of type of medical condition or service treatment. Many times lifetime specifications are used rather than yearly limits.

Medigap Insurance Policies: health insurance offered by a private medical insurance company, not the state or federal government. This does not represent Medicaid or Medicare. These medical insurance plans are developed to cover some of the medical costs that Medicaid and Medicare do not recognize.

Medical Payments Coverage: This insurance coverage covers hospital or medical treatment bills and sometimes funeral expenses if a primary operator or passengers are critically injured or killed in an insured passenger vehicle.

No-Fault Insurance: Type of auto insurance coverage establishing how an insurance company will settle a claim covered by their policy. Many times responsibility does not need to be assigned prior to an insurance claim being settled.

No-Fault States: States that require insurance companies to cover a policyholder's financial losses, regardless of who has been determined legally responsible for an accident. Many no-fault states also prohibit the right to legally pursue damage claims. In states that do not recognize no-fault obligations, insurance companies are obligated to cover financial losses that occur as a result of an accident involving a policyholder.

Open-ended HMOs: HMO programs that allow enrolled participants to use out-of-plan medical professionals and still redeem partial or full payment for the health care services provided in a standard indemnity health insurance plan.

Out-Of-Plan: refers to doctors, hospitals, and other medical treatment service providers who are not actually participants in a health insurance program (such as an HMO or PPO). Costs depend on the health insurance plan and type of health services performed by any out-of-plan medical professionals that are not covered, or only partly covered by the group health insurance company.

Out-Of-Pocket Maximum: fixed sum of money that any single insured person must pay using their own money or funds, prior to a national health insurance company covering a consumers' health care bills in full.

Outpatient: Any person that undergoes health care or medical treatment on an outpatient basis that does not mandate an overnight hospital stay. Many major health insurance companies publish lists of specific medical treatments, tests, and services that are not recognized unless they are performed on an outpatient basis. This term can also pertain to ambulatory care or to list specific medical treatment facilities that offer specialty surgeries.

Policy Expiration Date: The calendar date that an insurance policy ends if it is not renewed. This validation end date is usually listed on the declarations page of an insurance policy, and is referred to often on insurance renewal notice documents.

Policy Term: Specific length of time an insurance policy is valid.

Pre-Admission Certification: can also be names pre-certification review, that means a medical case manager or certified health insurance associate must request admittance to a medical treatment facility, before being physically admitted to the facility. The health insurance policyholder usually assembles pre-admission certification documents. Physicians, Surgeons, or nurses may contact the patient. This avoids patients from early exposure to unnecessary health care treatment services.

Pre-Admission Review: A review of a patient's health status or physical condition, before admission is granted to an inpatient medical facility or hospital. Pre-admission reviews administered by health insurance representatives in cooperation with the doctor, HMO, PPO or health insurance provider.

Preadmission Testing: Medical tests conducted prior to hospital or health care facility admission.

Pre-existing Conditions: medical conditions outside of health insurance coverage as the condition or ailment existed before the health insurance policy was granted.

Preferred Provider Organizations (PPOs): a group that offers discount health insurance rates that offer doctors from a pre-determined list of professional care givers. If a doctor not included in the PPO plan is selected, the health insurance policyholder must cover the all fees for the medical treatment.

Primary Care Provider (PCP): A doctor responsible for administering a health insurance consumer's health care needs. PCP is usually the medical care gatekeeper, sending the patient too more specialized physicians for specialist care.

Primary Driver: The consumer that operates the insured vehicle most often.

Primary Policyholder: The consumer designated to function as the primary contact person with the insurance company. The insurance policy usually lists the name of this consumer who is essentially responsible for any premiums associated with the coverage.

Property Damage Liability Coverage: Protects car insurance or auto insurance policyholders from financial requirements related to property damage that occurs as a result of a car accident. Property damage insurance premiums help covers the costs of damaged property and also helps pay some legal expenses incurred from lawsuits that result. Property Damage policy clauses usually include a cap or ceiling limit established upon acceptance of the car insurance coverage or auto insurance policy.

Provider: health care professionals who perform specific professional medical services. Many times this refers specifically to physicians. Sometimes this also relates health care professionals such as treatment centers, nurses, physical therapists, and other specialized doctors.

Reasonable and Customary Fees: fees set forth by health care providers within a designated state or geographic market area. These phrases are often used by medical plans as the set amount of money that approves a specific medical test or surgical procedure. If the medical fees are greater than the pre-approved amount, the individual receiving the service is responsible for paying the difference. Sometimes, however, if an individual questions his doctor concerning the fees, some professionals will lessen the amount that any insurance company has listed as customary.

Rental Car Reimbursement: An optional item found in many car insurance or auto insurance policy programs that assists in covering rental car payments if the insured vehicle is lost, stolen, damaged, or not operating as a result of an accident.

Risk: The probability percentage of loss or the amount of possible loss to the holding medical insurance company. Risk represents probabilities including the: likelihood of complicated surgery, prescription drug side effects, chance of infection, or the length of suffering caused by a lifestyle choice. Consumers increase their risk of obtaining cancer if they partake in smoking tobacco.

Second Opinion: an additional review by another doctor or surgeon, when a first surgeon registers a diagnosis or suggests a type of surgery to any individual health care consumer. Patients are encouraged to obtain a second opinion when a doctor urges complicated or difficult surgical procedures to patients with a serious medical problem.

Second Surgical Opinion: assumed health care benefits in most group health insurance plans. An opinion detailed by second surgeon, when the first opinion encourages surgery to a health services consumer.

Secondary Driver: An additional vehicle operator listed on a car insurance or auto insurance policy insured to operate the vehicle covered in the policy in addition to the primary operator.

Short-Term Disability: injury or sickness that prevents a consumer from attending work for a brief period of time. The definition of short-term disability usually varies by Health Insurance Company and corporate employers. Short-term disability insurance coverage is offered to ensure a health care consumer receives full employment wages during a leave of absence required from a physical injury or medical illness that prevents a health care consumer from attending work on a regular basis.

Towing Coverage: An optional item included in many car insurance or auto insurance policies, that provides monetary benefits to cover towing of a vehicle that stops operating as a result of an accident.

Triple-Option: a medical Insurance policy that provides three separate options that an individual is allowed to choose from. Often times, these three choices can include: a Health Maintenance organization - HMO, Preferred Provider Organization - PPO, or indemnity.

Usual, Customary and Reasonable (UCR) or Covered Expenses: A fixed cost incurred for medical services and treatment supplies that are deemed necessary, preferred by a doctor, or provided in treatment.

Variable Annuity: Provides insurance consumers the option of investing in multiple financial programs that function similar to mutual funds in a portfolio manner that includes tax deferred earning capabilities. Variable annuities present both risks and rewards superior to Fixed Annuity insurance programs and are subject to market fluctuations.

VIN: Stands for Vehicle Identification Number, a number used to identify every passenger vehicle. This number is similar to a serial number, that outlines specifics of every vehicle usually the production year, manufacturer, and model name. These VIN number needs to be listed on an auto insurance or car insurance policy agreement forms.

Waiting Period: A period of time when a health insurance policyholder is not covered by a medical insurance policy for a specific health services treatment.

Site Map | Texas Insurance | Texas Auto Insurance | Texas Homeowners Insurance | Texas Health Insurance | Texas Life Insurance