Insurance: Wisconsin Health
Adverse Selection - The tendency of risks with higher probability of loss to purchase and maintain
insurance more often than the risks who present lower probability.
Adult Day Care - A program for impaired adults that attempts to meet their health, social, and
functional needs in a setting away from their homes.
Adhesion - A contract offered on a "take-it-or-leave-it" basis by an insurer, in which the insured's
only option is to accept or reject the contract. Any ambiguities in the contract will be settled in favor of
the insured.
Accidental Death and Dismemberment - An insurance policy which pays a specified amount or a
specified multiple of the insured's benefit if the insured dies, loses his/her sight, or loses two limbs due
to an accident.
Accidental Bodily Injury - Unplanned, unforeseen traumatic injury to the body.
Accidental Death Benefits - A policy rider that states that the cause of death will be analyzed to
determine if it complies with the policy description of accidental death.
Acquired Immunodeficiency Syndrome (AIDS) - An infectious and incurable disease caused by the
human immunodeficiency virus (HIV).
Activities of Daily Living - Activities individuals must do every day such as moving about, getting
dressed, eating, bathing, etc.
Accident - An unplanned, unforeseen event which occurs suddenly and at an unspecified place.
Actual Charge - The amount a physician or supplier actually bills for a particular service or supply.
Admitted (Authorized) Insurer - An insurance company authorized and licensed to transact
insurance in a particular state.
,Agent - An individual who is licensed to sell, negotiate, or effect insurance contracts on behalf of
an insurer.
Accident Insurance - A type of insurance that protects the insured against loss due to accidental
bodily injury.
Aleatory - A contract in which participating parties exchange unequal amounts. Insurance
contracts are aleatory in that the amount the insured will pay in premiums is unequal to the amount the
insurer will pay in the event of a loss.
Alien Insurer - An insurance company that is incorporated outside the United States.
Alzheimer's Disease - A disease that causes the victim to become dysfunctional due to
degeneration of brain cells and severe memory loss.
Ancillary - Additional, miscellaneous services provided by a hospital, such as x-rays, anesthesia,
and lab work, but not hospital room and board.
Approved Amount - The amount Medicare determines to be reasonable for a service that is
covered under Part B of Medicare.
Assignment - A claim to a provider or medical supplier to receive payments directly from
Medicare.
Attained Age - The age of the insured at a determined date.
Attending Physician's Statement (APS) - A statement usually obtained from the applicant's doctor.
Avoidance - A method of dealing with risk (e.g. if a person wanted to avoid the risk of being killed
in an airplane crash, he/she might choose never to fly in a plane).
, Basic Hospital Expense Insurance - Coverage that provides benefits for room, board and
miscellaneous hospital expenses for a certain number of days during a hospital stay.
Basic Medical Expense Insurance - Coverage for doctor visits, x-rays, lab tests, and emergency
room visits; benefits, however, are limited to specified dollar amounts.
Beneficiary - The person who receives the proceeds from the policy when the insured dies.
Benefit Period - The length of time over which the insurance benefits will be paid for each illness,
disability or hospital stay.
Birthday Rule - The method of determining primary coverage for a dependent child, under which
the plan of the parent whose birthday occurs first in the calendar year, is designated as primary.
Blanket Medical Insurance - A policy that provides benefits for all medical costs, including doctor
visits, hospitalization, and drugs.
Boycott - An unfair trade practice in which one person refuses to do business with another until
he or she agrees to certain conditions.
Buyer's Guide - A booklet that describes insurance policies and concepts, and provides general
information to help an applicant make an informed decision.
Cafeteria Plan - A selection of health care benefits from which an employee may choose the ones
that he/she needs.
Capital Amount - A percentage of the principal amount of a policy paid to the insured if he/she
suffered the loss of an appendage.
Carriers - Organizations that process claims and pay benefits in an insurance policy.
Adverse Selection - The tendency of risks with higher probability of loss to purchase and maintain
insurance more often than the risks who present lower probability.
Adult Day Care - A program for impaired adults that attempts to meet their health, social, and
functional needs in a setting away from their homes.
Adhesion - A contract offered on a "take-it-or-leave-it" basis by an insurer, in which the insured's
only option is to accept or reject the contract. Any ambiguities in the contract will be settled in favor of
the insured.
Accidental Death and Dismemberment - An insurance policy which pays a specified amount or a
specified multiple of the insured's benefit if the insured dies, loses his/her sight, or loses two limbs due
to an accident.
Accidental Bodily Injury - Unplanned, unforeseen traumatic injury to the body.
Accidental Death Benefits - A policy rider that states that the cause of death will be analyzed to
determine if it complies with the policy description of accidental death.
Acquired Immunodeficiency Syndrome (AIDS) - An infectious and incurable disease caused by the
human immunodeficiency virus (HIV).
Activities of Daily Living - Activities individuals must do every day such as moving about, getting
dressed, eating, bathing, etc.
Accident - An unplanned, unforeseen event which occurs suddenly and at an unspecified place.
Actual Charge - The amount a physician or supplier actually bills for a particular service or supply.
Admitted (Authorized) Insurer - An insurance company authorized and licensed to transact
insurance in a particular state.
,Agent - An individual who is licensed to sell, negotiate, or effect insurance contracts on behalf of
an insurer.
Accident Insurance - A type of insurance that protects the insured against loss due to accidental
bodily injury.
Aleatory - A contract in which participating parties exchange unequal amounts. Insurance
contracts are aleatory in that the amount the insured will pay in premiums is unequal to the amount the
insurer will pay in the event of a loss.
Alien Insurer - An insurance company that is incorporated outside the United States.
Alzheimer's Disease - A disease that causes the victim to become dysfunctional due to
degeneration of brain cells and severe memory loss.
Ancillary - Additional, miscellaneous services provided by a hospital, such as x-rays, anesthesia,
and lab work, but not hospital room and board.
Approved Amount - The amount Medicare determines to be reasonable for a service that is
covered under Part B of Medicare.
Assignment - A claim to a provider or medical supplier to receive payments directly from
Medicare.
Attained Age - The age of the insured at a determined date.
Attending Physician's Statement (APS) - A statement usually obtained from the applicant's doctor.
Avoidance - A method of dealing with risk (e.g. if a person wanted to avoid the risk of being killed
in an airplane crash, he/she might choose never to fly in a plane).
, Basic Hospital Expense Insurance - Coverage that provides benefits for room, board and
miscellaneous hospital expenses for a certain number of days during a hospital stay.
Basic Medical Expense Insurance - Coverage for doctor visits, x-rays, lab tests, and emergency
room visits; benefits, however, are limited to specified dollar amounts.
Beneficiary - The person who receives the proceeds from the policy when the insured dies.
Benefit Period - The length of time over which the insurance benefits will be paid for each illness,
disability or hospital stay.
Birthday Rule - The method of determining primary coverage for a dependent child, under which
the plan of the parent whose birthday occurs first in the calendar year, is designated as primary.
Blanket Medical Insurance - A policy that provides benefits for all medical costs, including doctor
visits, hospitalization, and drugs.
Boycott - An unfair trade practice in which one person refuses to do business with another until
he or she agrees to certain conditions.
Buyer's Guide - A booklet that describes insurance policies and concepts, and provides general
information to help an applicant make an informed decision.
Cafeteria Plan - A selection of health care benefits from which an employee may choose the ones
that he/she needs.
Capital Amount - A percentage of the principal amount of a policy paid to the insured if he/she
suffered the loss of an appendage.
Carriers - Organizations that process claims and pay benefits in an insurance policy.
