Glossary of Terms

Supplemental medical plan that pays indemnity-based benefits to the member based on treatment of accidental injuries. Can be structured for 24-Hour or Off-Job coverage.

Supplemental medical plan that pays a lump sum benefit to the member if they meet the diagnosis requirements for a covered condition. Sample conditions include: Cancer, Heart Attack, Strokes.

Supplemental medical plan that pays indemnity-based benefits to the member if they are confined to the hospital for illness or injury. Optional benefits may also be available for outpatient treatment.

Typically refers to individual policies (or an individual contract) sold on a payroll deducted basis as an employee benefit.

Commission structure that pays a level commission amount year after year, typically 10%, 15%, or 20%.

Heaped Commissions pay a high 1st year commission, with a lower flat renewal – for instance a 60% commission in year 1, with a 10% renewal available thereafter. 

The act of proactively notifying or processing claims based on data collected internally or through a 3rd party.

When a Member experiences an event that potentially qualifies for a claim payment, and are then automatically notified that they have a potential claim they can file on their Supplemental Health plan once that claim is processed on another line of coverage (Ex. Health Insurance).

When a Member experiences an event that potentially qualifies for a claim payment, and the claim is automatically submitted on their Supplemental Health plan based on data collected on another line of coverage, and the Member receives a notification.

When a Member experiences an event that potentially qualifies for payment, the claim is automatically processed and paid with minimal human intervention from Member or carrier, based on data the carrier has in-house or through a 3rd party.

 The concept of Minimum Essential Coverage (MEC) was established by the Patient Protection and Affordable Care Act (ACA) in 2010. The ACA, also known as Obamacare, was a comprehensive healthcare reform law that aimed to improve access to healthcare and make it more affordable for Americans. The MEC provision of the ACA mandates all health insurance plans to offer essential health benefits, ensuring access to basic healthcare services for all Americans regardless of their income or health status.

Data exchange standards created by LIMRA, focused on automating the application and enrollment processes for most insurance product lines; thus creating quicker turnaround times and eliminating the potential for mistakes.