Glossary

Annualized Premium: The total amount of premiums paid within 12 policy months. For example, if the monthly premium is $10, the annualized premium is $120 ($10 x 12 months).

Assignment: The transfer of ownership rights in a life insurance policy or other type of contract from one party to another, or the document that causes the transfer of ownership rights to go into effect.

Benefit Period: The maximum number of days for which benefits can be paid for any one or successive periods of confinement or disability.

Cafeteria Plan/Flex Plan — Participating: A benefit plan maintained by an employer for its employees, under which all participants have the opportunity to select benefits that are suitable for their lifestyles, and for which premiums can be deducted from their paychecks on a pre-tax basis.

Cafeteria Plan/Flex Plan — Nonparticipating: A benefit plan maintained by an employer for its employees, under which all participants have the opportunity to select benefits that are suitable for their lifestyles, and for which premiums can be deducted from their paychecks on an after-tax basis.

Canceled: Policy terminated by request.

Claim: Written proof of financial loss.

Claims History: History of claims previously processed.

Compliance (or Conformity With State and Federal Statutes): To abide by the statutory requirements established at the federal, state, and industry levels.

Continuous Coverage: Occurs when a person is deleted from a policy and issued a new policy under one of the following conditions: policy upgrade, divorce of a husband and wife who hold a family policy, dependent child has reached the age limit or marries, a husband and wife decide they want separate policies.

Conversion: The process of exchanging benefits for the purpose of increasing or decreasing coverage.

Decline: An applicant is denied coverage with Aflac for specified reasons.

Denial: The process of reviewing a claim and deciding that, due to the terms of the policy contract, no benefits are due for the claim.

Dental Hygienist: A legally qualified person, other than a member of your immediate family, who is licensed by the state to treat the type of condition for which a claim is made.

Dentist: A legally qualified person, other than a member of your immediate family, who is licensed by the state to treat the type of condition for which a claim is made.

Dependent Children: Please see your policy for specific definition. 

Direct Billing: A mode of premium payment in which policies are billed on an individual basis to the policyholder at home.

DOD: Date of death.

Downgrade: Change in coverage to a plan with lower premiums/benefits than that of the original plan.

Due Date: Date to which premiums have been paid.

Each Subsequent Year: Every 12-month period after the policy year.

Effective Date: Date the policy goes into effect.

Effective Date Family: Date family coverage was added to the policy.

Elimination Period: Please see your policy for a specific definition. 

Employer Statement: Part of the Aflac claim form that is to be completed by the employer.

Endorsement: An endorsement adds or deletes a person or benefit to/from an existing policy. The endorsement is mailed to the policyholder to attach to the original policy.

Entire Contract Clause: A provision in an insurance contract stating that the entire agreement between the insured and the insurer is contained in the contract, including the application (if it is attached), declarations, insuring agreements, exclusions, conditions, and endorsements.

Excessive Coverage: A policyholder is covered by two or more like policies which, when combined, provide more coverage than Aflac guidelines allow.

Exclusion: An exclusion refers to a person(s) or a condition(s) not covered by the policy due to policy provisions or underwriting requirements.

First Policy Year: The period of time that begins on the effective date of coverage as shown in the Policy Schedule and ends 365 days from the effective date.

Flex One ® : The trademarked name of Aflac's Section 125 Cafeteria Plan (see Cafeteria Plan above for more detail).

Grace Period: A period of time beyond the due date for premium payment (usually 31 days) during which time a policyholder may still remit the premium payment without losing coverage.

Group Number: A five-digit identification code assigned by Aflac for group billing.

Guaranteed-Issue: Insurance coverage for which there is usually no individual underwriting. All eligible members of a particular group of proposed insureds who apply for the policy and who meet certain conditions are automatically issued a policy.

Husband and Wife Only: Coverage for the insured and the spouse only.

Immediate Family: Anyone related to the insured in the following manner: spouse, brother, or sister (includes stepbrother and stepsister); children (includes stepchildren); parents (includes stepparents); grandchildren; father- or mother-in-law; and spouses of any of these, as applicable.

Inactive: Term used to describe a policy that is lapsed, terminated, or canceled.

Indemnity: Term used to describe a benefit that pays a specific dollar amount rather than the actual charges or a percentage of the charges.

Individual: Coverage for only the insured person listed in the Policy Schedule.

Initial Start Date: The actual date the account was established.

Insured: Primary person covered under the policy.

Insurer: The party to an insurance arrangement who undertakes payment for losses, provides benefits, or renders services.

Issue Date: The effective date of the policy.

Issue State: State in which the policy was issued.

L&Es: Limitations and exclusions regarding policy provisions and benefits.

Line of Business: Refers to various types of policies sold by Aflac (for example, cancer, intensive care, accident).

Minimum Salary Requirements: Salary required to qualify for the total amount of coverage provided by the policy.

Occurrence Date: Initial date of loss for a specified claim.

One-Parent Family: Please see your policy for a specific definition.

Original Effective Date: The effective date of the policy as stated in the Policy Schedule.

Paid-to Date: The day, month, and year through which a policy is paid.

Participating Employee: Status of an employee who chooses to participate in an account's Section 125 Cafeteria Plan.

Pending: A claim that cannot be processed completely until additional information requested by the claims specialist is received.

Physician Statement: The part of the claim form that is to be completed by the physician.

Plan Effective Date: Beginning date of coverage for a current plan.

Plan Code: Six-digit code used to identify the type of policy payable under the plan.

Policyholder: Person listed as the owner of the policy and who is responsible for premium payment.

Premium: The amount of money required at specified intervals to keep a policy contract in force.

Pre-existing Condition: Please see your policy for a specific definition.

Pre-tax: Premiums that are deducted from the employee's paycheck before taxes are calculated and deducted.

Primary Policyholder: The person to whom the policy was issued.

Proof of Loss: Written proof that is required to be furnished to the insurer about a loss to help determine the extent of insurer liability.

Provider: A facility, licensed as such, that provides health services for an individual.

Reinstatement: The act of putting a lapsed policy back in force.

Reinstatement Date: Date the lapsed or terminated policy was put back in force.

Replacement Policy: A policy that has replaced a similar product from another company.

Rider: A supplementary section or page that is attached to and made a part of the insurance contract to modify or add to the coverage the contract provides.

Supplemental Insurance: Insurance policies designed to supplement other basic coverage.

Term: Period of time the policy is in force.

Terminated: A term used to describe a policy or account that is no longer active.

Termination Date: The actual date the coverage ceased.

Transit One®: Name of Aflac's Section 132 transportation expense program.

Two-Parent Family: Please see your policy for a specific definition.

Unearned Premium: The portion of the written premium that can be applied to the unexpired or unused part of the period for which the premium has been paid or refunded to the insured. For example, in the case of an annual premium, at the end of the first month of the premium period, 11/12 of the premium is unearned.

Waiting Period: Please see your policy for a specific definition. 

Waiver of Premium: The provision of the policy that relieves payment responsibility for the policyholder as defined in the policy.

Note: Some definitions included here are from Insweb.com.

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