Glossary

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    Accidental death benefit

    Money paid to the beneficiary if the insured person dies accidentally

    Accident insurance

    Provides a lump-sum payment to the insured in the event of a covered accident

    AD&D insurance

    Pays an additional benefit if the insured suffers a covered loss due to an accident

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    Basic life insurance

    Coverage that employers provide to employees; usually term insurance coverage paid for by the employer

    Basic procedures (dental)

    Dental care such as fillings, root canals, non-surgical extractions, periodontics; sometimes referred to as Type II procedures

    Beneficiary

    Person who receives money from an insurance policy or investment account

    Beneficiary, contingent

    Back-up beneficiary; person who receives the money from the life insurance policy if the first beneficiary dies before the insured

    Beneficiary, irrevocable

    A beneficiary who can’t be changed without his or her permission

    Benefit amount (disability)

    Amount of replacement income you receive if you become totally disabled; determined either as a percentage of your current income or as a specific dollar amount to be paid per week (short-term disability) or per month (long-term disability)

    Benefit duration (disability)

    Length of time you continue to receive benefits, assuming you remain totally disabled; normally 13 or 26 weeks for short-term disabilities and from 2 years to Social Security normal retirement age for long-term disability

    Benefit schedule (applies to Accident insurance and Dental insurance)

    The list of what is covered under your plan and the benefits payable for those covered conditions. Also known as schedule of benefits

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    Calendar year maximum (dental)

    Maximum dollar amount of benefits your plan will pay toward the cost of dental care over the course of a calendar year (i.e., January 1 to December 31)

    Cancer insurance

    An insurance policy that pays you a lump sum benefit (up to a maximum and subject to exclusions, limitations, waiting periods, and pre-existing conditions) upon diagnosis of a covered cancer condition

    Coinsurance (dental)

    The portion of the cost of care that your dental plan is responsible for paying (you pay the rest)

    Conversion

    When you change, or "convert," your group coverage to an individual policy

    Coverage

    Amount of protection you have purchased. The maximum amount of money an insurance company will pay you if you make a claim for a loss or event covered by your policy

    Covered accident

    An accident covered by the policy. If you experience a covered accident, you will receive a cash benefit according to the schedule of benefits. The amount you receive depends on your injury and your corresponding treatment. You may use this money however you wish—for example, to pay for prescriptions, crutches, or other out-of-pocket expenses as a result of a covered accident.

    Critical illness insurance

    An insurance policy that pays you a lump sum benefit (up to a maximum and subject to exclusions, limitations, waiting periods, and pre-existing conditions) upon diagnosis of a covered critical illness condition

    Critical illness and cancer insurance

    An insurance policy that provides coverage for covered conditions that include critical illness and cancer diagnoses (see definitions for "Critical illness insurance" and "Cancer insurance")

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    Death benefit

    Money paid to the beneficiary when the person covered by the life or AD&D insurance dies 

    Deductible (dental)

    Amount you pay to the dentist before the insurance company starts to pay benefits

    Dependent child

    A dependent child can be the Insured’s child (whether by blood or adoption) or stepchild child of a Spouse; foster child; a child of a sibling or stepsibling; or a descendant of any of these, such as a grandchild. Also, the child must be unmarried and under the age of 26 with the same principal residence as the Insured; or an unmarried child under age who is enrolled as a full time student and depends on you for 50% or more of the child’s support. For more information on a Dependent child, please check your policy.

    Disability insurance

    Replaces part of your income if you are totally disabled and cannot earn an income yourself for a qualifying period of time. As with other types of insurance, you make scheduled payments (called premium payments) to keep the coverage in place. The income amount, waiting period, and maximum amount of time the benefit will vary by plan.

    Dismemberment

    Loss of a body part

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    Effective date

    Date you become covered by benefits

    Eligible

    Allowed or qualified to participate in benefits 

    Elimination period

    Amount of time (or waiting period) between the first day of disability and the date you begin receiving benefits; for short-term disabilities, normally 7 or 14 days, and for long-term disabilities, 60, 90, or 180 days 

    Evidence of Insurability

    A statement, or proof, of an employee’s or dependent’s medical history. It is used to determine whether or not coverage will be provided. In some cases, it may be required that you submit to a paramedical or other physical examination, at our expense, as part of the Evidence of Insurability. Also known as "proof of good health."

    Exclusion

    Something that is not covered by the plan

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    Flexible Spending Account (FSA)

    Tax-advantaged medical savings account that allows employees to contribute a portion of their earnings to pay for qualified expenses, such as medical or dependent care expenses. Subject to guidelines and maximums. An FSA is not the same as a Health Savings Account (HSA).

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    Group insurance

    Insurance through a group, such as an employer, an association, or a union

    Guaranteed Issue

    The maximum amount of insurance coverage you may elect without answering medical questions (providing Evidence of Insurability).

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    Health Savings Account (HSA)

    Tax-advantaged medical savings account used to help employees enrolled in High Deductible Health Plans (HDHP) pay for or receive reimbursement for certain medical expenses. Eligibility criteria apply.

    High Deductible Health Plan (HDHP)

    A health insurance plan with a relatively high deductible and a relatively low premium. In the U.S., an HDHP is a requirement for a Health Savings Account (HSA) (which helps people pay the premium and certain medical expenses). Eligibility criteria apply.

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    In-network (dental)

    A dentist who is in your PPO network and who generally offers lower out-of-pocket costs

    Insured

    The person(s) covered by the policy

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    Life insurance

    An insurance policy that pays a set amount to those named in the policy (the beneficiaries) when the insured dies

    Lifetime maximum

    The highest benefit amount that will be paid in one person’s lifetime

    Limitation

    The provisions of the plan that limit coverage

    Long-term disability

    Provides replacement income for long-term or chronic disabilities. Benefits can last from 2 years to Social Security normal retirement age

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    Major procedures (dental)

    Dental care for bridges, dentures, partial dentures, oral surgery; sometimes referred to as Type III procedures

    Maximum benefit amount

    The highest possible amount of a benefit that may be issued per covered condition

    Millennial

    Any person born between 1980 and 1995

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    Optional life insurance

    Additional coverage that an employee can add on to basic life coverage; paid through payroll deductions

    Ortho/orthodontics (dental)

    Detection, prevention, and correction of abnormalities in the positioning of the teeth in their relationship to the jaw; usually braces; sometimes referred to as Type IV procedures

    Out-of-network (dental)

    A dentist not in your PPO network—you may incur higher out-of-pocket costs

    Out-of-pocket expenses

    Expenses that are not covered by health insurance

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    Partial disability benefits

    Disability benefits that supplement your income if you return to work part-time or on a modified schedule

    Permanent universal life insurance

    Combines term life insurance with an optional cash accumulation account (CAA). The CAA acts like a tax-deferred savings account that pays interest. The insured may withdraw funds or take loans against the balance.

    Several group life carriers offer Group Universal Life (GUL) and Group Variable Universal Life (GVUL) products that appeal to employees who are looking for cash accumulation life insurance products. At this time, Sun Life Financial does not offer GUL or GVUL products.

    Portability

    Group coverage that you can take with you, or “port,” after employment ends

    Pre-existing condition

    A pre-existing condition can include any condition for which you, prior to the effective date of the policy, sought medical treatment, consultation, advice, care, or services; for which you took prescribed medications for the condition; or for which you had symptoms that a prudent person would consider significant enough to consult a health care provider. The lookback period for a pre-existing condition can range from a couple of months to a year prior to the effective date of the policy and should be explicitly stated within the policy. Having a pre-existing condition could limit the benefits payable to you.

    Preventive procedures (dental)

    Dental care such as X-rays, exams, prophylaxis (cleanings), fluoride, sealants; sometimes referred to as Type I procedures

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    Recurrence Benefit Rider (Critical Illness and Cancer Insurance only)

    Provides an additional lump sum benefit to Insureds who are diagnosed with a covered condition for which we previously paid a benefit. The diagnosis must be for a new event while the rider is in effect (not a re-diagnosis of the covered condition that was previously paid for), and a certain number of months must pass between diagnoses.

    Rider

    Clause or term added to your insurance policy to provide additional protection, usually for an additional cost, for risks not covered in a basic policy

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    Short-term disability

    Income replacement for typically 13 or 26 weeks if you are totally disabled and cannot work

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    Term insurance

    Issued to provide coverage for a specified period, or "term." If the insured dies during the period that the policy is in force, the insurance benefit is payable. At the end of the term, the insurance protection ends. Term life is usually the most economical form of life insurance. Term life has no cash value. Most group life insurance purchased is term life insurance.

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    Usual & customary charge (dental)

    The fee dentists usually charge for dental services and procedures in a given geographic area

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    Voluntary life insurance

    Life insurance where the employee funds the premium, usually through payroll deductions

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    Wellness Screening Benefit (Critical Illness and Cancer Insurance only)

    Provides an annual benefit to help promote healthy lifestyles and early detection. Employees and covered spouses (not children) can receive a benefit once per calendar year, when they send us proof of a health screening like a mammogram, electrocardiogram, or diabetes test.

    Whole life insurance

    Provides permanent death protection. The premium is generally payable until the insured dies or reaches age 100. The policy accumulates cash value, and the premium is level throughout the life of the contract. Whole life insurance is not available as a group product, but it may be sold to individuals as an investment vehicle for retirement purposes. The insured may take partial surrenders of the cash value of the policy or apply for loans. Beneficiaries receive the face value of the policy (and any accumulated cash value, less any outstanding loans) when the insured dies.

    SLPC 24199 1/14 (exp. 1/16)

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