OR Life & Health key terms

An insurance company authorized by the Oregon Department of Consumer and Business Services to sell insurance in Oregon, which must follow state rules on solvency, rates, and policy forms.

A nonadmitted insurer that is not licensed in Oregon but may sell coverage through a specially licensed surplus lines producer when admitted insurers will not write the needed risk.

A state-mandated pool funded by admitted insurers that pays certain unpaid claims of policyholders when an admitted insurer becomes insolvent, subject to statutory limits.

The principle that both parties to an insurance contract must deal honestly and disclose material facts, with the applicant revealing information the insurer needs to judge the risk.

A financial or emotional stake in the continuation of another person's life or health that justifies insuring that person; for life insurance it must exist when the application is made.

A contract in which the amounts exchanged by the parties are unequal and depend on chance, so one party may pay far more or far less than the other depending on whether a loss occurs.

A contract prepared entirely by one party, the insurer, and offered to the other on a take-it-or-leave-it basis, so any ambiguity is interpreted in favor of the policyholder.

Waiver is the voluntary giving up of a known right, while estoppel prevents a party from later asserting that right if the other party reasonably relied on the waiver to their detriment.

The stated death benefit of a life insurance policy, paid to the beneficiary if the insured dies while coverage is in force, before adjustments for loans, riders, or dividends.

The savings portion of a permanent life policy that grows over time and is available to the owner through a loan, withdrawal, or surrender; term policies generally have none.

Temporary life insurance that pays a death benefit only if the insured dies during a stated period, builds no cash value, and usually costs the least for a given face amount.

Permanent life insurance with premiums guaranteed to stay level for life, a guaranteed cash value that grows over time, and coverage that remains in force as long as required premiums are paid.

Flexible permanent life insurance with an adjustable premium and death benefit; the policy's cash value earns interest and monthly mortality and expense charges are deducted from that value.

A period set by state law after a newly delivered policy is received during which the owner may return it for a full premium refund, allowing the buyer to reconsider the purchase.

Choices that let the owner of a permanent policy with cash value keep some benefit when premiums stop, such as cash surrender, reduced paid-up insurance, or extended term insurance.

The ways a participating policyowner may receive policy dividends, including cash, premium reduction, accumulation at interest, paid-up additions, or one-year term insurance.

The methods a beneficiary may use to receive life insurance proceeds instead of a single lump sum, such as interest only, fixed period, fixed amount, or a lifetime income.

A rider that cancels premiums due while the insured is totally disabled and the waiting period has been satisfied, keeping the policy in force without further out-of-pocket payment.

A provision allowing the insured to receive part of the death benefit early upon diagnosis of a terminal or other qualifying illness, which reduces the amount later paid to beneficiaries.

The transfer of a policyowner's rights under a life insurance policy to another person or entity, either absolutely as a gift or sale, or collaterally as security for a loan.

A contract with an insurer that pays a stream of income, often for life, in exchange for premiums paid, designed mainly to protect a person from outliving their money.

The point at which an annuity's accumulated value is converted into a series of guaranteed income payments, a decision that generally cannot be reversed once payouts begin.

A fee an insurer charges when a policy or annuity is cashed in during its early years, intended to recover costs the insurer incurred in selling the contract.

A document given when an application and initial premium are submitted; coverage may begin as of the application date if the proposed insured proves to meet the insurer's underwriting requirements.

A life policy that fails the seven-pay test because premiums were paid too quickly; loans and withdrawals are taxed as income first and may face a 10% penalty before age 59½.

A tax-free transfer of cash value from one life insurance policy or annuity into another of the same or a comparable type, permitted under Section 1035 of the Internal Revenue Code.

The risk category an insurer assigns an applicant after reviewing health and other factors, such as preferred, standard, or substandard, which determines the premium charged.

The amount a covered person must pay out of pocket for covered services during a benefit period before the health plan begins paying its share of the remaining cost.

The percentage of covered medical costs the insured pays after the deductible is satisfied, while the insurer pays the rest until the plan's out-of-pocket limit is reached.

A health condition that was diagnosed or treated before new coverage began; group plans may limit benefits for it only within the limits allowed by federal law.

A disability definition that treats an insured as disabled when unable to perform the duties of their own occupation, often paying benefits even if the person works in another field.

The waiting period that must pass after a disability or illness begins before benefits become payable; it works like a time deductible and affects the premium charged.

A health plan that delivers care through a network of contracted providers and typically requires members to use a primary care physician for referrals before seeing specialists.

A health plan that contracts with a provider network and pays a larger share when members use network providers, while still allowing out-of-network care at a higher cost.

Rules that determine the order in which two or more health plans pay when a person is covered by more than one, preventing total payments from exceeding the actual charges.

A method of setting group insurance premiums that uses the group's own past claims and usage rather than relying only on the insurer's average rates for similar groups.

The federal health program for people age 65 and older and certain disabled individuals, with Part A hospital coverage, Part B medical coverage, Part C Medicare Advantage, and Part D drug coverage.

A private supplemental policy that helps pay Medicare cost sharing such as deductibles and coinsurance; federal rules standardize the benefit plans sold in most states.

A state and insurer arrangement in which buying a qualifying long-term care policy lets the policyholder protect a matching amount of assets from Medicaid spend-down rules.

A tax-advantaged account for people enrolled in a qualifying high-deductible health plan, used to pay medical expenses, with tax-free contributions, growth, and qualified withdrawals.