WA Life & Health key terms

The Washington state agency that licenses insurers and producers, reviews policy forms and rates, handles consumer complaints, and enforces the state's insurance statutes.

A credential from the Insurance Commissioner that lets a person legally solicit, negotiate, or sell insurance in Washington; it must be renewed and kept in good standing.

An insurer's written authorization, filed with the state, that allows a licensed producer to write business on that insurer's behalf for specified lines of coverage.

Prohibited marketplace behaviors such as misrepresentation, rebating, twisting, coercion, and unfair claim settlement, which can lead to fines, license suspension, or revocation.

A financial or emotional stake in another person's continued life or health that must exist when a policy is purchased; without it, the contract is not legally enforceable.

The tendency for people with the highest health or mortality risk to seek and keep coverage, which can push up costs unless the insurer uses underwriting and pricing controls.

The principle that both applicant and insurer must deal honestly, disclosing all facts that would matter to the other party when forming the insurance contract.

If an insurer knowingly gives up a contractual right and the insured relies on that action, the insurer may be barred from enforcing the right later.

The stated death benefit printed on a life policy, paid to the beneficiary if the insured dies while coverage is in force, before loans or other adjustments.

The savings component inside a permanent life policy that grows over time and can be borrowed against, withdrawn, or taken if the policy is surrendered.

The person or entity named to receive a life policy's death benefit; the primary is first in line and a contingent receives proceeds if the primary cannot.

Underwriting practice of grouping applicants by expected mortality or morbidity-preferred, standard, or substandard-so each group pays a premium reflecting its risk.

Coverage that lasts a set number of years, such as 10 or 20, pays a death benefit if the insured dies during that period, and builds no cash value.

Permanent coverage with level premiums, a guaranteed death benefit, and guaranteed cash value growth that lasts the insured's lifetime as long as required premiums are paid.

Flexible permanent coverage allowing the owner to vary premium payments and sometimes the death benefit; the cash value earns interest while monthly cost-of-insurance charges are deducted.

Permanent coverage whose cash value is invested in subaccounts chosen by the owner, so value and sometimes the death benefit move with market results; sold with securities disclosures.

A provision stating that after the policy has been in force for a set period, usually two years, the insurer generally cannot contest it over misstatements on the application.

A window, commonly 30 or 31 days after a premium is due, during which the policy remains in force; any premium still owed is subtracted from a death benefit paid in that window.

Putting a lapsed policy back in force by paying overdue premiums with interest and showing evidence of insurability, usually within a limited period after the lapse.

A rider that keeps coverage in force and cancels premiums while the insured is totally disabled, typically after a waiting period of several months.

A contract that converts a lump sum or series of deposits into regular income payments, often used to provide retirement income that cannot be outlived.

The moment an annuity's accumulated value is converted into a stream of periodic payments that continue for a set period or for life.

An annuity that credits a guaranteed minimum interest rate during accumulation and pays a guaranteed level income during payout, with the insurer carrying the investment risk.

An annuity whose value is held in investment subaccounts and is not guaranteed, so income payments rise or fall with market performance and the owner bears the investment risk.

The amount an insured pays for covered services before the health plan starts paying, usually reset each plan year or applied per covered service.

The percentage of covered costs the insured pays after meeting the deductible, such as 20%, while the insurer pays the remaining share.

A yearly cap on the deductibles, coinsurance, and copayments an insured pays for covered in-network care; above that point the plan pays most or all covered costs.

Rules determining which plan pays first when a person has two or more health plans, so combined payments never exceed the actual cost of care.

Contract language describing the insurer's right to cancel coverage or change premiums at renewal, such as noncancellable, guaranteed renewable, or conditionally renewable.

Advance approval a health plan requires before certain services, procedures, or drugs will be covered; without it, the plan may reduce or deny payment.

A fee benchmark based on what providers typically charge in a geographic area, used by insurers to decide how much of a bill is covered.

Coverage that replaces part of an insured's earned income when illness or injury prevents working, typically paying 50% to 70% of predisability income.

A disability standard that pays benefits when the insured cannot perform the duties of their specific occupation, even if they could work in another field.

The waiting period after a disability or long-term care event begins before benefits are payable; a longer elimination period usually means a lower premium.

Basic self-care tasks such as bathing, dressing, eating, toileting, transferring, and continence, used as benefit triggers when a person cannot perform a required number of them.

Coverage that pays for custodial care-nursing home, assisted living, or home care-when the insured cannot perform ADLs or has a cognitive impairment.

Coverage issued to an employer or association under one master contract, with each eligible member receiving a certificate describing their benefits.

Private plans approved by Medicare that deliver Part A and Part B benefits, and often drug coverage, instead of original Medicare.

Private supplemental insurance that helps pay Medicare cost sharing such as deductibles and coinsurance; it is used with original Medicare, not Medicare Advantage.

A federal law that lets employees and dependents keep group health coverage for a limited time after a job loss or other qualifying event, paying the full premium.