WY Life & Health key terms

A license from the Wyoming Insurance Commissioner that lets an insurance company legally sell insurance in the state. A company without one is not admitted and cannot operate as a Wyoming insurer.

An insurance company that holds a Wyoming certificate of authority and therefore must follow state insurance laws, file required reports, and participate in the state guaranty association.

The appointed state official who enforces Wyoming insurance law by licensing insurers and producers, examining company records, investigating complaints, and issuing fines or license revocations.

An insurer's written notice filed with the state that authorizes a licensed producer to represent that insurer. A producer cannot legally submit business for a company without a valid appointment.

A producer's legal obligation to hold premiums and other client money in a trust account, keep it separate from personal funds, and account for it accurately.

Prohibited claim-handling conduct such as misrepresenting policy terms, delaying a claim without good reason, or offering far less than the policy owes. It is a regulated unfair trade practice.

A Wyoming license issued to someone already licensed as a producer in another state, usually granted through reciprocity so the person can sell Wyoming business without a full resident exam.

Using the cash value, surrender, or lapse of an existing life policy to buy a new one. Wyoming rules require the producer to give the buyer a disclosure notice comparing the old and new coverage.

A financial or close family stake in another person's continued life. It must exist when a life policy is applied for; without it the contract is not enforceable.

The tendency of people who expect to need coverage, because of poor health or risky habits, to buy or keep more insurance than people at lower risk. Insurers counter it with underwriting.

A statistical chart showing how many people out of a given number are expected to die at each age during a year. Insurers use it to calculate life insurance premiums.

A premium that stays the same every year for the life of a policy. It works because the insurer averages the rising cost of protection over the whole payment period.

The insurer's review of an applicant's health history, hobbies, occupation, and finances to decide whether to issue coverage, how much coverage to issue, and at what rate.

A backup beneficiary named in a life policy who receives the death benefit only if the primary beneficiary dies before the insured or otherwise cannot collect.

A policy provision saying the policy plus the attached application is the complete agreement. Statements made outside those documents cannot change or add to the contract.

After a policy has been in force for a set period, usually two years, the insurer can no longer cancel it or refuse to pay because of a misstatement on the application, apart from fraud.

The number of days after a premium due date that a policy stays in force before it can lapse. If the insured dies during the grace period, the unpaid premium is subtracted from the benefit.

A policy right that lets the owner restore lapsed coverage by paying overdue premiums with interest and providing proof of insurability, usually within a stated number of years.

A provision that borrows from a policy's cash value to pay a premium not paid by the end of the grace period, so the policy does not lapse.

Money the owner borrows from a permanent life policy's cash value. The insurer charges interest, and any unpaid loan plus interest reduces the death benefit or cash surrender value.

Guaranteed choices for what happens to the cash value if a permanent policy is surrendered or lapses: cash surrender, reduced paid-up insurance, or extended term insurance.

A nonforfeiture option that uses a policy's cash value to buy term insurance for the full face amount, lasting as long as that value will pay for.

Ways a beneficiary can take life insurance proceeds instead of a lump sum, such as payments for a fixed period, payments of a fixed amount, or income for life.

An optional benefit that cancels premiums while the insured is totally disabled for a required waiting period, keeping the policy in force with no further payments.

A rider allowing an insured who is diagnosed with a terminal illness to collect part of the death benefit early; the remaining amount is paid to the beneficiary later.

The amount an insured must pay out of pocket for covered health services each year before the insurer starts paying its share of the bill.

The split of covered costs between insurer and insured after the deductible is met. With an 80/20 plan, the insurer pays 80 percent and the insured pays 20 percent.

A fixed dollar fee the insured pays for a specific service, such as $30 for an office visit, instead of paying a percentage of the charge.

The maximum an insured pays in a year for covered care, including deductible, coinsurance, and copayments. Once reached, the plan pays 100 percent of covered services.

An illness or injury the insured was diagnosed with or treated for before coverage started. Policies may limit or exclude payment for it during a stated period.

Rules that decide which health plan pays first when a person has coverage under two plans, so providers are not paid twice for the same expense.

A health policy right requiring the insurer to renew coverage up to a stated age as long as premiums are paid; the insurer can raise rates only for the whole class of policyholders.

Coverage that replaces part of a worker's income, usually 50 to 70 percent, when illness or injury stops the person from working.

A disability definition that pays benefits when the insured cannot perform the duties of the specific job held before disability, even if the person could work elsewhere.

The waiting time after a disability begins before benefits are paid. It works like a time-based deductible, and longer periods usually lower the premium.

A benefit that pays part of the monthly amount when the insured returns to work but still earns less than before because of the disability.

A managed care plan that provides care through a network and a primary care physician who coordinates treatment. Care outside the network is generally not covered except in emergencies.

The federal health program for people age 65 and older and some people with disabilities, with Part A for hospital care, Part B for medical care, and Part D for prescription drugs.

A federal law that lets workers and their dependents keep group health coverage for a limited time after events like job loss or divorce, paying the full premium themselves.