Page: 2 - 4 - 5 - 6 - 7 - 8 - 9 - 10 - 11 - 12 - 13 - 14 - 15 - 16 - 17 - 18 - 19 - 20


Nonparticipating Provider (1) A provider who has not signed a contract with a health plan. (2) A medical or health care provider who is not certified to participate in the Medicare program.
Nonprofit Insurers Insurers organized under special state laws, usually exempting them from some taxes imposed on regular insurers, to supply Medical Expense Reimbursement Insurance, usually on a service basis. "Blue" plans (Blue Cross and Blue Shield) in most states are an example.
Nonresident Agent Insurance agents must be licensed in each state where they write business. When an agent is domiciled in one state but also writes business in another, the agent is considered a nonresident in all states except the state of domicile.
Nonsmoker Discount Because of the data and statistics available showing that non-tobacco users have fewer health problems, credits are offered in some life and health insurance programs for those insureds who commit to not using tobacco products.
Notice of Loss The notice submitted by an insured to the insurer regarding the occurrence of a loss. Policy conditions specify how long the insured has to notify the insurer of the loss, in what format, and the information the loss notice must contain.
Notice of Occurrence The notice of the occurrence of a loss, that must be submitted by an insured to the insurer in a liability contract. Policy conditions specify when the insured should notify the insurer of the loss, in what format, and the information the notice should contain.
Nurse Fees A provision in a medical expense reimbursement policy calling for reimbursement for the fees of nurses other than those employed by the hospital.
Nursing Home A licensed facility which provides general nursing care to those who are chronically ill or unable to take care of necessary daily living needs. May also be referred to as a Long Term Care facility.
Obligee The party in whose favor a bond runs, such as the party protected from loss under the bond.
Obligor One bound by the obligations covered by a bond. Also called the principal.
Occupancy 1)The use to which a building is put. 2)The type of contents a building contains.
Occupational Disease Impairment of health caused by continued exposure to conditions inherent in a person's occupation or a disease caused by an employment or resulting from the nature of an employment.
Occurrence 1)In a non-insurance sense, an incident, event or happening. In insurance, the term may be defined as continual, gradual or repeated exposure to an adverse condition which is neither intended nor expected to result in injury or damage, as contrasted with an accident, which is a sudden happening. In reinsurance, per occurrence coverage permits all losses arising out of one event to be aggregated instead of being handled on a risk-by-risk basis. 2)One basis or determinant for calculating the amount of loss or liability in insurance or reinsurance when an aggregation of related losses is to constitute a single subject of recovery. For example, in property catastrophe reinsurance treaties, occurrence is usually defined so that all losses within a specified period of time involving a particular peril are deemed an occurrence.
Occurrence Policy The traditional occurrence liability insurance method provides coverage for losses from liability-imposing causes which occurred during the policy period, regardless of when the claim is asserted. Once the policy period is over in a claims-made form, the approximate extent of the underwriter's liability is known. With the traditional occurrence liability coverage method, the underwriter may not discover the extent of liability for years to come from losses claimed to have occurred within the policy period.
Ocean Cargo Insurance A type of marine insurance that provides property protection for cargo that is being shipped by sea or over water.
Ocean Marine Insurance The protection of ships, their cargoes, and the freight, including protection and indemnity insurance to cover shipowners' liabilities for loss of life to any person, illness or injury to crew, damage to cargoes carried, and damages to fixed or floating objects.
Off-Premises Clause Language which may be added to a policy indicating that personal property is covered when elsewhere than on the premises described in the policy.
Off-Premises Services Coverage Property and time element endorsements designed to cover the insured for losses that result from the interruption of services by an insured cause of loss. The current endorsements allow the insured to select coverage for off-premises services, whether supplied by a private or public utility. Protection may be purchased for the following options, including water suppliers, communication suppliers, or power supplies.
Office Visit Services provided in the physician's office.
Omissions Clause A provision that applies to treaty reinsurance agreements. In those cases where the reinsurance treaty would have normally applied to a risk,but the ceding insurer unintentionally omitted the risk from the Bordereau (the report of ceded risks) the omitted risk is still covered.
Omnibus Clause A part of an automobile or yacht liability policy which extends coverage to persons and orgnizations other than the named insured, such as members of the insured's family, servants and others using the automobile with the owner's permission. When these extensions were introduced,the policy was said to have an "omnibus clause."
Open Access Allows a participant to see another participating provider of services without a referral. Also called open panel.
Open Debit A Life and Health Insurance debit (territory) currently without an agent.
Open Enrollment Period A period during which members can elect to come under an alternate plan, usually without providing evidence of insurability.
Open Panel See Open Access.
Optionally Renewable A contract of Health Insurance in which an insurer reserves the unrestricted right to terminate coverage at any anniversary or, in some cases, at any premium due date. It may not do so in between.
Ordinance or Law Coverage A property endorsement which provides the insured the option to purchase coverage for three types of common building ordinance or law requirements that apply after an insured has suffered a physical damage loss such as fire. These ordinance or law damages are normally excluded in standard property coverage forms. The coverages available in this endorsement are cost to demolish the undamaged portion of the building, cost to replace with superior construction as required by law, and cost to clear the land of debris after demolition.
Other Insurance Clause Language in many policies which states the method for apportioning the loss between two or more policies covering the same property at the time of loss.
Out-of-Area (OOA). Treatment given to a member outside of the normal area.
Out-of-Network Describes a provider or health care facility which is not part of a health plan's network. Insured individuals usually pay more when using an out-of-network provider, if the plan uses a network.
Out-of-Pocket Costs The amounts the covered person must pay out of his or her own pocket. This includes such things as coinsurance, deductibles, etc.
Out-of-Pocket Limit The maximum coinsurnace an individual will be required to pay, after which the insurer will pay 100% of covered expenses up to the policy limit.
Outcomes Measurement A method of keeping track of a patient's treatment and the responses to that treatment.
Outpatient A patient who is not a bed patient in the hospital in which he or she is receiving treatment.
Over-The-Counter Drugs (OTC) A drug that can be purchased without a prescription.
Overage Insurance Health Insurance issued at ages above the usual limit, which is generally 65.
Overhead Expense Insurance Insurance which covers such things as rent, utilities, and employee salaries when a business owner becomes disabled. The insurance benefit is generally not a fixed amount, but pays the amount of expenses actually incurred.
P & I Insurance Protection and indemnity insurance for shipowners, contractors, and charterers against liabilities arising out of the operation of the vessel for loss of life to any person, illness or injury to passengers and crew, damage to cargo while loading, carrying or unloading cargo, damage to piers and docks, and removal of wreckage as required by law.
Paid Business Insurance for which the application has been signed, the medical examination completed, and the settlement for the premium tendered.
Paid Claims Loss Ratio Paid claims divided by total premiums.
Pair-And-Set Clause An inland marine policy provision which requires the insurer, at the insured's option, to restore or pay for the entire pair or set of jewelry or fine arts when only a part has been lost, destroyed or damaged.
Partial Disability A condition in which, as a result of injury or sickness, the insured cannot perform all of the duties of his occupation but can perform some. Exact definitions vary from policy to policy.
Partial Hospitalization Services Additional services provided to mental health or substance abuse patients which provides outpatient treatment as an alternative or follow-up to inpatient treatment.
Partial Loss One involving less than all of the values insured or calling on the policy to pay less than its maximum amounts.
Participant An employee or former employee who is eligible to receive benefits from an employee benefit plan or whose beneficiaries may be eligible to receive benefits from the plan.
Participating Provider A health care provider approved by Medicare to participate in the program and receive benefit payments directly from carriers or fiscal intermediaries.
Participation The number of employees enrolled compared to the total number eligible for coverage. Many times, a minimum participation percentage is required.
Patent Insurance 1)Insurance coverage for losses the insured may suffer as a result of another party's infringing upon the insured's patent rights. 2)Insurance coverage for allegations against the insured of infringements upon the rights of a patent holder.
Payroll Audit An examination and verification of an insured's records for the amount of payroll for classes of employees which is used in determining the premium for certain lines of insurance, such as workers compensation. The company sends out auditors to determine the accuracy of the figures provided by the insured.
Peak Season Endorsement A property endorsement that allows an insured to purchase additional property damage insurance for specified cyclical periods occurring on a regular basis. The insured purchases an underlying limit that remains constant throughout the entire year. Additional limits are purchased to increase the underlying limits for specified periods of time. Both the amounts and the dates of the increase are indicated in the endorsement. This type of endorsement provides protection for risks that are seasonal or have significantly higher inventories at set times each year, such as the holidays.


↑ Top