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Residual Disability That form of disability which becomes defined as partial disability when an insured has returned to work immediately following a period of total disability.
Residual Income A clause used with disability income policies that provides for benefits to be paid when the insured can do some but not all of his/her normal duties. For example, if the insured suffers a disability that causes him or her to lose a third of his or her earning power, the residual diasability clause would provide one-third of the benefit that the policy would provide for total disability.
Resource Based Relative Value Scale (RBRVS) This is a classification system which is used to determine how physicians will be compensated for services provided under Medicare benefits.
Respite Care Normally associated with Hospice care, respite care is a benefit to family members of a patient whereby the family is provided with a break or respite from caring for the patient. The patient is confined to a nursing home for needed care for a short period of time.
Restoration of Benefits A provision in many Major Medical Plans which restores a person's lifetime maximum benefit amount in small increments after a claim has been paid. Usually, only a small amount ($1,000 to $3,000) may be restored annually.
Retention 1)The amount which an insured or an insurer assumes as its own liability and which is not insured otherwise. 2)In reinsurance, the amount which a primary insurer assumes for its own account. In pro rata reinsurance contracts, the retention may be a percentage of the policy limit. In excess of loss contracts, the retention is a dollar amount of loss.
Retention Clause A clause in a policy of reinsurance by which the ceding company agrees to retain for its own account a certain part of the line.
Retroactive Date The earliest date for which coverage is afforded under a claims-made form. Usually the effective date of the first year of such policy form provided to the insured.
Retrospective Rate Derivation (RETRO) A rating system whereby the employer becomes responsible for a portion of the group's health care costs. If health care costs are less than the portion the employer agrees to assume, the insurance company may be required to refund a portion of the premium.
Retrospective Rating A plan under which the premium is determined after the policy has expired based on contractual factors, chiefly the loss experience of the insured during the policy term. Designed to encourage safety by the insured and to compensate the insurer if larger than expected losses are incurred.
Return Premium That part of a premium returned to an insured upon cancellation or partial cancellation of a policy, when rate adjustments are necessary, or when an advance premium is in excess of the actual premium.
RHU Registered Health Underwriter.
Riot Violent and tumultous actions by a number of people, coverage for which is included in the extended coverage endorsement.
Risk 1)Defined variously as uncertainty of loss, chance of loss, or the variance of actual from expected results. However defined, its existance is the reason people buy insurance. 2)The subject matter of an insurance contract, such as the building, cargo or liability exposure insured.
Risk Manager The person or manager in charge of the active identification, evaluation, and management of all of the potential hazards and exposures to loss a risk may experience. The handling of those exposures is not limited to insurance options, but includes a variety of methods such as alternate financing, retention, reduction, elimination, transfer, and/or any combination of methods.
Robbery The taking of property by violence or threat of violence.
Running Down Clause The clause in an ocean marine hull policy which covers damage done to another ship by collision, and other property damage caused by collision.
Runoff In a reinsurance contract, there may be a termination provision to require a reinsurer to continue the liability for any losses that may occur to policies still in force at the time the contract terminates, until those policies expire.
Safe -Harbor Provisions Legal or regulatory conditions, the compliance with which insulates a taxpayer from unfavorable tax consequences.
Salvage Property in a loss saved from further loss.
Schedule 1)The plan or formula applied to arrive at a fire insurance rate. 2)A list of insured properties, and the amount of insurance on each, which is attached to a "schedule" policy, as distinguished from a "blanket" policy. In the latter, one amount of insurance applies to the total of all insured properties.
Schedule (Surgical) A list of specified amounts payable for surgical procedures, dismemberments, ancillary expenses, and the like in hospital and medical reimbursement policies.
Seasonal Risk An insured risk which is occupied for part of the year only, such as a summer dwelling. In the case of a manufacturer, it may be a plant which is operated only a part of a year according to the season, such as cannery.
Second Surgical Opinion A cost containment technique to help patients and insurance companies determine whether a recommended procedure is necessary, or whether an alternative method of treatment could accomplish the same result. Some health policies require a second surgical opinion before specified procedures will be covered, and many policies pay for the second opinion.
Secondary Care Medical services provided by physicians who do not have first contact with patients. Examples would be specialists such as urologists, cardiologists, etc. See also Primary Care and Tertiary Care.
Secondary Coverage Coverage which provides payment for charges not covered by the primary policy or plan. See also Coordination of Benefits.
Section 125 Plan A plan which provides flexible benefits. This plan qualifies under the IRS code which allows employee contributions to meet with pre-tax dollars.
Self-Funded Plan Plan of insurance where an employer, which has fairly predictable claim costs, pays the claims rather than an insurance company. See also Administrative Services Only.
Self-Inflicted Injury An injury to the body of the insured inflicted by himself.
Self-Insurance The retention of sufficient exposure units by an entity to permit the operation of the law of large numbers. Self insurance is a term often mistakenly used to describe the situation when an entity decides to retain its own risks. The mistake arises when the exposure units are too few in number to permit the application of the law of large numbers. When the exposure units are too few a better and less misleading term of such a practice is "self-assumption of risk."
Selling Price Clause An endorsement which can be added to a fire policy covering a stock of merchandise, which extends the policy to cover beyond the actual value of the stock. One form, covering only stock already sold, is available to both mercantile and manufacturing risks and pays the price for which the stock has been sold. The other form, covering unsold stock is available for manufacturers only and pays the price for which the owner expected to sell the stock.
Service Area The area, allowed by state agencies or by the certification of authority, in which a health plan can provide services.
Service Benefits Medical expense benefits provided by service associations whereby benefits are identified in terms of days of coverage instead of monetary values.
Service Plans Plans of insurance where benefits are the actual services rendered rather than a monetary benefit. See Blue Cross and Blue Shield.
Sexual Harassment When one employee is subjected to unsolcited, unwarranted, and unwanted physical or verbal advances, innuendoes, comments, or conditions from either the employer or another employee.
Sexual Harassment Defense Coverage An insurance coverage providing claims-made coverage for the legal defense and costs for alleged charges of sexual harassment. Sexual harassment is when one employee is subjected to unsolicited, unwarranted, and unwanted physical or verbal advances, innuendoes, comments, or conditions from either the employer or another employee.
Shock Loss A much larger loss than anticipated. Usually a loss large enough to have an impact on a company's underwriting results in any given territory.
Shock Loss A much larger loss than anticipated. Usually a loss large enough to have an impact on a company's underwriting results in any given territory.
Short-Term Disability Income Policy A disability income policy with benefits payable for "Short Term," usually less than two years, as opposed to a Long Term Disability Income policy.
Short-Term Medical Temporary health coverage for an individual for a short period of time, usually from 30 days to six months.
Sickness Includes physical illness, disease, pregnancy, but does not include mental illness.
Sickness Insurance A form of Health Insurance against loss by illness or disease. It does not include accidental bodily injury.
Sidetract Agreement An agreement between the owners of a premises and a railroad with respect to a railroad sidetrack (transfer or access track) on the premises of the insured. The railroad will allow use of the sidetrack as long as the property owner guarantees access by the railroad to the sidetrack and agrees to certain conditions of property maintenance. It may also contain specified conditions of hold-harmless between the railroad and property owner.
Single Interest Cover (Or Insurance) Used in connection with property sold on the installment plan, it protects the lender of money advanced to purchase a property, but does not protect the borrower or purchaser directly.
Skilled Nursing Care Daily nursing and rehabilitative care that is performed only by or under the supervision of skilled professional or technical personnel. Skilled care includes administering medication, medical diagnosis and minor surgery.
Skilled Nursing Facility (SNF) A facility designed to qualify for treatment to Medicare eligible people. Included is treatment for rehabilitation and other care such as 24-hour nursing coverage, physical, occupational, and speech therapies, etc.
Small Employer Group Groups with 1 - 99 employees. The definition of small employer group may vary between states.
Small Group Pooling The combining into one pool of several small group business _ used especially for computing more accurate premium rates for members of the pool.
Smoke Damage Damage caused by smoke other than smoke which accompanies a hostile fire. One of the extended coverage endorsement perils, but subject to certain restrictions.
SNF Skilled Nursing Facility


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