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Social Health Maintenance Organization (SHMO) A demonstration project funded by the Health and Human Services Department that combines the delivery of acute and long term care with adult day care services and transportation.
Soft Market The capacity and availability of insurance is said to progress in cycles of hard market and soft market. The soft market period is the portion of the cycle in which capacity is high, and coverage is readily available at affordable, competitive and even artifically low prices.
Softwear All documents, manuals, and written instructions which guide a computer operation.
Special Form A property coverage form protecting insureds from all causes of physical damage loss unless otherwise limited or excluded.
Special Hazard A hazardous risk, or more generally, a risk with manufacturing occupancy.
Special Multi-Peril Policy (SMP) A package policy for commercial accounts containing four principal sections of coverage: property, liability, crime and boiler and machinery. The basic policy contains declarations, general provisions and definitions applicable to these sections. The specific coverage requirements for each section are handled by separate forms. The types of accounts eligible for this policy can be grouped in eight categories: motel/hotel, apartment house, office, mercantile, service, industrial and processing, institution and contractors. This policy is rarely used., it has been replaced in most jurisdictions by the commercial package policy (CPP).
Specified Disease Policy See Dread Disease Policy.
Specified Perils An insurance contract that covers only those causes of loss (otherwise known as perils) that are specifically indicated as being covered.
Split Dollar Coverage An arrangement of Disability Income Insurance in which the employer and employee each pay a portion of the premium. The employer purchases coverage for the sick pay or paid disability leave provided as an employee benefit. The employee pays for disability coverage beyond what the employer provides as a benefit.
Split Limits A limits concept used in general liability and automobile liability policies whereby separate limits are set for each coverage. The most common example is one limit for bodily injury and another for physical damage, with still another for medical payments.
Staff Model HMO This is an HMO where physicians are employed and all premiums are paid to the HMO, which then compensates the physicians on a salary and bonus arrangement.
Stamping Bureau An office which checks rates and forms of issued policies for accuracy of rates and rules. Sometimes called audit bureau because the daily report is stamped with a rubber stamp if correctly prepared.
Standard Class Rate (SCR) This is rate which is arrived at by using a base rate per participant multiplied by a factor to allow for group demographic information.
State Funds An amount of money assessed certain insurers in a given state to reimburse policyholders and calimants of an insolvent insurer in that state. The fund may be created before an insolvency occurs (pre-assessment, as in New York) or afterward (post-assessment), and virtually all states now have such protection. Also called insolvency funds and guaranty associations.
State Mandated Benefits State laws requiring that commercial health insurance plans include specific benefits.
Stated Amount When the value of property, either real or personal, is agreed upon at the issuance of the contract and, therefore, coinsurance and any other valuation clauses will not apply at the time of a loss.
Statement of Values When a risk is rated with a blanket rate which is when a single rate is to cover more than one item or building, the policyholder is asked to give the amount of value in each separate risk and usually in the contents of each, so that a correct average may be determined. The information required is a "statement of values".
Statue of Limitations A statute limiting the time within which a legal action may be brought.
Stop Loss Excess Aggregate A company wishing to protect itself in the event aggregate losses exceed an agreed upon amount of self-retention in any one year, may purchase this type of coverage or reinsurance for the excess. This type of approach is most often used in the liability lines.
Stop-Loss The dollar amount of claims filed for eligible expenses at which the insurance begins to pay at 100% per insured individual. Stop-loss is reached when an insured individual has paid the deductible and reached the out-of-pocket maximum amount of co-insurance.
Stop-Loss Insurance This is a type of reinsurance which can be taken out by a health plan or self-funded employer plan. The plan can be written to cover excess losses over a specified amount either on a specific or individual basis, or on a total basis for the plan over a period of time such as one year.
Stranding Running aground, such as a vessel may do in shallow water.
Subrogation In insurance, the substitution of one party (insurer) for another party (insured) to pursue any rights the insured may have against a third party liable for a loss paid by the insurer.
Subscriber Contract An agreement which describes the individual's benefits under a health care policy.
Sue And Labor Clause Language in marine and inland marine policies requiring the policyholder in event of loss, to take all necessary means to save the property from further loss and recover from others who caused the loss. The insurer agrees to pay the costs, even if they exceed the policy's limit of liability.
Suit A civil proceeding alleging damages for injuries or offenses committed by one party against another.
Summary Plan Description This is a recap or summary of the benefits provided under the plan. It is used most often with employees covered by self-funded plans.
Superbill A form that specifically lists all of the services provided by the physician. It cannot be used in place of the standard AMA form.
Superintendent of Insurance The official of a state charged with the duty of enforcing its insurance laws. Called the superintendent of insurance (in three states) and director of insurance (in eight states). The official is elected in 11 states, appointed by a governor or state agency in 38 states, and is a civil service apointee in Colorado.
Supplemental Medical Insurance (SMI) Part B of Medicare is a voluntary program which generally covers physician's services and various outpatient services. A premium is charged for electing Part B coverage.
Supplemental Services Additional services which can be purchased over and above the basic coverage of a health plan.
Surety 1)The guarantee given for the fulfillment of an obligation. 2)The person or organization guaranteeing the fulfillment of an obligation. 3)The underwriter who guarantees something under a bond.
Surety Bond A written agreement wherein one party (the surety) obligates itself to a second party (the obligee or beneficiary) to answer for the default of a third party (the principal) in failing to perform specified acts within a stated time. Such obligations include payment of debts and responsibility for defaults.
Surgi-Center A separate facility (from a hospital) that provides outpatient surgical services
Surgical Insurance Benefits A form of Health Insurance against loss due to surgical expenses.
Surgical Schedule Usually part of a basic medical expense plan which itemizes various surgical procedures and the monetary benefit allocated to each procedure.
Surplus The remainder after a company's liabilities are deducted from its assets.
Surplus Line A line of insurance provided by insurers not licensed in the states where the risks are located and placed under the surplus line laws of the various states. Before such placements can be made through specially licensed surplus line agents and brokers, state laws generally require evidence that placements could not be readily made in licensed insurers. Broadly referred to as being all lines of insurance placed with nonadmitted insurers.
Surplus Lines Insurance Insurance written by insurers not licensed in the states where the risks are located and placed with such insurers under the surplus line laws of the various states. Before such placements can be made through specailly licensed surplus line agents and brokers, state laws generally require evidence reported before some predetermined future date ("sunset").
Surplus Lines Tax The tax levied on a surplus lines placement,payable by the licensed surplus lines producer placing the risk under the law of a particular state, and charged to the insured. Not to be confused with the direct placement tax, which is applicable in approximately half the states in taxing the insured directly for placement of insurance with a nonadmitted insurer where no surplus lines tax is paid.
Survey The description of a subject of insurance made for the information of the insurer by an inspector or surveyor.
Surveyor One who determines either the condition of insured marine property or the amount of loss or damage in ocean marine practice.
Swap Maternity A provision granting immediate maternity coverage in a Group Health Insurance plan but terminating coverage on pregnancies in progress upon termination of the plan. The term "swap" means providing the coverage at the beginning of the policy where it is not usually provided, but not providing it after the end of the policy where it usually is provided.
Switch Maternity A provision for Group Health Maternity coverage on female employees only when their husbands are included in the plan as dependents.
Tail Liability that exists for losses that are not discovered or reported, or claims made and settled until some time after the policy has expired. Tail exposures may be found in almost all of the liability lines.
Tail Coverage Insurance coverage available to provide protection for tail exposures. The present occurrence version of the commercial general liability (CGL) form already provides protection for losses that occurred during the policy period, regardless of when they are reported or claims made. The claims-made version of the CGL must be endorsed to provide coverage for claims that are not made during the policy period.
Temporary Disability Benefits (TDB) Legislated benefits payable to employees for nonoccupational disabilities under TDB laws in certain states. See also Disability Benefits Law.
Ten Day Free Look A notice, placed prominently on the face page of the policy, advising the insured of his or her right to examine a health policy, and if dissatisfied return the policy within ten days for a full refund of premium and no further obligation.
Tenants Policy A form of homeowners policy sold to persons who rent their living quarters or who are co-op apartment owners.
Term Insurance A type of life insurance policy that is not whole life or written to cover the whole remainder of the insured's lifetime, but instead is only written to cover a period of time. Often that period of time is a set number of years, such as one year, 10 years or 20 years. At other times, the policy is written for a term that expires at a specified age, for example, when the insured turns 65.


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