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Foundation Wall A masonry wall below the surface which supports a building.
Frame Building A type of construction in which the outer walls are made of lumber.
Fraud Dishonesty.
Free Trade Zone A special section of the New York State Insurance Law that exempts from rate regulation certain risks which develop property-liability policy premiums in excess of $100,000 annually, as well as certain other classes of unusual or exotic risks.
Free-Look Period The time period allowed a new insured to look over the terms and conditions of the final policy after delivery, during which the insured may cancel the policy with a full premium refund. The free-look period is often 10 days after delivery of the policy for life and health, or up to 30 days on property and liability.
Free-Standing Emergency Medical Service Center A facility whose primary purpose is the provision of care for emergency medical conditions. Also called emergi-center or urgi-center.
Free-Standing Outpatient Surgical Center A facility which only provides outpatient surgical services. Also called surgi-center.
Frequency The number of times a service is provided over a given time period.
Friendly Fire A visible flame or glow started voluntarily, under control, and in its intended place.
Full Coverage The use of this terminology usually refers to a coverage that has been written without a deductible. The entire amount of loss is covered, up to the state policy limit.
Funding Level The dollar amount required to purchase a particular medical care program. Usually measured by the premium rate for an insured program, or an amount assessed for expected claim loss and related fees under a self-funded program.
Funding Methods The agreed means by which an employer pays for health coverage. (H) Future Increase Option. An option which allows the insured to increase disability income benefits at predetermined times, specified in the policy, without evidence of insurability.
Gatekeeper Model Under this model of HMO and PPO organizations, the primary care physician (the gatekeeper) is the initial contact for the patient for medical care and for referrals. This is also called a closed access or closed panel.
General Agent 1)An independent agent who represents one or more insurers with the authority to appoint sub-agents who report their business through the general agent, who receives an overriding commission for services provided. In some territories a general agent also sells insurance, while functioning in others solely as a manager.
General Average In ocean marine insurance, a loss which is common to all interests, such as the hull owners, the cargo owners and the receivers of the freight and charges, etc., which may arise due to a peril to the entire venture, which requires a sacrifice or expenditure for the benefit of all. An example is the stranding of the vessel wherein the vessel must engage a tug to remove her from the strand. Without the tug's assistance, all would be lost. The expenses incurred are shared pro rata based on the value of each interest, whether insured or not.
Generic Drug A drug which is exactly the same as a brand name drug and which is allowed to be produced after the brand name drug's patent has expired. It is also called a "generic equivalent."
Generic Equivalence See Generic Drug.
Golden Parachute Legal Expense A specialty insurance coverage designed specifically to provide reimbursement for the legal expenses of corporate executives that result from contesting denials of "golden parachute" employment contracts after a corporate takeover.
Governing Classification In determining rates for compensation insurance, the principal occupation of the insured.
Grace Period An amount of time (usually one month) after the life insurance policy's premium due date, during which the policy continues in effect when the premium due is not paid. Many policies which have cash values also provide an automatic premium loan provision, in which part of the cash value is used as a loan to pay the premium due, thereby keeping the policy in force for a longer period. Most state laws require a grace period in life insurance policies.
Grievance Procedure A procedure which allows a member of a health plan or a provider of benefits to express complaints and seek remedies.
Gross Premium In company language, the written premim before deducting any premium paid for reinsurance and, in some cases, before paying any return premium.
Group Coverage of a number of individuals under one contract. The most common "group" is employees of the same employer.
Group Certificate The document provided to each member of a group plan. It shows the benefits provided under the group contract issued to the employer or other insured.
Group Contract A contract of insurance made with an employer or other entity that covers a group of persons identified by reference to their relationship to the entity buying the contract. The group contractual arrangement is generally used to cover employees of a common employer, members of a trade association or trusteeship, members of a welfare or employee benefit association, members of a labor union, or members of a professional or other association not formed only for the purpose of obtaining insurance.
Group Credit Insurance Insurance on the Life or Health of debtors of a creditor, payable for reduction or extinguishment of the debts in case of the disability or death of the debtor.
Group Disability Insurance Coverage provided for a group of individuals for loss of compensation due to accident or sickness.
Group Health Insurance The same definition as Life Insurance but with the application to Health Insurance coverages. See Group Life Insurance.
Group Insurance An insurance contract made with an employer or other entity that covers individuals in the group.
Group Model HMO A health plan where a group of physicians is reimbursed for services they provide at a negotiated rate. The HMO also contracts with hospitals for the care of the patients of the physicians who belong to the group.
Guaranteed Insurability Life and health insurance provisions which guarantee the insured the right and ability or purchase additional coverage without proving insurability.
Guaranteed Issue Group insurance programs designed to offer affordable health coverage to a natural group, such as employees of an employer or members of an association and their families. The difference between this and other group insurances is that no proof of insurability is required. It is guaranteed that all participants will be issued. A single contract is provided for the entire group which outlines the standard benefits, terms and provisions that apply to all members of the group. These benefits, however, may be tempered by the age and size of the group. Individual certificates are usually issued to the members to verify that they are covered.
Guaranteed Standard Issue (GSI) An underwriting term used to describe the fact that a group insurance contract was issued without reference to any medical underwriting. All group participants are covered regardless of health history.
Guaranty Fund An amount of money assessed certain insurers in a given state to reimburse policyholders and claimants 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.
Hard Market In the property and liability insurance business, underwriting philosophies fluctuate between periods called the hard market and the soft market. The hard market is the period during which underwriting standards are very tight and the rates are high. Normally the hard market closely follows a soft market period during which the underwriting standards had been soft and the price or rates are very low, resulting in substantial underwriting losses. The cycle swings back and forth between the two cycles and bounces between soft underwriting with low rates and heavy losses, to the hard market with subsequent tightening of standards and dramatic increases in price.
Harter Act A law passed by Congress in 1893 which provides that a vessel owner is not responsible for loss or damage caused by faults or errors in navigation, provided the shipowner has taken proper care to see that the ship is in all respects seaworthy and properly manned and equipped.
Hazard A condition which may lead to a loss, such as oily rags leading to a fire.
Hazardous Waste Products or residues known or suspected to be toxic that require special care in their handling and disposal. Examples are asbestos, dioxin or radioactive substances.
HCFA Health Care Financing Administration.
HCFA 1500 A form used by providers of health services to bill their fees to health carriers. It was developed by the government agency known as Health Care Financing Administration.
Health Benefits Package The coverages offered by a health plan to an individual or group.
Health Care Financing Administration (HCFA) Part of the Department of Health and Human Services, responsible for administration of the Medicare and Medicaid programs. The HCFA establishes standards for medical providers which must be complied with if the provider is to meet certification requirements.
Health History A form used by underwriters to assist in evaluating groups or individuals to determine whether they are acceptable risks.
Health Insurance (HI) . Insurance against loss by sickness or bodily injury. The generic form for those forms of insurance that provide lump sum or periodic payments in the event of loss occasioned by bodily injury, sickness or disease, and medical expense. The term Health Insurance is now used to replace such terms as Accident Insurance, Sickness Insurance, Medical Expense Insurance, Accidental Death Insurance, and Dismemberment Insurance. The form is sometimes called Accident and Health, Accident and Sickness, Accident, or Disability Income Insurance.
Health Insurance Association of America (HIAA) An association supported by Life and Health insurers to provide the research, public relations, education, and legislative base for the promotion of voluntary private Health Insurance.
Health Insurance Institute (HII) The public relations arm of the Health Insurance Association of America. It provides for a flow of information from Health insurers to the public and from the public to the insurers.
Health Maintenance Organization (HMO) An HMO is a prepaid medical service plan which provides services to plan members. Medical providers contract with the HMO to provide medical services to plan members. Members must use contracted providers. The emphasis is on preventive medicine, and it is an alternative to employee benefit plans. Employers of more than 25 persons are required to offer the alternative of HMO to employees, but not if the cost exceeds that of present employee benefit plans.
Health Plan This refers to any kind of plan that covers health care services such as HMOs, insured plans, preferred provider organizations, etc.
Health Service Agreement (HSA) The agreement between employer and the health plan which outlines a description of benefits, enrollment procedures, eligibility standards, etc.
Health Services The benefits covered under a health contract.

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