Activities of daily living (ADLs)
Activities that are a normal part of everyday life, such as bathing, continence, dressing, eating, toileting, and transferring.
Actual cash value (ACV)
The value of the property when it is damaged or destroyed. This is usually figured by taking the replacement cost and subtracting depreciation.
Actual charge
The amount of money a doctor or supplier charges for a certain medical service or supply. This amount is often more than the amount Medicare approves.
Additional living expenses
If your home is so damaged that you are unable to live there, most homeowner insurance policies pay for some additional living expenses while repairs are being made. This could include limited motel, restaurant, and warehouse storage expenses.
Adjuster
An insurance company representative who seeks to determine the extent of the firm's liability for loss when a claim is submitted.
Administrative services only (ASO)
An arrangement whereby an organization (usually an employer) hires an outside firm to perform specific administrative services, such as providing claim forms and processing claims, for a group health insurance program. The organization retains financial responsibility for paying claims.
Adult day care
Care given in a nonresidential facility, community-based group program designed to meet the needs of functionally impaired adults. It is a structured, comprehensive program that may provide a variety of health, social, and related support services during any part of a day.
Adverse selection
Occurs when the applicants for insurance represent a sample of the population that is biased toward those with a greater loss exposure rather than a true random sample. In flood insurance, those persons and businesses with serious flood exposures are likely to purchase flood insurance.
Agent
A person licensed by a state insurance department who solicits, negotiates, or effects insurance contracts on behalf of one or more insurers.
All risks coverage
The term "all risk" means there is coverage for all perils except those excluded. A particular exposure would be insured against economic loss by any peril that is not specifically excluded under the terms of the contract.
Allowable charge
The amount Medicare considers a reasonable charge for medical services or supplies based on the usual or customary charges in your area (Medicare pays 80% of the amount).
Alternative plan of care
If you otherwise qualify for benefits, this provision allows you to qualify for benefits not specifically listed in the policy upon the agreement of you, your physician, and the company.
Amendment
A formal document changing the provisions of an insurance policy signed jointly by the insurance company and by the policyholder or his or her authorized representative.
Annual election period (AEP)
An annual period during which Medicare beneficiaries may enroll in or disenroll from a Medicare Advantage plan. The AEP occurs November 15 through December 31 each year. The plan coverage becomes effective on January 1 of the coming year.
Annual "out-of-pocket" maximum
The most you will have to pay in any given year for all services received under an insurance policy. This amount includes copayments, coinsurance and deductibles. If you exceed this amount, the insurance company will pay all other expenses for the remainder for that year.
Annuity
An investment that provides an income over a specified period of time, often used as a device for retirement income.
Appeal
An appeal is a special kind of complaint you make if you disagree with any decision about your health care services. This complaint is made to your health plan. There is usually a special process you must use to make your complaint.
Application
A statement of information made by someone applying for insurance. The information gathered helps the insurance company assess whether the risk presented by the applicant is acceptable.
Appraisal
A review of a property claim to determine the value of a particular item, or the value of the loss to the damaged property.
Approved amount or charge
Also called the allowable, eligible, or accepted charge, this is the maximum fee set by Medicare that it will approve for a particular service or procedure, of which Medicare will reimburse 80%.
Appurtenant structures
Buildings on the same premises as the main building insured under a property insurance policy. A detached garage, a tool shed or a gazebo would be called an appurtenant structure.
Arbitration clause
Clause of a policy that provides that if a policyholder and the company cannot agree on the amount of a claim settlement, each appoints an appraiser. The appraisers select a neutral umpire. When at least two of the three, appraisers and umpire, agree on the settlement amount, it is binding on both the insured and the insurer.
Assisted living facility
A facility certified or registered by the Wisconsin Department of Health and Family Services (DHFS). These facilities exist to bridge the gap between independent living and nursing homes and provide a variety of services depending on the needs of the residents.
Attained age
This means that as you age, your premiums will change to meet your age range and your premiums will become higher.
Auto insurance
A type of insurance that protects the policyholder against losses involving automobiles. Different coverages can be purchased depending on the needs and wants of the insured.
Automatic premium loan
A provision in a life insurance policy that any premium not paid by the end of the grace period (usually 31 days) is automatically paid by a policy loan if there is sufficient cash value.

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