Glossary

​​​​​​​​​​​​​​​​​
A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  R  S  T  U  V  W  Y | Acronyms​


A​

Abstract
A transcript of the text of each instrument that has affected the land from the patent to the certification date.


Activities of Daily Living (ADLs)
Activities that are a normal part of everyday life, such as bathing, continence, dressing, eating, toileting, and transferring.


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.


Actuarial Value
The percentage of total average costs for covered benefits a plan will cover. For example, if a plan has an actuarial value of 80%, on average, you would be responsible for 20% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy.


Adult Day Care
Care given in a nonresidential, 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.


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.


Annual Disenrollment Period
An annual period during which Medicare beneficiaries can disenroll from their Medicare Advantage plan and return to Original Medicare.


Annual Election Period or Annual Enrollment Period
An annual period during which Medicare beneficiaries may enroll in or disenroll from a Medicare Advantage plan. The annual election period occurs October 15 through December 7 each year. The plan coverage becomes effective on January 1 of the coming year.


Annuitant
A person who receives benefit payments from an annuity.


Annuity
An insurance contract where an insurance company promises to make payments to an annuitant over a specified period of time or for life.


Appeal
A special kind of complaint you make if you disagree with any decision about your health care services. This complaint is made directly to your health plan. There is usually a special process you must use to make your complaint.


Appraisal
An estimate of valu​e.


Approved Amount or Charge
Also called the allowable, eligible, or accepted charge; this is the maximum approved fee set by Medicare for a particular service or procedure, of which Medicare will reimburse 80%.


Assignment
This means a doctor agrees to accept Medicare's fee as full payment. Accepting assignment means the doctor agrees to bill no more than the approved charge for a service. In other words, a doctor will not charge more than Medicare will approve. Doctors not accepting assignment charge 15% more and you will be responsible for 100% of the excess charges.


Assisted Living Facility
A facility certified or registered by the Department of Health Services (DHS). 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. Assisted Living Facilities are covered only if your policy identifies these facilities as a covered benefit and the facility has been certified or registered by DHS.


Attained Age
As you age, your premiums will change to meet your age range and your premiums will become higher.

 

B

Bed Reservation
This benefit is payable if you are receiving nursing home care and need to spend time in a hospital. The company will cover any charge made by the nursing home for reserving your bed during your hospitalization.


Beneficiary
A person who has health insurance through the Medicare program.


Benefit Appeal
The opportunity for the Medicare beneficiary to submit a written request for review by the insurer of the denial of a claim for Wisconsin mandated benefits under the Medicare Supplement policy.


Benefit Determination
A decision from the Medicare managed care plan to offer coverage under the provisions of the policy. The benefit could require a deductible or copayment. The benefit could also be limited to a certain amount by the plan.


Benefit Period
A designated period of time during and after a hospitalization for which Medicare Part A​ will pay benefits.


Benefit Triggers
A term used to describe when to pay benefits. One type of benefit trigger is an activity of daily living (ADL). Insurance companies may use different events or types of benefit triggers to determine when benefits will begin to be paid. The triggers are described in the eligibility criteria of the policy.


Binder
A temporary or preliminary agreement providing coverage until a policy can be written or delivered.


Bronze Plan
One of four metal level plan categories, in addition to Silver, Gold, and Platinum. Bronze plans are designed to cover 60% of the total average cost of care.

 

C

Care Coordination
Services provided by a licensed or certified health care professional designated by the insurance company to perform an assessment and develop a plan to meet your long-term care needs.


Caregiver Training
Training provided in order to assist an informal and unpaid caregiver to care for you at home.


Carrier
A private company contracting with Medicare to process your Medicare Part B bills.


Case Management
A process by which an enrollee with a serious, complicated, or chronic health condition is identified by a managed care plan and a plan of treatment is established to achieve optimum health outcomes in a cost-effective manner.


Centers for Medicare & Medicaid Services (CMS)​
The federal agency that runs the Medicare program.


Certificate of Insurance
A document issued by an insurance company or broker that verifies existence of an insurance policy​ and summarizes key benefits and conditions of the policy. In health insurance, the certificate contains copayment and/or deductible requirements, specific coverage details, exclusions, and the responsibilities of both the certificate holder and the insurance company.


Claim
A request made by the insured for insurer remittance of payment due to loss incurred and covered under the policy agreement. In health insurance, the request may be made by the insurance subscriber’s medical provider for reimbursement for services rendered.


Closed Panel
A type of health plan requiring members to seek care only from a medical provider who is either employed by or under contract to the health maintenance organization or limited service health organization.


Closing Process
When purchasing a home or other real property, all of the necessary functions performed between the time the sales contract is signed and the time the legal title to the property (the deed) is delivered.


COBRA
A federal law (short for Consolidated Omnibus Budget Reconciliation Act of 1985) allowing individuals insured under a group health plan to purchase an additional 18 months of coverage after becoming otherwise ineligible for coverage throught the group (ex: after leaving employment). See https://www.dol.gov/general/topic/health-plans/cobra​ for additional information.


Cognitive Impairment
A deficiency in your short-term or long-term memory, orientation as to person, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness.


Coinsurance
The percentage of costs of a covered health care service you pay after you've paid your deductible.


Community-Based Residential Facility (CBRF)
These facilities are licensed, registered, or certified by the Department of Health Services (DHS). CBRFs are covered only if your policy identifies these facilities as a covered benefit and the facility has been licensed as a CBRF by DHS.


Construction Lien
A person or company who builds or replaces a building or permanently attached improvement to the land has a right to a lien on the property. The lien begins on the day the work commences, but a lien notice is not required to be filed until six months after the lienholder's last work is supplied.


Contingent Nonforfeiture or Contingent Benefit upon Lapse
If you reject the mandatory offer of a nonforfeiture benefit, the insurance company must provide a “contingent benefit upon lapse." This means when the premiums increase to a certain level (based on a table of increase provided to you in the policy information), the benefit will take effect. You will then be offered, within 120 days of the due date of the new premium, the opportunity to accept one of the following options: 1) reduce your benefits provided by the current policy so your premium will stay the same, or 2) convert your policy to a paid-up status with a shorter benefit period.


Conventional Mortgage
A loan not obtained under a government-insured program such as FHA or VA. Conventional mortgage loans are typically held by institutional investors such as banks or insurance companies.


Coordinated Care Plan
Any form of Medicare Advantage plan relying on a provider network​ to deliver care to enrollees, including HMOs and other managed care plans. Most coordinated care plans will make you pay for all or part of the cost of using a provider who is not part of their network.


Coordination of Benefits (COB)
A provision in a health insurance policy applying when a person is covered under more than one health plan or another type of policy such as an automobile insurance policy. It requires the payment of benefits to be coordinated by all insurers who cover the person in order to eliminate over insurance or duplication of benefits.


Copayment
A fixed amount you pay for a covered health care service after you've paid your deductible. Also referred to as "copay."


Coverage
Services meeting the plan requirements for reimbursement. A medical service is not necessarily covered, even if your health care provider says you need it, unless the service meets the terms of the health plan.


Credit Report
A file containing your credit history, maintained by any of the three national credit bureaus.


Creditable Coverage
Health insurance coverage under any of the following: a group health plan; individual health insurance; student health insurance; Medicare; Medicaid; CHAMPUS and TRICARE; the Federal Employees Health Benefits Program; Indian Health Service; the Peace Corps; Public Health Plan (any plan established or maintained by a State, the U.S. government, a foreign country); Children’s Health Insurance Program (CHIP); or, a state health insurance high risk pool. If you have prior creditable coverage, it will reduce the length of a preexisting condition exclusion period under new job-based coverage. The Medicare Modernization Act (MMA) imposes a late enrollment penalty on individuals who do not maintain creditable drug coverage (coverage at least as good as Part D​ coverage) for a period of 63 days or longer following their initial enrollment period for the Medicare prescription drug benefit.


Custodial Care
Personal care, such as help with activities of daily living like bathing, dressing, eating, getting in and out of a bed or chair, moving around, and using the bathroom. It may also include care most people do themselves like using eye drops. Medicare does not pay for custodial care.

 

D

Declarations Page
The page attached to the front of a homeowner's insurance policy including policy statements regarding the applicant and property covered such as demographic and occupational information, property specifications, and expected mileage per year.


Deductible
Portion of the insured loss (in dollars) paid by the policy holder. In health insurance, the amount paid by the insured for services before the plan begins to pay.


Deed
A written document by which the ownership of land is transferred from one person to another.


Defined Network Plan
Any health benefit plan that requires or creates incentives for an enrollee to use providers that are owned, managed, or under contract with the insurer offering the plan. This type of plan is sometimes referred to as a managed care plan.


Depreciation
A decrease in the value of property due to wear and tear or obsolescence.


Disenrollment
Ending your health care coverage with a health plan. There are plan rules that must be followed in order to leave the plan officially.


Drug Formulary
A list of prescription drugs the plan considers medically appropriate and cost effective. The plan will provide coverage for only those prescription drugs named in the list. However, in some cases exceptions can be requested.


Durable Medical Equipment
Medical equipment ordered by a doctor for use in the home. These items must be reusable, such as walkers, wheelchairs, or hospital beds.

 

E

Elder Benefit Specialists/Disability Benefit Specialists
All benefit specialists can help people with Medicare questions and concerns. Elder Benefit Specialists are trained to help anyone 60 years of age or older who is having a problem with private or government benefits and are available at either an Aging and Disability Resource Center (ADRC) or a county/tribal aging unit. Disability Benefit Specialists are available at all ADRCs and serve Medicare beneficiaries ages 18-59. All local contact information can be found at dhs.wisconsin.gov/benefit-specialists/index.htm.


Elimination Period
The number of days a policyholder must wait between when an illness or disability begins and when they are eligible for benefits. Sometimes also referred to as a waiting period or a qualifying period.


Emergency Care
An illness, injury, symptom, or condition so severe that would cause a reasonable person to expect that delay in treatment may cause serious harm.


Emergency Services
Services delivered by an appropriately trained health care professional required to diagnose and stabilize an emergency condition.


Endorsement
An amendment or rider to a policy adjusting the coverages and taking precedence over the general contract.


Enrollment Period
For Medicare, the six-month period after you turn 65, during which you may enroll in any Medicare Supplement insurance plan or policy if you have enrolled in Medicare Part B. During this period, you cannot be denied based on any preexisting medical condition.


Escrow
In homebuying, a procedure whereby a disinterested third party handles legal documents and funds on behalf of a property seller and buyer. Money or other obligations is kept by the mortgage company to ensure taxes can be paid in full when due.


Essential Health Benefits (EHB)
The minimum level of covered services insurers must offer in the individual and small group markets.


Examination
A thorough review of the abstract or title search to determine the condition of title to the real estate (who owns it, if the taxes are paid, what use restrictions there may be, etc.).


Excess Charge
The difference between a doctor's or other health care provider's actual charge and the Medicare-approved payment amount.


Exclusion
Any condition or expense that is specifically not covered by the policy.


Exclusive Provider Organization (EPO)
A health plan requiring the use of a specific network of providers participating in the plan. EPOs do not cover care outside the network chosen by the enrollee except for emergency medical condition treatment.

 

F

Face Amount
The amount stated in a life insurance policy paid in the event of death. It does not include dividend additions or additional amounts payable under other special provisions.


Family Care
A Medicaid program that serves Wisconsin residents with physical disabilities, or intellectual/ developmental disabilities and the frail elderly that is designed to provide them with choice about and access to long-term care that will increase their ability to live in the community.


Federal Housing Administration (FHA)
An agency of the federal government insuring private loans for financing of new and existing housing and for home repairs under government-approved programs.


Federally Facilitated Marketplace (FFM)
A federal website that allows consumers to: (1) check their eligibility for any subsidies available to help pay for private health insurance; (2) compare health insurance plans based on cost; and (3) link consumers to insurers for the purchase of health insurance after they choose a plan they are interested in. It is also referred to as the federal exchange. The website is HealthCare.gov.


Fee-for-Service
The traditional health care payment system under which physicians and other providers receive a payment for each service provided. Under a fee-for-service insurance plan, insureds usually may choose to go to any provider they want. However, providers are not required to accept the insurance company's payments as payment in full.


Formulary
A list of prescription medications covered by an insurance plan.​


Free-look Period
The specific period of time when you can review an insurance policy. If you change your mind about keeping the policy during this period, you may cancel the policy and get your money back.

 

G

Gold Plan
One of four metal level plan categories, in addition to Bronze, Silver, and Platinum. Each metal level is designed to cover a specific percent of the total average cost of care.


Grace Period
A period of time after a premium becomes due in which you can still pay for the insurance and keep it in force. Wisconsin law requires at least 31 days for group health insurance.


Grievance
Any dissatisfaction with the administration, claims practices, or provision of services by an insurer filed by, or on behalf of, an enrollee.​


Guaranteed Issue Rights
Rights you have in certain situations when insurance companies are required to accept your application for a coverage. In these situations, an insurance company cannot deny you insurance coverage or place conditions on a policy, must cover you for all preexisting conditions​, and cannot charge you more for a policy because of past or present health problems.


Guaranteed Purchase
A rider to a policy that allows you to increase the benefits during specific periods of time without proof of insurability.


Guaranteed Renewable
The right to automatically renew or continue your policy as long as premium is paid on time.

 ​

H

Health Maintenance Organization (HMO)
A health care financing and delivery system providing comprehensive health care services for members in a particular geographic area. HMOs require the use of specific plan providers.


Home Health Care
Care including skilled nursing services, such as providing therapy treatments or administering medication; home health aide services, such as checking temperature and blood pressure; personal care, such as help with bathing, dressing, walking, and exercise; and physical, occupational, respiratory, or speech therapy.


Hospice Care
A specially designed package of social and medical services that primarily provides pain relief, symptom management, and supportive services to terminally ill people and their families.

 

I

Indemnity Plan
(see Fee-for-Service)​


Independent Agent
A representative of multiple insurance companies who sells and services policies for records they own and operate under the American Agency System.


Independent Review
An appeal process in which a health care professional with no connection to an enrollee's health plan reviews a dispute involving a medical judgment. This is also referred to as an external appeal.


Insurance
An economic device transferring risk from an individual to a company and reducing the uncertainty of risk via pooling.


Insured
Party(s) covered by an insurance policy.


IRIS (Include, Respect, I Self-Direct)
A Medicaid-funded long term care program available in counties where Family Care operates. It is a self0directed program for Wisconsin’s frail elders and adults with disabilities. See IRIS (Include, Respect, I Self-Direct) from the Wisconsin Department of Health Services for more information. ​


Issue Age
Premiums are set at the age you are when you buy the policy and will not increase because you get older. Premiums may increase for other reasons.

 

J

Judgment
A decree of a court.

 

L

Licensed Health Care Practitioner
A physician, physician's assistant, nurse practitioner, physical, speech or occupational therapist, an occupational therapy assistant, a registered nurse, a licensed practical nurse or any other health or health service professional subject to the jurisdiction of the Wisconsin Department of Safety and Professional Services.


Lien
A hold, claim, or charge allowed to a creditor upon the property of a debtor.


Limited Service Health Organization (LSHO)
A health care plan making available to its enrollees a limited range of health care services, such as dental or eye care, performed by providers selected by the plan.


Limiting Charge
The maximum a doctor or other provider who does not accept assignment may legally charge for a Medicare-covered service. This is 15% over Medicare's approved amount a​nd you are responsible for 100% of the excess charges.


Loan-to-Value Ratio
The relationship between the amount of the mortgage loan and the appraised value of the property as a percentage.

 

M

Managed Care Plan
A health plan making available to its enrollees health care services performed by providers selected by the plan and seeking to manage the cost, accessibility, and quality of care.


Mandatory Supplemental Benefits
Additional benefits included in Medicare coordinated care plans required to be purchased by you. These benefits will differ among Medicare Advantage plans.


Market Value
Fair value or the price derived from current sale of an asset.


Medically Necessary
Services or supplies needed for the diagnosis or treatment of your medical condition; are provided for the diagnosis, direct care, and treatment of your medical condition; meet the standards of good medical practice in the local area; and are not mainly for the convenience of you or your doctor.


Medicare Advantage Eligible Individual
Anyone eligible for Medicare Part A​ and enrolled in Medicare Part B who does not have end stage renal disease (ESRD).


Medicare Advantage Organization
A private or public entity agreeing to meet the contractual requirements to offer a Medicare Advantage​​ health plan. A Medicare Advantage organization may offer more than one plan or type of plan.


Medicare Advantage Plan
A private health plan offered by a Medicare Advantage organization​; formerly known as Medicare+Choice Plan and also referred to as Medicare Part C.


Medicare Part A (Hospital Insurance)
Coverage for inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.


Medicare Part B (Medical Insurance)
Coverage for certain doctors' services, outpatient care, medical supplies, and preventive services.


Medicare Part C (Medicare Advantage Plan)
A type of Medicare health plan offered by a private company contracting with Medicare to provide you with all your Part A and Part B benefits. Medicare services are covered through the plan and are not paid for under Original Medicare.


Medicare Part D (Prescription Drug Coverage)
Optional benefits for prescription drugs available to all people with Medicare for an additional charge. This coverage is offered by insurance companies and other private companies approved by Medicare.


Medicare Supplement (Medigap)
Medicare supplement and Medicare select policies sold by private insurance companies to fill “gaps" in Original Medicare plan coverage. Medigap policies only work with Original Medicare.

 

N

Network
A group of doctors, hospitals and facilities, pharmacies, and other health care professionals contracting with a managed care plan to provide health care services to plan members. Generally, managed care plan members may only receive covered services from providers in the plan's network.

Network Provider
A provider who has a contract with the managed care plan or LSHO to provide health care services to enrollees. Some plans may use the terms plan providers, preferred providers, or participating providers to refer to network providers.​​​

O

Open Enrollment Period
A one-time-only six-month period when you can buy any Medicare Supplement policy that is sold in Wisconsin. It starts when you sign up for Medicare Part B and you are age 65 or older. You cannot be denied coverage or charged more due to present or past health problems during this time period.


Open Panel
A type of health plan other than a closed panel plan allowing covered enrollees to receive care from the provider of their choice. These plans may provide incentives for the enrollee to use providers participating in the plan.


Optional Supplemental Benefits
Additional benefits offered by Medicare coordinated care plans you may choose and may include additional premiums.


Organization Determination
A decision by a Medicare Advantage organization regarding the amount of service provided or the price the plan will reimburse for the service.


Outline of Coverage
A summary of a policy's benefits and limitations that makes it easier to understand a policy and compare it to others. Insurance companies must provide you with this summary before you purchase a long-term care policy.


Out-of-Pocket Expenses/Out-of-Pocket Costs
Expenses paid by the enrollee in addition to plan premiums, which may include any or all of the following:

  • Deductible: A fixed amount paid for covered services prior to the plan making payments. Deductibles are usually required to be paid annually. Expenses counted toward your deductible are the amounts your plan would pay for the service, not what you may have actually paid.

  • Copayment/copay: A fixed dollar amount for use of medical services. For example, many health plans require you pay a fixed amount for each drug prescription you receive.

  • Coinsurance: A fixed percentage of the total cost of services, paid each time you use the service. Your health plan may have an annual cap on total out-of-pocket expenses.

P

PACE (Program of All-inclusive Care for the Elderly)
A Medicare and Medicaid program that helps eligible Wisconsin residents meet their health care needs in the community instead of going to a nursing home or other care facility.


Paid-up Survivor
A rider that, in the event of the death of your spouse, waives the premiums for life if both you and your spouse had coverage for a specified time with the same company.


Passport Plan
A network of providers who are outside of your plan's geographic service area, usually in a different state, which can be used by you in non-emergency or urgent care situations. Some managed care plans have these networks available to individuals who travel to certain states. Check with your plan on the availability of this provision.


Personal Property
Single interest or dual interest credit insurance (where collateral is not a motor vehicle, mobile home, or real estate) covers perils to goods purchased or used as collateral and concerns a creditor's interest in the purchased goods or pledged collateral either in whole or in part; or covers perils to goods purchased in connection with an open-end credit transaction.


Plan Determination
A decision by a Medicare Advantage plan regarding the amount of service it will provide you or the price the plan will reimburse the provider for the service.


Plan of Care
A plan outlining the care you need and the length of time the care will be needed.


Platinum Plan
One of four metal level plan categories, in addition to Bronze, Silver, and Gold. Platinum plans are designed to cover 90% of the total average cost of care.


Point-of-Service (POS)
A type of managed care plan providing financial incentives to encourage enrollees to use network providers​ but allows enrollees to choose providers outside the plan.


Policy
A written contract ratifying the legality of an insurance agreement.


Preexisting Condition
A medical condition diagnosed or treated up to six months prior to the purchase of an insurance policy. Medicare Supplement policies may impose up to a 180-day waiting period before coverage for the condition begins.


Preferred Provider Organization (PPO)
An organization contracting with insurers and other organizations to provide health care services at a discounted cost by providing incentives to members to use physicians and other health care providers contracting with the PPO.


Preferred Provider Plan (PPP)
A health care plan making available to its enrollees either comprehensive health care services or a limited range of health care services performed by providers selected by the plan. It allows enrollees to use providers outside the network​, but enrollees may be liable for a significant portion of these claims.


Premium
The price you pay for an insurance policy.


Prescription Drug Plan (PDP)
Medicare offers optional prescription drug plan coverage, also called Medicare Part D. There are two types of Medicare plans offering prescription drug coverage: stand-alone PDPs and Medicare Advantage​ prescription drug plans.


Primary Care Provider
A physician, nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law, who provides, coordinates, or helps a patient access a range of health care services. Insurance plans may provide a list of providers who are contracted with the plan, that you can choose from and designate as your primary care provider.


Primary Payer
An insurance policy, plan, or program paying first on a claim for medical care. This could be Medicare or other health insurance.


Prior Authorization/Precertification
A provision in insurance policies requiring prior approval by a managed care plan or LSHO in order for services to be covered by the plan. Prior authorization is not a guarantee of coverage.


Property Coverage
Coverage protecting the insured against loss or damage to real or personal property from a variety of perils including, but not limited to, fire, lightning, business interruption, loss of rents, glass breakage, tornado, windstorm, hail, water damage, explosion, riot, civil commotion, rain, or damage from aircraft or vehicles.


Provider Network
A provider network is a list of the doctors, other health care providers, and hospitals a plan has contracted with to provide medical care to its members. These providers are also called network providers or in-network providers.

 

R

Rate
Value of insured losses expressed as a cost per unit of insurance.


Referral
A process for making a request to a managed care plan to receive medical care from a nonparticipating provider or specialist. Some managed care plans require a referral from a primary care provider before the enrollee receives services from another plan provider. In many Medicare managed care plans, you need to get a referral before you get care from anyone except your primary care doctor. If you do not get a referral first, the plan may not pay for your care.

Replacement Cost Coverage
The cost of replacing property without a reduction for depreciation due to normal wear and tear.


Replacement Cost on Contents
This additional coverage pays for your losses on the basis of how much it would cost to replace or repair the item at current costs without depreciation. If the item is not replaced or repaired, only the actual cash value is payable.


Residential Care Apartment Complexes (RCAC)
These facilities are certified by the Department of Health Services (DHS). RCACs are covered only if your policy identifies these facilities as a covered benefit and the facility has been certified as an RCAC by DHS.


Respite Care
The provision of personal care, supervision, or other services to a functionally impaired person to relieve a family member or other primary caregiver from caregiving duties. Respite care services are usually provided in the impaired person's home or in another home or homelike setting, but may also be provided in a nursing home.


Restoration of Benefits
If you collect benefits from a policy and then recover to the point where you are not receiving care qualifying you for benefits for a certain period of time, you can have those benefits restored back to the original level. Look to see if this is a provision in the policy or if it is available as a rider for an additional premium.


Return of Premium
A rider providing that if you die after being insured for a specified period or if you have paid premiums for a specified period, the insurance company will return premiums paid minus any benefits paid.


Rider
Additional coverage for items not otherwise covered by your policy. Also called a floater or endorsement.


Risk
Uncertainty concerning the possibility of loss by a peril for which insurance is pursued.

 

S

Second ​Mortgage
A mortgage, the lien of which is subordinate to another mortgage.


Secondary Payer
An insurance policy, plan, or program paying second on a claim for medical care. This could be Medicare, Medicaid, or other health insurance depending on the situation.


Service Area
The area where the plan accepts enrollees and, for managed care plans, where the plan has contracted providers you are required to use. Most coordinated care plans operate in a limited geographic area known as a service area. It is usually stated as county or zip code of operation.


Silver Plan
One of four metal level plan categories, in addition to Bronze, Gold, and Platinum. Silver plans are designed to cover 70% of the total average cost of care.


Small Business Health Options Program (SHOP)
A federal program allowing small employers with 50 or fewer employees to purchase coverage covering essential health benefits and preexisting conditions​. Small employers with 25 or fewer employees may be eligible for the Small Business Health Care Tax Credit.


State Health Insurance Assistance Program (SHIP)
A state program getting money from the federal government to give free health insurance counseling and assistance to people with Medicare.

 

T

Title Insurance Agency
A corporation, attorney, or other entity authorized by a title insurance underwriter to issue title insurance policies​ for the underwriter; a title agency must employ at least one title insurance agent.


Title Insurance Agent
A person who meets specific education and character requirements, licensed by the state, and appointed by a title insurance underwriter to sign title insurance policies.


Title Insurance Commitment or Binder
Prior to closing, a document in the same form as shown in the commitment to insure obligates a title insurance policy is issued once certain requirements are met.


Title Insurance Policy (two basic types):
Owner's policy: issued after the closing of the real estate transaction is completed, insures marketable title in the buyer/owner subject only to the exceptions contained in the policy.
Lender's policy: issued after the closing of the real estate mortgage is completed, insures there are no lien rights which come ahead of the lender's mortgage.


Title Insurance​
Coverage guarantees the validity of a title to real and personal property. Buyers of real and personal property and mortgage lenders rely upon the coverage to protect them against losses from undiscovered defects in existence when the policy is issued.


Title Insurer
A title insurance company licensed by OCI to underwrite title insurance policies.


Title Search
An examination of public records and court decisions to disclose the current facts regarding ownership of real estate.


Title
The evidence or right a person has to the ownership and possession of land.


Trust Account
The bank account to which the buyer's funds are deposited and held until the time closing is completed.

 

U

Underwriting
The process insurance companies use in assessing risk factors of prospective buyers in determining whether to insure someone and how much to charge.


Urgent Care
Care for an illness, injury, or condition serious enough that a reasonable person would seek care right away, but not so severe it requires emergency room care.


Usual and Customary Charge
The fee most commonly charged by providers for a particular service, procedure, or treatment, for that specialty, in that geographic area.

 

V

Veterans Affairs (VA) Loan
A loan guaranty program established as part of the original GI bill guaranteeing home loans for veterans.

 

W

Waiting P​eriod
The time between when you sign up with a Medicare Supplement insurance company or Medicare health plan and when the coverage starts.


Waiver of Premium
The suspension of premium payments after you have been receiving benefits from the policy for the period of time specified in the policy.

 



​Acronyms​

We have tried to limit the use of acronyms and initials, but some terms are used so often, the acronyms are practical and of assistance to you. The term has been spelled when first used in the text with the acronym or initials following in parentheses. For your convenience, the following is a listing of acronyms and initials appearing in the Consumer's Guide to Managed Care Health Plans in Wisconsin publication.