an event that results in an insured loss.

a specified period of time when new subscribers may enroll in a health insurance plan or HMO regardless of their health.

usually applied to level premium whole life policies.

is a dollar limit on the portion of covered medical expenses that the insured must pay during a benefit period (usually a calendar year). When the out of pocket limit is met, the insured will not have to pay further deductibles or coinsurance for that year. To illustrate, say the out of pocket is $1000 per calendar year and the insured’s coinsurance is 20%. When $5000 of covered medical expenses have been incurred, the $1000 out of pocket limit will be met ($5000 at 20%). Thereafter, the plan will pay benefits at 100% and the insured’s portion will be $0 for the remainder of that year.

same as premium

services usually provided in clinics, physician or provider officers, ambulatory surgical centers, hospices, home health services, and so forth.