Affordable Care Act (ACA)

The Affordable Care Act (ACA) refers to the health care reform law which was signed on March 23, 2010. The ACA has brought about brought about many changes to health care consumers, providers and insurance companies. It dictates who must buy insurance, how insurance will be sold and what health benefits have to be included in health plans.

Benefits

Benefits refers to services covered by your health care provider. Examples of some benefits may include hospital stays, prescription drugs, physician visits, etc.

Bodily injury (BI) liability coverage

Provides payment for injury or death resulting from an accident for which you are at fault. BI can help pay for the injured party’s medical expenses and lost wages, and may also help provide compensation for legal defense. The limit, or the amount covered, is select when you purchase your auto insurance policy.

Claim

A request by the insured to the insurance company to pay for services/coverage.

Collision coverage

Pays for damage to an insured vehicle when it hits or is hit by another car or object, or If the car overturns. The maximum amount paid for repair or replacement is the car’s actual cash value (ACV) minus the deductible you choose when you purchase your policy.

Comprehensive coverage

If your insured vehicle is damaged due to an event other than a collision (i.e. damages from fire, theft, windstorm, flood, falling objects, accidents involving animals, vandalism, or if your vehicle is stolen), comprehensive coverage will pay for the damage. The maximum amount paid for repair/replacement is the car’s actual cash value (ACV), minus your deductible of course.

COBRA

A federal law that allows you to continue your group health insurance coverage provided by your employer after your group coverage ends due to death, divorce, or termination of eligibility in certain situations.

Coinsurance

The percentage that you may pay for coverage after you meet the deductible amount for the plan. The deductible is paid first, and then coinsurance may apply. It is also sometimes referred to as cost sharing.

Copay

A flat fee that individuals with health insurance are required to pay at the time of appointment for covered health services.

Deductible

The amount you agree to pay out of pocket before your insurance carrier will pay for services/coverage.

Dwelling coverage

The term “dwelling” refers to your home. Dwelling coverage applies when your home is damaged or destroyed (i.e. total loss) as a result of a covered claim.

Exclusions

Services, property, perils or other coverages that are not included (i.e. excluded) on your insurance plan.

In-Network

A group of physicians, hospitals or other health care providers that have agreed to lower negotiated charges. In order to pay the lowest out-of-pocket costs you should select providers who are within your network.

Individual health insurance policies

Health insurance coverage that is not provided through an employer or group plan.

Liability

Any legally enforceable obligation or responsibility for the injury of another person or damage to another person’s property.

Loss of use

Loss of use on a homeowners insurance policy applies to reasonable living expenses you incur as a result of being unable to reside in your home due to a covered loss. Loss of use, as it applies to auto insurance, pays up to a selected limit for a rental car while your vehicle is being repaired.

Marketplace

“Marketplace” refers to the government’s health insurance Marketplace where individuals can shop and compare health plans online or in person, by contacting your local health insurance provider, such as McGriff-Williams insurance.

Network

A group of physicians, hospitals and other health care providers that have agreed to charge a lower amount (referred to as an Allowed Amount) in order to be included in an insurance company’s “network.”  It typically costs less money out-of-pocket when you visit providers in your plan’s network.

Open Enrollment

The period of time during which you are allowed to choose from available individual health plans. Dates may vary depending on the year and type of coverage (i.e. Medicare); however, there are exceptions, known as Special Enrollment Periods, for certain life events.

Out-of-Network

Refers to health care providers that are not contracted providers for your health plan. These providers are permitted to charge full price for medical care, making you responsible for the difference.

Out-of-Pocket

The term ”out-of-pocket” refers to money paid by the insured, rather than the insurance company. Out-of –pocket expenses are incurred after the deductible has been paid and your insurance company has paid out its allotted amount.

Peril

Anything that can cause damage or loss to your property.

Personal Injury Protection (PIP)

Auto insurance coverage in which the insurance company pays the medical, hospital and funeral expenses of the insured person, people in the insured vehicle and pedestrians struck by the insured vehicle (within the specified limits). PIP is the term used for basic coverage implemented in no-fault automobile insurance states, such as Florida.

Premium

The amount of money paid to an insurance company in exchange for coverage.

Primary Care Physician (PCP)

The physician you select for your general health care needs. If you have a condition that requires specialized medical care, your primary care physician may choose to refer you to a specialist physician, although this is not required.

Replacement cost

The amount of money necessary to replace damaged, destroyed, or stolen property. However, if you have actual cash value coverage, your policy will pay an amount equal to the depreciated value of your property, regardless of how much it may cost to replace it.

Uninsured motorist (UM) coverage

If a driver or owner of a vehicle is legally liable for an accident and does not have insurance, you can use UM coverage for injuries (or even death) that you, your resident relatives, and occupants of your insured vehicle sustain, up to the limits you select. UM also sometimes refers to underinsured motorist coverage, which applies when a driver or owner of a vehicle is legally liable for an accident but does not have enough coverage.