Insurance Terminology in USA

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Navigating the world of Insurance with a seemingly endless list of terms and jargon is a tough task. Understanding Insurance terminology is crucial for making informed decisions about your coverage. In this article, we’ll demystify common Insurance terms used in the United States, helping you become a more savvy consumer when it comes to Insurance.

Insurance Terminology in USA

Photo by Vlad Deep

  1. Premium:
    • The premium is the amount you pay to your insurance company regularly (monthly, quarterly, or annually) to maintain your coverage.
  2. Deductible:
    • The deductible is the out-of-pocket amount you must pay before your insurance coverage kicks in. For example, if you have a $1,000 deductible and incur a covered expense of $10,000, you’ll pay $1,000, and your insurance will cover the remaining $9,000.
  3. Policyholder:
    • The policyholder is the person who owns an insurance policy. This individual is responsible for paying premiums and making policy decisions.
  4. Coverage Limit:
    • The coverage limit refers to the maximum amount your insurance will pay for a covered loss. It can apply to various aspects of your policy, such as liability coverage or property damage coverage.
  5. Premium Tax Credit:
    • This is a subsidy provided by the government to help lower-income individuals and families afford health insurance premiums through the Health Insurance Marketplace.
  6. Copayment (Co-pay):
    • A copayment is a fixed amount you pay for specific services or medications, typically due at the time of service. For example, you might have a $20 copayment for a doctor’s office visit.
  7. Coinsurance:
    • Coinsurance is the percentage of covered costs you share with your insurance company after meeting your deductible. For instance, if you have a 20% coinsurance, you’ll pay 20% of covered expenses, and your insurance will cover the remaining 80%.
  8. Underwriting:
    • Underwriting is the process insurers use to assess an applicant’s risk profile and determine their eligibility for coverage and premium rates.
  9. Claim:
    • A claim is a formal request you make to your insurance company for payment or coverage of a specific loss or expense, such as a medical bill or property damage repair.
  10. Exclusion:
    • Exclusions are specific conditions or situations not covered by your insurance policy. It’s essential to understand these exclusions to know what your policy does and does not cover.
  11. Claim Adjuster:
    • A claim adjuster, also known as an insurance adjuster, is a professional employed by the insurance company to assess and evaluate the validity and extent of insurance claims.
  12. Coverage Rider:
    • A coverage rider is an additional provision or modification to your insurance policy that can expand or restrict coverage for specific circumstances. Riders are typically optional and come at an additional cost.
  13. Grace Period:
    • The grace period is the period after the due date for an insurance premium payment during which coverage remains in effect. It allows policyholders extra time to make their payment without policy cancellation.
  14. Beneficiary:
    • A beneficiary is the person or entity designated to receive the benefits or payouts from an insurance policy, such as life insurance or a retirement plan, in the event of the policyholder’s death.
  15. Premium Waiver:
    • A premium waiver is a provision that allows a policyholder to stop paying premiums temporarily or permanently due to a disability or other qualifying circumstances, while the policy remains in effect.
  16. Subrogation:
    • Subrogation is a legal process in which the insurance company assumes the right to recover its expenses from a third party responsible for a loss or claim that the insurer has already paid out.
  17. No-Fault Insurance:
    • No-fault insurance is an insurance system in which each party’s insurance provider pays for their policyholder’s losses, regardless of who was at fault in an accident. It is often associated with auto insurance.
  18. Peril:
    • A peril refers to a specific event or cause of loss that is covered by an insurance policy. Common perils in home insurance include fire, theft, and natural disasters.
  19. Waiting Period:
    • A waiting period is the time period a policyholder must wait after purchasing an insurance policy before certain coverage or benefits become effective. It is common in health insurance for pre-existing conditions.
  20. In-Network and Out-of-Network Providers:
    • In-network providers are healthcare providers (doctors, hospitals, etc.) that have agreements with your health insurance company to provide services at negotiated rates. Out-of-network providers do not have such agreements, and using them may result in higher costs.
  21. Term Life Insurance:
    • Term life insurance is a type of life insurance that provides coverage for a specific term or period, typically 10, 20, or 30 years. If the insured person passes away during the term, the policy pays out a death benefit to the beneficiary.
  22. Whole Life Insurance:
    • Whole life insurance is a type of permanent life insurance that provides coverage for the lifetime of the insured person. It includes both a death benefit and a cash value component that grows over time.
  23. Loss Adjuster:
    • A loss adjuster, also known as a claims adjuster, is a professional hired by the insurance company to assess and determine the value of a claim. They investigate the circumstances of a loss and help settle claims.
  24. Pre-Existing Condition:
    • A pre-existing condition is a health condition or illness that existed before you applied for or enrolled in a health insurance plan. Some policies may impose waiting periods or exclusions for pre-existing conditions.
  25. Term:
    • In insurance, the term refers to the length of time for which a policy provides coverage. For example, a term life insurance policy might have a 20-year term.
  26. Excess or Surplus Lines Insurance:
    • Excess or surplus lines insurance provides coverage for risks that standard insurance companies are unwilling or unable to insure. These policies are typically used for high-risk or unique situations.
  27. Indemnity:
    • Indemnity is a principle in insurance where the insurer compensates the policyholder for covered losses or damages. It aims to restore the insured to the financial position they were in before the loss occurred.


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