"taking the expected value" - ANSWERrefers to the process of accounting for the impact of probability
abridged financial report - ANSWERan annual report that is provided in the renewal process from non-refund plans. It shows only premiums, claims and waiver of premium and/ or disabled reserves
...
"taking the expected value" - ANSWERrefers to the process of accounting for the impact of
probability
abridged financial report - ANSWERan annual report that is provided in the renewal process from
non-refund plans. It shows only premiums, claims and waiver of premium and/ or disabled reserves
Accumulation-Oriented Benefits - ANSWERsuch as pension plans, profit-sharing plans, stock bonus
plans, stock purchase plans and so forth, could involve relatively long waiting periods and could be
subject to legal requirements. The theory might be that these kinds of benefits should be a reward
for relatively long service.
actuary - ANSWERare people who have specialized knowledge of the mathematics of finance,
statistics, demographics, risk management and probability theory.
Add-ons - ANSWERadditional optional coverage available to employees with traditional benefit plans
- optional life, optional CI, etc.
adjudication process - ANSWERthe process by which the insurer determines if the claim is eligible
and how much to pay for the claim. The timeline and process varies a bit based on benefit the claim
is being submitted for
Administration manual - ANSWERdesigned by the insurer for use by the plan administrator. It is
customized to the plan sponsor and outlines the general administrative procedures of the plan and
the plan sponsor's specific plan provisions.
Administrative Services Only (ASO) Agreement - ANSWERan uninsured agreement between a plan
sponsor and a service provider (generally an insurance carrier) to administer and manage specific
elements of a group benefit plan, most commonly health and dental benefits. The plan sponsor
assumes 100% of the net operating costs of this arrangement.
,Administrative Services Only (TPA Service) - ANSWERone of the types of services offered by TPA -
tracks plan members eligibility, maintains up-to date plan member data, handles ASO billing and
reporting requirements and address plan member inquiries and complains
Adverse Selection - ANSWERAlso known as "anti-selection". People are more likely to buy insurance
when they think they are going to suffer a loss
Advisor - ANSWERThe individual or companies that provide advise to group benefit plan sponsors.
There are several different types: a Consultant, an Agent and a Broker.
Agent of Record - ANSWERthe individual/company authorized to represent an insured in the
purchase, servicing and maintenance of insurance coverage with a designed insurer
Aggregate stop-loss pooling - ANSWERan insurance feature designed to limit the total dollar amount
of all claims charged under a specific group benefit, such as life insurance or health care, in a given
policy year.
Aggregate Stop-Loss Pooling - ANSWERprotects plan sponsor against unexpectedly high level of total
claims in one contract period for a certain benefit. they are protected if claims exceed an agreed
upon level expressed as a % of premium
Ancillary Benefits - ANSWERreflects benefits for needs that influence an individual's well-being and
work-productivity
Annual financial accounting - ANSWERan annual financial statement is prepared by the insurer or
TPA for groups underwritten on a refund arrangement. The report details paid premium, claims
charges, expense and interest credits or charges. States the year end balance. It is normally prepared
60 to 90 days after the end date.
annual financial report - ANSWERa report prepared by the insurer to reconcile paid premiums
against the claims charges and expenses for the contract period. It is a statement of the plan's
financial performance that provides details on how much the plan actually cost the plan sponsor and
whether the plan produced a surplus or a deficit.
annuity - ANSWERa series of cash flows with a specific start and end date, where all the cash flows
are equal
, annuity due - ANSWERan annuity where the cash flows occurs at the beginning of each period
appointed actuary - ANSWERis responsible for reporting to a company's management and directors
any imminent risks that could imperil the company and for reporting to the Superintendent of
Financial Institutions if the situation is not rectified
Association Plan - ANSWERthe plan sponsor is an association
Assuris - ANSWERA not-for-profit organization that protects Canadian policyholders in the event their
insurer should fail, by minimizing the loss of benefits and ensuring a quick transfer of their insurance
policies to a solvent company. All companies authorized to sell in Canada are required to become
members of Assuris. Funded by the life insurance industry and endorsed by government. No cost to
policyholders for this protection.
Autorite des marches financiers (AMF) - ANSWERThe body mandated by the government of Quebec
to regulate the province's financial markets and provide assistance to consumers of financial
products and services.
Benefit - ANSWERthe amount payable when a covered loss is incurred
Benefit Plan Management - ANSWERconsists of plan design, plan funding and plan administration
Benefit Provisions - ANSWERone of the five categories of provisions laid out in the master contract -
examples: wavier of premium, definition of disability, qualifying period, benefit period, offsets,
eligible expenses, exclusions & limitations
Benefit Schedule - ANSWERset out which benefits are provided, levels and limitations of coverage,
when coverage terminations, provisions if an employee is not actively at work
benefits booklets - ANSWERsummarizes the benefits and some provisions of the group contract.
Includes: name of plan sponsor and insurer, policy number, schedule of benefits, general provisions
Benefits/Needs Oriented Philosophy - ANSWERtends to focus primarily on the needs of plan
members and their dependents, rather than on compensation and service
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