co-payment: Partial payment of medical expenses, emergency room services, or prescription drugs required by an individual who is enrolled in a group health insurance plan. For example, a co-payment for a visit to a doctor’s office might be $10.
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co-insurance: Arrangement by which the insurer and the insured share, in a specific ratio, payment for losses covered by the policy, after the deductible is met.
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class action lawsuit: Legal action filed in court by one or more people on behalf of themselves and others having an identical interest in the alleged wrong.
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claim: Notification to an insurance company that payment of an amount is due under the terms of the policy. A claim is a demand by a person or business who is seeking to recover for a loss. A claim may be made against an individual. A claim may also be made against an insurance company, when an insured asks the insurance company to pay for a loss that may be covered by an insurance policy.
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churning: Whole life policies that are replaced by new ones, often at the urging of an agent, who gives the impression that the new policy is cheaper. In many instances, however, the buyer is not told that the cash value account, sometimes used to pay the new premium, must accumulate anew. It’s not unusual for whole life policies to have no cash value in their first few policy years.
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certificate: A statement issued to individuals insured under a group policy, setting forth the essential provisions relating to their coverage.
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cash value: The amount available in cash upon surrender of a policy before it becomes payable upon death or maturity.
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cash & short-term investments: Cash on hand and on deposit and short-term investments
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case base reserve: A discrete reserve established for the payment of expected claims on individual issues that are in default or have a reasonable expectation of defaulting.
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capitation: Method of payment whereby a physician or hospital is paid a fixed amount for each person in a particular plan regardless of the frequency or type of service provided.
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