Health & Dental Insurance terminology
Here are some of the more frequently used insurance terms. If you can't find a term you would like defined in the alphabetical list below, feel free to call us at 1-866-999-4CAA (1-866-268-3711), Monday through Friday, from 8 a.m. to 8 p.m. ET, or email us any time. We would be happy to help you with any insurance questions you may have. You can also find answers to many of the most commonly asked questions about insurance on our FAQ page.
All definitions provided are examples. Consult your policy for the terms that apply to your coverage.
For a definition, click on the letter that the insurance term begins with:
Accident or Accidental A sudden, unforeseeable event that causes bodily injuries.
Anniversary Year The 12 consecutive months following the Effective Date of the Policy and each 12-month period thereafter.Back to Top
Benefits The amounts paid to a claimant or beneficiary under the coverage of a policy.
Benefit Year The 12-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter.Back to Top
Calendar Year The 12-consecutive-month period that begins on January 1 and ends on December 31.
Claim A request for benefit payment under the terms of an insurance policy.
Co-payment The amount, often as a percentage of the total cost, the insurance company will pay.
Coverage Another term for the protection offered under an insurance policy. Coverage is used interchangeably with the terms insurance or protection.Back to Top
Deductible The amount you must first pay before the insurance company pays for a particular cost.
Dependent A child of the insured who is listed on the application and who is a natural child, adopted, stepchild or foster child, or a child for whom the insured is by law responsible, who is unmarried, unemployed and dependent on the insured for financial support and is under 21 years of age.
Dispensing Fee The dispensing fee represents the charge for the professional services provided by a pharmacist when dispensing a prescription.Back to Top
Effective Date The date when insurance coverage begins.
EHC Extended Health CareBack to Top
Generic A medication sold under its generic name, usually legal only after the patent has expired, or if no patent was issued for the substance. Generic drugs are usually less expensive than proprietary medications.Back to Top
Lifetime Maximum The maximum amount of benefits that will be paid for all covered services during the entire time you are insured.Back to Top
Name Brand or Brand-Name A medication sold by a pharmaceutical company under a trademark-protected name. Typically more expensive than generic drugs.Back to Top
Premium The cost of insurance coverage. A premium can be paid monthly, semi-annually or annually.
Pre-existing Health Condition An injury, a sickness, or a condition that existed before the date that an insurance policy takes effect.Back to Top
Reasonable and Customary The maximum amount a plan or insurance contract will consider eligible for reimbursement, based upon prevailing fees in a geographic area.
Recalls Time between routine dental examinations.Back to Top
Seniors Persons aged 65 years or over.Back to Top
Total Dental Services The combination of routine dental expenses and some specialized procedures.Back to Top