The persons, organization, or any other entity that the insured of the policy has designated to receive its benefits.
Glossary Group: Glossary of Insurance Terms
Insured
The person covered by an insurance policy.
Life annuity
It provides periodic benefit payments for at least the lifetime of a designated person.
Anti-selection or adverse selection
When selecting insurance risks, the major trend is to request or renew insurance policies of those who are known or suspected to have a probability higher than average of suffering a loss, than of those whose risks are unknown.
Policy anniversary
As a general rule, the date on which the coverage under the policy becomes effective.
Sickle cell anemia
Hemoglobin SS disease (Hb SS); sickle-cell disease. A disease transmitted from parents to children and which presents red cells in an abnormal crescent shape (red cells are usually disk-shaped). It is caused by an abnormal type of hemoglobin.
Claims analyst, claims investigator, claims examiner, or claims specialist
Employee of an insurance company whose responsibilities include investigating, establishing the validity of a claim, approving valid claims, or denying invalid or fraudulent ones.
Insurance or sales agent
A person authorized by an insurance company and the Office of the Commissioner of Insurance of Puerto Rico to represent that company in negotiations with insurance applicants.
Case management
A process through which an insurer evaluates not just the need for medical attention—like in an utilization review—but also alternative treatments or medical solutions required.
Endorsement or rider
An insurance policy modification that becomes part of the insurance contract and which broadens or limits the benefits payable thereunder.