Glossary Group: Glossary of Insurance Terms

The persons, organization, or any other entity that the insured of the policy has designated to receive its benefits.

The person covered by an insurance policy.

It provides periodic benefit payments for at least the lifetime of a designated person.

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.

As a general rule, the date on which the coverage under the policy becomes effective.

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.

Employee of an insurance company whose responsibilities include investigating, establishing the validity of a claim, approving valid claims, or denying invalid or fraudulent ones.

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.

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.

An insurance policy modification that becomes part of the insurance contract and which broadens or limits the benefits payable thereunder.