| Accident & Health Insurance | Policy covering the perils of injury and sickness |
| Accidental Injury | A spontaneous event, unforeseen and unintended, resulting in injury |
| Accident (Injury) | One of the following may be used: Accidental Results – Requires only that the injury be unintended and unforeseen. Accidental Means – Requires both the injury and the cause of the injury to be unintended and unforeseen; considered more restrictive. This definition is not allowed in some states. |
| Coinsurance | The cost sharing between the insurer and the insured stated as a percentage of the claim amount, payable after the deductible has been met |
| Copayment | A stated dollar amount that applies per claim in addition to any other cost-sharing |
| Deductible | The initial amount payable by the insured before insurance benefits apply |
| Morbidity Table | Table showing the mathematical probability of a loss due to a sickness or injury. This table is used to help determine premiums for accident and health insurance. The morbidity table is comparable to the mortality table used for life insurance rating. |
| Pre-existing Conditions | Prior medical conditions for which the applicant has received, or should have received, medical advice or treatment within a specified period before the effective date of a policy |
| Probationary Period | Specified period of time after the effective date and before new coverage goes into effect for specified conditions, such as losses due to a sickness or pre-existing conditions; probationary period is at least 30 days |
| Sickness | An illness or disease that is contracted after the probationary period has ended |
| Subrogation | Transfers an insured’s legal right of recovery to the insurer that has paid a claim. This prevents the insured from collecting twice for the same loss and holds the responsible 3rd party accountable for the loss |