Glossary of Insurance Terms

Occupational Hazards: Hazards associated with an insured's occupation that increases the possibility of injury, illness or death. Such hazards may have an impact on the insurability of an applicant.

Optional Coverage: These types of coverages are usually purchased and added to the base policy. Examples include, but are not limited to dental, prescriptions, maternity, and term life accidental death & disability (AD&D).

Orphan: A policy owner who is not currently being serviced by the writing agent/broker.

Overhead Expense Insurance: Insurance for business owners to help offset continuing business expenses if the owner becomes disabled.

Out-of-Network: The use of health care providers who have not contracted with the health plan to provide services. HMO members are generally not covered for out-of-network services except in emergency situations. Members enrolled in Preferred Provider Organizations (PPO) and Point-Of-Service (POS) coverage can go out-of-network, but will pay some additional costs.

Out-of-Pocket Maximum: The amount which a covered person must pay for deductibles, coinsurance and copays in a defined time period (generally calendar year) before the health plan covers all remaining medical services at 100 percent.

Outpatient: A patient who received medical services at a health facility without being admitted to the facility for an overnight stay.

Outpatient Surgery: Surgery performed in a facility or centre devoted primarily to the performance of one day or same day surgery without anticipation of the overnight say of patients.