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Contract Holder

A contract holder is the individual or organization that owns and controls an insurance policy. The contract holder is responsible for maintaining the policy, paying premiums, and making decisions related to coverage, renewals, and beneficiary designations. In most cases, the contract holder is also the insured person, but in group insurance, the employer or plan sponsor acts as the contract holder on behalf of all covered members.

The contract holder has the legal right to modify, cancel, or renew the policy, as well as to request policy documents or make administrative changes. They are also the main point of contact for the insurer regarding updates, billing, or changes to the terms of coverage. For group benefits, employees receive a certificate of insurance summarizing their coverage, while the employer, as the contract holder, retains the full master policy.

Example:

If an employer purchases a group health plan for its staff through an insurance provider, the employer is the contract holder. Each employee receives a certificate of insurance outlining their benefits under the employer’s master contract.

What to Watch For:

Confirm who the contract holder is when dealing with a group plan, as only the holder can authorize major changes to the policy. For individual plans, ensure your contact information and payment details remain current to avoid missed renewal notices or premium payments. Keep a copy of your policy and all amendments, as the contract holder is responsible for record keeping.

Related Terms

Claimant

A claimant is the person who submits a request for reimbursement or payment under an insurance policy. In health and dental insurance, the claimant is usually the insured individual who received the service, such as a medical treatment, prescription, or dental procedure. However, a claimant can also be a parent, spouse, or legal guardian submitting a claim on behalf of a covered dependent.

Policyholder

A policyholder is the individual or organization that owns an insurance policy and holds the legal rights and responsibilities associated with it. The policyholder is responsible for paying premiums, maintaining coverage, and making key decisions such as naming beneficiaries, adding or removing dependents, or canceling the policy. In return, the insurer is obligated to provide the benefits outlined in the policy contract.

Coordination of Benefits

Coordination of benefits (COB) is the process used by insurance companies to determine the order in which multiple plans will pay for the same claim when a person is covered under more than one policy. The goal is to ensure that combined reimbursements do not exceed 100 percent of the eligible expense, while allowing the insured to receive the maximum possible coverage across all plans.

Contract Expiry Date

The contract expiry date is the final date on which an insurance policy or agreement remains in effect unless it is renewed or extended. It marks the end of the policy’s coverage period and defines when the insurer’s obligation to pay benefits or accept claims under the existing terms stops. After this date, the policyholder must renew the contract, convert it to a new plan, or allow it to lapse if coverage is no longer needed.

Claim Submission Deadline

The claim submission deadline is the final date by which an insured person must submit a claim to their insurance company for reimbursement of eligible expenses. After this date, the insurer is not obligated to pay the claim, even if the expense itself would have been covered. This deadline ensures timely processing, accurate recordkeeping, and proper financial reporting for both the insurer and the policyholder.

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