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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.

In individual insurance, the policyholder is typically the same person as the insured. In group insurance, the employer or association acts as the policyholder, holding the master policy on behalf of its employees or members, who are covered under it as plan members. The policyholder receives official policy documents, renewal notices, and correspondence directly from the insurer.

Example:

If you buy an individual health and dental plan, you are the policyholder. If your employer offers group benefits, the employer is the policyholder, while you are a covered plan member under the group contract.

What to Watch For:

Keep your policy documents and premium payment records organized and current. If you are a policyholder, promptly update your insurer about changes in address, dependents, or beneficiary designations. In group insurance, remember that employees cannot make major changes to the master policy - only the employer or plan sponsor can modify coverage terms.

Related Terms

Premium

A premium is the amount of money an individual or organization pays to an insurance company in exchange for coverage under an insurance policy. It is the cost of maintaining protection against financial loss and ensures that the insurer can pay claims, manage risk, and cover administrative expenses. Premiums can be paid monthly, quarterly, semi-annually, or annually, depending on the policy and payment arrangement.

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.

Plan Sponsor

A plan sponsor is the employer, association, or organization that establishes and maintains a group insurance plan for its employees or members. The plan sponsor acts as the policyholder, holding the master contract with the insurance company and determining the benefits, eligibility rules, and cost-sharing arrangements for the group. Plan sponsors play a central administrative role by enrolling members, collecting premiums, and communicating plan details to participants.

Policy (Contract)

A policy, also referred to as a contract, is the legally binding agreement between an insurance company (the insurer) and the policyholder that defines the terms, conditions, and obligations of coverage. It outlines what is insured, the benefits provided, the premium amount, exclusions, and the responsibilities of both parties. Once the insurer accepts the application and the first premium is paid, the policy becomes active and enforceable.

Policy Maximum (Travel)

The policy maximum is the highest amount your travel medical insurance plan will pay for all eligible emergency medical expenses during a covered trip. This limit represents the maximum liability the insurer assumes and typically ranges from $1 million to $5 million per person, depending on the plan.

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