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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

Calendar Year

The calendar year defines a benefit period that runs from January 1 to December 31. Many annual maximums, deductibles, and claim resets follow this schedule. It provides a consistent framework across most insurers and simplifies tax reporting for medical expenses.

Certificate of Insurance

A certificate of insurance is an official document issued by an insurance company that summarizes the key details of your coverage. It serves as proof that you are insured and outlines the essential terms of your policy, including the type of coverage, effective dates, benefit limits, exclusions, and any dependents or beneficiaries listed under the plan.

Claim

A claim is a formal request you or your healthcare provider submit to your insurance company to receive reimbursement or direct payment for eligible medical or dental expenses covered under your plan. Submitting a claim provides the insurer with the necessary information - such as receipts, treatment details, and provider information - to verify the service and determine the amount payable according to your policy’s terms.

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.

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.

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