A clause or provision in a Policy where the Insurer pays all losses over a given level i.e., franchise, but no losses below that level i.e., falling within the franchise. Contrast with excess.
Insurance Encyclopedia
Franchise deductible
A deductible within a policy that states claims under a certain amount or certain percentage of the policy are not covered. Claims that cost more than those amounts are entirely covered.
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Deductible in which the insurer has no liability if the loss is under a certain amount, but once this amount is exceeded, the entire loss is paid in full.
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Type of deductible which originated with marine Insurance under which no claim is payable unless if exceeds a stated amount or a stated percentage of the amount of Insurance. For any loss which exceeds that amount or percentage, the entire amount of the loss is paid.
Franchise Insurance
A form of insurance in which individual policies are issued to the employees of a common employer or the members of an association and the employer or association agrees to collect the premiums for the insurer.
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MEDICAL,USA Accident and health insurance contracts sold to individuals of a common employer in which the employer collects and remits the premiums to the insurer. Usually the premiums are deducted from the payroll.
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Uniform individual health insurance protection provided to groups of persons, usually in the same occupation or profession.
Franchise insurance (Health Insurance)
Also called wholesale insurance. A plan for groups that are too small to obtain group coverage. Participants are usually solicited from a workplace with the employer’s approval. The plan issues participants with an individual contract with individual underwriting and the same provisions.
Franchise, blanket / employee life plan / wholesale plan
See: wholesale life insurance .
Fraternal benefit society
Professional organization that provides social and insurance benefits to its members.
Fraternal Insurance
A cooperative of insurance provided by social organizations for their members.
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A cooperative-type of insurance provided by social organizations for their members.
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MEDICAL,USA: Cooperative type of insurance protection plan given to members of a professional association or fraternal benefit society usually on a nonprofit basis.
Fraternal insurance (Health Insurance/Life Insurance)
Insurance written for members of a fraternal group or a lodge.
FRATERNAL LIFE INSURANCE
Life insurance provided by fraternal orders or societies to their members only. Examples range from Thrivent Financial for Lutherans to Modern Woodmen of America. Fraternal organizations also often involve volunteer opportunities and social organizations.
Fraud
MEDICAL,USA: 1. An intentional misrepresentation of the facts to deceive or mislead another. 2. In a health care setting, the intentional deception or misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person(s). In addition, fraud may be committed by either providers or patients to obtain services, payment for services, or claim program eligibility. 3. In insurance claims, some fraudulent practices are intentionally double billing for the same services, reporting diagnoses and procedures to maximize payments, billing for services that were not performed, altering claim forms for higher reimbursement, soliciting or receiving kickbacks or bribes, using another person’s Medicare card, and falsely representing services provided. 4. Lying or intentional misrepresentation by insurance company managers, employees, agents, or brokers for their own gain.
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Obtaining an advantage by unfair or wrongful mans. Deception or artifice used to deceive or cheat.
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The intentional perversion of the truth in order to mislead someone into parting with something of value. Black’s Law Dictionary, 6th Edition, defines “fraud” as an intentional perversion of the truth for the purpose of inducing another in reliance upon it to part with some valuable thing belonging to him or to surrender a legal right a false representation of a matter of fact, whether by words or by conduct, by false or misleading allegations or by concealment of that which should have been disclosed, which deceives and is intended to deceive another so that he shall act upon it to his legal injury.