See: beneficiary.
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An individual who is eligible to receive benefits from a health, life, or pension plan.
Insurance Encyclopedia
Participating
A policy that pays dividends to the policy owner. This term can also refer to insurance that pays a portion of the loss, along with other insurance coverage that applies to the same risk.
Participating dentist
State-licensed dentist who has signed a contract with an insurance plan to give dental services to the plan’s members.
Participating hospitals
1. State-licensed hospital that has signed a contract with an insurance plan to provide hospital services to the plan’s members. 2. Inpatient facilities that participate in the Medicare program.
Participating insurance
Type of insurance provision in which the insured is entitled to receive policy dividends that reflect the difference between the premium charged and actual costs. Premiums are calculated to give some margin over the expected cost of the insurance protection. Also called participating policy.
Participating Insurance Policy
(i) Insurance under which the insured is entitled to share in at least some portion of the surplus earnings of the Insurer through dividends, and based on loses experience, investment earnings, and other factors (ii) Insurance or Reinsurance which contributes with other Insurances to cover specified losses.
Participating or pro rata reinsurance
Includes quota share, first surplus, second surplus, and all other sharing forms of reinsurance under which the reinsurer participates pro rata in all losses and in all premiums.
Participating or Pro-Rata Reinsurance
These are contracts where in the event of a loss, the amounts payable by a Direct Insurer and the Reinsurer are in proportion which are arranged before the loss. In other words, under proportional Reinsurance there is a common apportionment between the Ceding Company and the Reinsurer of original sum insured, of premiums and of losses according to a pre-determined percentage. Includes Quota Share, First Surplus, Second Surplus and all other sharing forms of reinsurance where under the reinsurer participates pro rata in all losses and in all premiums.
Participating pharmacy
Pharmacy that has signed a contract with an insurance plan to give medical services to the plan’s members.
Participating physician
1. A physician who contracts with an HMO or other insurance company to provide services to the plan’s members. 2. A physician who has agreed to accept a plan’s payments for services to subscribers (e.g., some Blue plans). Eighty percent of practicing American physicians are participating physicians. 3. Doctor or supplier who agrees to accept assignment on all Medicare claims. These physicians or suppliers may bill the patient only for the Medicare deductible and coinsurance amounts. Also called affiliated health care provider, participating provider, in-network provider, network provider.