Person or company that has an interest in the risk covered by the policy not occurring. This is the party who enjoys the coverage.
Company that issues the policy, assumes the risk and pays claims. It is different from the insurance broker.
Early cancellation of a policy before its expiration. The premium refund is calculated proportionally to the unused time, applying a short-term scale that generally does not return 100%.
Coverage or service that covers the expenses and logistics of the funeral for the beneficiaries designated in the policy, according to the contracted terms.
A person or entity entitled to receive the indemnity at the time of the claim. In life insurance, these are usually the spouse or children; in property insurance, frequently a financial institution with a loss payee clause.
Loss of the effects of a right or policy due to non-compliance or the expiration of an established term.
Document that certifies the existence of coverage or the specific conditions of a group policy.
A percentage of the loss that the insured pays as a condition for the insurer to cover the rest. Example: with 20% coinsurance and a loss of Q10,000, the insured pays Q2,000 and the insurer Q8,000 (less the deductible and other charges).
Base rules that apply to all policies of the same product: definitions, how payment is made, how claims are filed, what is covered in general terms and what is not.
The specific details of your policy: the name of the insured, beneficiaries, sums insured, deductibles, effective dates and additional coverages purchased. It is the ‘customized’ part of the contract.
Person or entity that signs the insurance contract and pays the premium. May or may not be the same as the insured.
A mechanism that applies when the insured has more than one active medical expense policy. It defines the order in which each insurer responds, to prevent the insured from collecting more than 100% of the actual expense.
A fixed amount that the insured pays for using the insurer’s provider network. Example: if the consultation costs Q300 and your copay is Q75, you pay Q75 and the insurance covers the rest (within the network and the plan’s conditions).
An independent intermediary who advises the client on choosing the best policy among several insurers, and supports them before, during and after a claim. They do not issue policies or assume the risk.
In insurance, a “cuota” is the periodic payment of the premium (monthly, quarterly, annual). It does NOT mean deferred installment payment with a credit card (Visa installments). These are different concepts. Check with your advisor about the available payment methods.
A fixed amount the insured pays first when a claim occurs; from that point on, the insurer begins to pay. Example: if the deductible is Q2,000 and the expense is Q10,000, you pay Q2,000 and the insurance pays Q8,000 (if everything is covered).
A person who is economically dependent on the primary insured: generally the spouse (or common-law partner) and/or children under 25 years of age. Some policies extend the age to 30 if the child is not working.
The value of an asset after deducting its wear, use, and age. In a claim, the insurer may pay the asset’s current value (not what it cost when it was new).
The relationship between the premiums collected and the claims paid over a period. It is the main technical indicator for assessing the performance of a policy or portfolio.
Additional document that amends the original policy: change in sum insured, addition of a beneficiary, special clauses, etc.
A document provided by the insurer explaining how it processed a claim: amounts paid, amounts charged to the insured and the reasons for adjustments or denials. In Spanish: ‘Explicación de Beneficios’.
Situations expressly stated in the policy that the insurance does NOT cover. It is important to read them before purchasing.
A guarantee that ensures the fulfillment of contractual obligations toward a third party. Widely used in government contracts, construction, and leases.
A term equivalent to ‘Deductible’ used in several Latin American countries (especially outside Guatemala). If your policy or advisor uses this term, it refers to the same thing.
Administrative costs charged by the insurer when issuing or reissuing policy documents. They are not part of the net premium.
Expenses for eye exams and optical correction (eyeglasses, contact lenses) when included as a coverage in the medical expense policy.
Payment made by the insurer to the insured or beneficiary to cover a loss for a claim covered under the policy.
A situation in which the property is insured for a value lower than its actual value. In the event of a claim, the insurer may pay proportionally less. Example: a house worth Q1,000,000 insured for Q500,000.
A legitimate right to receive compensation, or an interest in the foreseen risk not occurring. It is a fundamental requirement for taking out a valid insurance policy.
Maximum amount the insurance will pay for an item, event or period of time, as established by the policy.
Maximum cap applicable to the coinsurance percentage assumed by the insured. Once reached, the insurer covers 100% of the excess.
Maximum total amount the policy will pay over the entire life of the insured for a specific coverage. Highly relevant in major medical expenses.
A claim arrangement in which the insurer pays the provider (hospital, repair shop, etc.) directly, without the insured having to pay out of pocket first. It requires the provider to be in the network.
A condition in which repairing an asset costs more than a previously defined percentage of its sum insured; it is considered a total loss and is indemnified at that value.
A waiting period at the start of the insurance during which certain coverages do not yet apply. Example: maternity covered only after 12 months with the policy.
Additional time the insurer grants after the payment date to catch up without the policy being immediately canceled.
Period during which the policy is active and the insurance provides coverage, as long as payments are up to date.
The contractual insurance document. It includes: the details of the insured and the insurer, the characteristics of the insured property, coverages, exclusions, sums insured, deductible and important conditions.
An illness or health condition that already existed before purchasing the insurance, even if it had not been formally diagnosed. Some insurance plans exclude it or cover it under special conditions.
Legal time limit after which certain actions or claims can no longer be pursued against the insurer.
The price of the insurance. What you pay (monthly, quarterly, annually, etc.) to keep the policy in force and be entitled to coverage.
Pure cost of the insured risk, calculated by the insurer before adding administrative expenses, taxes, and other charges.
A modality in which the premium stays the same or very stable for several years, averaging the cost over time instead of rising sharply with age.
Final amount paid by the insured, including net premium + issuance fees + taxes (stamp duties) and other additional charges.
Proportional calculation of the premium based on the actual coverage period when a policy begins or ends on an intermediate date within the term.
Temporary extension of a policy’s term agreed upon between the insured and the insurer, beyond the original expiration date.
Formal request submitted to the insurer for the policy to be applied and to cover the consequences of a loss.
The set of hospitals, clinics, doctors, repair shops or other providers with which the insurer has an agreement. Using providers within the network generally means direct payment and better conditions.
A claim arrangement in which the insured first pays the expense out of pocket and then asks the insurer to reimburse the covered amount, presenting the corresponding invoices and documents.
A clause that automatically renews the policy upon expiration, for the same period, unless the insured or the insurer states otherwise in advance.
Funds that the insurer is legally required to set aside to cover its obligations for reported claims and for claims that have occurred but not yet been reported.
Person or entity designated to assume payment of the premium or the expenses in a claim.
Insurance that specifically protects against accidents (not illnesses): it covers medical expenses, disability, or death resulting from an unforeseen accidental event.
Insurance that helps pay reasonable, usual, and customary expenses to treat an illness or accident: hospitalizations, surgeries, lab tests, medications, etc.
Insurance that pays a sum of money to the beneficiaries if the insured passes away. Some plans also cover serious illnesses or disability, depending on the product.
Event that triggers the policy: the accident, the illness, the fire, the theft, etc. When it occurs, a claim is filed with the insurer.
A specific cap within an overall coverage that applies to particular items. Example: a Q5,000 limit for prosthetics within a medical expense plan with a sum insured of Q1,000,000.
The right the insurer acquires to legally substitute the insured in order to claim against whoever caused the damage, after having paid the claim.
The maximum amount the insurer is willing to pay under the terms of the policy. Only in life, accident, or surety bond insurance can it be considered a guaranteed amount.
Practical rate table used by insurers to calculate premiums based on the type of risk, age, and coverage requested.
Technical factor (percentage or number) applied to the insurable base to calculate the net premium.
Fiscal tax applied in Guatemala to the issuance of insurance policies and documents. It is part of the total premium paid by the insured.
A type of policy that covers all risks except those expressly excluded, instead of covering only the listed risks (named policy). It offers broader coverage.
Amount at exposure under an insurance policy. It is not a guaranteed payment amount; it is the maximum value that could be affected in a claim.
Amount needed to replace an asset with a similar new one, without deducting depreciation.
Current value of the asset after deducting depreciation for use, age, and wear.
A value agreed in advance between the insured and the insurer for a given property. In the event of a total loss, the indemnity is based on that value, not on the actual value at the time of the claim.
A process or document that confirms coverage, limits, deductibles and requirements before receiving a medical service or authorization. In Spanish: ‘Verificación de Beneficios’. It is requested before a scheduled hospitalization.
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