A mathematician, working for a health insurance company, who is responsible for determining what premiums the company needs to charge based in large part on claims paid versus amounts of premium generated. Their job is to make sure a block of business is priced to be profitable.

Any activity carried out to help a person/group to get something the person/group needs or wants.

Salespersons who represent one or more health insurance companies and presents their products to consumers.

See Usual & Customary (U & C). In Cayman, see SHIF.

A request for your health insurer or plan to review a decision or a complaint again.

When you authorise (assign) that the provider can directly receive your benefits from the insurance company. It is recommended to review charges being submitted on your behalf.