Personal Privacy in an Information Society. Glossary of Terms

07/12/1997

Individual:
any natural person who is a past, present, or proposed named or principal insured (including any principal insured under a family or group policy or similar arrangement of coverage for a person in a group), policyowner, or past or present claimant.
Insurance Institution:
an insurance company (including so-called service plans like Blue Cross and Blue Shield and any other similar service plan), regardless of type of insurance written or organizational form, including insurance company regional, branch, sales, or service offices (or divisions or insurance affiliates), or insurance company solicitors; or agents and brokers.
Insurance-Support Organizations:
an organization which regularly engages in whole or in part in the practice of assembling or evaluating information on individuals for the purpose of providing such information or evaluation, to insurance institutions for insurance purposes.
Insurance Transaction:
whenever a decision (be it adverse or otherwise) is rendered regarding an individual's eligibility for an insurance benefit or service.
Adverse Underwriting Decision:
(1)with respect to life and health insurance, a denial of requested insurance coverage (except claims) in whole or in part, or an offer to insure at other than standard rates; and with respect to all other kinds of insurance, a denial of requested coverage (except claims) in whole or in part, or a rating which is based on information which differs from that which the individual furnished;
(2) a refusal to renew insurance coverage in whole or in part; or
(3)a cancellation of any insurance coverage in whole or in part.
Institutional Source:
an institutional source is any person who provides information as part of his employment or any other connection with an insurance institution.
Medical-Record Information:
information relating to an individual's medical history, diagnosis, condition, treatment, or evaluation obtained from a medical-care provider, from the individual himself, or from his spouse, parent, or guardian for the purpose of making a non-medical decision (e.g., an underwriting decision) about the individual.
Medical-Care Provider:
a medical professional or medical-care institution.
Medical Professional:
any person licensed or certified to provide medical services to individuals, including but not limited to, a physician, dentist, nurse, optometrist, physical or occupational therapist, psychiatric social worker, clinical dietitian, or clinical psychologist.
Medical-Care Institution:
any facility or institution that is licensed to provide medical-care services to individuals, including, but not limited to, hospitals, skilled nursing facilities, home-health agencies, clinics, rehabilitation agencies, and public-health agencies or health-maintenance organizations (HMO's).