Glossary
ACA (Affordable Care Act)
A federal law passed in 2010 that expanded access to affordable health insurance for individuals and families through government-regulated marketplaces and subsidies.
Agent
A licensed professional authorized to sell insurance policies and help clients choose the best coverage for their needs.
Annual Enrollment Period (AEP)
The time of year (October 15 – December 7) when individuals can enroll in or change their Medicare Advantage and Part D plans.
Appeal
The form completed by an applicant to apply for insurance coverage. It contains information used by carriers to determine eligibility.
Beneficiary
The person designated to receive benefits from a life or health insurance policy.
Broker
An independent professional who represents clients rather than specific insurance carriers and may work under an FMO to access multiple carrier contracts.
Broker Contracting
The process of becoming authorized to sell insurance products through an FMO or carrier.
Carrier
An insurance company that underwrites and issues policies. Examples include Molina Healthcare, Ambetter, Oscar, and UnitedHealthcare.
CMS (Centers for Medicare & Medicaid Services)
The federal agency that oversees Medicare, Medicaid, and ACA Marketplace operations.
Co-Insurance
The percentage of medical costs the insured must pay after meeting their deductible.
Co-Pay
A fixed amount a patient pays for a covered healthcare service at the time of care.
Coverage Effective Date
The date when an individual’s insurance policy begins.
CRM (Customer Relationship Management)
A system used by agents to manage leads, clients, renewals, and communications in one platform.
Deductible
The amount a policyholder must pay out-of-pocket before insurance coverage begins to pay for covered services.
Dependent
A family member (such as a spouse or child) covered under a primary policyholder’s insurance plan.
Downline
Agents or sub-agents who work under another agent’s or sub-agency’s hierarchy. The uplink or parent agent typically earns override commissions on their production.
Effective Date
The day an insurance policy becomes active and coverage starts.
E&O Insurance (Errors & Omissions)
Professional liability coverage that protects agents from legal claims due to mistakes or omissions in their work.
Enrollment Period
The timeframe when an individual can apply for or change insurance coverage. Outside of these periods, changes typically require a qualifying event.
FMO (Field Marketing Organization)
A national or regional organization that partners with independent insurance agents and agencies to provide carrier access, higher commissions, marketing tools, and operational support. Sunshine Life & Health Advisors operates as an FMO.
Formulary
A list of prescription drugs covered by a health insurance plan.
Group Health Insurance
Coverage offered by employers or organizations to their employees or members. Sunshine supports agents who sell both individual and group products.
Health Insurance Marketplace
The online platform (HealthCare.gov or state exchanges) where individuals can compare and enroll in ACA health plans.
HMO (Health Maintenance Organization)
A type of health plan that requires members to use a network of doctors and obtain referrals for specialists.
Hierarchy
The structured relationship between agents, agencies, and the FMO for commission reporting, training, and support.
Independent Agent
A licensed professional who is not tied to one carrier and can sell products from multiple companies.
In-Network
Providers or facilities contracted with an insurance carrier to offer discounted rates.
Leads
Prospective clients who have expressed interest in health or life insurance products. Sunshine provides agents with inbound and digital leads from national campaigns.
Life Insurance
A contract that pays a lump sum to designated beneficiaries upon the insured’s death.
Licensing
The process of obtaining legal authorization to sell insurance in one or more states.
Marketplace Plan
A health insurance policy purchased through the ACA exchange.
Medicare Advantage (Part C)
A type of Medicare plan offered by private carriers that combines Parts A and B and may include additional benefits like dental or vision.
Medicare Supplement (Medigap)
A private insurance plan that helps pay out-of-pocket costs not covered by Original Medicare.
Multi-State Licensing
Authorization that allows agents to sell insurance products in multiple states. Sunshine helps agents expand their reach with multi-state contracting support.
Network
A group of doctors, hospitals, and healthcare providers contracted with an insurance plan.
Non-Resident License
A license that allows an agent to sell insurance in a state where they do not reside.
Open Enrollment Period (OEP)
The yearly window when individuals can enroll in, renew, or change ACA Marketplace plans.
Override Commission
A percentage of commission earned by an upline agent or sub-agency for managing and supporting downline producers.
PPO (Preferred Provider Organization)
A health insurance plan that allows members to see any healthcare provider, with lower costs for using in-network providers.
Premium
The amount paid (monthly or annually) to keep an insurance policy active.
Producer
Another term for a licensed agent who sells and services insurance policies.
Qualifying Life Event (QLE)
A major life event (like marriage, birth, or loss of coverage) that allows individuals to enroll in health insurance outside the regular open enrollment period.
Quote
An estimate of premium costs and plan details provided before an application is submitted.
SEP (Special Enrollment Period)
A time outside of open enrollment when individuals can enroll due to a qualifying life event.
Sub-Agency
An independent agency operating under an FMO hierarchy. Sub-agencies benefit from shared tools, support, and carrier access while retaining their independence.
Subsidy
A federal financial assistance program that helps lower the cost of ACA health plans for eligible individuals.
Term Life Insurance
AA life insurance policy that provides coverage for a specific time period (such as 10, 20, or 30 years).
Training Portal
An online resource for Sunshine agents that provides product training, compliance education, and certification guidance.
Underwriting
The process an insurance company uses to evaluate risk and determine eligibility for coverage.
Upline
The agent or agency responsible for recruiting, training, and supporting downline agents, often receiving override commissions.
Wellness Benefits
Preventive care services, such as annual checkups and screenings, covered by most ACA plans at no cost to the member.
Zip Code Rating
The process of determining premium costs based on the applicant’s area of residence.
