A sudden, unexpected and unintended event.
Accidental Death & Dismemberment (AD&D):
An additional cash benefit to be paid to the insured person or his beneficiaries
(usually family members) if an accident causes either the death of the insured or
to lose body parts.
The ratio (%) of splitting a bill between the insurance company and you. 80% for
the first $5,000 means the insurance company will pay $4,000 and you are responsible
for the remaining $1,000.
The fee you pay for certain medical services or prescription drugs. For example,
you may pay $10 to fill a prescription and the health plan covers the balance of
Coverage in/out a PPO network:
The health insurance plan allows you to use any qualified medical service provider,
but offer you to save money by using the PPO network the insurance plan is affiliated
with. You will usually save money by getting higher benefits, or your Co-Insurance
will be lower if you use PPO service providers.
Any Insured and Dependent who enrolls for coverage and for whom the required premium
The dollar amount of covered expenses you are responsible to pay the physician or
hospital before the policy will pay any benefits. Deductible Per event means you
pay your deductible once for all different services you received per one sickness
or accident. So in case your doctor requires you to return for a check of your condition
due to the same sickness, you will not pay the deductible again.
The person's immediate family members: spouse (wife or husband) and children.
The date specified on your certificate of insurance as the beginning of coverage.
Most plans cover emergency care in a hospital emergency room if it is an extremely
urgent medical emergency, even if the hospital you are taken to is not in the plan's
The person who purchased the insurance, whose name appears on the certificate of
insurance or medical insurance ID card. It might include his dependents, if added
to the policy.
Maximum lifetime medical benefits:
The total amount payable by the insurance company for covered medical expenses due
to injury or sickness per policy lifetime.
Maximum per injury or sickness:
The total amount payable by the insurance company for covered medical expenses for
injury or sickness per medical event.
Transferring the insured person to the nearest hospital or medical facility in case
of an emergency injury or sickness or back to his home country.
PPO or Preferred Provider Organization:
A network of doctors, clinics, hospitals and related medical service providers who
are organized under the PPO to provide health care at a discounted or negotiated
Any injury or illness which you suffered from or for which treatment was received
prior to the date your insurance started.
Premium or monthly rate:
A specified amount of money that the insurer receives in exchange for its promise
to provide health insurance to an individual or a group.
Prescription Drug Coverage (Rx):
A type of specified expense coverage that provides benefits for the purchase of
drugs and medicines prescribed by a physician and not available over-the-counter.
Often a plan will provide a prescription drug card that allows the insured to obtain
medications by simply paying a co-pay at a participating pharmacy.
Qualified service provider:
A licensed doctor, laboratory, nurse or hospital. Many plans will limit you to a
list of doctors and hospitals organized under a PPO. This is a list of doctors and
other service providers who agree to negotiated (and much lower) rates for their
services. They, in exchange get referrals from the insurance company. Better plans
allow you to visit any licensed doctor or hospital.
Transporting the remains of insured person back to his home country.
An illness, disease or condition of the insured for which he/she incurs medical
expenses while covered under the Policy. All related conditions and recurrent symptoms
of the same or similar condition will be considered one Sickness.
Student Health Center (SHC):
A medical facility on campus (can also be known as "school clinic") that
provides medical services for the university?s students. For treatment given at
SHC some plans will offer a lower deductible.
Reasonable and Customary charges:
The amount normally charged by the provider for similar services and supplies and
do not exceed the amount ordinarily charged by most providers of comparable services
and supplies in the locality where the services or supplies are received.
The insurance company, the Insurer. The party to an insurance arrangement who undertakes
to indemnify for losses, provide pecuniary benefits, or render services.
This Insurance Dictionary provides a general explanation of commonly used insurance terms. Please refer to the specific brochures for the definitions applicable to the insurance plans.