Accident
means a sudden, unexpected and unintended event.
Accidental
Death & Dismemberment (AD&D) means 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.
Co-insurance
means 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.
Co-pay
means 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
the charges.
Coverage
in/out a PPO network means 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.
Covered
person means any Insured and Dependent who enrolls for coverage and
for whom the required premium is paid.
Deductible
means 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.
Dependent
means the person's immediate family members: spouse (wife or husband) and children.
Effective
date means the date specified on your certificate of insurance as the
beginning of coverage.
Emergency
care - 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 network.
Insured
personis 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 mean 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 means the total amount payable by the insurance
company for covered medical expenses for injury or sickness per medical event.
Medical
evacuation means 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 is 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 rate.
Pre-existing
condition means 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 means 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) is 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 means 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.
Repatriation
means transporting the remains of insured person back to his home country.
Sickness
means 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) means 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.
Usual
and Customary charges means 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.
Underwriter
(carrier) means the insurance company, the Insurer. The party to an
insurance arrangement who undertakes to indemnify for losses, provide pecuniary
benefits, or render services.