The terms below are an explanation of key terms and are not necessarily the terms used in ISO plans. In case of any contradiction, the terms provided in the policies will prevail. If you are still not clear about a term, please do not hesitate to contact ISO Customer Service representative and ask. We want you to be familiar with the key terms and understand them.
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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.
Alcoholism or Drug abuse
Excessive and self-damaging use of drugs and alcohol, leading to addiction or dependence, including serious physical and mental damage, or death.
The items or services covered under an insurance plan.
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. For example, you may pay $30 to fill a prescription and the health plan covers the balance of the charges.
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.
The Insured who enrolls for coverage and for whom the required premium is paid.
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.
A planned treatment/surgery that is subject to choice (election) therefore not involved a medical emergency.
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 network.
Fee for Service
A method in which doctors and other health care providers are paid for each service performed.
Group Health Plan
A health plan offered by an employer or employee organization that provides health coverage to employees and their families.
Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.
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.
A policy that allows you to choose any doctor and hospital and is not limited to a specific PPO. The service you received, if eligible, will be covered by the terms of 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.
A provider who does not have a contract with your insurer to provide services to you.
The most you pay during a policy period for covered treatments or services according to the benefit limits of your plan.
A medical treatment received without being admitted to a hospital.
A person who is legally qualified to practice medicine; doctor of medicine.
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 rate.
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 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.
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.
Transporting the remains of insured person back to his home country.
The act of harming oneself on purpose in order to take advantage of being injured.
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.
A physician whose practice is limited to a particular branch of medicine or surgery. For example: Eye specialist.
Injury sustained while participating in an amateur, club, intramural, interscholastic, intercollegiate, professional or semi-professional sports.
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.
The act of intentionally causing one's own death
Insurance that covers medical expenses, financial default of travel suppliers, and other losses incurred while traveling. Travel insurance coverage is usually provided for limited time.
The insurance company, the Insurer. The party to an insurance arrangement who undertakes to indemnify for losses, provide pecuniary benefits, or render services.
A type of health benefit that at least partially covers vision care, like eye exams and glasses.
Wellness and preventive care
These are services to prevent people from getting sick and detecting diseases and conditions before they become serious and more expensive to treat. These include physical check-ups, vaccinations and immunizations.
An electromagnetic image often used to diagnose illness or injuries.
The maximum the insurance will provide for treatments or services per policy year.