Access

The availability of medical care to the patient. It is determined by locality, transportation, and type of medical services in the area.

Accident/Injury

Bodily injury to the insured person resulting directly from an accident and independent of all other causes which occurs while the policy is in force and which is an injury covered by the policy.

Accident Insurance

A form of insurance against loss by accidental bodily injury to the insured.

Accidental Death and Dismemberment

A policy or a provision in a policy which pays a specified amount if the insured dies, loses his or her sight, or loses two limbs as the result of an accident. A lesser amount is payable for the loss of one eye, arm, leg, hand, or foot.

Actual Charge

The actual amount charged by a physician or hospital for medical services provided.

Acute Illness

Medical condition that is curable within a reasonable time.

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Aftercare

Individualized patient services required after hospitalization or rehabilitation.

Age Change

The date on which a person's age changes (for insurance purposes). Health insurers frequently use the age of the previous birth date for rate determinations. On the date of age change, a person's age may change to that of the last birth date, the nearer birth date, or the next birth date.

Agent

Insurance is sold by two types of agents: independent agents, who are self-employed, represent several insurance companies and are paid on commission; and exclusive or captive agents, who represent only one insurance company and are either salaried or work on commission. Insurance companies that use exclusive or captive agents are called direct writers.

Allocated Benefits

Payments authorized for specific purposes with a maximum specified for each

Allowable Charge

The lesser of the actual charge, the customary charge, and the prevailing charge.

Allowable Costs

Charges which are covered expenses.

AM Best Rating

The A.M. Best Company, is the most authoritative source of Insurance company information. The company provides comprehensive data to insurance professionals. Best is the world's oldest source of insurance company ratings and information. Its Best's Ratings are the industry's standard measure of insurer financial performance.

Ambulatory Care

Care which does not require hospitalization.

Ambulatory Setting

Institutions such as surgery centers, clinics, or other outpatient facilities which provide health care on an outpatient basis.

Ancillary

Additional services such as X-rays, anesthesia, lab work, etc.

Annual Travel Insurance

If you are a frequent traveler or a business traveler, this may be the plan for you. You pay an annual fee and are covered for twelve months, regardless of the number of trips you take.

Approved Health Care Facility or Program

A facility or program which has been approved by a health care plan as described in the contract.

Applicant

The person, group, company or institution named on the application form and the medical questionnaire requesting insurance coverage.

Assignment of Benefits

A method where the person receiving the medical benefits assigns the payment of those benefits to a physician or hospital.

Beneficiary

Person designated by the insured who would receive the proceeds of an insurance policy upon death of the insured.

Benefit

Amount an insurance company pays to a claimant, assignee or beneficiary when the insured suffers a covered loss, injury, accident etc.

Benefit Levels

The maximum amount a person is entitled to receive for a particular service or services as spelled out in the contract with a health plan or insurer.

Benefit Package

A description of what services the insurer or health plan offers to those covered under the terms of a health insurance contract.

Benefit Period

Benefit period is the maximum time period up to which the plan will pay benefits for any one eligible condition. Some policies have a 12 month while others have a 6 month benefit period; usually this period can extend beyond the date of policy expiration.

Best International Health Insurance

The best international health insurance is the plan that best covers your medical needs.

Best Travel Insurance

The best travel insurance is the one that will give you the best coverage for your money. You want to insure the total cost of your trip.

Binder

Temporary authorization of coverage issued prior to the actual insurance policy.

Blanket Medical Expense

A policy or provision in a Health Insurance contract that pays all medical costs, including hospitalization, drugs, and treatments, without limitation on any item except possibly for a maximum aggregate benefit under the policy. It is often written with an initial deductible amount.

Board Certified

A physician or other professional who has passed an examination which certifies him or her as a specialist in a particular medical area.

Broker

An intermediary between a customer and an insurance company. Brokers typically search the market for coverage appropriate to their clients. They work on commission and usually sell commercial, not personal, insurance. In life insurance, agents must be licensed as securities brokers/dealers to sell variable annuities, which are similar to stock market-based investments.

Calendar Year

January 1 through December 31 of the same year. Many deductible amount provisions are on a calendar year basis under major medical plans.

Carrier

Insurance company that actually underwrites and issues the insurance policy. The term refers to the fact that the company carries (or assumes) certain risks for the policyholder.

Carrier, Underwriter, Insurer

The company that insures you.

Carrier Replacement

This refers to a situation where one carrier replaces one or more carriers.

Case Manager

A person, usually an experienced professional, who coordinates the services necessary.

Certificate Booklet

The plan agreement. A printed description of the benefits and coverage provisions intended to explain the contractual arrangement between the carrier and the insured group or individual. May also be referred to as a policy booklet

Certificate of Coverage

A statement of coverage, also known as a certificate of insurance, that an individual receives when insured under a group contract. The certificate serves as proof of insurance, and outlines benefits and provisions.

Cheap Online Travel Insurance

Travel (better known as Trip) Insurance purchased online for a very affordable price.

Cheap Online Travel Insurance Quote

Travel (better known as Trip) Insurance purchased online for a very affordable price.

Cheap Annual Travel Insurance

If you are a frequent traveler or a business traveler, this may be the plan for you. You pay an annual fee and are covered for twelve months, regardless of the number of trips you take.

Chemical Equivalents

Drugs which contain identical amounts of the same ingredients.

Chronic Disease / Chronic Illness

Disease or illness persisting for an extended period of time and which cannot not easily be cured within reasonable time.

Claim

Request by the insured (or his/her provider) to an insurance company to pay for services obtained from a health care provider. The claim is usually submitted in a pre-determined format or a claim form.

Claim Form

A document that an insured person must complete as a part of the filing process. The form will usually ask specific questions relating to the medical treatment, previous history, etc.

Co-Insurance

After paying the deductible, percentage or amount of covered expenses that the insured pays. For example, an insurance policy brochure may mention that the policy will pay 80% of the first $5,000 and 100% thereafter of the usual and customary charges

Coinsurance Clause

A provision stating that the insured and the insurer will share all losses covered by the policy in a proportion agreed upon in advance, i.e., 70-30 would mean that the insurer would pay 70% and the insured would pay 30% of all losses.

Conditionally Renewable

A contract that provides that the insured may renew it to a stated date or an advanced age, subject to the right of the insurer to decline renewal only under conditions stated in the contract.

Contract Year

This period runs from the effective date to the expiration date of the contract.

Coordination of Benefits (COB)

A group policy provision which helps determine the primary carrier in situations where an insured is covered by more than one policy. This provision prevents an insured from receiving claims overpayments.

Co-Pay

This is an arrangement where the covered person pays a specified amount for various services and the health care provider pays the remainder. The covered person usually must pay his or her share when the service is rendered. Similar to coinsurance, except that coinsurance is usually a percentage of certain charges where the co-payment is a dollar amount.

Cost Sharing

A situation where covered persons pay a portion of the health costs such as deductibles, coinsurance, or co-payment amounts.

Covered Expenses

Health care expenses incurred by an insured or covered person that qualify for reimbursement under the terms of a policy contract.

Covered Person

A person who pays premiums into the contract for the benefits provided and who also meets eligibility requirements.

Coverage

The extent to which the insurance company will provide compensation for expenses in case of injury, diseases or illnesses. Coverage may be limited in terms of geographic area, maximum total amounts, maximum amounts per incident/injury/disease/illness, etc.

Coverage Period

Start and end date of coverage. Effective date for insurance coverage can be the date of departure from home country, or it can be any other later date specified by insured. It is wise to have the insurance effective date same as the date when you depart from home country for the destination and end date same as the date you arrive back in the home country so that you will be covered for any medical emergencies(for covered expenses) even during your journey.

Critical Illness

Major medical condition/health problem, e.g. cancer, blindness; coronary artery by-pass surgery, heart attack, kidney failure, stroke, multiple sclerosis, etc.

Date of Service

The date that the health service was provided.

Declaration

Part of a property or liability insurance policy that states the name and address of policyholder, property insured, its location and description, the policy period, premiums and supplemental information. Referred to as the “dec page.”

Deductible

Amount to be paid by the insured person before the insurance company begins to pay for the covered expenses. Deductible may be either per sickness/injury or once per policy period or once per year depending upon the insurance policy you purchase. You will not get receive any reimbursement later from insurance company for the deductible you pay.

Denial of Claim

Refusal by an insurance company to honor a a request by an insured (or his/her healthcare provider) to pay for healthcare services. This would usually be due to pre-existing conditions.

Dependent

The insured student’s spouse residing with the insured student; or the insured student’s unmarried child or children over the age of fourteen(14) days (including step children if dependent on the insured student), and under the age of nineteen (19) years, who are not self-supporting and who reside with the insured student.

Dependent Coverage

Insurance coverage on the head of a family which is extended to his or her dependents, including only the lawful spouse and unmarried children who are not yet employed on a full-time basis.

Diagnosis

The process of identifying a disease.

Dismemberment

The loss of, or loss of use of, specified members of the body resulting from accidental bodily injury.

Dismemberment Benefit

The benefits payable for various types of dismemberment. See also Accidental Death and Dismemberment.

Doctor

A licensed practitioner of the healing arts acting within the scope of his or her license and practice.

Duplicate Coverage Inquiry

A request to determine whether or not other coverage exists. Used to apply the coordination of benefits provisions where two or more insurance companies are involved.

Duplication of Benefits

A situation where identical or overlapping coverage exists between two or more insurance companies or service organizations.

Effective Date

The date requested by an employer for insurance coverage to begin.

Elective Surgery and Elective Treatment

Surgery or medial treatment which is not necessitated by a pathological or traumatic change in the function or structure in any part of the body.

Eligible Expenses

Usual and customary expenses that may be used as the basis for a claim under the terms of the insurance.

Eligibility Date

The date that a person is eligible for benefits.

Eligible Dependent

A dependent of an insured person who is eligible for coverage according to the requirements set forth in the contract.

Eligible Expenses

Expenses as defined in the health plan as being eligible for coverage. This could involve specified health services fees or "customary and reasonable charges”.

Elimination Period

A loosely used term, sometimes designating the probationary period, but most often designating the waiting period in a Health Insurance policy.

Emergency

An injury or disease which happens suddenly and requires treatment within 24 hours.

Emergency Accident Benefit

A medical benefit which reimburses the insured for expenses incurred for emergency treatment of accidents.

Emergency Admission

A hospital admission for inpatient hospital confinement for a condition which, unless promptly treated on an inpatient bases, would (1) put the patient’s life in danger; or (2) cause serious damage to a bodily function of the patient.

Emergency Evacuation

Coverage for emergency medical evacuation to the nearest qualified medical facility or the country of residence, as determined by the insurance company; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the country of residence or the country where the evacuation occurred, up to reasonable maximum limit.

Emergency Reunion

Emergency reunion coverage for certain maximum amount, and for certain maximum duration such as 15 days, for the reasonable travel and lodging expenses of a relative or friend during an emergency medical evacuation: generally either the cost of accompanying the insured during the evacuation or traveling from the country of residence to be reunited with the insured.

Endorsement

A written form attached to an insurance policy that alters the policy’s coverage, terms, or conditions. Sometimes called a rider.

Enrollee

An eligible individual who is enrolled in a health plan. Does not include an eligible dependent.

Enrolling Unit

The organization that contracts for participation in a health insurance plan.

Evidence of Insurability

The statement of information needed for the underwriting of an insurance policy.

Examination

The medical examination of an applicant for Life or Health insurance.

Exclusions

Healthcare services not covered by an insured's health insurance policy. This would usually be due to pre-existing conditions or due to the limitation of the insurance plan.

Expense

A policy's share of the company's operating costs, fees for medical examinations and inspection reports, underwriting, printing costs, commissions, advertising, agency expenses, premium taxes, salaries, rent, etc

Explanation of Benefits (EOB)

The statement sent to a participant in a health plan listing services, amounts paid by the plan, and total amount billed to the patient.

Hazardous Sports Coverage

Coverage for injuries incurred during amateur athletic activities which are non-contract and engaged in by an insured person solely for leisure, recreation, entertainment or fitness purposes. However, activities not covered include amateur or professional sports or other athletic activity which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition. Usually, following hazardous activities can be included by optional sports rider at additional premium cost: scuba diving, mountain climbing (up to 4500 meters or where ropes or guides are normally used), jet, snow and water skiing and snowboarding, sky diving, amateur racing, piloting an aircraft, bungee jumping and spelunking.

Health Insurance for Overseas Travel

Medical Insurance that will cover you when traveling overseas.

Hospital

An institution operating under the supervision of a licensed physician primarily for the care and treatment of injured and sick persons confined as inpatients, having organized facilities on the premises for diagnosis, major surgery and 24 hour-a-day nursing services but not primarily a place for alcoholics or drug addicts, not a nursing, rest or convalescent home.

Hospital Stay

A medically necessary overnight confinement in a hospital when room and board and general nursing care are provided and a per diem charge is made by the hospital.

ID card/Identification Card

Card given to insured individuals which advises medical providers that a patient is covered by a particular health insurance plan.

Illness

Sickness or disease for which no treatment or expense has been incurred for the six (6) month period immediately preceding the effective date of coverage of the insured person whose illness is the basis of the claim.

Individual Policy

An insurance policy (life, health, or disability) that provides coverage for an individual person (and, in some cases, his/her immediate family members), as opposed to a group policy that provides coverage for a group of individuals such as coverage through an employer.

In-Network

Describes a provider or health care facility which is part of a health plan's network. When applicable, insured individuals usually pay less when using an in-network provider

Insurance

General term describing the overall service offer of an insurance company, the policy conditions and policy schedule which are part of the insurance contract with the insurance company, setting out the scope of the insurance terms, the premium payable, deductible and reimbursement rates. Insurance provides indemnification against loss or liability from specified events and circumstances that may occur or be discovered during a specified period.

Insurance Carrier-Insurance Company

Company licensed to provide insurance services.

Insurance Contract

Agreement between a policy holder and an insurance company regarding the insurance coverage provided by the insurance company as confirmed in the policy. An Insurance contract determines the legal framework under which the features of an insurance policy are enforced. Normally an insurance contract is made in the form of an application submitted by the policy holder to the insurance company, and the subsequent acceptance of the application by the insurance company, subject to the policy conditions.

Insurance Rate

A factor used to determine the amount, called the premium, to be charged for a certain amount of insurance coverage

Insured

Person that purchases the insurance policy or enrolls into the insurance plan.

Insured Person

The person who's health is covered by the insurance policy.

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International Medical Insurance

Medical insurance that will cover you while away from your home country.

International Student Health Insurance

International students have unique health insurance needs and www.worldmedicalinsurance.com carries the right products created specifically for international students. For US Citizens traveling abroad and non-US Citizens coming into the USA we offer international student health insurance plans perfect for your needs. www.worldmedicalinsurance.com invites you to get your international student health insurance quote online then apply for immediate coverage.

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Trip Protection Insurance purchased online quickly.

Lifetime Maximum Benefit

The maximum amount a health plan will pay in benefits to an insured individual.

Limitations

A restriction on the amount of benefits paid out for a particular covered expense.

Loss

Medical expense or indemnity covered by the policy as the result of “injury” or “sickness”.

Lost luggage

This benefit will be paid in the event that the common carrier permanently looses an insured person's checked luggage. This coverage is secondary to any other available coverage, including the carrier's.

Maximum - Annual or Lifetime

An upper limit on costs or services covered by a plan. For example, a plan may limit you to 60 days of occupational therapy or put a ceiling on the dollar amount of coverage it will provide over your lifetime. Some plans have limits; some don’t, so check your policy.

Medical Questionnaire (Medical Form)

A form issued and required by some insurance companies on which medical/health information must be given on the insured person.

Medical Underwriting

The process whereby the persons to be insured are asked a number of questions about their health and, based on the information they provide, the insurance company will decide the conditions of your coverage.

Misrepresentation

A false or misleading statement. (1) In insurance sales, a false or misleading statement made by a sales agent to induce a customer to purchase insurance is a prohibited sales practice.
(2) In insurance underwriting, a false or misleading statement by an insurance applicant may provide a basis for the insurer to avoid the policy.

Network

A group of doctors, hospitals and other providers contracted to provide services to insured individuals for less than their usual fees. Provider networks can cover large geographic markets and/or a wide range of health care services. If a health plan uses a preferred provider network, insured individuals typically pay less for using a network provider.

Open Enrollment

Usually scheduled during the three months before the effective date of a benefit plan. This time is a window of opportunity during which you can make changes to your benefits package without having to prove creditable coverage or a qualifying event.

Out-of-Network

Describes a provider or health care facility which is not part of a health plan's network. Insured individuals usually pay more when using an out-of-network provider, if the plan uses a network.

Out-of-Pocket

Money you pay toward the cost of healthcare services. It’s essentially money you have to dig out of your own pocket, so it's aptly named. Out-of-pocket expenses include deductibles and co-payments. Sometimes, what you pay for services not covered by your plan is considered out-of-pocket as well. Plans vary widely in the amount of out-of-pocket costs you pay. Some plans put a cap on your out-of-pocket expenses. After you reach the out-of-pocket limit, the health plan pays all you are covered.

Out of Pocket Maximum

Maximum amount of money that the insured must pay on his own before the insurance company will pay 100% for insured's healthcare expenses.

Over 65 Travel Insurance

Persons over the age of 65 must be aware that once you leave your home country, you more often than not do not have health insurance. International Travel Health Insurance is a must for those who are concerned about not having any medical coverage while traveling.

Policy

Document issued by an insurance company confirming the insurance cover.

Policy Conditions

The terms and conditions of the purchased insurance.

Policy Holder

The person identified as the policyholder on the application form and on the insurance policy.

Policy Maximum

Maximum amount of money that the insurance company will pay for covered expenses. Policy maximum can be either per policy period, per year, life time or per injury/sickness depending upon the insurance policy you purchase.

Pre-Existing Conditions

A pre-existing condition is defined as any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that existed at the time of application or during the past duration (specified by each insurance plan) prior to the effective date of the insurance, including any subsequent, chronic or recurring complications or consequences related to thereto or arising there from.

Premium

Amount you pay to purchase medical insurance plan. Premium may be paid monthly, quarterly, semi-annually, annually or for entire duration of the coverage depending upon the insurance policy you purchase.

Pre-Certification

Pre-admission review and approval of appropriateness and medical necessity of hospitalization or other medical treatment.

Premium Invoice

Invoice issued by the insurance company to the policy holder stating the amount payable to receive or maintain the insurance coverage agreed and confirmed in the policy.

Prescription

Note issued to a patient by a medical specialist confirming that the patient should take a particular prescription drug.

Prescription Drugs

Any medicine that a medical specialist prescribes and that is not available without such a prescription.

Primary Care Physician (PCP)

A doctor who serves as your main contact with the health-care world, providing basic care and referring you to specialists as the need arises.

Qualifying Event

Certain events that would ordinarily cause an individual to lose health coverage. Sometimes know as life changes. These events include aging off a parent’s insurance plan at 23-25 years of age, getting married, getting divorced, having/adopting a child, or the death of a spouse or parent.

Referral

Within many managed care plans, transfer to specialty physician or specialty care by a primary care physician.

Reimbursement

A payment either to you or a health care professional for covered medical services. A fee-for-service plan may reimburse you or your doctor a set amount or maximum amount for specific services. This system can lead to larger out-of-pocket costs for you. For example, your doctor may charge $60 to remove that pesky wart, but your health plan pays just $40. You may have to pay the difference. On the other hand, your health plan may negotiate the doctor’s fees in advance, including an agreement that prevents you doctor from billing you for the remaining $20.

Reimbursement Rates

The maximum amount of money which will be paid by way of reimbursement of medical expenses.

Reinsurance

A means by which an insurance company can protect itself through other insurance companies against the risk of losses. Individuals and corporations obtain coverage from insurance companies to provide protection for various risks. Reinsurance companies provide insurance to insurance companies.

Renewal

The automatic or not automatic renewal of an insurance policy as subject to the anniversary date.

Repatriation of Remains

If a covered illness/injury results in a death, expenses for returning of bodily remains or ashes to the country of residence.

Return of Minor Children

If an insured person is hospitalized due to a covered illness/injury and is traveling alone with child(ren) of age 19 or under that otherwise would be left unattended, the cost of one way economy fare to their home country, usually up to some reasonable maximum amount.

Rider

A modification to a Certificate of Insurance policy regarding clauses and provisions of a policy. A rider usually adds or excludes coverage.

Risk

Uncertainty of financial loss.

Schedule

A list of individual items or groups of items that are covered under one policy or a listing of specific benefits, charges, credits, assets or other defined items.

Short-Term Medical

Temporary health coverage for an individual for a short period of time, usually from 30 days to six months.

Special Terms

Restrictions, limitations or conditions applied to the insurance company's standard terms as detailed in the policy or policy conditions

Specialist

A specialist is an expert in a specific area of medicine. You may need an oncologist to treat cancer; a nephrologist to treat kidney disease; or a pulmonologist to treat a serious lung conditions

Stop-Loss

The dollar amount of claims filed for eligible expenses at which the insurance begins to pay at 100% per insured individual. Stop-loss is reached when an insured individual has paid the deductible and reached the out-of-pocket maximum amount of co-insurance.

Surgery

Medical treatment of injuries, diseases and illnesses through a direct intervention within the patient's body

Surgical Procedure

Cutting, suturing, treating burns, correcting fracture, reducing a dislocation, manipulating a joint under general anesthesia, electro cauterizing, tapping (paracentesis), applying plaster casts, administering pneumothorax, endoscope or injecting sclerosing solution.

Travel Insurance Policies

Commonly called Trip protection plans or Trip cancellation insurance. Trip cancellation insurance provides trip reimbursement benefits that help guarantee you are ready in the event of a sickness, accident or loss when out of the country. Trip cancellation insurance also provides reimbursement Treatment
Medical care provided by means of consulting any medical provider about symptoms resulting from injury or sickness. Also includes, (but is not limited to) care by means of diagnostic procedures (i.e., x-rays, lab, surgery); the taking of medications; therapy (physical, mental health, etc.); or the use of any appliance (mental or dental).

Therapy Services (Medical)

Services used to treat or promote recovery from illness/injury.
A) Radiation therapy is treatment using x-ray, radium, cobalt, or high energy particle sources. Radiation therapy includes rental or cost of radioactive materials. Diagnostic services requiring use of radioactive materials are not radiation therapy. B) Chemotherapy is treatment of malignant disease by using chemical or biological agents.

Trip Cancellation Insurance

Insurance that covers trip costs and related unforeseen costs, such as lost baggage trip interruption and delay, etc., if your trip is interrupted or cancelled as a result of weather, tour operator default or other events that may cause disruption or cancellation.

Trip Interruption

If, during a covered trip, there is a death of an immediate family member (spouse, child, parent or sibling) or the substantial destruction of the insured's principal residence, many plans would pay the insured to the area of principal residence. Many plans usually pay for one way air or ground transportation ticket of the same class as the unused travel ticket, less the value of the unused return ticket.

UC&R (or Usual, Customary & Reasonable)

UC&R (or Usual, Customary & Reasonable) Charges represent the average or most common amount charged by providers for a particular service, treatment, or supply in the same geographic area. Typically information on rates for procedures is compiled into a data bank and updated periodically.

Underinsured

You are underinsured if you do not have sufficient insurance to cover medical expenses.

Underwriting

Insurance underwriting is the process of evaluating and deciding how much coverage can be provided for a particular policy, how much the policy holder should pay for it, or whether to even accept the risk and provide coverage at all.

Usual and Customary Charge/Reasonable and Customary

The charge for the offered service or supply usually made by the provider when there is no insurance, not to exceed the prevailing charge in the area for a service of the same nature and duration and performed by a person of similar training and experience, or for a substantially equivalent supply.

Waiting Period

A period of time starting from the commencement date of a policy during which the insurance may provide no or limited coverage. Waiting periods may apply for example to pre-existing conditions, pregnancy, and similar situations where it may not be appropriate for the insurance company to provide immediate coverage.