Health Insurance Terms & Definitions
||The term used to describe the
period of time for which you have purchased coverage. Under this definition also, this is
the period of time in which the insurance company is responsible to act on your behalf
based on the terms of the policy.
||The cost sharing between you
and the insurance company. Normally a policy will require that you cost share with them on
the first $5,000 of medical claims.
Example: 80%/20% co-insurance: The
insurance company would pay 80% of the first $5,000 of medical claims and you would pay
20%, after which the insurance company begins to pay the remainder per the terms of the
policy. UCR applies.
Co-insurance can vary with different policies, so be sure you understand the
terms of the plan in which you are interested.
|A dollar amount you
have selected which you will pay before the insurance company begins to pay at the
co-insurance level. You have several options of deductibles, and the deductible can impact
what your monthly premium will be.
||The country where an insured
person(s) has his/her true, fixed and permanent home and principle establishment.
|A rider can be added
to your basic policy which will give you added benefits for specific needs (Hazardous
Sports Coverage, Home Country Coverage, Frequent Traveler, etc.).
||This is the maximum
amount of money (benefit you choose to purchase) for the time period you select. Your are
purchasing coverage for Major Medical expenses per the terms of the policy.
||You call your insurance
company and advise them that your doctor says you require certain medical treatment. You
do this before receiving treatment from the doctor or hospital. A policy of insurance will
normally list the medical conditions that require pre-certification before receiving
treatment. If you do not pre-certify, your benefits will be reduced or possibly will not
be covered. Each policy will have the requirements listed for things that must be
pre-certified. If you are not sure, then call the Plan Administrator and they will advise
|(Not covered under
the policy guidelines.) Pre-existing condition is defined as an injury or illness which
was contracted or which first manifested itself; or for which manifestations of symptoms
would have caused a prudent person to seek medical advice or treatment; or for which a
licensed physician was consulted; or for which treatment or medication was prescribed
within the five years prior to the effective date of the Insured Person's policy effective
|If injury or illness
commencing during the period of coverage under this policy results in death, all
reasonable expenses incurred for preparation and return of the remains to your Home
Country or Country of Residence are covered up to the maximum allowable amount.
Benefits and Exclusions
|A policy always lists
the benefits which are covered under the policy guidelines as well as services which are not
provided under the policy. When requesting a quote, this information can be provided to
and Reasonable (UCR)
|UCR rates refer to
medical research which has determined the fair and reasonable charges for various medical
procedures and treatments as well as fee for service charges based on the region of the
country in which those services are provided.
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