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Glossary of Health Insurance Terms & Definitions

Certificate Period 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.
Co-Insurance 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.
Home Country The country where an insured person(s) has his/her true, fixed and permanent home and principle establishment.
Optional Riders
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.).
Policy Maximum Benefit 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.
Pre-Certification 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 you.
Pre-existing Conditions
(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 date.
Repatriation of Remains
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.
Schedule of 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 you.
Usual, Customary, 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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