Glossary: Key Global Insurance Terms and Definitions
Researching and choosing the right global medical plan and provider is difficult enough. Understanding the terms and language used in the policy descriptions can make things even more confusing. This glossary of terms provides definitions for some of the more frequently used words and phrases you will find throughout the site.
Deductible: This is the amount that you must pay before the insurance will begin to pay. Many plans will allow you to choose your own deductible, if this is the case keep in mind that the higher the deductible, the lower the premium will be. However, the higher the deductible, the more you will have to pay when you use the plan.
Read: Deductibles Explained
Co-Insurance: After the deductible there might also be a co-insurance. This means that you and the insurance company will share the cost of your remaining fees. The co-insurance is typically broken down by percentage like 80/20 or 70/30. If you choose a plan that has a 80/20 co-insurance, typically you will be in charge of paying 20% and the insurance will be in charge of the other 80%.
Co-Pay: If you have a co-pay on your plan, this is the set fee that you must pay when you use the plan. If you visit the emergency room, there may be an additional co-pay as well.
Policy Maximum: Each plan will list the policy maximum, even if it is simply listed as unlimited. The policy maximum is the total limit as to what the insurance will pay towards your medical expenses.
Out of Pocket Expense: This is the amount of money that you will pay towards your medical expenses. Your out of pocket expense is usually in the form of a deductible, co-insurance, copay or some combination of the three.
Pre-existing Condition: Any medical condition that the insured has prior to contracting for insurance coverage.
Two types of PreExisting Conditions according to Lisa Smith of Investopedia,
Most insurance companies use one of two definitions to identify such conditions. Under the “objective standard” definition, a pre-existing condition is any condition for which the patient has already received medical advice or treatment prior to enrollment in a new medical insurance plan. Under the broader, “prudent person” definition, a pre-existing condition is anything for which symptoms were present and a prudent person would have sought treatment.
Additional International Insurance Terms and Definitions:
AD&D – Accidental Death and Dismemberment: Insurance that pays the insured or beneficiary in case of bodily injury or death due to an accident, that is not natural causes. This may or may not be included and can be offered as an Add-On to your plan.
Certificate of Creditable Coverage (CCC): A statement or certificate issued by an insurance company that provides documentation of the existence of insurance, dates of coverage, and thus is proof that a person has or has had valid medical insurance.
Claims: An amount of money requested by an insured person from an insurance company to pay for an incurred medical expense. Usually a claim is made in the form of a written notification to the insurance company requesting payment for medical care received, care that is covered under the terms of the insurance policy.
Common Carrier: Any land, sea, or air conveyance operating under a valid license for the transportation of passengers for hire.
Continuous Coverage: Health insurance coverage that is not interrupted by a lapse of a predetermined number days.
Covered Expenses: Expenses that the insurance company agrees to cover based on the insurance policy purchased. A summary of “covered expenses” will be listed in the Schedule of Benefits.
Covered Reasons: The specific situations and events that are covered by a specific coverage or policy.
Dependent: Usually a spouse and/or children who are legally dependent on the insured. Depending on the insurance plan, dependents may qualify for insurance coverage on the insured’s policy.
Effective Date: The date when the insurance coverage becomes effective.
Epidemic: An outbreak of a contagious disease that spreads rapidly and widely and that is identified as an epidemic by The Centers for Disease Control and Prevention (CDC).
Evacuation: Emergency Evacuation Categories
- Emergency medical evacuation (to the nearest qualified medical facility that can handle the medical condition)
- Medical due to outbreaks, epidemics
- Threat of natural disaster
- Political evacuation due to civil unrest (treated separately)
Includes expenses for reasonable transportation (either public transport or private as reasonable based on the condition) resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred. Sometimes includes remote transportation in the event of a diagnosis of a critical medical condition which is not necessarily immediately life-threatening, but severe enough that it could result in death or a permanent disability if not treated right away. Any medical treatment (after any deductibles) are usually paid from your medical insurance benefit. May also include an Emergency Reunion Benefit, or Return of Minor Children.
Fulfillment Kit: Materials sent to the client after they have been approved for insurance coverage. The kit usually contains the Medical ID card, a Certificate of Coverage, a detailed explanation of the insurance plan, information concerning filing claims, and contact information for the insurance company.
HIPAA: The Health Insurance Portability and Accountability Act. This is also known as the Kassebaum-Kennedy Act enacted by the US Congress in 1996. It includes basic requirements for health insurance privacy and portability of health insurance, thus avoiding exclusion of coverage for pre-existing medical conditions.
In-Network, Out-of-Network: Medical facilities and practitioners that have contracted with the insurance companies to provide discounted rates, direct billing and other services are considered In Network. Those facilities that have not contracted are considered “Out-of-Network.” The insured will typically save money by using “In-Network” providers and facilities.
In-patient: A patient admitted for at least a 24-hour residence (or at least overnight) in a medical facility where he is being treated.
Insurance Broker: An agency or individual who works as an intermediary between a person wanting insurance and one or more insurance companies to guide them in the purchase of insurance.
Lifetime Maximum: The maximum amount an insurance company will pay for all benefits received. The usual limits are $1,000,000; $3,000,000 or $5,000,000 but may be greater or, in some cases, unlimited.
Loss: Injury or damage sustained by you in consequence of happening of one or more of the occurrences against which the company has undertaken to indemnify you.
Lost Luggage: Aka Loss/Theft, if there is damage to, or loss of, or theft of your checked or stored baggage or personal items (Defined as suitcases, clothing, toiletries, books, photo equipment, mobile phones and laptops) by a common carrier, or while stored with your hotel. It will also usually include coverage for the replacement costs of travel documents, and sometimes bag tracking. May, or may not, include delayed baggage.
Maximum Limit, Maximum Coverage: Same as Lifetime Maximum listed above
Medical Evacuation (MedEvac, medivac): Timely and efficient evacuation and in-route care of ill or injured persons, usually by air transportation, to a place where they can receive adequate medical care.
Medically Necessary: Treatment that’s appropriate for your illness or injury, consistent with your symptoms, and that can safely be provided to you. It meets the standards of good medical practice and isn’t for your convenience or the provider’s convenience.
Natural disaster: A large-scale extreme weather or environmental event that damages property, disrupts transportation, or endangers people. Examples include: earthquake, fire, flood, hurricane, or volcanic eruption.
Online Fulfillment: Electronic communication of Medical ID card, certificate or indication of coverage, information on the policy purchased, how to file a claim, and the insurance company’s contact information.
Out-patient: A patient who receives medical treatment at a clinic or hospital, but is not admitted for an overnight stay.
Out-of-pocket: Direct outlays of cash that will not be reimbursed by the insurance company. This will include deductibles and co-insurance limits.
Policy Year: The amount of time from the effective date of the policy that comprises one full year. For example, if the effective date begins April 14, 2009, the policy year will end at midnight, April 13, 2010.
Political Evacuation: Often lumped together with non-medical or security evacuation, political evacuation is for situations where one is either trapped, or expelled, or at risk due to civil uprisings, riots, military coups, political unrest, or being identified as a “persona non grata” in the country you are visiting. Security evacuations (necessary for impending natural disasters, etc.) are different from political evacuations. Political evacuations are for situations of political instability, civil unrest, or military action. Coverage is sometimes dependent on the United States Department of State, Bureau of Consular Affairs, or similar government organization of the insured person’s home country, ordering the evacuation of all non-emergency government personnel from the host country.
Pre-certification: The need to check with the insurance company before receiving medical care, generally for major medical procedures, to confirm if the medical care received will be covered by the insurance company.
Premium: Payment for insurance, the amount paid by the insured to the insurance company for health insurance coverage.
Premiums Are Fully Earned: There will be NO REFUNDS if the policy is cancelled before the Insurance Certificate expires or if there is a reduction in coverage due to sale or loss of an item.
Preventive Care (see; Wellness Benefit, Well-care): Medical care given in advance of symptoms to prevent illness or injury. Generally includes emphasis on healthy behavior, regular testing, screening for diseases, routine physical examinations and immunizations.
Quarantine: Mandatory isolation or restrictions on where you can go, intended to stop a contagious disease from spreading.
Refund: Cash or a credit or voucher for future travel that you get from a travel agent, tour operator, airline, cruise line or other travel supplier, or any credit, recovery or reimbursement you get from your employer, another insurance company, a credit card issuer or any other entity.
Remote Transportation: If you experience a medical problem that is not immediately life threatening, but severe enough to result in death or permanent disability if not treated right away, Remote Transportation will provide for eligible charges arising out of the transportation for you to a qualified facility for further treatment.
Repatriation of Remains: Coverage for the transportation of the covered individual’s bodily remains back to their area of principle residence, in the event of a covered illness or injury that results in death.
Rider (Waiver): A formal written statement by the insurance company to the insured amending and modifying coverage, e.g., adding or excluding coverage. It could involve waiving coverage for a certain medical condition like cancer, hepatitis or adding coverage for such conditions.
Schedule of Benefits (SOB): A list of the benefits, amount of coverage provided in an insurance policy, usually one or two pages in length.
Scheduled Departure Date: The date on which you are originally scheduled to leave on the trip.
Scheduled Return Date: The date on which you are originally scheduled to return to the point of origin or to a different final destination.
Sickness: An illness or disease which is diagnosed or treated by a physician after the effective date of insurance and while you are covered under the policy.
Subrogation: Steps the travel insurance company takes, after paying a claim, to collect from other available sources such as other insurance plans or travel suppliers.
Term Life Insurance: An insurance plan that covers a person for a specified period of time (a day, week, year(s)), but not for his whole life. It only pays benefits if the person dies.
Terrorism: Includes criminal acts, including against civilians, committed with the intent to cause death or serious bodily injury, or taking of hostages, with the purpose to provide a state of terror in the general public or in a group of persons or particular persons, intimidate a population, or compel a government of international organization to do, or to abstain from doing, an act.
Trip Cancellation: Provides reimbursement for non-refundable trip payments and deposits if a trip is canceled for illness, death or other specific unforeseen circumstances. The “trip cancellation” benefit covers you in the event you have to cancel prior to your trip due to a covered reason listed in your travel insurance policy prior to your departure date.
Trip Interruption: Trip interruption plans typically reimburse you for pre-paid non-refundable travel expenses if an unexpected crises (e.g., death of a family member, sickness, airline strike, travel supplier bankruptcy, among other crises) occurs during your trip causing it to be cancelled, interrupted or delayed.
Underwriter: (1) The company that receives the insurance premium and accepts the responsibility to cover medical costs; (2) The employee in an insurance company who decides whether or not the insurance company should assume the risk of offering the insurance to an individual or group; (3) An insurance agent.
Usual, Reasonable & Customary (UCR): The amount an insurance company will pay for a covered medical expense based on the customary charges of all medical providers in a given geographic area for a similar service.
Waiting Period: A period of time the insured must wait before some or all of the coverages offered in an insurance plan begin and the insured can receive benefits.
Waiver (Rider): A formal written statement by the insurance company to the insured amending and modifying coverage, e.g., adding or excluding coverage. It could involve waiving coverage for a certain medical condition like cancer, hepatitis or adding coverage for such conditions.
Wellness Benefit (Preventive Care, Well-care): Medical care given in advance of symptoms to prevent illness or injury. Generally includes emphasis on healthy behavior, regular testing, screening for diseases, routine physical examinations and immunizations.