Glossary

Term

Descriptions

Persons added to a policy at renewal or mid-term. In some cases, persons added to a policy mid-term will enjoy pro-rata premiums.

All health insurance policies are annual contracts with either guaranteed or non-guaranteed renewal.

The overall maximum sum that the policy will cover in any one year.

A form which must be completed and submitted in order for cover to come into effect.

The geographic area in which the health insurance policy will provide cover.

A sum, shown on the plan's Benefit Schedule, showing any limit applied to a particular illness or service type. E.g.: Physiotherapy: US$1,000 per year.

Services, procedures, medicine, durable medical equipment that the policy will cover. Shown in full in the benefits schedule attached to the policy.

The official document outlining precisely what you are covered for. Includes details on any benefit limits.

A form which must be completed and submitted along with supporting documents. Forms the basis of claims submission.  Some providers do not require claim forms or originals.

The process of sending in a claim and requesting reimbursement for eligible expenses from the health insurance provider. Usually involves the completion of a claim form with receipts, invoices and a breakdown of services received attached.

A collection of medical facilities at which insured persons will be able to present their member card and enjoy direct billing. The size and scope of the clinic network varies from provider to provider.

If a policy is conditionally renewable, the Insurer reserves the right to not offer renewal of the policy.

A medical procedure or treatment that is covered by the benefits of the policy.

A sum of money that will need to be settled before the benefits of the policy will provide cover. Deductibles tend to be higher sums of money and applied on an annual basis. Once the annual deductible has been settled, the full benefits of the policy will provide cover.

The official definitions of the policy as listed in the policy terms and conditions of the policy. Forms the basis of the insurance policy's contract.

The immediate family of an insured person. Dependants may be added to an individual or group policy, subject to the approval of the policyholder and insurer.

A general term relating to how your claims are reimbursed. If you use direct billing, then you can leave clinics after receiving treatment without paying. The clinic will then settle the bill directly with your insurance provider.

A health condition / conditions caused by an injury. Sometimes benefits are applied on a 'per Disability' basis, meaning that a particular medical condition will only receive a certain amount of benefits as stipulated on the Benefits Schedule.

The date on which the policy becomes active, meaning you are covered under the benefits of the policy as per the policy terms and conditions.

Expenses that will be reimbursed as per the benefits and terms and conditions of the policy.

Persons who may be added to the policy, usually limited to the policyholder's spouse and any children.

In an emergency, seek treatment as soon as possible. Nearly all providers offer 24 hour hotlines if you need access to your benefits on an urgent basis. The hotline will be operated by the provider or a specialist partner.

The process of entering a policy. Usually involves the completion of an application form which includes a medical questionnaire.

Generally a small sum of money which you will have to fund before your plan will cover treatment. Excesses are usually applied on a per claim basis and start at around US$40 per claim. Once the excess for your claim is settled, the full benefits of the policy will cover your treatment.

Exclusions applied to you for a pre-existing condition or other health condition. Excluded conditions are not covered by the policy.

Usually applied to Group Policies. Renewal premiums  are assigned based on the claims experience of that particular group in the immediate preceeding years.

A style of underwriting for enrolment into a health insurance policy. All applicants complete full medical questionnaires and submit prior to the policy effective date. Any declared conditions are excluded or covered with a loading. This way, you should understand the full implications and cover of your pre-existing conditions before committing to a policy.

If a benefit is shown as Fully Covered or 100%, it means the service is covered up to the overall annual limit of the policy. If not Fully Covered, it will be subject to any limit shown on the benefit schedule.

A list of treatments; circumstances; and / or illnesses, usually shown in the Policy Terms and Conditions, which are always excluded by the policy.

A policy that is owned by a company to insure its employees and in some cases their dependants.

Benefits, claims, treatment relating to treatment at a hospital or involving a surgical procedure.

A policy that is owned by an individual person to insure him/herself and his/her immediate family.

Treatment received at a hospital, either as a day-patient or admitted patient.

The company who provides the financial strength behind your plan. The insurer of your plan will fund all claim payments.

A medical insurance plan that is designed with a high standard of service and benefits in mind. Not necessarily for expats, but always providing a certain level of cover and geographic portability.

In the event of a large claim, an insurer will issue a Letter of Guarantee. The insurer must be informed as soon as possible and any documents supporting the claim must be submitted. The insurer will then work directly with the hospital and formally guarantee to pay any eligible expenses on behalf of the insured person.

Benefits that will reimburse expenses relating to pre-natal, post-natal and childbirth.

The maximum age at which an insurer will accept persons into a policy.

The maximum age at which you will be allowed to renew the policy. When you reach the maximum renewable age, you will not be offered renewal of the policy.

The increase in costs of medical treatment. This includes but is not limited to: doctors' fees, costs of medicine, general hospital fees etc.

An insurance plan that is designed to reimburse expenses relating to medical treatment.

The company who administers and / or maintains the medical insurance plan.

A questionnaire that asks about your current health status and past medical history. Usually included in the application form. This is reviewed as part of the underwriting process.

The process by which providers assess applications. This is almost exclusively based on the declarations made in medical questionnaires and the profile of the applicant.

A form of identification issued to any insured person. Usually in the form of a plastic card, showing you general details and useful contact numbers for the policy.

Any movement, addition, deletion, change affecting the policy during the policy year, as opposed to at the start or renewal of the policy.

A style of underwriting for enrolment into a health insurance policy. Usually requires a less detailed application form compared to Full Medical Underwriting. The general condition is that any condition which you suffer from in the first e.g. 2 years of the policy will be automatically excluded.

A list of all persons insured by the policy.

Plans that have no deductible or excess will offer cover from the first dollar of expenses incurred. For example, if you submit a claim for US$250, then you will reimbursed US$250 (as per the benefits and terms of the policy).

Plans which have a North American Exclusion will exclude and / or restrict treatment in the United States and other North American countries.

Most providers offer information and services in secure online platforms. Functionality between health insurers varies, from a basic information sharing platform to interactive claim submission and health tips.

Most insurance policies are based primarily upon Hospital and Surgical benefits. Depending on the plan design offered by the provider, you may be able to add benefits on an optional basis. Typical examples of optional benefits include dental benefits and maternity benefits.

Treatment, procedures, medication that are administered with no involvement from a hospital. Main examples include medication and services rendered by General Practitioners and Specialists at their clinics.

Treatment that you pay for and then claim from your insurance provider at a later date.

Although premiums are usually shown on an annual basis, many providers offer payment intervals, meaning the premium can be paid quarterly, semi-annually etc. Payment intervals do sometimes require a minor surcharge to be paid.

All documents and items relating to the policy. Including but not limited to the policy terms and conditions; benefit schedule; name list.

An Individual or Company, named as the owner of the policy.

A key official document outlining any terms, conditions, general exclusions that affect the policy. The main document governing your health insurance policy.

The official time period in which the policy is in effect. E.g. 10 January 2014 to 9 Januray 2015. If the policy is renewed, this period will be extended by one year. If not renewed, cover will cease on the last day of the policy year.

A means by which Insurers group their policies. For example a pool of individual policies may include over 3,000 policies, all with similar benefits and paying a similar premium.

Most individual plans are pool rated. This means that individual policyholders will not be penalised for their claims. Premiums will however increase based on the general performance of the individual pool and as a result of general medical inflation.

Required for most hospital claims. The insurer / provider must be informed of treatment before treatment. The insurer / provider will then set up a letter of guarantee with the treating hospital.

The sum of money that must be paid for the policy to come into effect. The cost of the insurance.

A hospital, clinic or other medical facility that provides medical treatment and services.

The official prices of plans as offered by providers. These can give an indication as to the cost of insurance, but may change after the completion of the application process which includes underwriting. The premium you pay will depend upon which provider, plan, benefits you choose and your age at time of application.

A policy that is renewable for life must be renewed for as long as the policyholder wants.

The period at which the policy is coming to an end and needs to be renewed for another year.

All health policies are annual contracts. The renewal premium is the cost of renewing the policy for another year.

A company that may administer a medical insurance plan but does not fund claims. Claims will be funded by the insurer that backs the plan.

The process by which medical insurance providers and insurers assess the risk involved in providing medical insurance cover. Includes premium setting, setting of benefit levels, and writing of policy terms and conditions.

Some benefits in health insurance policies will only available after a certain period of time.  For example, certain dental or maternity benefits will only be available after e.g. 10 months of cover.

Plans that are Worldwide provide cover for elective and emergency treatment anywhere in the world.

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