This glossary provides general descriptions of commonly used terms in international health insurance. It should be noted that there are differences between plans and that they all do not function in the same way. Please refer to individual insurance policy brochures and/or policy/certificates of insurance for complete details about each insurance plan.
The A.M. Best Company, is considered the most authoritative source of Insurance company information. The company provides comprehensive data to insurance professionals. Founded in 1899 by Alfred M. Best, A.M. 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.
Please note these ratings are assigned to usually the insurance underwriters of the policies you purchase and not to the policy or the policy administrator or the insurance agent.
Following are various AM Best ratings:
A+ : Superior
A : Excellent
A- : Excellent
B++: Very Good
B+ : Very Good
B : Fair
B- : Fair
C+ : Marginal
C : Weak
C- : Weak
D : Poor
E : Under Regulatory Supervision
F : In Liquidation
S : Rating Suspended
Person(s) designated by the insured(s) that would receive the proceeds of an insurance policy upon death of the insured. You would typically assign a beneficiary at the time of completing the policy application.
Amount an insurance company pays to a claimant, assignee or beneficiary when the insured suffers a covered loss, injury, accident etc.
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.
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.
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.
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.
Regulations requiring an employer who employs more than 20 people to offer continued group insurance coverage to former employees for up to 18 months. If the employee dies, the employer must offer continued group health insurance coverage to widowed spouses and dependent children for up to 36 months.
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;
In some health insurance plans, it is also called “co-payment”.
e.g., Suppose you buy insurance policy with $50,000 policy maximum, $250 deductible per policy period and 80/20 co-insurance for the first $5000 and 100% coverage thereafter. Suppose you incur covered expense of $10,250. You pay first $250 deductible; then out of the remaining $10,000 covered expenses, you pay 20% of the first $5000 (i.e., $1000); the insurance policy pays for the remaining expenses (i.e. $9,000).
That means, you pay $250 + $1000 = $1250 total; and insurance company pays $4000 + $5000 = $9000.
A vehicle or service licensed to carry passengers for hire on a regularly scheduled basis. Good examples are airplanes, trains etc.
A predetermined flat fee that the insured pays for healthcare services, in addition to what the insurance covers. Copay is usually not specified in percentage of the total healthcare cost. e.g., you pay $10 for a visit to the doctor’s office, no matter how much the doctor’s office visit charge is.
In most plans, insurance coverage can be purchased in the combination of monthly and/or 15 days increments to suit your needs. e.g., for a trip of 3.5 months, you can choose 3 monthly increments and one 15 days increment. 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.
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.
e.g., Let us consider that you have purchased an insurance policy with a $50,000 policy maximum, $250 deductible per policy period and 80/20 co-insurance.
Suppose you incur a covered expense of $10,250; then the insurance company will pay the covered expenses according to policy terms after you make a a payment of the deductible (i.e. $250).
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.
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 coverage for certain maximum amount, and for certain maximum duration such as 15 days, for the resonable 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.
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.
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.
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.
Person that purchases the insurance policy or enrolls into the insurance plan.
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 amount of money that the insured must pay on his own before the insurance company will pay 100% for insured’s healthcare expenses.
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
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.
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.
If a covered illness/injury results in a death, expenses for repatriation of bodily remains or ashes to the country of residence.
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.
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 transporation ticket of the same class as the unused travel ticket, less the value of the unused return ticket.
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. So when a claim is submitted for a plan with UC&R benefits, the insurance company before making the claim payment reviews the UC&R rate and double checks that hospitals and doctors are not billing excessively for the particular service or procedure. Most well respected plans from Blue Cross, Aetna, Lloyds, Unicare etc. follow the UC&R schedule.
Please note that we have tried to answer the questions to the best of our knowledge. We make no guarantee of the accuracy of these answers, as actual answers may change from time to time as insurance companies change their policies or because of any other reason. We will not be liable in any case, for any problem arising out of reading these questions and answers. Please use this information at your own risk. If there is discrepancy between the information here and in the actual insurance policy/certificate of insurance, policy /certificate of insurance will override.