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What is Health Insurance Coverage: Glossary
What is Health Insurance Coverage: Co-Insurance
What is Health Insurance Coverage: Expatriate
What is Health Insurance Coverage: Benefit Limit

 

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Health Insurance Glossary:

Definitions and explanations of common health insurance terms

A

Accident

An involuntary, sudden, unexpected or unforeseen external event resulting in bodily injury to an insured person that requires medical care under the health insurance policy.

Acupuncture

The procedure of inserting and manipulating needles into various points on the body to relieve pain or for therapeutic purposes.

Adverse Selection

Refers to a situation where an individual's demand for health insurance is positively correlated with the individual's risk of loss, and the health insurance company is unable to allow for this correlation in the price of health insurance and may raise premium rates.

Age band

A defined range of life ages of applicants or insured persons, within which the same premium level applies. Health insurance companies normally charge tiered premiums with different age bands.

Acute illness/disease

Medical condition that is curable within a reasonable time.

Ambulatory treatment (Out-patient treatment)

A surgery or a medical treatment in a hospital, clinic or at a medical specialist's practice where it is not medically necessary to stay overnight.  This is usually referred to as outpatient cover within health insurance plans.

Applicant

The person, group, company or institution named on the health insurance application form and the medical questionnaire (if the applicant is also the insured person) requesting for insurance coverage.

Application

The application form and supporting documents (such as a medical questionnaire, further information about the health situation of the insured person(s), etc.); the procedure of applying for health insurance coverage

Area of cover / coverage area

The geographic region (the set of countries) in the world where the insured is entitled to claim for medical treatment. This is usually Worldwide or Worldwide excluding USA. Because of the unproportionally high medical costs in the USA, Insurers will demand a higher premium (+ 150% - 300%) if you want to be covered. Some Insurers will have more location specific areas of cover such as Africa, The Middle East, Asia as areas of cover.

Benefit

A broad term which describes any treatment, service or otherwise help under an international health insurance plan that will restore, maintain, facilitate or encourage good health. Benefits are segmented by type (in-patient, out-patient, dental, etc) and carry specific definitions, exclusions and limitations as described in the table of benefits and other supporting documentation.

Benefit Limit

Describes specifically at what point the insurance company will not, or under what conditions reimburse the insured for a specific benefit.

Benefit period

A benefit period is a length of time during which the insured can be reimbursed for the costs of the benefit incurred.

Benefit Rider

Add-on insurance policies that cover health-related services that are not typically covered. For example: an extreme sports rider or a terrorism rider.

Business International Health Insurance

International Health Insurance that is specifically designed for groups of people such as businesses and organizations.

C

Cancellation Period

The period of time within which you are entitled to change you mind and request a refund of your health insurance premium where applicable in the event you decide to cancel or not proceed with your medical cover.

Chiropractic

Refers to the set of medical procedures and treatments that are employed to relieve pain usually to the joints, spine and trunk.

Chronic disease / chronic illness

Disease or illness persisting for an extended period of time and which cannot not easily be cured within reasonable time. In many policy conditions chronic diseases are excluded from coverage.

Claim

The financial demand by a policy holder against the health insurance company to compensate for medical and other expenses of the policy holder or of the insured person for medical treatments which are covered in whole or in part by the insurance policy.

Claims handling (claims administration)

The procedures carried out by the health insurance company to receive, check and make payments for claims from policyholders. The efficiency of claims handling is an important aspect of the overall assessment of an insurance company's quality of service.

Co-Insurance

Refers to the shared amount of money that you are obligated to pay for covered medical services/treatment. In the table of benefits, you may see something like: "Dental - 20 % Co-Insurance". This means that you must share the cost of dental treatment costs with the Insurer where you will pay 20% of the bill and the medical insurer will pay the remaining 80% subject to you remaining within the benefit limit.

Co-payment / Co-pay

Refers to a specific charge that your international health insurance plan may require you to pay for a specific benefit, service or treatment. It is also referred to more loosely as "co-pay". For example, looking up your table of benefits for your plan you may find that you are required to pay $30 for branded prescription drugs meaning that you are required to pay $30 before the insurance company will start paying. Co-payments are popular in USA styled plans.

Commencement date

The date indicated in the health insurance policy on which the insurance begins, unless otherwise mentioned in the policy conditions

Compassionate Home Visit

In the event of a relative passing away some Insurers will cover the cost of an economy class return fare air ticket for you to return home.

Complementary treatment

Refers to therapeutic treatment as an alternative or is outside conventional Western medicine such as Chinese herbal medicine or acupuncture.

Complications of childbirth

This definition differs from health Insurer to health Insurer however generally this refers to abnormal conditions that arise during childbirth such as postpartum haemorrhage, retained placental membrane and medically necessary caesarean sections.

Complications of pregnancy

This refers to the health of the mother during the pre-natal (preceding) stages of pregnancy such as miscarriage or stillbirth.

Continuing Personal Medical Exclusions

If you have a current Private Medical Insurance Plan but wish to change to another health insurance company, for reasons of price, additional coverage or simply that you have suffered poor claims handling, then you may possibly be offered a "no worse terms" plan or Continuing Personal Medical Exclusions plan. This simply means that the underwriting insurance company of the new plan, will accept offering you coverage on the same terms as the previous plan.

Convalescent home

Refers to a medical facility designed to treat and care for patients with long-term or chronic illnesses.

Copayment (Copay)

A copayment, or copay, is a flat amount paid for a medical service by an insured person.  Health Insurance companies use copayments to share health care costs. Though the copay is often only a small portion of the actual cost of the medical service, it is thought to prevent people from seeking medical care that may not be necessary (e.g. an infection by the common cold), which can result in substantial savings for insurance companies and accordingly leads to lower premiums.

Country of Residence

The principle country in which you spend most of your time year living in.

Coverage (cover)

The extent to which the health insurance company will provide compensation for expenses in case of injury, diseases or illnesses.Coverage may be limited in terms of geographic area, maximum total amounts, maximum amounts per incident/injury/disease/illness, etc.

Coverage Period

The timeframe in which the insured can receive and claim for medical expenses as detailed in his or her international medical insurance policy documentation.

Critical illness

Major medical condition/health problem, e.g. cancer, blindness; coronary artery by-pass surgery, heart attack, kidney failure, stroke, multiple sclerosis, etc.

Critical illness insurance

An insurance that makes a lump sum cash payment if the policyholder is diagnosed with one of the critical illnesses listed on the insurance policy and survives a minimum number of days (the "survival period") from the date the illness was first diagnosed. Critical illness insurance is usually separate from international health insurance, but may be included in the same policy in some cases.

CT Scan (CAT Scan)

Or computerised axial tomography is a sophisticated x-ray / imaging procedure for showing bone detail primarily.

D

Day case treatment

A treatment which, for medical reasons, normally requires a patient to occupy a bed in a hospital or clinic for less than 24 hours. See also ambulatory treatment.

Death Benefit

A Death Benefit is an amount that shall be paid should the insured person pass away during the period of insurance as a result of sickness, illness or accident. Restrictions vary from Insurer to Insurer and plan to plan should the insured person(s) have a pre-existing and/or chronic condition(s).

Deductible (excess)

In a health insurance policy, the deductible or excess is the portion of any claim that is not covered by the insurance company. It is normally quoted as a fixed amount and is a part of most policies covering losses to the policy holder. The deductible must be "met", that is, paid by the insured, before the benefits of the policy can apply. Deductibles may apply as a total amount or as specific amounts for particular treatments or medications.

Denial of claim

This refers to a health insurance company refusing to pay for treatment that you received and have submitted a claim for. A denial could arise for many reasons. More information regarding denial of claims can be found here.

Dental prostheses

Amongst other things, dental prostheses usually includes or excludes cover for crowns, inlays, onlays, reconstructions, restorations, bridges, dentures and implants.

Dental surgery

Exact definitions differ from health Insurer to health Insurer however generally dental surgery refers to extraction of teeth, apicoectomy,treatment for jaw deformities, fractures and tumours. It does not cover surgical treatment that is related to artificial dental implants or wholly cosmetic.

Dependent

Refers to your spouse or partner (husband / wife / same sex partner) and children. Age definitions of children vary from Insurer to Insurer however they are usually eligible to be regarded as a child if they apply up until the day before their 18th birthday. Some Insurers will also accept 'children' up until the day before their 24th birthday if they are enrolled in full-time education.

Diagnostic tests

Refers to tests such as blood tests, x-rays, CT, ultrasound and MRI scans to investigate and determine the cause of patient symptoms. Exact definitions differ from Insurer to Insurer and plan to plan so it is worth checking the health insurance table of benefits and other supporting documentation.

Due date

Refers to the day on which your international health insurance policy premium must be paid for your policy to continue. Most insurance companies offer the following payment terms / frequency options: annually, bi-annually, quarterly and monthly. Failing to pay for your policy on your due date may terminate your policy.

E

Effective date

The date on which international health insurance coverage comes into effect / provides insurance cover.

Evacuation

The transportation of an insured person to the nearest appropriate medical facility.

Emergency Reunion

Is an international health insurance benefit that facilitates the transport of a family member to where you are receiving treatment should you become seriously ill.

Exclusions

Refers to conditions / situations / events which are not eligible for reimbursement under an international medical insurance policy. These usually include things like war, self-harm, terrorism, HIV/AIDS, cosmetic surgery, injuries arising from dangerous hobbies and usually, pre-existing conditions treated in the past two years.

Expatriate (Expat)

A person temporarily or permanently residing in a country and culture other than that of the person's upbringing or legal residence.

F

Full Cover / 100%

Found in the health insurance table of benefits, "full cover", "100%" or something else to that effect means that you can receive full compensation for the associated benefit up until the policy maximum (overall limit) has been reached.

G

General practitioner (GP)

A general practitioner (GP) or family physician is a medical specialist who provides primary care, i.e. a health care provider acting as a first point of consultation for all patients.

Group health insurance (group plans, corporate plans)

Group health insurance refers to the insurance plans offered to a specific group of people, for example employees of a corporation or of other institutions such as international organizations. Besides individual health insurance plans, insurance companies usually offer such group insurance (group plans, corporate plans) for companies and other organizations to collectively insure all or some of their employees, members, etc.

H

Health Maintenance Organization (HMO)

A concept first established in the USA, a HMO is a type of managed care, i.e. essentially a type of insurance under which an insurance company controls all aspects of the health care provided to the insured persons. Private health insurance plans in many countries now incorporate some managed care features such as pre-approval for non-emergency hospital admissions and utilization reviews. This arrangement allows the insurance company/HMO to charge a lower monthly premium, which is an advantage over normal health insurance, provided that the insured persons are willing to abide by the applicable restrictions.

Hazardous Sports Cover

Refers to cover for "dangerous" sporting activities such as but not limited to mountaineering, hang gliding, parachuting, bungee jumping, motor vehicle racing, snow mobiling, skiing and snow boarding.

Home country

Is the country for which the insured person holds a current passport and/or to which the insured person would want to be repatriated.

Homeopathy

A form of alternative medicine that attempts to treat patients with heavily diluted preparations which are claimed to cause effects similar to the symptoms presented.

Hospital / Provider Network

A directory / list of medical providers which are recognised by the insurance company and which usually the insurance company has an established relationship with. This is not to say that you cannot go to a hospital of your choice that is outside your insurance company's network but it is usually advantageous to do so in respect of claims handling.

Many health insurance companies have online hospital network databases where you can easily find information about hospitals close to wherever you are in the world.

Hospital accommodation

Refers to the type of room that you stay in when receiving treatment in hospital. Private, semi-private deluxe and executive suites are common benefits of international health insurance plans.

Hospitalization (In-patient treatment)

Medical treatment or surgery in a hospital or a clinic as an in-patient when it is medically necessary to occupy a bed overnight.

Hospital plan (standard plan)

Private Medical Insurance plan that covers hospital or emergency treatment with no optional extras or cover for ambulatory treatments and medications. Under a Hospital Plan you will usually be covered for Inpatient and Day-care treatment only. Hospital plans are also referred to as Standard Plans, as opposed to Comprehensive Plans which cover not only hospitalization but also ambulatory treatments and medications.

I

In-Patient Cash Benefit

Refers to an international health insurance benefit where monies are paid by the insurance company when treatment and/or accommodation for medical treatment, that would otherwise be covered under the insured's plan, is provided in a hospital where no charges are billed.

In-Patient Dental Treatment

Refers to emergency dental treatment due to a serious accident that requires you to be admitted to hospital.

In-Patient Treatment

Refers to treatment in a hospital / clinic where an overnight stay is medically necessary.

Infertility treatment

Refers to reproductive treatment and technology for either sexes used primarily to achieve pregnancy by artificial or partially artificial means. It may also refer to treatment used to investigate procedures necessary to establish the cause for infertility.

Insurance Certificate (Health Insurance Certificate)

A document which details what you as a policyholder are entitled to. It simply proves that a contractual relationship exists between the insured person(s) and the health insurance company.

Insurance Company / Insurer / Carrier

A company that sells health insurance to cover the cost or sometimes compensate for loss due to ill health or accident.

Insurance Year

Refers to the effective date (or the date that your insurance commences) of a policy and ends exactly one year later.

Insured Person(s)

A policy holder and other people such as dependents that are subscribed to a health insurance policy.

International Health Insurance

Also known as "Private Medical Insurance", "Expatriate Health Insurance" or "International Medical Insurance", refers to insurance designed to provide private medical care in the event of sickness, ill health or accident.

Illness

A subjective state of feeling unwell that may include impairment of normal physiological and social function.

Insurance

General term describing the overall service offer of a health insurance company, the policy conditions and policy schedule which are part of the insurance contract with the insurance company, setting out the scope of the health insurance terms, the premium payable, deductible and reimbursement rates. Insurance provides indemnification against loss or liability from specified events and circumstances that may occur or be discovered during a specified period.

Health Insurance Company (Insurer)

Company licensed to provide health insurance services.

Insurance contract

Agreement between a policy holder and a health insurance company regarding the health insurance coverage provided by the health insurance company as confirmed in the policy. A health Insurance contract determines the legal framework under which the features of an insurance policy are enforced. Normally an insurance contract is made in the form of an application submitted by the (future) policy holder to the insurance company, and the subsequent acceptance of the application by the insurance company, subject to the policy conditions.

Insurance rate

A factor used to determine the amount, called the premium, to be charged for a certain amount of health insurance coverage

Insured person

The person who's health is covered by the health insurance policy. For private policyholders usually the policyholder is also the insured person, except children who are in some plans included as insured persons in the policy of their parents.

L

Liability

A hindrance or obligation to pay money to another party.

Lifetime Maximum / Maximum Benefit / Policy Maximum

The maximum amount that the health insurance company will pay out during the entire term of the health insurance policy.

Loading (Premium loading)

The amount that a health insurance company adds to the basic premium to cover those that are applying. Sometimes premium loading is applied during the application process if you would like to cover pre-existing conditions.

Local Ambulance

Is ambulance transport that is required in the event of emergency or otherwise deemed medically necessary to transport an insured person(s) to hospital.

Local Plan

Short hand for private health insurance in countries that are outside an expatriate's home country that is primarily designed to cater to the local population.

Long Term Care

Refers to treatment and care over a long period of time after emergency / acute treatment has been completed. International health insurance plans can offer reimbursement for care at home, in a community, a hospital or nursing home, however, it is important to check restrictions/exclusions.

Loading (premium loading)

A pre-existing condition may lead to the insurance company imposing an exclusion as a special condition before providing insurance coverage to an applicant, or the insurance company may decide instead, or in addition, to impose a loading (premium loading) as a condition to providing insurance coverage. Such loadings usually are stated in percentages of the normal premium, e.g. a 25% loading means that the applicant would pay a 25% higher premium than the standard premium for his/her age band.

M

Managed Care

A broad term used to describe any system that manages healthcare delivery with the aim of controlling costs. In international health insurance this is encouraged by insurance companies through the use of primary care physicians, or by encouraging the use of a specific network of healthcare providers.

Maternity Insurance

Refers to cover for medical costs incurred during pregnancy and childbirth, including hospital charges, specialist fees, mother's pre- and post-natal care, as well as newborn care.

Medical Aids

Any instrument or device that is designed to help or increase the function of the insured person. Typically medical aids would include hearing aids, speaking aids, wheelchairs, crutches, braces and artificial limbs. Many Insurers have restrictions/exclusions in respect of these.

Medical Evacuation

Refers to reimbursement to cover transport costs to the nearest suitable medical centre, when the treatment you need is not available nearby. It may also cover additional expenses such as the cost of a return flight back to the insured's principle country of residence.

Medical History Disregard (MHD)

Refers to health insurance companies waiving pre-existing conditions of one or more insured members. Typically, group schemes of 20 or more people can offer MHD meaning that members suffering from pre-existing conditions can receive treatment and claim medical expenses that arise as a result of their

pre-existing condition or associated conditions.

Medical Necessity

Is the determination that a person requires medical treatment and services.

Medical Practitioner

Is a physician who is licensed to practice medicine under the law of the country in which treatment is given.

Medical Practitioner Fees

Refers to costs / bills arising from treatment performed or administered by a medical practitioner.

Medical Questionnaire

Asked during the application process, this is a document that applicants use to provide details of their medical history such as pre-existing or chronic condition details. It is used in conjunction with the general application form to determine if an applicant is insurable and at what price or not. 

Disclosing details of your medical history allows the insurance companies to better assess your case during the application process and can quicken approval.

Medical Repatriation

Refers to a policy benefit that covers costs for transport to your home country to be treated in familiar surroundings. It also sometimes covers costs for the return trip back to your principle country of residence.

Medical Underwriting

The process of determining if you are insurable or not based on your medical history.

Membership

Refers to when you are enrolled on / covered under an international health insurance policy.

Midwife Fees

This refers to fees charged to assist women during pregnancy, labour and postpartum period by a midwife (birth assistant).

Moratorium Cover

Moratorium cover refers to after a period of time has elapsed of continuous cover, some pre-existing medical conditions will become eligible for benefit. Pre-existing conditions will be covered after a set period only if you haven\'t consulted with any doctor or specialist for advice or treatment or if you haven\'t suffered any symptoms for that medical condition or any related condition for a continuous period determined by the Insurer.

Moratorium cover allows you to get cover for pre-existing conditions provided that your condition appears to have fully subsided.

MRI Scan

Magnetic resonance imaging is primarily used to visualise the internal structure and function of the body. It provides detailed images of the body in any plane. MRI has much greater soft tissue contrast than Computed tomography (CT) making it especially useful in neurological diseases.

Managed care

Managed care is a concept originally developed in the U.S. health care system, ostensibly as a means to control rising health insurance costs. Best known is the Health Maintenance Organization (HMO), which is essentially a health insurance plan under which a health insurance company controls all aspects of the health care provided to the insured persons. Private health insurance plans in many countries now incorporate some managed care features such as pre-approval for non-emergency hospital admissions and utilization reviews. International PMI plans usually offer a relatively free choice of hospitals and doctors, however there are some plans which use approved hospital lists and similar instruments to control some aspects of the health care provided to the insured persons.

Medical specialist

A person who is licensed to practice medicine in the country where the treatment is provided

Medical questionnaire (medical form)

A form issued and required by some health insurance companies on which medical/health information must be given on the insured person(s). This form must normally be included in an application, but may also be required by an insurance companies in certain cases.

Medical underwriting

The process whereby the persons to be insured are asked a number of questions about their health and, based on the information they provide, the health insurance company will decide the conditions of your coverage. Some health insurance companies provide coverage on a moratorium basis, which means the insured persons are not asked any questions about their health, but if they have suffered from any health conditions in the recent past (often the last five years), these will automatically be excluded from coverage initially.

Natural Disaster Benefit

Provides cover in the event of natural disasters such as floods, tornados, volcano eruptions, earthquakes or landslides.

Newborn Care

A specific medical maternity benefit associated with examinations and diagnostic test required to determine the health of a newborn child. They are carried out immediately following childbirth. Some plans but not all, also include more comprehensive diagnostic newborn tests such as blood type and hearing. If problems are discovered, then sometimes Insurers may include cover for more complex medically necessary treatment and diagnostic tests.

No Claims Discount

Refers to a discount that you can potentially receive should you renew your policy on condition that you haven't filed any claims over the insurance year. Not all health insurance companies offer a no claims discount.

No Cover

Found in the health insurance table of benefits, "no cover" refers to a specific benefit that the health insurance company will not provide reimbursement for.

Nursing at home

Refers to treatment and / or care at your home typically for patients that require long term attention or those suffering from chronic conditions.

O

Occupational Therapy (OT)

Refers to treatment and care associated with the development and/or restoration of fine motor skills, sensory integration, coordination, balance and other day-to-day skills such as dressing, eating, grooming, etc.

Oncology

Refers to treatment associated with tumours such as diagnostic tests, radiotherapy, chemotherapy and other hospital fees associated with the treatment of cancer.

Orthodontics

The dental practice and use of devices to restore teeth to proper alignment and function.

Orthomolecular Treatment

A form of complementary medicine that aims to prevent or treat diseases by correcting cell deficiencies on the molecular level with nutrients prescribed such as vitamins, minerals, enzymes, hormones, etc.

Osteopathy

Treatment based on the manipulation of bones and muscles.

Out of Area Cover

Refers to treatment and services that are outside your geographical area of cover (Worldwide, Europe, etc) that are none the less deemed eligible for treatment and reimbursement under the health insurance.

Out-Patient Surgery

A surgical procedure performed in a day-care or out-patient facility that does not require you to stay overnight in hospital.

Out-Patient Treatment

Refers to treatment provided in the practice or surgery of a medical practitioner, therapist or specialist that does not require the patient to be admitted to hospital.

P

Parental Accommodation

A benefit designed to provide cover for reasonable costs incurred by parents when having to stay in accomododation due to their child being admitted to hospital.

Payment Terms / Payment Frequency

International health insurance premiums can usually be paid for on a monthly, quarterly, semi-annual or annual basis. The lower the payment frequency, the lower your premium will be.

Periodontics

Refers to dental treatment related to gum disease.

Policy / Plan

Is a contract between the Insurer and the Insured which determines medical treatment, medical services and associated treatment claims which the insurance company is legally required to pay.

Policy Holder

The person who owns or is subscribed to an international health insurance policy.

Policy Wording

The policy wording is the exact offer from the insurance company to you. It is (usually) a document that contains full terms and conditions of the coverage offered, including any applicable exclusions, conditions and limitations to cover.

Post-natal Care

Refers to medical treatment received by the mother, the child or both after birth.

Pre-certification

Is a general term referring to the requirement that the insured must obtain authorisation / approval from the health insurance company before proceeding with treatment if the treatment is to be deemed eligible for reimbursement.

Pre-existing Conditions

Medical conditions or any related medical conditions for which one or more symptoms have surfaced over a number of years (usually 1-5 depending on the Insurer) prior to commencement of cover.

Pre-natal Care

Treatment for women during pregnancy/prior to childbirth such as diagnostic tests.

Premium

The amount made payable to the insurance company according to your policy wording. Typically premiums can be made on a monthly, quarterly, semi-annual or annual basis. Premiums are determined by the Insurer based on a variety of factors but primarily age, level of cover, geographical area of cover, and country of residence.

Prescription Drugs

Pharmaceutical drugs available only on the prescription of a registered medical practitioner and available only from pharmacies.

Preventative Treatment

Refers to treatment that is undertaken without any symptoms being present at the time of treatment in order to promote and encourage good health to thereby prevent ill health.

Primary Care

A broad term referring to routine care of common health problems and chronic illnesses that can be managed on an out-patient basis.

Psychiatry

Cover associated with the diagnosis and treatment of mental disorders.

Psychotherapy

Refers to personal counselling used to treat problems of living such as depression.

Policy (Health Insurance policy)

Document issued by an insurance company confirming the insurance cover.

Policy conditions

The terms and conditions of the purchased health insurance

Policy holder

The person identified as the policyholder on the application form and on the health insurance policy.

Premium invoice / premium note

Advice/invoice issued by the health insurance company to the policy holder stating the amount payable (insurance premium) to receive or maintain the insurance coverage agreed and confirmed in the policy.

Prescription

Note issued to a patient by a medical specialist confirming that the patient should obtain and take a particular medicine/drug (prescription drug).

Prescription drugs

Any medicine that a medical specialist prescribes and that is not available without such a prescription

Pre-existing condition(s)

The medical history and any disease, illness or injury which is manifest or the policy holder or insured person is aware of before an application is lodged for obtaining insurance coverage. Pre-existing conditions may affect an health insurance company's decision to insure or not to insure an applicant or to impose special terms such as loadings or exclusions.

Private hospital

A hospital which is owned by a company and is privately funded, through the payment for medical services by patients, by insurers or by institutions, who are sponsoring the patients to have their treatments in the private hospital.

Private medical insurance (PMI)

An health insurance plan by a private health insurance company (as opposed to government medical insurance schemes) to cover the costs of private medical treatment for curable short term medical conditions. PMI may cover the costs of surgery, specialists, accommodation and nursing at a private hospital or in a private ward of a public hospital, etc. PMI plans offered usually come in two types, Hospital plans or Comprehensive plans. A Hospital plan covers hospital or emergency treatment with no optional extras or cover for Outpatient treatment. Under a Hospital plan you will usually be covered for Inpatient and Day-care treatment only. Comprehensive plans often add extra modules or options to cover outpatient treatment, dental treatment, complementary medicine, maternity, travel and personal accident. Private medical insurance plans normally do not cover chronic or critical illness which cannot be cured.

Private patient

A patient who is paying his medical treatment him-/herself or through a private medical insurance and therefore can freely choose medical specialists and hospitals. Often the term private patient relates to a patient of a senior medical specialist (e.g. Managing Doctor of a Clinic, Professor) of a public hospital who receives direct and privileged attention and treatment from such a medical specialist, as opposed to the general public who is admitted and treated at public hospitals on their general admission rules.

Private ward

Section of a public or other non-private hospital where the rooms of private patients are located.

Public hospital

hospital which is owned by a government and receives government funding. This type of hospital provides medical care generally free of charge, or at specially reduced/flat charges, the cost of which is covered by the funding the hospital receives. Most hospitals world wide are public. The urban public hospitals are often associated with medical schools of Universities.

R

Reconstructive Surgery

Surgery used to restore function and tissue form to the body such as plastic surgery.

Rehabilitation

Refers to treatment aimed to restore normal form and function after a serious illness or injury.

Reimbursement

Amount of money that you receive for a claim, expenses, damages or losses as determined by your health Insurer.

Reinsurance

This refers to where a health insurance company policy enters into an arrangement with another insurance company to cover some or all of the benefits that are payable to the policyholder. It is used to spread risk.

Renewable

Simply means that an international health insurance policy can be renewed / extended.

Renewal Date

The date on which your international health insurance policy will expire unless extended (renewed).

Repatriation

To return to your home country on a permanent basis.

Repatriation of Mortal Remains

Refers to the transportation of the deceased's mortal remains from the country of residence to the country of burial.

Routine Health Checks

Refers to tests and screening performed when no medical symptoms of illness are present. They are used as a preventative and early warning mechanism to promote and encourage good health and can include things like checking vital signs, the cardiovascular system and cancer screening.

Routine Maternity

Refers to medical costs incurred during pregnancy and childbirth such as hospital accommodation, fees associated with normal pregnancy and midwife fees.

Reimbursement

The process whereby a health insurance company pays back medical expenses already paid by a policy holder or insured person

Reimbursement rates

The maximum amount of money which will be paid by way of reimbursement of medical expenses

Reinsurance

A means by which an insurance company can protect itself through other insurance companies against the risk of losses.Individuals and corporations obtain coverage from insurance companies to provide protection for various risks (e.g. medical costs). Reinsurance companies, in turn, provide insurance to insurance companies. Particularly with the many smaller international health insurance companies it is very important that they are properly reinsured to avoid an ultimate loss to the insured persons in case the insurance company is unable to meet its obligations.

Renewal

The automatic or not automatic renewal of an insurance policy as subject to the anniversary date

S

Schengen Visa

Is a specific visa type that allows the holder to travel to any or all Schengen member countries under one single visa. Currently there are 15 European member countries: Austria, Germany, Belgium, Denmark, Finland, France, Greece, Iceland, Italy, Luxemburg, Norway, Portugal, Spain, Sweden and The Netherlands.

Specialist

An expert doctor / physician that specialises in a particular branch of medical science.

Specialist Fees

Expenses associated with consultations or treatment by a specialist.

Speech Therapy

Refers to treatment that is intended to correct speech disorders.

Student International Health Insurance

Specific international health insurance plans that are designed for and cater to international students.

Substance Abuse

Refers to the excessive use and usually dependence on drugs that are detrimental to health.

Surgical Prostheses (Surgical Appliances)

Refers to artificial body parts or devices that are medically necessary following surgery.

Special terms

Restrictions, limitations or conditions applied to the insurance company's standard terms as detailed in the policy or policy conditions.

Subrogation

The right of an insurance company to enforce a remedy or claim which an insured person or policy holder has against a third party or another insurance company, and the insurance company's right to require the insured person or policy holder to repay the insurance company if it has paid expenses that are in fact recouped by the insured person or the policy holder from a third party or other insurance company. The term subrogation may also refer to the allocation of liabilities and payment coordination between insurance companies if more than one insurance company covers the same insured person or the same incident. Any involved insurance company will not normally be liable for more than its ratable portion.

Surgery

Medical treatment of injuries, diseases and illnesses through a direct intervention within the patient's body

T

Terrorism Benefit

Refers to cover for injuries and illnesses that arise from an act of terrorism.

Therapist

Someone who provides therapy (care) for someone.
Furthermore some of the benefits that travel insurance provides are different to international health insurance such as cover for lost baggage or missed departure.

Treatment

Refers to any medical procedure or practice with the intention of curing or relieving illness or injury.

Terminal phase

The stage of a illness/disease where the advent of death is highly probable and medical opinion has rejected active therapy infavour of the relief of symptoms and support of both patient and family.

Travel insurance (travel health insurance)

Temporary health insurance which normally provides coverage either for a single trip (single-trip insurance) or all year round on all your trips abroad for up to a specific period per trip.

U

Underinsured

You are underinsured if you do not have sufficient health insurance to cover loss/damage (e.g. medical expenses). The health insurance company will in such a case only partially reimburse you, depending on the degree to which you are underinsured.

Underwriting

Health Insurance underwriting is the process of evaluating and deciding how much coverage can be provided for a particular policy, how much the policy holder should pay for it, or whether to even accept the risk and provide coverage at all. Underwriting involves measuring risk exposure (e.g. higher likelihood of lung cancer and respiratory diseases for smokers) and determining the premium that needs to be charged to insure that risk. In simple terms, it is the process of issuing insurance policies.

University hospital

A public hospital associated with the medical school of an University.

Underinsured

Refers to those that do not have sufficient insurance to cover loss or damage adequately enough.

Underwriting

Refers to the process that a health insurance company uses to assess the eligibility of an applicant to get approval for international health insurance.

URC (Usual, Reasonable and Customary)

This refers to the standard or most common charge for a particular medical service when rendered. It is often seen in table of benefits meaning roughly that the Insurer will pay out whatever amount is usual or reasonable for that specific benefit.

Vaccinations

Refers to immunisations and booster injections in addition to the cost of consultation for administering the vaccine.

Waiting Period

A period of time during which you are not entitled to cover for particular benefits.