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Health Insurance International US
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.
• Emergency evacuation
• Emergency reunion
• Exclusions
• Hazardous sports coverage
• Individual policy
• Insured
• Lost luggage
• Out of pocket maximum
• Pre-existing conditions
• Policy maximum
• Premium
• Repatriation of remains
• Return of minor children
• Trip interruption
• UC&R (or Usual, Customary & Reasonable)
Emergency evacuation:
Coverage for emergency medical evacuation to the nearest qualified medical facility or the country of residence, as determined by the insurance compnay; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the countgry of residence or the country where the evacuation occured, up to resonable maximum limit.
Emergency reunion:
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.
Exclusions:
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.
Hazardous sports coverage:
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.
Individual policy:
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.
Insured:
Person that purchases the insurance policy or enrolls into the insurance plan.
Lost luggage:
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.
Out of pocket maximum:
Maximum amount of money that the insured must pay on his own before the insurance company will pay 100% for insured's healthcare expenses.
Pre-existing conditions:
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 thereffrom.
Policy maximum:
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.
Premium:
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.
Repatriation of remains:
If a covered illness/injury results in a death, expenses for repatriation of bodily remains or ashes to the country of residence.
Return of minor children:
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.
Trip interruption:
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):
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.
NRIOL has tried to answer these frequently asked questions to the best of our knowledge. However we make no guarantee regarding the accuracy of our answers. The exact answers for some of the questions can change periodically as insurance companies change their policies. NRIOL is not liable for any problem resulting from the content on this FAQ.
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