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Basic Insurance Terminology

This Basic Insurance Terminology guide below should help you better comprehend your health insurance policy.

  1. Accidental Death and Dismemberment Benefit: The amount of money the insurance company will pay your family if you die or the amount they will pay you should you lose bodily parts in an accident.

  2. Congenital Defects: Medical problems you are born with.

  3. Co-payment: The percentage of costs for services, which you must pay (e.g., if the company pays 80%, your "co-payment" is 20%).

  4. Deductible:The amount you must pay for treatment of an injury or illness before the insurance company will begin to pay for you.

  5. Exclusions: Illnesses or services the insurance company will not pay for.

  6. Health Maintenance Organization (HMO): A type of Health Benefit Plan under which the Member receive all medical services through a specific group of Participating Providers.

  7. Inpatient Care: Services provided while staying for a period of time in a hospital.

  8. Limitations: Limits on the amount the company will pay or the services they will pay for.

  9. Medical Evacuation Benefits (Medevac): The amount the company will pay if you need to be transported long distance for health care.

  10. Medical Expense Benefit: Services and amounts the company will pay for your medical coverage. (Also called your "Payment Limit")

  11. Outpatient Care: Medical services provided while you are not staying in a hospital (e.g., at a doctor's office).

  12. Policy: Specific contract or agreement between you and the insurance company, in which you pay to receive certain benefits.

  13. Pre-existing Conditions: Illnesses or injuries you had before your policy began.

  14. Premium: Monthly or yearly fee or cost which you pay to the insurance company for medical coverage.

  15. Primary Care Physician (PCP): A doctor selected by the member to be the first physician contacted for any medical problem. The doctor acts as the member's regular physician and coordinates any other care the member needs, such as a visit to a specialist or hospitalization.

  16. Provider: A licensed health care facility, program, agency, physician or health professional that delivers health care services.

  17. Referral: A written recommendation by a physician for a Member to receive care from a specialty physician or facility.

  18. Repatriation Benefit: The amount the company will pay to transport your body back to your home country if you die.

  19. Right of Subrogation: The insurance company has the right to sue others for your injuries even if you don't agree