Following is the general description of commonly used terms in
international visitor health insurance. It is important to
know that all plans
do NOT work in the same way. Please refer to the individual insurance
policy brochure and/or policy/certificate of insurance for
complete details about each insurance plan.
Notes: In this document, wherever the term insurance company
is mentioned, it actually means either the underwriting
insurance company or the insurance administrator as appropriate.
Also, wherever the term insurance policy is mentioned, it actually
means either the insurance policy or certificate of insurance as
appropriate.
Administrator:
A company that administers the insurance policies including but not limited
to policy branding, customer support, benefits approval, claims processing,
preferred provider coordination etc.
In most cases, you will not have to deal with the underwriter as everything
for you will be handled by the administrator, except the plans that are underwritten
by companies such as AIG where they handle claims directly.
Aroma therapy:
Aroma therapy is derived from the ancient practice of using natural plant essences to promote health and well being. It consists of the use of pure essential oils obtained from a wide assortment of plants, which have been steam distilled or cold-pressed from flowers, fruit, bark and roots.
Aroma therapy can help ease a wide assortment of ailments; easing aches, pains, and injuries, while relieving the discomforts of many health problems.
Aroma therapy also acts on the central nervous system, relieving depression and anxiety, reducing stress, relaxing, uplifting, sedating or stimulating, restoring both physical and emotional well being.
Bedside visit:
If the Covered Person is Hospital Confined due to an Injury or Sickness for more
than several days while traveling outside his/her Home Country, the Insurer
will pay up to some maximum benefit for the cost of one economy round trip
air fare ticket to, and the hotel accommodations in, the place of the
Hospital Confinement for one person designated by the Covered Person.
With respect to any one trip, this benefit is payable only once for
that trip, regardless of the number of Covered Persons on that trip.
Please look at the individual plan brochure for more details.
Certain illnesses:
The following illnesses which exist, manifest themselves, or are treated or have treatment recommended prior to or during the first 180 days of coverage from the initial effective date are considered pre-existing conditions under the plan,
and are subject to the waiting period and other limitations of coverage described: tonsillectomy, disc disease, adenoidectomy, hemorrhoids or hemorhoidectomy, disorders of the reproductive system, hysterectomy, hernia, gall stones or kidney
stones, any condition of the breast, and any condition of the
prostate.
This list varies by insurance company. e.g., Citizen Secure from HCCMIS also excludes
of sebaceous glands, acne, other acne, sebaceous cyst, seborrhea, unspecified
disease of the sebaceous glands, moles, skin tags, hypertrophic and atrophic
conditions of the skin, nervous conditions.
Please look at the brochure for the complete list of diseases in each plan.
Chemical dependency:
"Chemical dependency" is the use of any chemical substance, legal or illegal, that creates behavioral
and/or health problems, resulting in operational impairment. This term includes alcoholism and/or drug dependency that endanger the health, interpersonal relationships, or economic
functions of an individual or the public health, welfare or safety.
A "chemical dependency facility" is a facility whose function is the treatment, rehabilitation and
prevention of chemical dependency as defined above.
Inpatient chemical dependency treatment includes inpatient treatment in a hospital setting and
inpatient treatment in a free-standing facility outside a hospital. It does not include day
treatment, intermediate care or transitional living, intensive outpatient treatment or
outpatient treatment.
Chemotherapy:
A drug therapy for cancer.
Chemotherapy is generally given in cycles: a treatment period is followed by a recovery
period, then another treatment period, and so on. Usually a patient has chemotherapy as
an outpatient at the hospital, at a doctor's office or clinic, or at home. However,
depending on which drugs are given and the patient's general health, the patient may
need to stay in the hospital for a short time.
The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives. Hair loss
is a major side effect.
Co-Insurance:
After paying the deductible, percentage or amount of covered
expenses that the insured pays.
When the insurance policy brochure says co-insurance is 20%
or it is 80/20, it means that insurance company will pay
80% of usual and customary charges, and the insured will be
responsible for remaining 20%. Usually, in many plans, there
is a maximum out of pocket amount after which insurance
company pays 100% of covered expenses, up to selected policy maximum.
In some health insurance plans, it is also called "co-payment".
e.g., Suppose you buy an insurance policy with $50,000 policy maximum,
$250 deductible per policy period and 80/20 co-insurance, $1000
maximum out of pocket for co-insurance.
Suppose you incur covered expense of $7250. You first pay $250
deductible. Out of $7000 covered expenses, insurance company
will pay 80% for the first $5,000 expense (i.e., $4,000). You pay 20%
(i.e., $1000). For the rest of $2000 expense, they will pay 100%.
That means, you pay $250 + $1000 = $1250 total, and insurance
company pays $4000 + $2000 = $6000. If you again later incur
expense of, say, $3000, insurance company will pay all $3,000,
as you have already satisfied your deductible and maximum
out of pocket expenses.
Common carrier AD&D beneficiary:
If the insured person gets into an accident (while in plane for example),
and either loses hand, foot, eye etc. or dies, the insurance company will
pay the benefit amount. You should specify the name of the relative as 'Common Carrier AD&D Beneficiary' who should receive the benefit amount if the insured should die. That is usually close relative like son,
daughter, son-in-law etc.
If you are buying insurance for your mother and father both, please do not
put any of their names in the beneficiary. This question is for who receives the
money in case both die.
If you are buying insurance for your in-laws, put YOUR spouse's name there.
If you would like to enter multiple beneficiaries, you can separate them by commas.
Unless indicated otherwise, the primary insured will be deemed the beneficiary for his/her spouse and children.
Concierge services:
Non insurance related services such as Restaurant Referrals and Reservations,
Airport Transportation, Event Ticketing, Tee Times and Course Recommendations,
Flower Ordering, destination information and advice, international dining recommendations
and several other things.
Cystoscopy:
A procedure in which the doctor inserts a lighted instrument called a cystoscope into the urethra (the tube that carries urine from the bladder to the outside of the body) in order to look inside the urethra and bladder.
The cystoscope has lenses like a telescope or microscope. These lenses let the doctor focus on the inner surfaces of the urinary tract. Some cystoscopes use optical fibers (flexible glass fibers) that carry an image from the tip of the instrument to a viewing piece at the other end. The cystoscope is as thin as a pencil and has a light at the tip. Many cystoscopes have extra tubes to guide other instruments for procedures to treat urinary problems.
Cystoscopy may be done for any one of a number of reasons including frequent urinary tract infections; blood in the urine (hematuria); loss of bladder control (incontinence) or an overactive bladder; unusual cells that have been found in urine sample; the need for a bladder catheter; painful urination, chronic pelvic pain, or interstitial cystitis; urinary blockage such as prostate enlargement, stricture, or narrowing of the urinary tract; an unusual growth, polyp, tumor, or cancer: and a stone in the urinary tract.
Deductible:
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 receive any
reimbursement later from insurance company for the deductible you pay.
e.g., Suppose you buy an insurance policy with $50,000 policy maximum,
$250 deductible per policy period and 80/20 co-insurance, $1000
maximum out of pocket for co-insurance.
Suppose you incur covered expenses of $7250, insurance company will
start paying for covered expenses according to policy terms after
you make initial payment of chosen deductible, $250.
Note: This is just an example of the deductible. It does not describe
the benefits of all the products. Not all products provide the same benefits.
Durable medical equipment:
Durable Medical Equipment includes devices, controls, or appliances specified
in the plan of care that enable the beneficiary to increase their ability to
perform activities of daily living, or to perceive, control or communicate with
the environment in which they live. This includes items necessary for life
support, ancillary supplies and equipment necessary for the proper functioning
of such items.
e.g., wheelchairs, crutches etc.
Emergency room visit:
Visit to an emergency room. It is considered such when you go to the hospital emergency
room, and you come back the same day and you are not admitted into the hospital and you are
not utilizing hospital room and board.
Medical emergency is a condition that would lead a "prudent layperson"
(someone with average knowledge of health
and medicine) to believe that a serious medical condition existed, or the absence of medical attention would result
in a threat to his or her life, limb or sight and requires immediate medical treatment or which has painful symptoms
requiring immediate attention to relieve suffering.
Insureds are advised not to rush to emergency room for minor ailment such as fever or cold. Depending upon the
insurance product, if it is not true emergency, you may not be covered, may be partially covered, may be subject to
higher deductible or copay.
Endoscopy:
Endoscopy is a broad term used to describe the examination of the inside body
using a lighted, flexible instrument called an endoscope. In general, an endoscope
is introduced into the body through a natural opening like the mouth or anus.
Although endoscopy can include examination of other organs, the most common
endoscopic procedures evaluate the esophagus (swallowing tube), stomach,
and portions of the intestine.
Extended care facility:
Also called skilled nursing.
An institution, or a distinct part of an institution, which is licensed as a
Hospital, Extended Care Facility or rehabilitation facility by the state or
country in which it operates; and is regularly engaged in providing 24-hour
skilled nursing care under the regular supervision of a Physician and the
direct supervision of a Registered Nurse, and maintains a daily record on
each patient, provides each patient with a planned program of observation
prescribed by a Physician, and provides each patient with active Treatment of
an Illness or Injury. Extended Care Facility does not include a facility
primarily for rest, the aged, Substance Abuse, Custodial Care, nursing
care, care of Mental or Nervous Disorders or the mentally incompetent.
Flight accident:
You are covered for the amount purchased for accidental death,
dismemberment or loss of sight as the result of an accident while
a passenger on a regularly scheduled airline flight (and in several
other situations also, please see brochure of each policy for details).
100% benefit paid for loss of life, loss of both limbs, loss of sight
in both eyes, loss of one limb and sight from one eye.
50% benefit paid for loss of limb, loss of sight in one eye.
Hazardous sports coverage:
Coverage for injuries incurred during amateur athletic activities
which are non-contact 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, the 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, snowboarding, sky diving,
amateur racing, piloting an aircraft, bungee jumping and spelunking.
Magnetic therapy:
Magnetic therapy involves the use of a magnetic device placed on or near the body to relieve pain and facilitate healing. Many different types of magnetic products are available in the market today that can be
taped to the skin, worn as jewelry or in your shoes, or slept on as pillows and mattresses. Many people try this
in arthritis, insomnia, carpal tunnel syndrome, and fractures. It is believed that it has a profound effect on the body in
relieving pain.
Theory is that magnetic fields produced by magnets (or by devices that generate electromagnetic current)
can penetrate the human body and affect the functioning of individual cells and improve the
working of the nervous system and various organs.
MRI: Magnetic Resonance Imaging:
A special radiology technique designed to image internal structures of the body using
magnetism, radio waves, and a computer to produce the images of body structures.
In magnetic resonance imaging (MRI), the scanner is a tube surrounded by a
giant circular magnet. The patient is placed on a moveable bed that is inserted into
the magnet. The magnet creates a strong magnetic field that aligns the protons of
hydrogen atoms, which are then exposed to a beam of radio waves. This spins the
various protons of the body, and they produce a faint signal that is detected by the receiver portion of the MRI scanner. A computer processes the receiver information, and an image is produced. The image and resolution is quite detailed and can detect tiny changes of structures within the body, particularly in the soft tissue, brain
and spinal cord, abdomen and joints.
An MRI is painless and has the advantage of avoiding x-ray radiation exposure. There are
no known risks of an MRI. The benefits of an MRI relate to its precise accuracy in
detecting structural abnormalities of the body. Patients with heart pacemakers,
metal implants, or metal chips or clips in or around the eyes cannot be scanned
with MRI because of the effect of the magnet. Metallic chips, materials, surgical
clips, or foreign material (artificial joints, metallic bone plates, or prosthetic
devices, etc.) can significantly distort the images obtained by the MRI scanner.
Similarly, patients with artificial heart valves, metallic ear implants, bullet
fragments, and chemotherapy or insulin pumps should also not have an MRI.
Claustrophobia can be a problem. For an MRI, patients lie in a closed area
inside the magnetic tube. Some patients experience a feeling of claustrophobia.
Natural disaster benefit:
In the event of natural disaster (hurricane, flood, tornado, tsunami, etc), insurance plan will cover up to a
certain amount per day and up to certain number of days if you are displaced from your planned, paid
accommodations due to evacuation from forecasted disaster or following a disaster strike.
Displaced is defined as required to depart your destination due to an evacuation ordered by prevailing
authorities. Proof of paid accommodations must be submitted at time of claim.
Out of pocket maximum:
Maximum amount of money to be paid out of pocket in terms of co-insurance. e.g., if the co-insurance
is 80/20 for first $5,000, out of pocket maximum is $1,000 (20% of $5,000).
Out of pocket maximum does not include deductible, as it is in addition to the deductible.
Once out of pocket maximum is paid, insurance company pays 100% up to the policy maximum
for eligible medical expenses.
Outpatient surgical facility:
Outpatient surgical facility is used in connection with outpatient day surgery; excluding non-scheduled surgery, and
a surgery performed in a hospital emergency room, trauma center, physician's office, or clinic. Benefits will be paid for
services and supplies such as: the cost of operating room, laboratory tests and x-ray examinations including
professional fees, anesthesia, drugs or medicines, therapeutic services and supplies.
Pre-admission tests:
Pre-admission tests would be tests ordered by a physician prior to and related to the
admission of the insured to a hospital confinement. e.g., complete blood count,
urinalysis, chest x-ray. If otherwise payable under the policy, major diagnostic
procedures such as, CT Scan, NMR's and blood chemistries will be paid under the
"Hospital Miscellaneous" benefit.
Precertification/Referral:
Each proposed hospital admission and inpatient or outpatient surgery must
be Precertified for medical necessity, which means the insured person or
their attending physician must call the number listed on the insurance
identification card prior to admittance to a hospital or
performance of a surgery. In case of an Emergency Admission, the Precertification
call must be made within 48 hours of the admissions, or as soon as
reasonably possible. If a hospital admission or a surgery is not
Precertified, eligible claims and expenses would be reduced by certain
percentages such as 20%, 50% that varies by insurance plan. Precertification
is not an assurance of coverage, a verification of benefits, or a guarantee
of payment. All medical expenses must meet usual, reasonable, customary,
and eligible payment guidelines.
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 thereto or arising there from.
Chronic diseases such as diabetes, heart disease or blood pressure
are always considered to be existing currently and they are never
covered if you have previous history of those diseases, no matter
what the pre-existing condition exclusion period written in any policy.
Some plans provide very limited coverage for sudden and acute
re-occurance of pre-existing conditions.
Prosthetic devices:
An artificial substitute for a missing part of the body of humans or
other animals is called a prosthetic device, or prosthesis.
Prosthetic devices include artificial hands, limbs, eyes, ears,
as well as replacement materials for the heart,
kidneys, skin, and blood.
Psychiatrist:
A psychiatrist is a physician who specializes in the diagnosis, treatment, and prevention
of mental illnesses and substance abuse disorders. It takes many years of education and
training to become a psychiatrist: He or she must graduate from college and then medical
school, and go on to complete four years of residency training in the field of psychiatry.
(Many psychiatrists undergo additional training so that they can further specialize in
such areas as child and adolescent psychiatry, geriatric psychiatry, forensic psychiatry,
psychopharmacology, and/or psychoanalysis.) This extensive medical training enables the
psychiatrist to understand the body's functions and the complex relationship between
emotional illness and other medical illnesses. The psychiatrist is thus the mental
health professional and physician best qualified to distinguish between physical and
psychological causes of both mental and physical distress.
Radiation therapy:
The use of high-energy rays to damage cancer cells, stopping them from growing and
dividing. Like surgery, radiation therapy is a local treatment that affects cancer
cells only in the treated area.
Radiation can come from a machine (external radiation or from an a small container
of radioactive material implanted directly into or near the tumor (internal radiation).
Some patients receive both kinds of radiation therapy. External radiation therapy is
usually given on an outpatient basis in a hospital or clinic, five days a week for
several weeks. Patients are not radioactive during or after the treatment. For
internal radiation therapy, the patient stays in the hospital for a few days.
The implant may be temporary or permanent. Because the level of radiation is
highest during the hospital stay, patients may not be able to have visitors,
or may have visitors only for a short time. Once an implant is removed, there
is no radioactivity in the body. The amount of radiation in a permanent implant
goes down to a safe level before the patient leaves the hospital.
Side effects of radiation therapy depend on the treatment dose and the part of
the body that is treated. The most common side effects are tiredness, skin
reactions (such as a rash or redness) in the treated area, and loss of appetite.
Radiation therapy can cause inflammation of tissues and organs in and around the
body site radiated. Radiation therapy can also cause a decrease in the number of
white blood cells. Although the side effects of radiation therapy can be unpleasant,
they can usually be treated or controlled. It also helps to know that, in most cases,
they are not permanent.
Renewable:
If some insurance policies are purchased for at least certain duration
at a time, they are renewable. Please note that this is renewal of
policy and NOT a new policy. That means
that if something happens in the previous policy period, it will not be
considered as a pre-existing condition. While if you take a new policy,
it will be considered as a pre-existing condition. Thus renewability is
a big advantage. If you purchase a new policy, new deductible, co-insurance etc.
may apply again and that varies by each policy. Please refer to the
brochure for specific details.
There are some policies which are renewable for certain duration at a time
if purchased online and renewable for a larger duration at a time for
paper applications. (e.g., Inbound USA is renewable every 5 days
if purchased online while it is renewable every 3 months if paper application
is made.)
Insurance company (or administrator) may charge administrative fees such as
$5 or $10 every time the policy is renewed. And if
you forget to renew it even once, even by one day, the policy will
expire and you will have to make a new purchase. In other words, it is not
automatic renewal. You have to explicitly renew it every time.
Transplants:
The grafting of a tissue from one place to another. The transplanting of tissue can
be from one part of the patient to another (autologous transplantation), as in the
case of a skin graft using the patient's own skin; or from one patient to
another (allogenic transplantation), as in the case of transplanting a
donor kidney into a recipient.
Common examples are kidney transplant, heart transplant, lung transplant, liver transplant
etc.
Trip cancellation:
The insurer will pay this benefit up to the maximum limit shown on the
schedule of benefits if a trip is delayed, cancelled, or interrupted
due to any of the unforeseen covered reasons.
Common reasons include
sickness, injury, or death of an insured or immediate family member,
termination of employment, insured's principal residence or destination
being made uninhabitable by fire, flood, vandalism, etc, military duty,
etc. Please check the plan brochure for listing of all reasons as they
differ in various plans.
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 transportation ticket
of the same class as the unused travel ticket, less the
value of the unused return ticket.
Urgent care:
Urgent care is treatment for an illness or injury that does not pose
an immediate, serious health threat or would not result in further disability or death if not
treated immediately, but require prompt attention and have the potential to develop such a threat
if treatment is delayed longer than 24 hours.
In other words, urgent care is the delivery of
ambulatory care in a facility dedicated to the delivery of
unscheduled, walk-in care outside of a hospital emergency department.
e.g.,
ear infections, sore throat, sprained ankles, rising temperature are
examples of conditions that urgent care staff can treat.
Vitamin therapy:
The use of vitamins to prevent or cure disease. Many physicians are now recognizing the
beneficial uses of anti-oxidant and other vitamins for a wide variety of conditions,
often as a complementary therapy to accompany medication or other treatments.
One variant on this theme, megavitamin therapy, is still rather controversial.
Always consult your doctor before adding vitamin supplements to your health regimen.
Important disclaimer: 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 and
also generic description may be different from actual
coverage in a given policy.
We will not be liable in any case, for any problem
arising out of reading explanation of glossary terms.
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.