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The Payment Card Industry Data Security Standard (PCI DSS)—which was developed by the PCI Security Standards Council (PCI SSC) created by Visa, MasterCard, American Express, Discover, and JCB—is an extensive set of technical and operational standards that a company needs to follow to ensure that all companies that process, store, or transmit credit card information maintain a secure environment.
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When a business is PCI-compliant, it means that that the business reviews and follows the guidelines set forth by the credit card companies to help ensure your credit card information is protected and your personal information is secure.
The Claims procedure in travel medical insurance may differ based on the specific insurance plan you have purchased. Your out of pocket expenses can be significantly different between fixed vs comprehensive coverage plans.
There are primarily 3 types of plans.
The insurance company has a set limit for each type of treatment/visit, as clearly mentioned in the brochure and the policy. The insurance company will pay the maximum according to the schedule and anything beyond that is your responsibility.
ExampleAfter you pay the deductible for covered expenses, the insurance company in most cases pays 80% for the first $5,000 of covered expenses and you will pay the remaining 20%. After $5,000, the insurance company will pay 100% up to the policy maximum limit for all covered expenses. The policy maximum limit is for the lifetime of the policy. E.g., your deductible is $250, maximum coverage is $50,000 and if your covered expense is $14,000, you would first pay the $250 deductible, then you will pay 20% of the first $5,000 which is $1,000. Thus you would end up paying $1,250 and the remaining $12,750 would be paid by the insurance company, for that covered illness/accident. But if your covered expense is $1,400 instead, you pay the $250 deductible, then 20% of $1150, which is $230. In this case, you would end up paying $480 and the insurance company would pay the remaining, $920.
After you pay the deductible once, the insurance company will pay 100% up to the policy maximum limit for all covered expenses. The policy maximum limit is per incident. E.g., your deductible is $250, maximum coverage is $50,000, and if your covered expense is $14,000, you would first pay the $250 deductible, then the remaining $12,750 would be paid by the insurance company for that covered illness/accident. If you get sick or injured again and if your covered expense is $15,000, you will not have to pay the deductible again in the same policy period. The insurance company will pay 100% up to your maximum coverage amount.
Fixed coverage plans pay a fixed amount for every procedure and you have to pay the difference, no matter how high it is.
The deductible is the amount you have to pay first before the plan pays anything at all. The deductible is applied only towards the eligible expenses.
The following are 2 examples that will help you clarify the most frequently asked situation about doctor's office visits. Lets assume that a doctor's office visit is covered at $55/visit and X-rays are covered up to $400 and you have taken a $50 deductible.
Let's assume you visit the doctor's office several times and every time you visit the doctor, he charges you $80 for the visit. Also assume that you are not using any other medical services. As the plan pays only $55/visit, you always have to pay the difference of $25 from your pocket in this case. Again, the insurance company is only concerned about the first $55/visit.
When you visit the doctor for the first time, the insurance company is supposed to pay you $55, you have $50 towards the unsatisfied deductible. Therefore, that $55 goes towards the $50 deductible. That means, the insurance company will pay $5.
When you visit the doctor for the second time, the insurance company is supposed to pay you $55 and you don't have any unsatisfied deductible. Therefore, the plan pays $55.
For all subsequent visits, up to the covered number of visits, it will continue to pay $55/visit.
Let's assume that you visit the doctor's office several times and get one X-ray taken.
When you visit the doctor for the first time, the insurance company is supposed to pay you $55, you have $50 towards the unsatisfied deductible. Therefore, that $55 goes towards the $50 deductible. That means, the insurance company will pay $5.
The doctor orders X-rays when you visit for the first time and it costs you $150 for the X-ray. The insurance company will pay all $150 as you have completely satisfied your deductible.
For all subsequent visits, up to all covered number of visits, it will continue to pay $55/visit.
Follow the instructions provided in the Claim Submission Process article below.
Taking an appointment for any ailment is a time consuming process, hence many hospitals provide an emergency room facility. There are also many urgent care centers around. These are quick medical care services provided by almost all medical centers.
Emergency services are those services required as a result of unforeseen injuries or an acute illness, for which a delay in treatment would result in a permanent physical impairment, or loss of life. Such as heart attacks, strokes, poisoning, sudden inability to breathe etc.
On the other hand, urgent care includes less serious medical conditions which require immediate attention. Such as fever, fractured bone, any cuts which require immediate attention, etc.
** Note: Always make sure from your insurance company as to what situations are treated as urgent and emergency. If possible, it is better to contact your primary care physician in an urgent situation and arrange for your urgent care.
No.
No. In most plans, you need to inform the insurance company (called pre-notification or pre-certification) only for major things like hospitalization, surgery, MRI etc.
You always pay only the insurance premium to the insurance company. When you use any medical services, you owe the money to that service provider. Insurance helps you pay some of those expenses. The remaining amount is your responsibility to the provider. Therefore, you would pay all of the out of pocket expenses directly to the provider (doctor, hospital, urgent care etc.) and not the insurance company.
That depends upon the provider, irrespective of the insurance plan you purchase. Some providers may ask for your payment portion upfront and while others may bill the insurance company first and then bill you later for the remainder.
E.g., The doctors office contacts the insurance company to verify benefits first. If you chose a $1,000 deductible and you have not filed any claims or paid the full $1,000 when you visit a doctor who is going to charge you only $140, this doctor may require you to pay upfront because they know they are not going to be paid anything from the insurance company. In this situation, you would pay the money upfront, then file a claim with the insurance company to tell the insurance company that you have incurred certain eligible expenses that go towards meeting your deductible. You won't be reimbursed for you deductible, but it helps if you have a claim later because then the insurance insurance company wouldn't require you to pay your deductible again.
No, the deductible amount is your responsibility and you never get it reimbursed from the insurance company. You always have to pay that amount out of your pocket.
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Buy U.S. based visitors insurance and enjoy your trip.
Learn MoreDid you know that your insurance may not cover you abroad or that it may only provide limited coverage?
Purchase travel medical insurance that includes emergency medical evacuation.
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Purchase new immigrant medical insurance to bridge the gap.
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Buy J visa medical insurance to meet your requirements.
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Purchase annual multi trip travel insurance for your travels.
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