Definition of Terms
Glossary of key words regarding health insurance:
Claim - a written request by the insured individual for payment by the insurance company of medical expenses that are covered under the insurance policy.
Co-payment - the portion of a covered expense, after the deductible is paid, that must be paid by the insured individual. The co-payment may be a specific dollar amount, or may be expressed as a percentage of the covered amount.
Cost Containment - actions or practices designed to minimize costs to both the insured individual and the insurance company. Cont containment helps to maintain reasonable insurance premiums and slows the rate of inflation of medical expenses.
Covered expense - any expense for which complete or partial payment is provided under the insurance policy.
Deductible - the initial portion of a covered expense that must be paid by the insured person before the insurance policy pays its part of the expense.
Exclusion - any condition or expense for which no coverage is provided and no payment will be made.
Fee for service - the doctor, clinic, or other medial professional expects the charge to be paid at the time that service is provided.
Insurance (HMO) identification card - a card provided by the insurance company or HMO, showing the name of the insured individual, the policy or identification number, and the address and telephone number for claims and questions. The card must be presented when treatment is requested.
Insurance policy - a written contract defining the insurance plan, its coverage, exclusions, eligibility requirements, and all benefits and conditions that apply to individuals insured under the plan.
Insurance premium - the amount of money required for coverage under a specific insurance policy for a given period of time. Depending on the policy agreement, the premium may be paid monthly, quarterly, semi-annually, or annually.
Lapse in coverage - a break in continuous insurance coverage, usually resulting from nonpayment of premium.
Preexisting condition - a medical condition that existed before an insurance policy was purchased. Depending on the policy, a preexisting condition may be defined based on whit it originated, when symptoms first appeared, or when treatment was first sought.
Preventative care - measures taken in advance of symptoms to prevent illness or injury.
Renewal - paying a premium in order to continue coverage after the initial policy period has expired.
Source: Medical Insurance for International Students, Scholars, and Their Families
Author(s): Judith A. Green
Publisher: NAFSA: Association of International Educators, 2002