ACCIDENT -- A sudden event (unforeseen, unexpected, and unplanned),
occurring beyond the control of the insured; the result being property
damage, loss, bodily injury or death.
BASIC MEDICAL EXPENSE COVERAGE -- Generally, refers to three
types of coverage including: Basic Hospital Expense which includes Miscellaneous
Hospital Expenses, Surgical Expense and Regular Medical Expense.
BENEFICIARY -- The person who receives the proceeds or benefits
from the insurance policy.
CLAIM -- When the insured submits paperwork to the insurance
company to be reimbursed for a financial loss.
COINSURANCE -- When submitting a claim, an amount of money that
the insured must pay toward the cost of a claim. The insured usually
pays the smallest percentage or dollar amount. It is used by insurers
to keep health insurance costs low, and temper insureds from using benefits
for minor claims.
COPAYMENT -- A sum of money that is paid by the insured. It
is usually a flat dollar amount such as $10 per visit. The theory is
that if the insured has to pay part of each claim, they will be more
judicious in their use of their health insurance.
DEDUCTIBLE -- An amount of money that is paid by the insured
before the insurer pays any money on a claim.
DISMEMBERMENT -- Accidental loss of sight, hearing, speech or
any one of two limbs.
EVACUATION -- Discharge of waste materials from the excretory
passages of the body.
EXCLUSIONS -- Terms listed in an insurance policy that will
cause a claim to be denied.
HEALTH MAINTENANCE ORGANIZATION (HMO) -- Managed care health
insurance with an emphasis is on preventive care. The "subscribers"
can attend classes on topics such as how to stop smoking, weight loss,
INSURED -- The person who is covered by an insurance policy.
INSURER -- The insurance company.
LAPSE IN COVERAGE -- Termination of policy normally due to nonpayment
NON-CANCELLABLE POLICY -- A policy that guarantees you can receive
insurance as long as you continue to pay the premium. Also called a
guaranteed renewable policy.
POLICY PERIOD -- Also known as the term period. The length of
time the policy is in effect.
PRE-AUTHORIZATION -- The approval that you must obtain from
your insurance provider prior to treatment for non-emergency care. This
is not required for the student health insurance plan.
PRE-EXISTING CONDITION -- A medical condition that existed before
the plan was purchased. The insurance company does not normally cover
expenses related to this condition.
PREFERRED PROVIDER ORGANIZATION (PPO) -- A type of managed care
in which the providers provide services at pre-arranged prices on a
fee-for-service basis rather than on a pre-paid basis. If the insured
uses one of these, they usually have no or low deductible or copayment.
PREMIUM -- Money paid by the insured to the insurer to pay for
the insurance purchased.
REPATRIATION -- To restore or return to the country of birth,
citizenship, or origin.
UNDERWRITER -- A person in an insurers home office whose job
is to assess risk and determine the classification of the person applying
USUAL AND CUSTOMARY -- The average fee that a health care provider
charges for any given service in your geographic area.