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Health Insurance Glossary
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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, etc.

INSURED -- The person who is covered by an insurance policy.

INSURER -- The insurance company.

LAPSE IN COVERAGE -- Termination of policy normally due to nonpayment of premiums.

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 for insurance.

USUAL AND CUSTOMARY -- The average fee that a health care provider charges for any given service in your geographic area.

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Know the difference!
What is the difference between Traditional Major Medical, HMO, and PPO? Click here.


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