opt flip book 2019 - Flipbook - Page 16
INSURANCE DICTIONARY
• Annual Maximum: The total amount the insurance company will cover
for you per policy year.
• Co-insurance: It’s the split between how much you pay against how
much the insurance company pays. E.g.) 80% for the first $5000 means
that the company will pay $4000 (80%) and you will have to pay $1000
(20%).
• Co-pay: A fixed fee you pay for a medical service according to your
insurance plan. The amount varies according to the type of provider
(eg. specialist or primary care provider)
• Deductible: The amount of money you need to meet before the
insurance pays for anything. The annual deductible is the amount you
must reach for that year period, after which the insurance will cover
expenses according to plan benefits.) $100 annual deductible means
that, once you have spent $100 on medical expenses for various reasons,
the insurance company begins to cover expenses at the co-insurance ratio.
• Maximum per injury or sickness: The total maximum amount that the
insurance will pay, for expenses that are covered under the chosen plan,
per event (injury or sickness, for instance).
• Medical evacuation: In extreme emergencies, this refers to transferring
the insured person to the nearest hospital (such as airlift) or medical facility.
• Out-of-pocket expenses: The combined cost that you have paid that
includes your deductible, co-pay and co-insurance for covered services.
• PPO or Preferred Provider Organization: A network of doctors,
clinics, hospitals and related providers who are organized under the PPO
to provide health care at a negotiated rate. Each insurance policy has a
specific PPO. Getting treatment from a member of your insurance’s PPO
network may provide higher benefits or more savings. They are referred to
as ‘in-network’, whereas those providers outside of your insurance’s PPO
are ‘out-of-network’.
• Pre-existing condition: Any injury or illness that you had or received
treatment for before the date that your insurance becomes effective.
• Provider: The medically licensed person authorized to treat patients;
could be a doctor, nurse practitioner, clinical psychologist, chiropractor,
dentist and such.
• Reasonable and customary charges: The amount normally charged
by the provider(s) for similar services and supplies. They should be
comparable costs.
• Repatriation: In the case of death, this refers to transporting the
insured persons remains back to their home country.