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Glossary - International Health Insurance

The following is an overview of the most common terms used with regard to international health insurance.

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An involuntary, sudden, unexpected or unforeseen external event resulting in bodily injury to an insured person.

A defined range of life ages of applicants or insured persons, within which the same premium level applies. Insurance companies normally charge tiered premiums with different age bands.

Medical condition that is curable within a reasonable time.

A surgery or a medical treatment in a hospital, clinic or at a medical specialist's practice where it is not medically necessary to stay overnight.

The person, group, company or institution named on the application form and the medical questionnaire (if the applicant is also the insured person) requesting for insurance coverage.

The application form and supporting documents (such as a medical questionnaire, further information about the health situation of the insured person(s), etc.); the procedure of applying for insurance coverage

Disease or illness persisting for an extended period of time and which cannot not easily be cured within reasonable time. In many policy conditions chronic diseases are excluded from coverage.

The financial demand by a policy holder against the insurance company to compensate for medical and other expenses of the policy holder or of the insured person for medical treatments which are covered in whole or in part by the insurance policy.

see Claims handling

The procedures carried out by the insurance company to receive, check and make payments for claims from policyholders. The efficiency of claims handling is an important aspect of the overall assessment of an insurance company's quality of service.

The date indicated in the insurance policy on which the insurance begins, unless otherwise mentioned in the policy conditions

see Private Medical Insurance (PMI)

If you have a current PMI Plan but wish to change to another insurance company, for reasons of price, additional coverage or simply that you have suffered poor claims handling, then you may possibly be offered a "no worse terms" plan or Continuing Personal Medical Exclusions plan. This simply means that the underwriting insurance company of the new plan, will accept offering you coverage on the same terms as the previous plan.

A term that often describes a splitting or spreading of risk between multiple parties. Particularly used in the United States or Canada, coinsurance indicates how an insurance company and an insured person or policy holder will share the costs of a bill that exceeds the insurance policy's deductible up to the policy's stop loss. Once the insured's out-of-pocket expenses equal the stop loss the insurer will assume responsibility for 100% of any additional costs. Coinsurance is expressed as a percentage or pair of percentages generally with the insurance company's portion stated first.

A copayment, or copay, is a flat amount paid for a medical service by an insured person. Insurance companies use copayments to share health care costs. Though the copay is often only a small portion of the actual cost of the medical service, it is thought to prevent people from seeking medical care that may not be necessary (e.g. an infection by the common cold), which can result in substantial savings for insurance companies and accordingly leads to lower premiums.

see Group health insurance (group plans)

The extent to which the insurance company will provide compensation for expenses in case of injury, diseases or illnesses. Coverage may be limited in terms of geographic area, maximum total amounts, maximum amounts per incident/injury/disease/illness, etc.

Major medical condition/health problem, e.g. cancer, blindness; coronary artery by-pass surgery, heart attack, kidney failure, stroke, multiple sclerosis, etc.

An insurance that makes a lump sum cash payment if the policyholder is diagnosed with one of the critical illnesses listed on the insurance policy and survives a minimum number of days (the "survival period") from the date the illness was first diagnosed. Critical illness insurance is usually separate from international health insurance, but may be included in the same policy in some cases.

A treatment which, for medical reasons, normally requires a patient to occupy a bed in a hospital or clinic for less than 24 hours. See also ambulatory treatment.

In an insurance policy, the deductible or excess is the portion of any claim that is not covered by the insurance company. It is normally quoted as a fixed amount and is a part of most policies covering losses to the policy holder. The deductible must be "met", that is, paid by the insured, before the benefits of the policy can apply. Deductibles may apply as a total amount or as specific amounts for particular treatments or medications.

The date on which the premium has to be paid to renew an insurance policy.

see Deductible

Healthcare services or medications not covered by an insured's health insurance policy. This would usually be due to pre-existing conditions or due to the limitations of the insurance plan.

A general practitioner (GP) or family physician is a medical specialist who provides primary care, i.e. a health care provider acting as a first point of consultation for all patients.

Group health insurance refers to the insurance plans offered to a specific group of people, for example employees of a corporation or of other institutions such as international organizations. Besides individual health insurance plans, insurance companies usually offer such group insurance (group plans, corporate plans) for companies and other organizations to collectively insure all or some of their employees, members, etc.

A concept first established in the USA, a HMO is a type of managed care, i.e. essentially a type of insurance under which an insurance company controls all aspects of the health care provided to the insured persons. Private health insurance plans in many countries now incorporate some managed care features such as pre-approval for non-emergency hospital admissions and utilization reviews. This arrangement allows the insurance company/HMO to charge a lower monthly premium, which is an advantage over normal health insurance, provided that the insured persons are willing to abide by the applicable restrictions.

Medical treatment or surgery in a hospital or a clinic as an in-patient when it is medically necessary to occupy a bed overnight.

PMI plan that covers hospital or emergency treatment with no optional extras or cover for ambulatory treatments and medications. Under a Hospital Plan you will usually be covered for Inpatient and Day-care treatment only. Hospital plans are also referred to as Standard Plans, as opposed to Comprehensive Plans which cover not only hospitalization but also ambulatory treatments and medications.

A subjective state of feeling unwell that may include impairment of normal physiological and social function.

see Hospitalization

General term describing the overall service offer of an insurance company, the policy conditions and policy schedule which are part of the insurance contract with the insurance company, setting out the scope of the insurance terms, the premium payable, deductible and reimbursement rates. Insurance provides indemnification against loss or liability from specified events and circumstances that may occur or be discovered during a specified period.

see Insurance company

Company licensed to provide insurance services.

Agreement between a policy holder and an insurance company regarding the insurance coverage provided by the insurance company as confirmed in the policy. An Insurance contract determines the legal framework under which the features of an insurance policy are enforced. Normally an insurance contract is made in the form of an application submitted by the (future) policy holder to the insurance company, and the subsequent acceptance of the application by the insurance company, subject to the policy conditions.

see Policy

A factor used to determine the amount, called the premium, to be charged for a certain amount of insurance coverage

see Insurance company

The person who's health is covered by the insurance policy. For private policyholders usually the policyholder is also the insured person, except children who are in some plans included as insured persons in the policy of their parents.

A pre-existing condition may lead to the insurance company imposing an exclusion as a special condition before providing insurance coverage to an applicant, or the insurance company may decide instead, or in addition, to impose a loading (premium loading) as a condition to providing insurance coverage. Such loadings usually are stated in percentages of the normal premium, e.g. a 25% loading means that the applicant would pay a 25% higher premium than the standard premium for his/her age band.

Managed care is a concept originally developed in the U.S. health care system, ostensibly as a means to control rising health insurance costs. Best known is the Health Maintenance Organization (HMO), which is essentially an insurance plan under which an insurance company controls all aspects of the health care provided to the insured persons. Private health insurance plans in many countries now incorporate some managed care features such as pre-approval for non-emergency hospital admissions and utilization reviews. International PMI plans usually offer a relatively free choice of hospitals and doctors, however there are some plans which use approved hospital lists and similar instruments to control some aspects of the health care provided to the insured persons.

see Medical questionnaire

A person who is licensed to practice medicine in the country where the treatment is provided

A form issued and required by some insurance companies on which medical/health information must be given on the insured person(s). This form must normally be included in an application, but may also be required by an insurance companies in certain cases.

The process whereby the persons to be insured are asked a number of questions about their health and, based on the information they provide, the insurance company will decide the conditions of your coverage. Some insurance companies provide coverage on a moratorium basis, which means the insured persons are not asked any questions about their health, but if they have suffered from any health conditions in the recent past (often the last five years), these will automatically be excluded from coverage initially.

see Medical underwriting

see Ambulatory treatment

see Medical specialist

see Private Medical Insurance

Document issued by an insurance company confirming the insurance cover.

The terms and conditions of the purchased insurance

The person identified as the policyholder on the application form and on the insurance policy.

Advice/invoice issued by the insurance company to the policy holder stating the amount payable (insurance premium) to receive or maintain the insurance coverage agreed and confirmed in the policy.

Note issued to a patient by a medical specialist confirming that the patient should obtain and take a particular medicine/drug (prescription drug).

Any medicine that a medical specialist prescribes and that is not available without such a prescription

see Loading

The medical history and any disease, illness or injury which is manifest or the policy holder or insured person is aware of before an application is lodged for obtaining insurance coverage. Pre-existing conditions may affect an insurance company's decision to insure or not to insure an applicant or to impose special terms such as loadings or exclusions.

A hospital which is owned by a company and is privately funded, through the payment for medical services by patients, by insurers or by institutions, who are sponsoring the patients to have their treatments in the private hospital.

An insurance plan by a private insurance company (as opposed to government insurance schemes) to cover the costs of private medical treatment for curable short term medical conditions. PMI may cover the costs of surgery, specialists, accommodation and nursing at a private hospital or in a private ward of a public hospital, etc. PMI plans offered usually come in two types, Hospital plans or Comprehensive plans. A Hospital plan covers hospital or emergency treatment with no optional extras or cover for Outpatient treatment. Under a Hospital plan you will usually be covered for Inpatient and Day-care treatment only. Comprehensive plans often add extra modules or options to cover outpatient treatment, dental treatment, complementary medicine, maternity, travel and personal accident. PMI plans normally do not cover chronic or critical illness which cannot be cured.

A patient who is paying his medical treatment him-/herself or through a private medical insurance and therefore can freely choose medical specialists and hospitals. Often the term private patient relates to a patient of a senior medical specialist (e.g. Managing Doctor of a Clinic, Professor) of a public hospital who receives direct and privileged attention and treatment from such a medical specialist, as opposed to the general public who is admitted and treated at public hospitals on their general admission rules.

Section of a public or other non-private hospital where the rooms of private patients are located.

hospital which is owned by a government and receives government funding. This type of hospital provides medical care generally free of charge, or at specially reduced/flat charges, the cost of which is covered by the funding the hospital receives. Most hospitals world wide are public. The urban public hospitals are often associated with medical schools of Universities.

The process whereby an insurance company pays back medical expenses already paid by a policy holder or insured person

The maximum amount of money which will be paid by way of reimbursement of medical expenses

A means by which an insurance company can protect itself through other insurance companies against the risk of losses. Individuals and corporations obtain coverage from insurance companies to provide protection for various risks (e.g. medical costs). Reinsurance companies, in turn, provide insurance to insurance companies. Particularly with the many smaller international health insurance companies it is very important that they are properly reinsured to avoid an ultimate loss to the insured persons in case the insurance company is unable to meet its obligations.

The automatic or not automatic renewal of an insurance policy as subject to the anniversary date

Restrictions, limitations or conditions applied to the insurance company's standard terms as detailed in the policy or policy conditions.

see Hospital plan

The right of an insurance company to enforce a remedy or claim which an insured person or policy holder has against a third party or another insurance company, and the insurance company's right to require the insured person or policy holder to repay the insurance company if it has paid expenses that are in fact recouped by the insured person or the policy holder from a third party or other insurance company. The term subrogation may also refer to the allocation of liabilities and payment coordination between insurance companies if more than one insurance company covers the same insured person or the same incident. Any involved insurance company will not normally be liable for more than its ratable portion.

Medical treatment of injuries, diseases and illnesses through a direct intervention within the patient's body

The stage of a illness/disease where the advent of death is highly probable and medical opinion has rejected active therapy in favour of the relief of symptoms and support of both patient and family.

Temporary health insurance which normally provides coverage either for a single trip (single-trip insurance) or all year round on all your trips abroad for up to a specific period per trip.

You are underinsured if you do not have sufficient insurance to cover loss/damage (e.g. medical expenses). The insurance company will in such a case only partially reimburse you, depending on the degree to which you are underinsured.

Insurance underwriting is the process of evaluating and deciding how much coverage can be provided for a particular policy, how much the policy holder should pay for it, or whether to even accept the risk and provide coverage at all. Underwriting involves measuring risk exposure (e.g. higher likelihood of lung cancer and respiratory diseases for smokers) and determining the premium that needs to be charged to insure that risk. In simple terms, it is the process of issuing insurance policies.

A public hospital associated with the medical school of an University.

A period of time starting from the commencement date of a policy during which the insurance may provide no or limited coverage. Waiting periods may apply for example to pre-existing conditions, pregnancy, and similar situations where it may not be appropriate for the insurance company to provide immediate coverage.