ACCIDENTAL INJURY – See “Injury“.
ACTS OF TERRORISM – An act, including but not limited to, the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s) committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear.
ACTUARY – This is an employee of an insurance company who is specifically trained to use mathematical and statistical measurements to determine premium rates, payment levels for claims, and so on.
ACUPUNCTURE/ACUPRESSURE – These are Eastern Medicine practices that are to be provided only by a licensed Acupuncturist or Acupressurist. See also “Alternative Medicine“.
ACUTE CARE – Typically acute care is for serious injuries or illnesses in the hospital. When needed for a medical condition, it is typically for a shorter period of time. It can also be for recovery from a surgical procedure.
ACUTE ONSET OF PRE-EXISTING CONDITION – A sudden and unexpected outbreak or recurrence of a Pre-existing Condition, which occurs spontaneously and without advance warning, either in the form of Physician recommendation or symptoms which would have caused a prudent person to seek medical attention prior to the outbreak or recurrence. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence.
AGENT – This is an individual who is licensed, by state, to sell and provide service for health (and for some states, life) insurance policies for specific insurance companies.
ALLOWABLE CHARGE (also called ELIGIBLE EXPENSE, ALLOWED AMOUNT, APPROVED CHARGE, or MAXIMUM ALLOWABLE) – This is the amount to which an insurance company will apply the coverage benefits stipulated in one’s insurance policy. Typically, the Allowable Charge excludes co-pays, provider network negotiated discounts, and any charges excluded from coverage.
ALTERNATIVE MEDICINE – Non-Western style medicine and treatments. These treatments are not typically recognized by the established US medical community. An example of these treatments are acupuncture, acupressure and homeopathic alternatives. Many health insurance plans do not provide coverage for these types of services.
ANCILLARY SERVICES – These are services like cat scans, x-rays, lab work, etc. that are typically run as part of medical or hospital care.
ANNUAL OB/GYN EXAM – This is a yearly preventive examination for females that includes procedures like a pap smear and a mammogram.
ANNUAL PHYSICAL EXAM – This is a yearly examination by your physician to check your overall health status.
ANNUAL SAVINGS – This is the amount an insured person has saved by using providers in their insurance company’s network, as they were able to receive reduced rates for the services provided.
BENEFIT – This is the insurance coverage provided for specified medical expenses.
BENEFIT LEVEL or BENEFIT LIMIT – This is the maximum dollar amount a health insurance company will pay for a specific covered benefit within the Benefit Period.
BENEFIT PACKAGE – This is the complete list of covered expenses and possibly services that are provided to you when purchasing a specific policy.
BENEFIT PERIOD – A benefit period is the extent of time a policy will cover eligible medical expenses for a covered illness or injury, starting on the first date you receive a diagnosis or treatment.
BENEFIT RIDER – This is a supplementary product that you purchase as an addition to your health insurance plan, like dental coverage.
BROKER – This is a licensed individual or group of individuals who are licensed to sell, by state, health (and life in some states) insurance. Brokers, also called Agents, tend to sell multiple insurance companies’ products.
CARRIER – This is the actual insurance company that underwrites and issues the policy. It is this insurance company (and not the administrator if they are different), that assumes the risk on your behalf.
CERTIFICATE OF CREDITABLE COVERAGE or CERTIFICATE OF COVERAGE – An official certificate issued by your health insurance issuer that verifies the time period in which you were covered by your health plan.
CERTIFICATE PERIOD or COVERAGE PERIOD – The period of time beginning on the date and time of the Certificate Effective Date and ending on date and time of the Certificate Termination Date.
CHILD ONLY COVERAGE – See “Dependent Coverage“.
CHIROPRACTOR – Licensed physician that diagnoses and treats patients with musculoskeletal system, nervous system, and/or general health problems. Many chiropractic treatments deal specifically with the spine and the manipulation of the spine.
CLAIM – A request for payment to the insurance company from either the insured person or the service provider.
COBRA (Consolidated Omnibus Budget Reconciliation) – US government regulations that require employers of 20+ people to offer group health insurance to employees after termination of employment up to 18 months. For more information, visit the U.S. Department of Labor’s COBRA section of their website.
COINSURANCE – The payment by the Member of Eligible Expenses at the percentage specified in the Schedule of Benefits and Limits.
COMMON CARRIER ACCIDENTAL DEATH – A benefit that provides a lump sum payment to the beneficiary named on the policyholder’s application in the event of his or her death resulting from an Accident while a fare-paying passenger on a common carrier (i.e. airplane, bus, watercraft, etc.).
COMPLICATIONS OF PREGNANCY – Illnesses whose diagnoses are distinct from pregnancy, but are adversely affected by pregnancy or caused by pregnancy, and not associated with a normal pregnancy. This includes: ectopic pregnancy, spontaneous abortion, hyperemesis gravidarum, pre-eclampsia, eclampsia, missed abortion and conditions of comparable severity.
CONGENITAL CONDITION – This is a medical condition, whether it is a defect, abnormality or disease, that a person has present at birth.
CONTACT SPORTS – A sport or other athletic activity that necessarily involves physical contact with opposing players as part of normal play. Contact Sports include, but are not limited to: American football, boxing, ice hockey, rugby, soccer, and wrestling.
COORDINATION OF BENEFITS – Process of two or more insurers determining the responsibilities of each health plan to handle a medical claim.
COPAY or COPAYMENT – This is the amount the Member must pay for specific medical expenses in lieu of the deductible.
DEDUCTIBLE – This is the amount the policyholder must pay out-of-pocket for medical expenses before the insurance policy begins to pay.
DEPENDENT COVERAGE – Health insurance coverage that provided for either a spouse and/or a dependent (child) within the primary insured’s health insurance policy. Some states have different age limitations that apply.
DURABLE MEDICAL EQUIPMENT (DME) – A standard basic hospital bed and/or a standard basic wheelchair.
ELECTRONIC FUNDS TRANSFER (EFT) – This is the term used to describe a method of payment where funds (money) are moved electronically from one account to another.
ELIGIBILTY DATE – This is the date on which the insured is able to utilized specific insurance benefits within their policy.
ELIGIBILTY REQUIREMENTS – This is the list of conditions that must be met in order for an individual or group/family to be eligible for specific health insurance coverage.
ELIGIBLE DEPENDENT – This is usually a spouse (or domestic partner) or a dependent (child) who is able to be covered under the primary insured’s policy based on specified criteria.
ELIGIBLE EMPLOYEE – An employee that meets the criteria set forth in a company’s group insurance plan.
ELIGIBLE EXPENSES – These are specified medical expenses outlined in an insurance plan that are covered.
EMERGENCY DENTAL – Emergency Dental treatment and Dental surgery necessary to restore or replace sound natural teeth lost or damaged in an Accident that is covered under certain insurance plans and Emergency Dental Treatment necessary to resolve acute, spontaneous and unexpected onset of pain.
EMERGENCY MEDICAL EVACUATION – If recommended by your attending Physician, who certifies that Evacuation is necessary to safeguard your life and that Medically Necessary treatment is not available locally, and if approved in advance and coordinated by HCCMIS, then certain plans will provide the following benefits: Emergency air and/or ground transportation to the nearest Hospital that is qualified to provide the Medically Necessary treatment.
EMERGENCY REUNION – An emergency reunion is the transportation of one relative (parent, spouse, sibling or child aged 18 or older) to the hospital where a member is receiving inpatient care in the event of a covered emergency medical evacuation.
EMERGENCY ROOM – A room or designated area of a hospital that is designated to treat those who need immediate medical attention.
EXCLUSIONARY RIDER - This is an agreement between a member and the insurance company where the member is agreeing to reduced or eliminated coverage for specified pre-existing conditions. An Exclusionary Rider could also be for future conditions (like pregnancies).
EXCLUSIONS – These are specific medical conditions, treatments, services or procedures that are not covered under a health insurance plan.
FULL TIME SCHOLAR – An individual who is affiliated with an educational institution and is engaged in educational activities for at least 30 hours per week. These activities may include but not be limited to performing research in an area of specialty or teaching for a temporary period of time.
FULL TIME STUDENT – A student at a college or university who is taking 10 credit hours (undergraduate students) or 6 credit hours (graduate students). Full-time Student status for individuals enrolled at colleges or universities that do not use a credit hour system must provide documentation of Full-time Student status.
GENERIC DRUG – These prescription medications are created with the same mixture of ingredients as the brand-name medications, but produced by a manufacturer other than the original patent holder. These medications are typically cheaper than brand-name.
GRACE PERIOD – The period of time coverage following the premium due date that insurance coverage remains in effect despite lack of premium payment.
GRIEVANCE – This is a formal complaint you file about the way your health insurance plan administrator is providing customer service and claim management. A grievance is not the correct process for handling complaints about specific treatment decisions or services that are not covered under the plan.
GUARANTEED ISSUE – A type of insurance policy that is not medically underwritten.
HOME COUNTRY – If you are a US citizen, your Home Country is the United States, regardless of the location of your Principal Residence. If you are not a US citizen, your Home Country is the country where you principally reside and receive regular mail.
HOME HEALTH CARE – This is health care that is provided within the insured’s home for services like physical therapy, respiratory therapy and the provision of medical equipment like wheelchairs and oxygen.
HOSPITAL INDEMNITY – If you are hospitalized as an inpatient for treatment of a covered illness or injury, additional benefits are available, based on your plan, for each night you spend in the hospital. This benefit is in addition to payments for other covered expenses and is not subject to deductible or coinsurance.
HOST COUNTRY – The country, other than the Home Country, in which the Participant will engage in educational pursuits. For US citizens and residents, the Host Country must be outside the US, including the US Virgin Islands and Puerto Rico. US citizens and residents residing within the continental US, Alaska, and Hawaii are eligible for coverage in Guam, American Samoa, and the Northern Mariana Islands.
IMMEDIATE CARE FACILITY – See “Urgent Care Center”.
INDIVIDUAL POLICY – This is a health insurance policy that a person purchases for themselves and/or their family, but does so on their own and not through an association or employer sponsored group plan.
ILLNESS - A sickness, disorder, illness, pathology, abnormality, ailment, disease or any other medical, physical or health condition.
INJURY – Bodily harm resulting from an accident.
INPATIENT – You are considered to be inpatient if you are admitted to a hospital overnight and charged for room and board.
INPATIENT CARE – This is the medical service and health care you receive upon admittance to the hospital or a nursing facility.
INSURED – This is the person named in an insurance policy as being the owner of the policy and therefore the one to receive benefits. This person is also referred to as the Primary Insured as well.
LENGTH OF STAY – This is the number of days a member stays as inpatient in a hospital or related medical facility.
LIFE INSURANCE – A contractual agreement between the person purchasing a policy and the insurance company to provide the purchaser’s designed beneficiary with a set sum of money upon the death of the purchaser.
LIFETIME MAXIMUM – See “Overall Maximum Limit“.
LIMITATIONS – Within a health insurance policy, there are specific limits set for benefits, which tell you how much the insurance company is willing to pay for specific medical care services.
LOCAL AMBULANCE – The physical transportation in a vehicle designated for the transportation of sick or injured persons to the closest medical facility for treatment.
LONG-TERM CARE – This is medical care that is provided over an extended period of time for an ongoing injury or disease.
LOST CHECKED LUGGAGE – Lost Checked Luggage is a benefit that provides money for the replacement of clothes and personal hygiene items in the event your checked luggage is permanently lost by the transportation provider.
LOST LUGGAGE ASSISTANCE – Tracking service to assist in locating luggage or other items lost in transit.
MAJOR MEDICAL INSURANCE – This is comprehensive medical insurance coverage that provides coverage for both inpatient and outpatient treatment of illnesses and injuries. Major medical insurance policies usually have a set amount, or deductible, for which the patient is responsible. Once that is paid, the policy covers most of the remaining cost of care, subject to co-pays or co-insurance paid by the patient. It typically includes wellness and preventative care benefits as well and provides a higher lifetime policy maximum.
MATERNITY COVERAGE – This is coverage for prenatal, delivery, and postnatal medical services during a woman’s term of pregnancy. The amount of coverage will depend on your policy’s benefits.
MEDICAL COVERAGE – Medical coverage is the inclusion of benefits that pertain to the payment of expenses for a specific treatment, procedure, test or diagnosis.
MEDICAL MONITORING – Consultations with attending medical professionals during your hospitalization and establishment of a single point-of-contact for family members to receive ongoing updates regarding your medical status.
MEDICAL UNDERWRITING – This is the administrative process an insurance company follows to determine whether or not to accept your application for a plan, based on your medical history. This process also determines whether or not to add waiting periods or riders for pre-existing conditions and the amount of premium to charge you.
MEDICALLY NECESSARY/MEDICAL NECESSITY – A service or supply which is necessary and appropriate for the diagnosis or treatment of an Illness or Injury based on generally accepted current medical practice as determined by Underwriters. A service or supply will not be considered Medically Necessary if is provided only as a convenience to the Member or provider, and/or is not appropriate for the Member’s diagnosis or symptoms, and/or exceeds in scope, duration or intensity that level of care which is needed to provide safe, adequate and appropriate diagnosis or treatment of an illness or injury.
MEMBER – Any individual that is covered under a policy.
MENTAL HEALTH DISORDERS – A mental or emotional disease or disorder which generally denotes a disease of the brain with predominant behavioral symptoms; or a disease of the mind or personality, evidenced by abnormal behavior; or a disorder of conduct evidenced by socially deviant behavior. Mental Health Disorders include: psychosis, depression, schizophrenia, bipolar affective disorder, and those psychiatric illnesses listed in the current edition of the diagnostic and Statistical Manual for Mental Disorders of the American Psychiatric Association.
MENTAL HEALTH SERVICES – When a member is receiving psychological, psychiatric, and behavioral therapy inside a hospital or treatment center where they must stay, it is considered inpatient mental health services. If the treatment is received intermittently or simply without admission, then it is considered to be outpatient mental health services.
NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS (NAIC) – This is the national association of state officials who oversee insurance in their respective states. They are typically found in the state’s Department of Insurance (DOI) and are responsible for creating uniformity among the insurance processes in that state.
NATURAL DISASTER – Any event of force of nature caused by environmental factors that has catastrophic consequences. For the purpose of this insurance, covered natural disasters are: avalanche, earthquake, flood, hurricane, impact event, landslides, mudslides, tornado, tsunami, tropical cyclone, typhoon, volcanic eruption, and wildfire.
NETWORK PROVIDER – This is a physician that has entered a contract with our provider network administrator, CMN, to provide services at a reduced rate for members.
OUT-OF-NETWORK CARE – This is medical care, services, supplies and treatment received from a provider that is not part of the provider network.
OUT-OF-POCKET COSTS – This is the total amount your policy requires that you would have to pay towards eligible health care costs, beyond your premiums.
OUT-OF-POCKET MAXIMUM – This is the total amount your policy requires that you would have to pay towards eligible health care costs, beyond your premiums.
OUTPATIENT – When a member receives medical care for an illness or injury without being admitted to the hospital overnight.
OUTPATIENT SURGERY – When undergoing a minor surgery where you are not required to stay overnight at the hospital, then the surgery is considered to be outpatient surgery.
OVERALL MAXIMUM LIMIT – This is the maximum amount the insurance company will pay for specific benefits or as whole for the policy during your lifetime.
OVER-THE-COUNTER DRUGS – These are drugs/medications/supplies/treatments that can be purchased without the necessity of being prescribed by a doctor.
PHYSICIAN – A doctor of Medicine (MD), doctor of Dental Surgery (DDS), doctor of Dental Medicine (DDM) or a licensed Physical Therapist of Physiotherapist. Physician does not include a doctor of Chiropractic (DC), doctor of Osteopathy (DO), a doctor of Psychology (Ph.D), a doctor of Psychiatry (Psy.D) or any other degree or designation. A Physician must be currently licensed by the jurisdiction in which the services are provided, and the services provided must be within the scope of that license.
PLACE OF SERVICE (POS) – This is the physical location where you received medical care or treatment, whether it’s a clinic, hospital, doctor’s office, etc.
PLAN ADMINISTRATOR – This is the company responsible for managing the plan, including customer service, claims processing and payment, underwriting and provider questions, etc. In regard to our international products, HCC Medical Insurance Services is the Plan Administrator.
PLAN TYPE – There are general groupings used for health insurance plans to give you a general sense of how the plan works, covers benefits, and reimburses claims. We offer international student health insurance plans, international travel medical plans, and international term life insurance plans.
POLICY MAXIMUM – This is the maximum dollar amount the insurance company will pay for eligible medical expenses incurred under your policy.
POLITICAL EVACUATION – Political evacuation is a benefit offered under certain plans that assists in the coordination and associated costs of transportation to a safe country after a US Government travel warning has been issued after arrival to the destination country.
PRE-EXISTING CONDITION – Any (1) condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the 2 years immediately preceding the Certificate Effective Date; (2) condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the 2 years immediately preceding the Certificate Effective Date; (3) injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of application or within the 2 years immediately preceding the Certificate Effective Date. For the purposes of the Complications of Pregnancy coverage offered hereunder, Pregnancy will not be included within the definition of a Pre-existing Condition.
PREMIUM – The amount of money you must pay to your insurance company for coverage, whether for short-term international travel or international term life.
PRENATAL CARE – This is to describe the standard care that a woman should receive while she is pregnant. An example would be a procedure like an ultrasound.
PRESCRIPTION DRUGS/MEDICATIONS – Medications that can only be purchased with a physician’s prescription.
PRE-TRIP DESTINATION INFORMATION – Up-to-date information regarding the required vaccinations, health risks, travel restrictions, and weather conditions specific to your destination country. Pre-trip destination information is available via our HCC Travel Board.
PREVENTIVE CARE SERVICES – Various tests and procedures to maintain health and prevent disease and illness. This includes procedures like pap smears, mammograms, prostate exams, immunizations, etc.
PRIMARY CARE DOCTOR/PHYSICIAN (PCP) – Sometimes referred to as your family doctor, the primary care physician is the doctor you see for routine care.
PRIMARY COVERAGE – When an individual is insured by more than one insurance plan, one has to be designated as the primary coverage provided and the other is the secondary. All claims are to be processed first by the primary carrier and then by the secondary carrier for consideration of reimbursement. All of HCCMIS’s international insurance products are secondary to any other coverage.
PROBATIONARY PERIOD – The time period specified in a policy that a pre-existing condition will be excluded.
PROVIDER – This is a medical professional who provides treatment, advice, supplies, tests or other types of health-related services. Typically you can define them by their ability to provide an insurance claim.
PROVIDER REFERRALS – Contact information for Western-style medical facilities and medical and dental practices and pharmacies in your destination country where English is spoken.
RATING PROCESS – This is the actuarial process used to determine what the premium cost will be for an individual or family/group. There are several factors taken into consideration, including age, health, administration costs, etc.
REGULAR & CUSTOMARY -An insured person can carry on a substantial part of the standard and commonly practiced activities of a person in good health of the same sex and age.
REHABILITATION – Services ordered by a physician for your recovery from an accident or injury that are provided by occupational therapists, speech therapists, nurses, and physical therapists.
REPATRIATION OF REMAINS – This is a benefit that covers expenses to return an insured’s remains (bodily or ashes) to their home country in the event of his or her death resulting from a covered Injury or Illness.
RETURN OF MINOR CHILDREN – Return of minor children is the assistance and financial coverage of transporting covered minor children to the terminal serving the area of Principal Residence when the only person age 18 or older traveling with them has been hospitalized for treatment of a covered Illness or Injury resulting in the children being left unattended for a period of time expected to exceed 36 hours.
SERVICE AREA – This is the actual geographic area where coverage is available for purchase.
SPECIALIST- This is a physician that focuses on specific parts of the body, specific genders, or even specific ages to treat.
SUBSTANCE ABUSE – Alcohol, drug or chemical abuse, overuse or dependency.
TERM LIFE INSURANCE – Term Life Insurance is a life insurance policy that provides benefits if the insured dies within the policy’s defined time period, provided such death is not the result of a condition or circumstance excluded under the policy’s provisions.
TERMINAL ILLNESS – This term refers to a disease or condition that is deemed to be incurable/untreatable and is expected to cause the death of the person inflicted.
TRAVEL ASSISTANCE SERVICES – Travel Assistance Services are complimentary services that focus on potential travel issues, which are available to every member that purchases an international insurance product from HCCMIS. See the Travel Assistance Services list for more details.
TRAVEL DOCUMENT REPLACEMENT – Assistance with obtaining replacement passports, birth certificates, visas, airline documents, and other travel-related documents.
TREATMENT – Treatment is the process of using various techniques, like medications, physical therapy, and procedures, to promote healing and improvement in a patient’s health.
UNDERWRITING – The process that your insurance carrier will use to review your medical history and current health status to identify any potential risks and determine whether or not to accept your application for an insurance policy.
URGENT CARE CENTER – These medical clinics are designed to treat routine, minor illnesses, and some injuries like ear infections, the flu, ankle sprains, etc. This level of medical care does not require the use of a hospital emergency room and is not meant to be a replacement for an individual’s family doctor.
USUAL, REASONABLE & CUSTOMARY (URC) – The most common charge for similar services, medicines or supplies within the area in which the charge is incurred, so long as those charges are Reasonable. What is defined as Usual, Reasonable and Customary Charges will be determined by Underwriters. In determining whether a charge is Usual, Reasonable and Customary, Underwriters may consider one or more of the following factors: the level of skill, extent of training, and experience required to perform the procedure or service; the length of time required to perform the procedure or services as compared to the length of time required to perform other similar services; the severity or nature of the Illness or Injury being treated; the amount charged for the same or comparable services, medicines or supplies in the locality; the amount charged for the same or comparable services, medicines or supplies in other parts of the country; the cost to the provider of providing the service, medicine or supply; such other factors as Underwriters, in the reasonable exercise of discretion, determine are appropriate.
UTILIZATION – Utilization is the measurement of how often an insured member uses the benefits in their plan.
WAIVER – See “Benefit Rider“.
WELL BABY CARE – This is preventive and routinely scheduled care for infants to promote growth, development and health.
WELL CHILD CARE – This is preventive and routinely scheduled care for children up to a defined age within the insurance policy. This includes services like immunizations and annual physicals.
WELL WOMAN CARE – This is preventive care like annual pap smears and mammograms that are specific to women-only.
Tokio Marine HCC - MIS Group international insurance products are underwritten by Lloyd's. Tokio Marine HCC - Medical Insurance Services Group (MIS Group) is a service company and a member of the Tokio Marine HCC group of companies. Tokio Marine HCC - MIS Group has authority to enter into contracts of insurance on behalf of the Lloyd's underwriting members of Lloyd's Syndicate 4141, which is managed by HCC Underwriting Agency Ltd.