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Medical Insurance Glossary for Visitor Insurance, Visitors Medical Insurance, Travel Health Insurance, International Health Coverage

This glossary provides general descriptions of commonly used terms in international visitor medical insurance and visitors coverage. It should be noted that there are differences between plans and that they all do not function in the same way. Please refer to individual insurance policy brochures and/or policy/certificates of insurance for complete details about each insurance plan.

P

•  Parol
•  Parol Evidence Rule
•  Partial Disability
•  Payment of Claims
•  Peril
•  Periodontics
•  Permanant Disability
•  Persistency
•  Personal Contract
•  Physical Exam and Autopsy
•  Policyholder
•  Policy maximum
•  Policyowner
•  Pre-existing conditions
•  Preferred Provider Organization
•  Preferred Risk
•  Premium
•  Presumptive Disability
•  Primary policy
•  Principal Amount
•  Private Insurance
•  Pro Rata Cancellation
•  Probationary Period
•  Producer
•  Proof of Loss
•  Prosthodontics
•  Provider
•  Pure Risk

R

•  Rate Service Organization
•  Rebating
•  Reciprocal Excange
•  Reciprocity
•  Recurrent Disability
•  Reduction
•  Reinsurance
•  Renewability Clause
•  Repatriation of remains
•  Return of minor children
•  Representations
•  Rescission
•  Reserve
 •  Residual disability
•  Respite Care
•  Restorative Care
•  Rider
•  Risk
•  Risk, Pure
•  Risk Retention Group
•  Risk, Speculative
•  Risk, Standard
•  Risk, Substandard

S

•  Service Plans
•  Short-Rate Cancellation
•  Short-Term Disability Insurance
•  Sickness
•  Skilled Nursing Care
•  Standard Provisions
•  Standard Risk
•  Stock Companies
•  Subrogation
•  Substandard Risk
•  Superintendent

T

•  Terminally III
•  Total Disability
•  Trip interruption
•  Twisting

U

•  Underwriter
•  Underwriting
•  Unearned Premium
•  Unilateral Contract
•  UC&R
•  Utmost Good Faith

Z

•  Waiting Period
•  Wavier
•  Warranty
•  Workers Compensation





Parol:
Legal term that distinguishes oral statements from written statements.

Parol Evidence Rule:
A rule that states a contract may not be altered without written consent of both parties; in other words, the contract may not be altered by an oral agreement.

Partial Disability:
Ability to perform some, but not all, of the duties of the insured's occupation as a result of injury or sickness.

Payment of Claims:
A provision that specifies to whom claims payments are to be made.

Peril:
The cause of a possible loss.

Periodontics:
A speciality of dentistry that involves treatment of the surrounding and supporting tissue of the teeth such as treatment for gum disease.

Permanant Disability:
Disability from which the insured does not recover.

Persistency:
The tendency or likelihood of insurance policies not lapsing or being replaced with insurance from another insurer.

Personal Contract:
An agreement betwen an insurance company and an individual that states that insurance policies cover the individual's insurable interest.

Physical Exam and Autopsy:
A provision that allows an insurer, at its own expense, to have an insured physically examined when a claim is pending or to have an autopsy performed where not prohibited by law.

Policyholder:
The person who has possession of the policy, usually the insured.

Policy maximum:
Maximum amount of money that the insurance company will pay for covered expenses. Policy maximum can be either per policy period, per year, life time or per injury/sickness depending upon the insurance policy you purchase.

Policyowner:
The person who is entitled to exercise the rights and privileges in the policy. This person may or may not be the insured.

Pre-existing conditions:
A pre-existing condition is defined as any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that existed at the time of application or during the past duration(specified by each insurance plan) prior to the effective date of the insurance, including any subsequent, chronic or recurring complications or consequences related to thereto or arising thereffrom.

Preferred Provider Organization (PPO):
An organization of medical professionals and hospitals who provide services to an insurance company's clients for a set fee.

Preferred Risk:
An insurance classification for applicants who have a lower expectation of incurring loss, and who, therefore, are covered at a reduced rate.

Premium:
Amount you pay to purchase medical insurance plan. Premium may be paid monthly, quarterly, semi-annually, annually or for entire duration of the coverage depending upon the insurance policy you purchase.

Presumptive Disability:
A provision that is found in most disability income policies which specifies the conditions that will automatically qualify the insured for full disability benefits.

Primary policy:
A basic fundamental insurance policy which pays first with respect to other outstanding policies.

Principal Amount:
The full face value of a policy.

Private Insurance:
Insurance furnished by nongovernmental insuring organizations.

Pro Rata Cancellation:
Termination of an insurance policy, with an adjustment of the premium charge in proportion to the exact coverage that has been in force.

Probationary Period:
The period of time between the effective date of a health insurance policy and the date coverage for all or cerain conditions begins.

Producer:
Insurance agent or broker.

Proof of Loss:
A claim form that a claimant must submit after a loss occurs.

Prosthodontics:
A special area of dentistry that involves the replacement of missing teeth with artificial devices like bridgework or dentures.

Provider:
Any group or individual who provides health care services.

Pure Risk:
The uncertainity or chance of a loss occuring in a situation that can only result in a loss or no change.

Rate Service Organization:
An organization that is formed by, or on behalf of, a group of insurers to develop rates for those insurers, and to file the rates with the insurance department on behalf of its members. They may also act as a collection point for actuarial data.

Rebating:
Any inducement offered in the sale of insurance products that is not specified in the policy.

Reciprocal Excange:
An unincorporated group of individuals who mutually insure one another, each separately assuming a share of each risk.

Reciprocity:
A situation in which two parties provide the same help or advantages to each other (for example, Producer A living in State A can transact business as a nonresident in State B if State B's resident producers can transact business in State A).

Recurrent Disability:
A policy provision that specifies the period of time during which the recurrence of an injury or illness will be considered a continuation of a prior period of disability.

Reduction:
Lessening the possibility or severity of a loss.

Reinsurance:
A form of insurance whereby one insurance company (the reinsurer) in consideration of a premium paid to it, agrees to indemnify another insurance company (the ceding company) for part or all of its liabilities from insurance policies it has issued.

Renewability Clause:
A clause that defines the insurance the insurance company's and the insured's right to cancel or renew coverage.

Repatriation of remains:
If a covered illness/injury results in a death, expenses for repatriation of bodily remains or ashes to the country of residence.

Representations:
Statements made by the applicant on the insurance application that are believed to be true, but are not guaranteed to be true.

Rescission:
The termination of an insurance contract due either to material misrepresentation by the insured or by fraud, misrepresentation, or duress on the part of the agent/insurer.

Reserve:
An amount representing actual or potential liabilities kept by an insurer in a seperate account to cover debts to policyholders.

Residual disability:
Type of disability income policy that provides benefits for loss of income when a person returns to work after a total disability, but is still not able to perform at the same level as before becoming disabled.

Respite Care:
A type of temporary health or medical care provided either by a paid workers who come to the home or by a nursing facility where a patient stays to give a caregiver a short rest.

Restorative Care:
An area of dentistry that involves treatments that involves treatments that restore functional use to natural teeth such as fillings or crowns.

Rider:
Any supplemental agreement attaached to and made a part of the policy indicating the policy expansion by additional coverage, or a waiver of a coverage or condition.

Risk:
Uncertainty as to the outcome of an event when two or more possibilities exist.

Risk, Pure:
The uncertainty or chance of a loss occuring in a situation that can only result on a loss or no change.

Risk Retention Group:
A liability insurance company owned by its members, which are exposed to similar liability risks by virtue of being in the same business or industry.

Risk, Speculative:
The uncertainty or chance of a loss occuring in a situation that involves the opportunity for either gain or loss.

Risk, Standard:
An applicant or insured who is considered to have an average probability of a loss based on health, vocation and lifestyle.

Risk, Substandard:
An applicant or insured who has a higher than normal probability of loss, and who may be subject to an increased premium.

Return of minor children:
If an insured person is hospitalized due to a covered illness/injury and is traveling alone with child(ren) of age 19 or under that otherwise would be left unattended, the cost of one way economy fare to their home country, usually up to some reasonable maximum amount.

Service Plans:
Insurance plans where health care services rendered are the benefits instead of monetary benefits.

Short-Rate Cancellation:
Canceling the policy with a less than proportionate return of premium.

Short-Term Disability Insurance:
A group or individual policy that covers disabilities of 13 to 26 weeks, and in some casses for a period of up to two years.

Sickness:
A physical illness, disease, or pregnancy, but not a mental illness.

Skilled Nursing Care:
Daily nursing care or skilled care, such as administration of medication, diagnosis, or minor surgery that is performed by or under the supervision of a skilled professional.

Standard Provisions:
Requirements approved by state law that must appear in all insurance policies.

Standard Risk:
An applicant or insured who has a higher than normal probability of loss, and who may be subject to an increased premium.

Stock Companies:
Companies owned by the stockholders whose investments provide the capital necessary to establish and operate the insurance company.

Subrogation:
The legal process by which an insurance company seeks recovery of the amount paid to the insured from a third party who may have caused the loss.

Substandard Risk:
An applicant or insured who has a higher than normal probability of loss, and who may be subject to an increased premium.

Superintendent (Commissioner, Director):
The head of the state department of insurance.

Terminally III:
A patient who is expected to die within 6 months of a specific illness or sickness.

Total Disability:
A condition which does not allow a person to perform the duties of any occupation for payment as a result of injury or sickness.

Trip interruption:
If, during a covered trip, there is a death of an immediate family member(spouse, child, parent or sibling) or the substantial destruction of the insured's principal residence, many plans would pay the insured to the area of principal residence. Many plans usually pay for one way air or ground transporation ticket of the same class as the unused travel ticket, less the value of the unused return ticket.

Twisting:
A form of misrepresentation in which an agent persuades an insured/owner to cancel, lapse, or switch policies, even when it's to the insured's disadvantage.

Underwriter:
A person who evaluates and classifies risks to accept or reject them on behalf of the insurer.

Underwriting:
The process of reviewing, accepting or rejecting applications for insurance.

Unearned Premium:
The portion of the premium for which policy protection has not yet been given.

Unilateral Contract:
A contract that legally binds only one party to contractual obligations after the premium is paid.

UC&R (or Usual, Customary & Reasonable):
UC&R (or Usual, Customary & Reasonable) Charges represent the average or most common amount charged by providers for a particular service, treatment, or supply in the same geographic area. Typically information on rates for procedures is compiled into a data bank and updated periodically. So when a claim is submitted for a plan with UC&R benefits, the insurance company before making the claim payment reviews the UC&R rate and double checks that hospitals and doctors are not billing excessively for the particular service or procedure. Most well respected plans from Blue Cross, Aetna, Lloyds, Unicare etc. follow the UC&R schedule.

Utmost Good Faith:
The fair and equal bargaining by both parties in forming the contract, where the applicant must make full disclosure of risk to the company, and the insurance company must be fair in underwriting the risk.

Waiting Period:
Time between the beginning of a disability and the start of disability insurance benefits.

Wavier:
The voluntary abondonment of a known or legal right or advantage.

Warranty:
A material stipulation in the policy that if breached may void coverage.

Workers Compensation:
Benefits required by state law to be paid to an employee by an employer in the case of injury, disability, or death as the result of an on-the-job hazard.


Disclaimer:

 ServeGlobe and/or its associates have tried to answer these frequently asked questions to the best of our knowledge. However we make no guarantee regarding the accuracy of our answers. The exact answers for some of the questions can change periodically as insurance companies change their plans/policies. ServeGlobe is not liable for any problem resulting from the content on this FAQ.

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