The maximum amount an insured will pay for covered medical bills in any one year. A cap is reached when out-of-pocket expenses, including the annual deductible and coinsurance payments, total a specific amount stated in the insurance policy.
Insurance company that actually underwrites and issues the insurance policy. The term refers to the fact that the company carries (or assumes) certain risks for the policyholder.
Certificate of Coverage:
A statement of coverage, also known as a Certificate of Insurance, that an individual receives when insured under a group contract. The certificate serves as proof of insurance, and outlines benefits and provisions.
Certificate of Insurance:
A written document issued to individuals insured mentioning the essential provisions covered under the policy.
Request by the insured(or his/her provider) to an insurance company to pay for services obtained from a health care provider. The claim is usually submitted in a pre-determined format or a claim form.
COBRA (Consolidated Omnibus Budget Reconciliation):
Regulations requiring an employer who employs more than 20 people to offer continued group insurance coverage to former employees for up to 18 months. If the employee dies, the employer must offer continued group health insurance coverage to widowed spouses and dependent children for up to 36 months.
After paying the deductible, percentage or amount of covered expenses that the insured pays.
For example, an insurance policy brochure may mention that the policy will pay 80% of the first $5,000 and 100% thereafter of the usual and customary charges;
In some health insurance plans, it is also called "co-payment".
e.g., Suppose you buy insurance policy with $50,000 policy maximum, $250 deductible per policy period and 80/20 co-insurance for the first $5000 and 100% coverage thereafter. Suppose you incur covered expense of $10,250. You pay first $250 deductible; then out of the remaining $10,000 covered expenses, you pay 20% of the first $5000 (i.e., $1000); the insurance policy pays for the remaining expenses (i.e. $9,000).
That means, you pay $250 + $1000 = $1250 total; and insurance company pays $4000 + $5000 = $9000.
A provision which states that the insured and the insurance company will share the losses covered by the policy in a proportion as agreed upon in advance.
A vehicle or service licensed to carry passengers for hire on a regularly scheduled basis. Good examples are airplanes, trains etc.
Common carrier AD&D beneficiary:
If the insured person gets into an accident(while in plane for example), either loses hand, foot, eye etc. or dies, the insurance company will pay money. You should specify enter the name of the relative to whom that money should go to (in case of death) as 'Common Carrier AD&D Beneficiary'. That is usually close relative like son, daugther, son-in-law etc. If you are buying insurance for your mother and father both, please do not put any of their names in the beneficiary. This question is for who should that money go to in case both die.
A policy plan that provides the insured a package of health care services, including preventive care, routine physicals, immunization, outpatient services and hospitalization.
A predetermined flat fee that the insured pays for healthcare services, in addition to what the insurance covers. Copay is usually not specified in percentage of the total healthcare cost. e.g., you pay $10 for a visit to the doctor's office, no matter how much the doctor's office visit charge is.
In most plans, insurance coverage can be purchased in the combination of monthly and/or 15 days increments to suit your needs. e.g., for a trip of 3.5 months, you can choose 3 monthly increments and one 15 days increment. Effective date for insurance coverage can be the date of departure from home country, or it can be any other later date specified by insured. It is wise to have the insurance effective date same as the date when you depart from home country for the destination and end date same as the date you arrive back in the home country so that you will be covered for any medical emergencies(for covered expenses) even during your journey.
The Expenses that an insurance company agrees to pay the insured as per the terms and conditions mentioned in the policy.