Common Health Insurance Terms

 

Common Health Insurance Terms

The language of health insurance can be hard to understand. Here, you’ll find the most common health insurance terms.

We think you’ll agree that a little knowledge will help you make smart decisions that will benefit you and your family, today and for years to come.

And now, some basic terms:

 

Accidental dental emergency treatment – Dental treatment in the dental department of a hospital following an accident

Coverage area – The geographical territory where you are covered by your insurance.

Community rated provider – A risk rating method in which an insurer group all of their members together. The premiums of the group are equally raised based on the groups claim ratio in the previous year + inflation. Your renewal insurance premium will be a fixed percentage and will not be higher or lower than any other member, regardless of how much or little you used the insurance in the previous year. Unless the provider offers a no-claims discount.

Day-patient – Being admitted to a hospital but not requiring an overnight stay

Deductibles & Co-Pays

  • Co-payment – A portion of the medical bills that the insured is responsible which the provider will not pay.

For example, a 25% co-pay means that you are responsible for 25% of the cost of treatment. This may be taken to reduce the initial premium.

  • Deductible/Excess – A set cost that you’re responsible for before the insurance provider will cover treatments. 

For example, a $50/visit excess means that you pay $50 and then the insurance will cover anything after that. This can be per visit, or per year and may be taken to reduce the initial premium.

What is a Copayment? What is a Deductible?

Direct billing network – The hospitals and clinics an insurer works with that offer cashless system for claims. The insurer will pay the hospital or clinic directly.

Effective date – The date that your insurance policy starts to take effect.

Experience rated provider – The provider evaluates the risk of the insured on an individual basis. They look at how much or little you’ve used your insurance in the previous year.

Emergency evacuation – emergency medical transportation costs if treatment is not available locally. This is only available in a life-threatening situation.

Guarantee of payment – The insurer will issue a guarantee of payment to a hospital which guarantees the payment to the hospital. If the hospital accepts it, then direct billing will apply and you don’t have to pay and claim.

Inpatient / Hospitalization – Being admitted in a hospital to a bed. In most cases, you have to stay overnight

Insurer – The insurance company that provides the insurance cover for your plan.

Insured person – The person that is eligible to get insurance coverage.

Medical repatriation – Being returned to your country of residence or your home country following an emergency medical evacuation.

Newborn free cover – Your newborn will be added at no cost to your insurance policy until the next renewal as long as you sing up for insurance a specific of time before your baby DOB.

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    Patrik Shore Tenzing Pacific Services

    Patrik Shore

    Senior Advisor
    From Sweden & New Zealand
    7 years' insurance experience
    Joined Tenzing in 2019
    Crim Science
    Speaks English and Swedish

    Speciality:
    - Savings Plans
    - Health Insurance
    - Life Insurance