Accident means a fortuitous, sudden, unforeseen and unintentional event exclusively attributable to an external cause resulting in bodily injury. Some insurance policies exclude injury caused or contributed to by the consumption of or abuse of any alcohol, drugs or medications by the insured person.
Accidental Death and Dismemberment.
Insurance companies have different meaning for "Age". It could be the insured age either at the time of application or at the time of the policy effective date.
Aggregate limit means the total number or the maximum value of insured losses resulting from any one accident or event causing loss.
Person(s) designated by the insured(s) that would receive the proceeds of an insurance policy upon death of the insured. You would typically assign a beneficiary at the time of completing the policy application.
Amount an insurance company pays to a claimant, assignee or beneficiary when the insured suffers a covered loss, injury, accident etc.
Benefit Period is the maximum time period up to which the plan will pay benefits for any one eligible condition. Some policies have a 12 month benefit period while others have a 6 month benefit period; usually this period can extend beyond the date of policy expiration.
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.
An unmarried dependent son or daughter under the age of 21 or over that age if the child is mentally or physically challenged. 25 years of age if the child is a full time student.
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.
Co-Insurance or co-payment:
After your deductible is met, co-insurance is the percentage of the covered medical expenses that you, the insured person, must pay. For instance, if your health plan has an 80/20 co-insurance rate, your insurance plan pays for 80% of your eligible medical expenses and you are responsible for the remaining 20%.
Example: If you buy an insurance policy with $50,000 policy maximum, $250 deductible per policy period and 80/20 co-insurance for the first $5,000 and 100% coverage thereafter. Suppose you incur medical claim for a covered condition of $10,250. You pay first $250 deductible; then out of the remaining $10,000 covered expenses, you pay 20% of the first $5,000 (i.e., $1,000); the insurance policy pays for the remaining expenses (i.e. $9,000).
That means, you pay $250 + $1,000 = $1,250 total; and insurance company pays $4,000 + $5,000 = $9,000.
A vehicle or service licensed, intended for and used to transport paying passengers. Good examples are airplanes, trains, bus, taxi etc.
Confirmation of coverage:
Confirmation of coverage is a document or set of documents confirming your policy coverage and include your information, application date, effective date, expiry date, benefit amount and policy number.
Controlled medical condition:
There has been no alternation in any medication or its usage or dosage for the condition, nor any change in the treatment, prescribed or recommended by a physician within the period before your trip specified in the insurance policy.
Coverage period is the number of days between the effective and expiry date of your insurance policy. Visitor insurance policy periods can be as short as 5 days and as long as 12 months. For example, if you complete an application and pay for 6 months of insurance, the policy period for that insurance will be 6 months.
Covered expenses means reasonable and customary charges you incur for supplies and services which are eligible expenses under the benefit sector in the insurance policy and/or not covered under any other benefit plan.
Country of origin:
Country of origin means the country in which the insured maintained a permanent residence prior to entry into Canada.
This represents the amount of eligible medical expenses that must be paid by the insured before the insurance company begins to reimburse for covered expenses. As an example, if you purchase a plan with a $50 deductible and incur $200 of eligible medical expenses, the insurance company will begin to reimburse for expenses after you have paid the first $50 of your medical bills.
There are two different kinds of deductibles, per-claim and per-policy period. A per claim deductible means that the insured must pay a new deductible for each separate incident (example: pay the deductible once for a broken leg and then a second time for a flu treatment). A per-policy period deductible means that the insured must pay the deductible only once during the period of the insurance policy. If your plan has a $100 deductible, you pay the first $100 of expenses and then the insurance company picks up the rest. The higher the deductible, the lower the premium cost and vice versa.
Denial of claim:
Refusal by an insurance company to pay directly or reimburse expense for a medical service incurred by an insured person.
Effective date means the date and time coverage begins as indicated on your "Confirmation of Coverage".
Elective (non-emergency) treatment or surgery:
This means any treatment or surgery either not required for the immediate relief of acute pain and suffering; or which reasonably could be delayed until the insured's return to their country of permanent residence.
Emergency means a sudden, unforeseen sickness or injury, which requires immediate medical treatment to alleviate existing danger to life or health.
Coverage for emergency medical evacuation to the nearest qualified medical facility or the country of residence, as determined by the insurance company; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the country of residence or the country where the evacuation occurred, up to a reasonable maximum limit.
Emergency reunion coverage for a certain maximum amount, and for a certain maximum duration such as 15 days, for the reasonable travel and lodging expenses of a relative or friend during an emergency medical evacuation: generally either the cost of accompanying the insured during the evacuation or traveling from the country of residence to be reunited with the insured.
Healthcare services not covered by an insured's health insurance policy. This would usually be due to pre-existing conditions or due to the limitation of the insurance plan.
Expiry date means the date coverage ends as indicated in the "Confirmation of Coverage".
Hazardous sports coverage:
Coverage for injuries incurred during amateur athletic activities which are non-contract and engaged in by an insured person solely for leisure, recreation, entertainment or fitness purposes. However, activities not covered include amateur or professional sports or other athletic activity which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition. Usually, following hazardous activities can be included by optional sports rider at additional premium cost: scuba diving, mountain climbing (up to 4,500 meters or where ropes or guides are normally used), jet, snow and water skiing and snowboarding, sky diving, amateur racing, piloting an aircraft, bungee jumping and spelunking.
Injury means bodily harm which is directly caused by or resulting from an accident, being a sudden and unforeseen event, excluding bodily harm that results from deliberate or voluntary action, and independent of sickness and all other causes.
Insured means an eligible person named on the application, who has been accepted by an insurance company and has paid the required premium for a specific plan of insurance.
Period of coverage:
Period of coverage means the period from the effective date to the expiry date as indicated in this policy and for which premium has been paid.
Physician means a medical doctor who is currently registered and licensed in accordance with the regulations applying in the jurisdiction where the physician practices.
Generally, pre-existing conditions are defined as any sickness, injury or medical condition, for which the insured consulted a physician, has symptoms, has been hospitalized or was prescribed medications within a certain period before the effective date of coverage. Each insurance company treats pre-existing conditions differently and this is a major reason for declined medical claims. The look back period may vary from 3 months to a life time.
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.
Amount you pay to purchase a 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.
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.
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.
Stable Chronic Condition:
This means a condition which is under treatment and which has been controlled by diet or consistent use of medication prescribed by a physician and there has been no new symptoms or change in symptoms; and/or there has been no hospitalization or change in treatment, medication or dosage in a certain period before the effective date of your policy.
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 return to the area of principal residence. Many plans usually pay for a one way air or ground transportation ticket of the same class as the unused travel ticket, less the value of the unused return ticket.
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.
Waiting period for sickness is the period of time following the effective date of insurance during which are not covered medical expenses related to sickness. The waiting period can range from 48 hours to 8 days.
We cannot guarantee the accuracy of this information, as actual definitions may change from time to time because insurance companies change their policies or because of any other reason. We will not be liable in any case, for any problem arising out of the information found on this web site. If there is discrepancy between the information here and in the actual insurance policy/certificate of insurance, policy /certificate of insurance will override. Please use this information at your own risk.
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