Acquired Immune Deficiency Syndrome as that term is defined by the United States Centers for Disease Control and Prevention
An attending physician statement (APS) is a report by a physician, hospital or medical facility who has treated, or who is currently treating, a person seeking insurance. In traditional underwriting, an APS is one of the most frequently ordered additional sources of medical background information. Insurance companies that use medical underwriting request an APS during the application process and this can delay the application approval by many weeks while the insurance company waiting for the clinic/doctor/hospital to return it then it gets evaluated and a decision made (medical underwriting process).
AIDS Related Complex as that term is defined by the United States Centers for Disease Control and Prevention.
.png)
A sudden, unexpected event which causes a bodily injury, and which is unintentional from the Member.
Death of the Insured Person resulting from an Accident.
Complete severance from the body of one or more limbs or eyes resulting from an Accident. For purposes of the Accidental Dismemberment benefits provided by this insurance, the term “limb” shall mean: the arm, when the severance is at or above (toward the elbow) the wrist, or the leg, when the severance is at or above (toward the knee) the ankle. Loss of eye(s) shall include complete, permanent and irrevocable loss of sight.
In the context of juvo:
The costs of accommodation and essential subsistence (including food, clothing and necessary toiletries) incurred by You for or on behalf of a member following a Crisis Evacuation, provided that:
.png)
An act, including but not limited to the threat or use of force or violence of any person orgroup of persons whether acting alone or on behalf of any organisations or governments, committed for political, religious, ideological or similar purpose or reasons include the intention to influence governments, and or put the public, or any section of the public, in fear.
The replacement cost of an item, less proper deduction for depreciation at the time of the loss.
The sudden onset of a medical condition which is likely to respond quickly to medical Treatment and is aimed to return You to the state of health You were in immediately before suffering the medical condition or which leads to Your full recovery
Admission - hospital inpatient care for any medical condition.
A sporting activity undertaken for the purposes of recreation or an unusual experience or excitement, typically performed outdoors, and involving a medium degree of risk, including only the following: Absailing, BMX, Bob-sledding, Bungee jumping, Canyoning, Caving, Downhill and/or cross-country snow skiing and snowboarding and snowmobiling, provided that such activity is not in any violation of applicable laws, rules or regulations or away from prepared and marked in-bound, patrolled territories or against the advice of the local ski school or local authoritative body, Hot air ballooning, Kitesurfing and Kiteboarding, Mountaineering below 4,500 meters from ground level, Motorcycle riding as a driver or passenger, Zip lining, Parachuting, Paragliding, Parascending, Rappelling, Scuba diving or sub-aqua pursuits at less than depth of 50 meters, Skydiving, Spelunking, Whitewater kayaking or whitewater rafting (in water less than Class V difficulty), Wildlife Safaris Windsurfing
.png)
Any information, consultation or Treatment received from a Nurse, Physician or Specialist; including the issuing of any medication or prescription.
Health services provided to members who are not confined to a health care institution. Ambulatory services are often referred to as "outpatient" services.
All Hospital services for a patient other than room and board and professional services. Laboratory tests and radiology are examples of Ancillary Services.
The yearly maximum that a policy will cover, regardless of how many claims are made.
The fully answered and signed (including electronic signatures) form that is submitted by or on behalf of the Insured Person for acceptance into the insurance provided under this Master Policy, submitted to the Plan Administrator and maintained on file with the Plan Administrator. Any insurance agent/broker or other person or entity assigned to, soliciting, or assisting with the Application is the agent and representative of the applicant/Insured Person and is not and shall not be deemed or considered as an agent or representative for or on behalf of Underwriters or the Plan Administrator.
The task of locating a hospital/facility that will accept an injured (or especially when critically ill) is called bed finding. Excellent providers of this service are Going Home Medical (USA) and Mayday Group (UK and global). The case managers will step in to identify the best medical facilities along with the most qualified accepting physicians to address all of the medical needs of the patient.
On the World Explorer plans, the beneficiary is the individual named in the Insured Person's Application to be the recipient of any Accidental Death or Common Carrier Accidental Death benefit. For Insured Persons age 18 and older who do not designate a Beneficiary on the Application, the Beneficiary is automatically as follows: 1) Spouse (if any), 2) Children (if any) equally, 3) Estate of the Insured Person. For Insured Persons who are under age eighteen (18) who do not designate a Beneficiary on their Application, the Beneficiary is automatically as follows: 1) Custodial parent(s) (if any), 2) Siblings (if any) equally, 3) Estate of the Insured Person.
.png)
An intermediary, who acts on behalf of a person who is applying for insurance. They earn a commission from the insurer; however, they have a responsibility to obtain cover appropriate to the needs of the insured. In certain circumstances a broker can also act as an agent for the insurer in terms of issuing a policy or collecting a premium.
The Certificate Period is the period of time beginning on the Certificate Effective Date and ending on the Certificate Termination Date.
The document issued to You stating details of the Policyholder, the Insured Persons, the period of Cover, the Date of Entry of each Insured Person, the Area of Cover, the Plan level, the name of the Insurer, the medical underwriting terms including any special exclusions or restrictions to the Plan.
According to Nomads Health Insurance:
An illness that fails to respond effectively to treatment, or is ongoing or frequently recurring without likelihood of complete cessation, or requires Palliative Treatment, or requires constant or long periods of supervision.
Benefits under this section are not subject to the Policy Excess in Nomad Health Insurance (verify in benefit schedule)
i) Curative: Benefits are limited to Covered Charges and Surgeries related to costs in relation to Inpatient curative Treatment of a Chronic Condition.
ii) Stabilisation of an Acute episode: Benefits are limited to Covered Charges and Surgeries related to costs in relation to Inpatient stabilisation of an acute attack of a Chronic Condition.
iii) Routine Management: Benefits are limited to Covered Charges and Surgeries related to a Chronic condition, subject to a limit of $/€2,000 per Insured Person per Period of Cover.
According to International Health Insurance:
A disease, Illness or Bodily Injury that has 2 (two) or more of the followingcharacteristics:
It has no known recognised cureIt continues indefinitely
It is recurrent in nature
It is permanent
It needs Palliative Treatment
It requires prolonged monitoring and/or supervision through consultations, examinations, check-ups, tests ormedication
It is Degenerative
In the context of juvo:
A substantial violent uprising by a group of persons assembled together and acting with common purpose of religious, ideological or political intent.
In the context of juvo:
Civil War means a hostile contention by armed forces carried on between opposing citizens or subjects of the same country or nation.
The percentage You must pay in respect of any Covered Charges, as detailed in the Policy Wording or as shown in the Benefit Schedule. In all instances any Excess applicable must be satisfied before the Co-insurance becomes effective.
A cohabitant is defined as the person living with the Member and fulfilling together the following two cumulative conditions:
a.) they are both free of any former marriage or partnership agreement bond,
b.) cohabitation must be declared by the Member upon enrollment, along with a cohabitation certificate or proof of residency mentioning both names and a sworn statement that they live together. The certificate must be in force and legally recognized by a competent authority in the country of cohabitation. Termination of cohabitation must be declared in writing by the Member. Only one person can be enrolled as a cohabitant.
The date on which the Policy becomes effective as shown on the Policy Schedule.
Expatriate Group, administering Nomad Health Insurance, acting on behalf of certain Underwriters, including any organization appointed by Us to act on Our behalf.
A benefit in certain Nomad Health Insurance plans that is limited to an economy return airfare, for the Primary Insured (or their spouse/partner, who is insured under this Policy) to return to Your Country of Nationality to attend the funeral of a parent, sibling or child. This benefit is limited to costs incurred 12 months after Your Effective Date and is limited to one claim every 2 years of cover.
According to the plans: International Health Insurance (Preferred & Preferred+):
Therapeutic and diagnostic Treatments which exist outside of institutions where conventional medicine is taught and specifically within this Plan refers to acupuncture, homeopathy, osteopathy, chiropractic Treatment, traditional Chinese medicines, ayurvedic Treatments, provided by a practitioner who is qualified and licensed to practice in the country where Treatment is given.
According to the plans: Nomad Health Insurance (Select, Primary+, Primary):
Treatment or medicine provided by a registered and properly qualified Osteopath, Chiropractor, Homeopath and Acupuncturist on the written recommendation of Your treating Physician for a Covered Charge.
In the context of juvo, the benefit includes:
In the event of Conflict in the Country of Assignment (or where travel is taking place to) of the member(s), the program will cover the costs of Crisis Evacuation by the Emergency Response Provider for member(s) and Additional Costs if:
A sport in which the participants purposely hit or collide with each other, inanimate objects, the ground or water, with force, including without limitation: American football, Basketball, High diving and cliff diving, Fighting or combat sports, including without limitation, boxing, wrestling, martial arts, mixed martial arts, fencing and kickboxing Hockey, including ice and field hockey, Lacrosse, Polo, Rodeo, Rugby, Ski jumping, Soccer.
An arrangement where the covered person pays a specified amount for various services and the health care provider pays the remainder. The covered person usually must pay his or her share when the service is rendered. Similar to coinsurance, except that coinsurance is usually a percentage of certain charges where the co-payment is a dollar amount.
Surgery performed primarily to change or restore physical appearance.
The country of expatriation of the Member.
The country stated in Your Policy Schedule.
The sudden, violent and illegal overthrow of a sovereign government.
The following items exclusively: mobile phones, tablets and laptop computers.
Covered Sports Equipment, Covered Photography Equipment and Covered Electronics and Communication Equipment exclusively.
The following items exclusively: cameras, camera flash accessories and camera lenses.
The following items exclusively: skis, ski boots, ski poles, snowboards, snowboard boots, golf clubs, golf bags, tennis rackets.
A charge incurred for Your Medically Necessary Treatment which is Reasonable and Customary and incurred during the Period of Cover.
In the context of juvo:
An Expatriate Crisis Evacuation and/or a National Crisis Evacuation.
A twenty-four (24) hour period during which an Insured Person engages in normal daily activities including but not limited to eating, drinking and washing.
Medically Necessary Treatment received in a hospital that requires the use of an operating theatre, but where You are not admitted to a hospital bed overnight.
The dollar amount of Eligible Medical Expenses, specified in the Master Policy, that the Insured Person must pay before receiving benefits or coverage hereunder, not including any applicable Coinsurance.
Sudden and unexpected experience of severe pain in the teeth, gums or bones supporting the teeth.
Benefits on Nomad Health Insurance (Select plan) that are payable for covered charges for restorative treatment to natural teeth including capping, crowns and bridges in plastic or porcelain fused to gold, limited to a maximum of €750 per period of cover per insured person.
A benefit of World Explorer plans for emergency dental treatment necessary to restore or replace sound natural teeth lost or damaged in an accident which was covered under this insurance; however, loss or damage to sound natural teeth while eating or biting into hard objects such as, but not limited to, pencils, ice cubes, nuts, popcorn and hard candies, are not covered. It also includes limited dental treatment necessary to resolve acute onset of dental pain, subject to a maximum of $100 per insured person per certificate period, only if the certificate period is thirty (30) days or more.
Benefits on Nomad Health Insurance plans that are payable for covered charges incurred as a result of an accident for dental Treatment received within 48 hours of the occurrence of the accident to restore or replace sound natural teeth lost or damaged.
Benefits on Nomad Health Insurance (Select plan) that are payable for covered charges for complex treatment including covered charges for periodontal surgery, inlays and implants, dental prosthesis - fitting of artificial oral appliances, apicectomy - molars and premolars, and the surgical extraction of wisdom teeth, limited to a maximum of €1,000 per Period of Cover per Insured Person.
Benefits on Nomad Health Insurance (Select plan) that are payable for covered charges for basic treatment such as X-rays required prior to treatment, extractions, root canal fillings, treatment of abscesses, anterior or amalgam fillings, scaling, polishing and prophylaxis limited to a maximum of €750 per period of cover per insured person.
A family member of the Primary Insured who is either:
a) the legally married spouse or partner with whom you permanently reside, provided the spouse/partner is at least 18 years of age and younger than 65 at the time of application for cover under this Policy and permanently resident with You, or
b) a child, who is unmarried, below 21 years of age, permanently resides with, and is financially dependent on You.
Laboratory tests, X-rays, MRI, PET or CT scans which are ordered by a Physician or Specialist.
In the context of juvo:
Targeted actions by the authorities and/or population of the Country of Assignment against foreigners or foreign-owned businesses in the Country of Assignment.
In the context of juvo:
Earnings Expenses means:
(a) Contractual Net Income paid by You to an Insured Person(s) who has been the subject of a Crisis Evacuation; and/or
(b) Contingent Salary paid to an Insured Person(s).
(c) reasonable expenses that have been agreed with Us prior to their expenditure by You or an Insured Person(s).
.png)
Care for restoration (by education or training) of one’s ability to function in a normal or near normal manner following an Illness or Injury. This type of care includes, but is not limited to, vocational or occupational therapy and speech therapy. Eligible Medical Expenses: Expenses for services and supplies for treatment of Injury or Illness.
The date of first inclusion under this Policy of eachInsured Person, as noted on the Policy Schedule.
A medical condition or situation, which in Our opinion, cannot adequately be treated in the location in which it has arisen. In this event the Emergency Assistance provider will arrange for You to be transferred to the nearest location where adequate appropriate Treatment can be provided.
The excess which corresponds to the amount to be born by the Member during one insurance year.
In the context of juvo:
The necessary transport from the Host Country (or from the region of the Host Country in which the Insured Person(s) is located) of a Insured Person(s) who is not a national of the Host Country to the place considered by Emergency Response Provider to be the nearest place of safety or their Resident Country, caused by or relating to the InsuredEvent(s).
The risk of possible loss. In health insurance is generally refers to an individual's susceptibility to various risks encountered in daily life. It denotes the individual's potential for accidents and other losses. Insurance companies evaluate the level of risk an individual faces and use it to calculate premiums.
.png)
An institution, or a distinct part of an institution, which is licensed as a Hospital, Extended Care Facility or rehabilitation facility by the jurisdiction in which it operates; and is regularly engaged in providing twenty-four (24) hour skilled nursing care under the regular supervision of a Physician and the direct supervision of a Registered Nurse; and maintains a daily record on each patient; and provides each patient with a planned program of observation prescribed by a Physician; and provides each patient with active treatment of an Illness or Injury. Extended Care Facility does not include a facility primarily for rest, the aged, Substance Abuse treatment, Custodial Care, nursing care or for care of Mental Health Disorders or the mentally incompetent.
A sporting activity, including practice, preparation and actual sporting events, which involves a high degree of risk. These activities often involve speed, height, a high level of physical exertion and/or highly specialized gear, and often carry the potential risk of serious or permanent physical Injury and even death. These activities include, without limitation, the following and any combination or derivative of the following: Back country snow skiing, snowboarding or snowmobiling, Base jumping, Cave diving, Downhill mountain biking, Extreme Skiing, Free diving, Free flying, Free running and Parkour, Free skiing, Freestyle scootering, Gliding, Heli-skiing, Ice canoeing, Ice climbing, Jet skiing, Racing any vehicle or animal, including mountain bikes, motocross, motorcycle racing, motor rally, snowmobile racing, truck racing, horse racing, boat racing, Mountaineering above elevation of 4,500 meters from ground level, Piloting a commercial or non-commercial aircraft, Powerboking, Skateboarding, Snow skiing, snowboarding or snowmobiling off piste, Scuba diving or sub-aqua pursuits below a depth of 50 meters, Whitewater kayaking or whitewater rafting Class V or higher difficulty (Class V = A section of a river, stream or other waterway or watercourse where the current moves with enough speed or force to meet, but not to exceed, the qualifications of Class V as determined by the International Scale of River Difficulty or as commonly published by a local authority or government agency.) Wingsuit flying.
A benefit on certain Nomad Health Insurance plans (see schedule of benefits) that is limited to the cost of economy class transport for up to two close relatives (being your parent(s), sibling(s) or child(ren)), who reside outside Your Country of Residence, to attend you if you are admitted to a hospital bed in respect of a valid claim for more than three consecutive nights. Limited to a maximum of €250 per period of cover.
A person who is enrolled in a program that leads to a degree, certificate or other recognized educational credential and regularly attends an Educational Institution for the minimum number of credit hours required by the Educational Institution in order to maintain a full-time student status. On-the-job training courses, correspondence schools, and schools offering courses only through the internet do not qualify as Educational Institutions, Full-time Scholar: A graduate student, teacher, researcher, or professor who is affiliated with an Educational Institution and is engaging in educational activities for at least thirty (30) hours per week. On-the-job training courses, correspondence schools, or schools offering courses only through the internet do not qualify as Educational Institutions.
The geographical regions in which You are able to receive Treatment for Covered Charges. The countries in which You are able to receive covered Treatment is as detailed in Your Policy Schedule, to be read in conjunction with the Geographical Coverage Schedule.
Health Insurance Portability and Accountability Act of 1996 (USA) It was passed as an effort to
An HMO is a prepaid medical service plan which provides services to plan members. Medical providers contract with the HMO to provide medical services to plan members. Members must use contracted providers. The emphasis is on preventive medicine, and it is an alternative to employee benefit plans. Employers of more than 25 persons are required to offer the alternative of HMO to employees, but not if the cost exceeds that of present employee benefit plans.
Activities that carry an increased potential for injury. These may include, but are not limited to: professional, semi-professional or competitive sporting events of any kind; organized group, club, interscholastic or intercollegiate sports play; use of any type of firearms (any device that discharges a projectile of any type); any activity relating to flying except while traveling as a passenger in a fully licensed passenger carrying aircraft; parachuting, para-gliding, bob-sleighing, gliding/soaring, hang-gliding, micro-light flying, skeleton, luge; American football; bungee jumping; base jumping; trekking above 3,500 meters; mountaineering / rock-climbing; scuba diving in excess of 25meters or any flights within 24-hours of diving activity; whitewater canoeing, white water rafting; skiing or snowboarding, except on the normally marked publicly open ski trails at a ski resort; skating, off-road mountain biking, ice hockey; participation in any type of motor-sport, motor-sport race or motor-sport contest. Unless otherwise accepted by Us in writing.
Medical examination carried out without any visible clinical symptom. These health check-ups aim at anticipating the detection of illnesses. They include the following tests: blood, sugar, cholesterol, kidney function, thyroid, lipids, bone densitometry.
Medical care provided by a registered nurse at the Member's home and in accordance with the prescription of a doctor, immediately following or in the place of a hospitalisation or outpatient care.
An institution which operates as a Hospice, is licensed by the state or country in which it operates; and operates primarily for the reception, care and palliative control of pain for terminally ill persons who have, as certified by a Physician, a life expectancy of not more than six (6) months
A facility which operates as a Hospital in accordance with the laws of the respective country, is open at all times, is operated mainly to diagnose and treat Illnesses as an Inpatient, has organized facilities for major Surgery, has a staff of one or more physicians on call at all times, has 24 hour nursing services by, or under, the supervision of government licensed nurses, is not, other than incidentally, a skilled nursing facility; clinic place for alcoholics or drug addicts, nursing home, rest home, convalescent home; home for the aged; place for the Treatment of mental disorders or a similar establishment, and maintains a daily medical record foreach patient, which is accessible by us.
A benefit that pays a fixed amount for each day that you are hospitalized. The amount paid is fixed at the time of taking the policy and would remain fixed. This benefit amount is stated in your schedule of benefits for your policy.
Confined and/or treated in a Hospital as an Inpatient.
.png)
In the context of juvo:
The country being visited by the Insured Person, or where the Insured Person resides temporarily. Host Country does not include the Insured Person’s Home Country.
A country of origin for which You hold a passport.
A disease or body impairment, which is not a consequence of an Accident, and which requires Medically Necessary Treatment.
A period of time not to exceed fourteen (14) days during a Certificate Period during which an Insured Person is covered for Eligible Medical Expenses incurred in his or her Home Country. An Incidental Trip Home begins on the date and time the Insured Person departs his or her Host Country to return to his or her Home Country, and ends on the next date and time the Insured Person departs his or her Home Country, subject to a maximum of 14 days. The Incidental Trip Home benefit is only available to Insured Person’s with Certificate Periods of ninety (90) days or more.
Medically Necessary Treatment received where You are admitted to a Hospital bed overnight.
Any person who is covered under the Policy and is named as such in the Policy Schedule.
The insurance organisation covering the insured risk. This is MFPrévoyance, registered by Code desassurances, RCS 507 648 053 PARIS, Head office: 4, place Raoul DAUTRY, 75015 Paris, France.
The organisation that has underwritten the policy is Guardrisk Insurance Company Mauritius Ltd PCC, authorised and regulated by the FSC in Mauritius (Registration number: C142417/C1/GBL). It is administered by Expatriate Group & Expatriate Healthcare (trading styles of Strategic Insurance Services Limited), authorised and regulated by the Financial Conduct Authority (FCA). FCA Firm reference Number is 307133. Strategic Insurance Services Limited is authorised to carry on Regulated Activities in accordance with the permissions granted by the FCA under PART IV of the Financial Services and Markets ACT 2000.
The insurance organization covering the insured risk. This is HDI/Hannover Specialty, who has granted global delegated authority to Point Comfort Underwriters, 306 Prospect St, Indianapolis, IN 46225, USA.
In the context of juvo:
A violent uprising of citizens in resistance to their government.
Terms used to describe procedures, services or supplies that are by nature or composition, or are used or applied, in a way which deviates from generally accepted standards of current medical practice.
An insurance policy providing coverage for ransom or extortion costs and related expenses. Also referred to as K&R
The termination of a policy due to failure to pay the required renewal premium.
An individual who is not a citizen of the US who is living in the US under legally recognized and lawfully recorded permanent residence as an immigrant.
In the context of International Health Insurance (Preferred & Preferred Plus plans):
The period beyond which a party's rights may no longer be invoked.
A corporation and an association (marketplace, or market).
The Corporation of Lloyd's, the company that oversees the insurance marketplace. The corporation ensures that the syndicates are financially sound and that the marketplace operates efficiently.
The Association offering membership in various syndicates of wealthy individuals organized for the purpose of writing insurance for a particular hazard.
Lloyd's began as a place where ship captains, vessel owners, traders and others interested in shipping gathered in the 1600's to buy or sell insurance for their ocean cargo. Now, brokers and underwriters convene at the Lloyd's office building in East Central London. Lloyd's is now a major hub for buying and selling a variety of coverages.
Transportation and accompanying treatment provided by licensed, qualified professional emergency personnel from the location of a covered Accident, Injury or acute Illness to a Hospital or other appropriate health care facility.
The Master Policy Period is the period of time beginning on the Effective Date and ending on the Termination Date indicated on the Master Policy Declaration.
.png)
These are policies issued in the USA in association with the Federal/State entitlement program created by Title XIX of the Social Security Act of 1965 that pays for medical assistance for certain individuals and families with low incomes and resources. Visit www.medicaid.gov for more information
.png)
The increase in healthcare costs associated with medical trends and developments. It often includes the costs of advanced treatments and procedures, and the increased availability and usage around the world. Therefore, the expenditure on health has increased year to year, affecting governments, employers, insurance companies and individuals.
A physical examination with a Physician, including the cost of the Physician’s fee, blood test (red blood count, white blood count, blood sugar, cholesterol, triglyceride, uric acid) and urine test (sugar, protein).
Hearing aid, phonation aid (electronic larynx), wheelchair and personal mobility aid, artificial limb, ostomy product, hernia support, abdominal bandage, elastic support stockings or orthopaedic sole and any other medically prescribed apparatus.
.png)
As defined for International Health Insurance:
Medically Necessary Treatment which in the opinion of a qualified Medical Practitioner/Specialist is appropriate and consistent with the diagnosis, is proven and has demonstrated to give medical value, and which isin accordance with the generally accepted medical standards and could not have been omitted without adversely affecting the Insured Person’s condition or the quality of care rendered. Treatments must be required for purposes other than comfort or convenience of the patient and provided only for an appropriate duration of time.Member: The party in respect of which the risk is insured. For the purpose of this policy, this refers to the mainMember and, where relevant, his/her Dependants.
Medically necessary: Corresponds to services and goods that are defined from a medical point of view as appropriated and necessary. They must:
a) Be necessary to define or treat the condition, the illness or the injury of a patient,
b) Be appropriated to the symptoms, diagnosis or treatment of the patient,
c) Comply with the medical practices generally accepted and with the professional medical standards applied by the medical community at the time the patient receives the relevant care,
d) Be required for other reasons than comfort or pleasure of the patient or his/her doctor,
e) Have medical proven and demonstrated effects,
f) Be considered as from the most appropriate type and level,
g) Be provided with an equipment, in quantity and quality appropriate to the level of care required by the patient condition,
h) Be only provided during the period appropriate to the patient condition.
As defined for Nomad Health Insurance (Select, Primary+, Primary):
A service, supply or Period of Hospitalization which is ordered by a Physician or a Specialist for the diagnosis and/or Treatment of an Accident or Illness and is:
a) appropriate and consistent with the symptoms and findings or diagnosis, and
b) provided in accordance with generally accepted medical practice on a national basis, and
c) the most appropriate supply or level of service which can be provided on a cost effective basis, and
d) not of an experimental or research nature and is not of an investigative nature for the purposes of experiments or research, and
e) is not solely of a preventative nature.
In the USA, there is a state assistance program, passed under Title XVIII of the Social Security Amendments of 1965, to provide hospital and medical expense insurance to those over 65 years of age, it is called Medicare.
Part A provides inpatient/hospital coverage.
Part B provides outpatient/medical coverage.
Part C covers all of the same Part A and B services that you get from Medicare. You will have both hospital and outpatient benefits. However, instead of paying deductibles and 20% of your medical services, you will pay the plan's copays.
Part D - Stand-Alone - stand-alone Part D coverage written through individual contracts; stand-alone Part D coverage written through group contracts and certificates; and Part D coverage written on employer groups where the reporting entity is responsible for reporting claims to the Centers for Medicare & Medicaid Services (CMS).
Medicare Supplement - Insurance coverage sold on an individual or group basis to help fill the "gaps" in the protections granted by the federal Medicare program. This is strictly supplemental coverage and cannot duplicate any benefits provided by Medicare. It is structured to pay part or all of Medicare's deductibles and co-payments. It may also cover some services and expenses not covered by Medicare. Also known as Medigap" insurance.
