UNDERSTAND THE Words

Insurance Dictionary

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AIDS

Acquired Immune Deficiency Syndrome as that term is defined by the United States Centers for Disease Control and Prevention

APS or Attending Physician Statement

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).

ARC

AIDS Related Complex as that term is defined by the United States Centers for Disease Control and Prevention.

Accident

A bodily injury resulting solely from sudden & unexpected external force and which is independent of all other causes.

Accidental Death

Death of the Insured Person resulting from an Accident.

Accidental Dismemberment

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.

Act of Terrorism

An act, including without limitation, the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s) committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear.

Actual Cash Value

The replacement cost of an item, less proper deduction for depreciation at the time of the loss.

Acute

An Accident or Illness that is not Chronic and that responds quickly to Treatment and which leads to Your full recovery.

Admission

Admission - hospital inpatient care for any medical condition.



Adventure Sports (World Explorer Max & add-on)

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

Advice

Any information, consultation or Treatment received from a Nurse, Physician or Specialist; including the issuing of any medication or prescription.

Ambulatory Services

Health services provided to members who are not confined to a health care institution. Ambulatory services are often referred to as "outpatient" services.

Ancillary Services

All Hospital services for a patient other than room and board and professional services. Laboratory tests and radiology are examples of Ancillary Services.

Annual Aggregate Maximum

The yearly maximum that a policy will cover, regardless of how many claims are made.

Application

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.

Bed finding

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.

Beneficiary

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.

Broker

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.

Certificate Period

The Certificate Period is the period of time beginning on the Certificate Effective Date and ending on the Certificate Termination Date.

Certificate of insurance

A certificate that acts as proof that a policy has been issued.

Chronic Conditions

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.

Co-insurance

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.

Commencement Date

The date on which the Policy becomes effective as shown on the Policy Schedule.

Company/Our/Us/We

Expatriate Group, administering Nomad Health Insurance, acting on behalf of certain Underwriters, including any organization appointed by Us to act on Our behalf.

Compassionate Home Travel

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.

Complementary Medicine/Therapies

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.

Contact Sport(s)

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.

Copay

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.

Cosmetic surgery

Surgery performed primarily to change or restore physical appearance.