Insurance Glossary

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Member

In the International Health Insurance policy (Preferred & Preferred Plus):

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.

In the contect of juvo:

The person who has access to the membership program called juvo for 12 months from the start of the membership granting access to ancillary services and features not related to the insurance policy.

Mental Health Disorder(s)

A mental, nervous or emotional Illness which generally denotes an Illness of the brain with predominant behavioral symptoms; or an Illness of the mind or personality, evidenced by abnormal behavior; or a disorder of conduct evidenced by socially deviant behavior. Mental Health Disorders include, without limitation, those psychiatric Illnesses listed in the current edition of the International Classification of Diseases as published by the US Department of Health and Human Services and those psychiatric and other mental Illnesses listed in the current edition of the Diagnostic and Statistical Manual for Mental Disorders of the American Psychiatric Association.

Natural Catastrophe

In the context of juvo, this benefit includes:

The program will cover the costs of Crisis Evacuation by the Emergency Response Provider for the member(s) and Additional Costs if there is a Natural Catastrophe occurring in or in close proximity to the Country of Assignment (or where travel is taking place to) which, in the opinion of the Emergency Response Provider, and with Our agreement, places the member(s) in physical danger and causes the location in which the member(s) is located to suffer any one of the following difficulties (a) loss of all power and/or utilities, (b) the closure of all medical facilities, and/or(c) a shortage of reliable and/or safe sources of food, water and/or fuel, and such difficulties result in the complete cessation of Your operations in that location.

Natural Disaster

In the context of juvo:

Widespread disruption of human lives by disasters such as flood, drought, tidal wave, fire, hurricane, earthquake, windstorm or other storm, landslide or other natural catastrophe or event resulting in immigration of human population for its safety. The occurrence must be a disaster that is due entirely to forces of nature and could not reasonably have been prevented.

Needle Stick Injury

A break in the skin caused by a hypodermic syringe or other type of needle for surgical or medical use, which was caused during, or immediately following, administering surgical or medical Treatment.

Newborn

A baby who is within the first 16 (sixteen) weeks of its life following birth.

Newborn care

In the context of Nomad Health Insurance (Select plan)

Treatment received by a newborn child from the date of birth until 30 days following discharge from Hospital, provided that an Application Form has been completed and accepted by Us for the child within fourteen days of birth. No other benefits are available to newborns until 30 days following birth, which shall be the child’s Effective Date (or as noted in the Policy Schedule, if later) when the selected Plan Benefits ,Exclusions and Rules apply.

Nursing at home

Services provided in Your home by a qualified nurse, following Inpatient Treatment, which is prescribed by the treating Physician or Specialist.

Oncology

A malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant includes but is not limited to leukaemia, sarcoma and lymphoma.

Out of Pocket Costs

In the context of Nomad Health Insurance (Select, Primary Plus and Primary plans):

The expenses that a covered person must pay out of his or her own pocket. It includes such things as coinsurance, deductibles, excess, copay, etc.


Out of Pocket Expenses

In the context of International Health Insurance (Preferred and Preferred Plus plans):

The maximum amount that is your share of covered healthcare costs, including the money you pay for deductibles/excesses, co-pays, and coinsurance.

Out of territory

Any Treatment received outside of Your Geographical Treatment Area that was selected for the policy purchased.

Outpatient treatment

Medically Necessary Treatment received when You are not an Inpatient and are not receiving Day Care Treatment.

PACS

The person linked to the Insured member by a civil union, in force (article 515-5 of the French Civil Code).

Palliative Treatment

In the context of International Health Insurance (Preferred & Preferred Plus plans):

Aimed at alleviating the physical or psychological suffering of a progressive, incurable, chronic medical condition.

Parent Accomodation

Benefits are limited to costs incurred in respect of Hospital accommodation of a parent or guardian insured under this plan accompanying an insured dependent, who is under the age of 18, receiving covered Inpatient Treatment.

Physician

A medical or dental practitioner who is registered and legally licensed to practice medicine or dentistry in the country where Treatment is provided and who is not a relative of the Insured Person.

Physiotherapy

In the context of International Health Insurance (Preferred & Preferred Plus plans):

Physiotherapy prescribed by a certified doctor only for medical purpose. The "Mensendieck" physiotherapy is also included.

Policy

The legally binding document between Us and You providing insurance cover as detailed within. Your Policy Schedule, Benefit Schedule, Geographical Coverage Schedule, Your Application Form together form the Policy and must be read in conjunction with each other.

Policy Anniversary Date

The anniversary of the Policy Commencement Date.

Policyholder

In the context of International Health Insurance (Preferred & Preferred Plus plans):

The legal entity which signs the policy which is the object of the Insurance leaflet, for the benefit of its Members.

Political Evacuation & Repatriation

Transportation of an Insured Person to an alternative country or location, and/or to the Insured Person’s Home Country, which becomes necessary due to Political Threat in the proximity of the Insured Person.

In the context of juvo, Political Evacuation benefit is included as such:

In the event that the Country of Assignment of the member is experiencing Political Instability, the program will cover the costs of Crisis Evacuation by the Emergency Response Provider for the member and Additional Costs if:

  1. Officials of the Resident Country where the Insured's headquarters are located or of the Resident Country issuing, for reasons other than medical, an updated recommendation that categories of person which include the member(s) should leave the country in which such Insured Person(s) is temporarily resident or visiting, and/or
  2. the increase in Political Instability in the Country of Assignment materially contributes to the Risk Rating equalling or exceeding the relevant Risk Rating TriggerPoint for that country set out in the Schedule; and/or
  3. The increase in Political Instability in the Country of Assignment (or where travel is taking place to) that in the opinion of Response Consultants and with Our agreement places the member(s) in physical danger that requires crisis evacuation and/or
  4. a member(s) is expelled or declared persona non-grata on the written authority of the legal government of the Country of Assignment.

Political Threat

Political and/or military events which have created a situation in which the Insured Person is in danger of or has incurred serious bodily harm.

Political instability

In the context of juvo:

The failure and/or inability of the authorities to uphold law and order due to political change and includes Civil Commotion, Insurrection, Rebellion, Revolution and/or Coup d’Etat.

Pre-Existing Condition

A Medical Condition, or a mental health disorder or any Related Condition for which You have suffered symptom (whether investigated or not), received Treatment or sought advice, prior to Your Date of Entry to the Plan. (as defined in the context of International Health Insurance: Preferred & Preferred Plus plans)

In the context of Nomad Health Insurance (Select, Primary Plus and Primary plans:

Any condition, disease, Illness or injury, secondary or associated complaint where you have sought or received advice, treatment, therapy, been submitted to a special diet or shown symptoms in the two years prior to your effective date (whether or not the condition has been diagnosed).

Any (1) condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the two (2) years immediately preceding the Certificate Effective Date; (2) condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the two (2) years immediately preceding the Certificate Effective Date; (3) Injury, Illness, sickness, disease, or other physical, medical, mental, or nervous condition, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of the Insured Person’s Application or within the two (2) years immediately preceding the Certificate Effective Date.

Pre-authorization

The requirement to contact Our helpline to obtain written authorization, in advance of receiving any Treatment.

Precertification Authorization

A cost containment technique which requires physicians to submit a treatment plan and an estimated bill prior to providing treatment. This allows the insurer to evaluate the appropriateness of the procedures, and lets the insured and physician know in advance which procedures are covered and at what rate benefits will be paid.

Preferred Provider Organization (PPO)

If your plan has a PPO, it is a network/managed care organization that they want you to go to an incentive you to participate in, and if you go to a provider outside the PPO you will be penalized.

A managed care organization of doctors, hospitals and other health care providers who have agreed with an insurer or a third-party administrator to provide healthcare at reduced rates to the top insurer's or administrator's clients.A PPO administrator executes a contract with a benefit plan sponsor, third party administrator, or insurance carrier by whose terms the payer agrees to pay bills submitted by medical service providers, within a certain time period and with certain restraints on what the payer can do with the claims, in exchange for the provider accepting a reduced (discounted) payment as payment in full (meaning the provider will not balance bill the patient). The PPO administrator executes a contract with medical service providers as well, regarding the same arrangement.

Premium

The amount of money charged for the insurance coverage reflecting an expectation of loss.


Prescribed Medicine & Drugs

Benefits are limited to Covered Charges for prescribed medicine and drugs, whose sale and use are legally restricted, by the order of a Physician.

Prescription Savings Program

A savings program for when you are in the United States that is simple to register for online then simply present your ScriptSave WellRx card at any of the thousands of participating pharmacies nationwide to receive your instant savings. It's that easy! Just show your card to the pharmacist each time you pick up your prescription, whether you're filling for the first time or refilling. There is no paperwork to complete and no limit on usage.

Primary Insured

The main applicant for cover and the person who is responsible for paying the premium.

Producer

An individual who sells, services, or negotiates insurance policies either on behalf of a company or independently.


Proof of Claim

A completed and signed Claimant’s Statement and Authorization form, together with any/all required attachments, original itemized bills from Physicians, Hospitals and other Medical Providers, original receipts for any expenses which have already been paid by or on behalf of the Insured Person, and any other documentation that is deemed necessary by the Underwriters.

Reasonable and Customary

As defined in the context of International Health Insurance (Preferred & Preferred Plus plans):

The standard fee that would typically be charged in respect of Your Treatment costs in the country where the Treatment took place.

As defined in the context of Nomad Health Insurance (Select, Primary+ & Primary plans):

The average cost of any Covered Charge within any particular region, area or country as determined by Us.

Rebellion

In the context of juvo:

A deliberate, organised and open resistance by force of arms to the laws or operations of a government by its citizens or subjects.

Registered Nurse

A graduate nurse who has been registered or licensed to practice by the local authority Board of Nurse Examiners or any other authority, and who is legally entitled to place the letters “RN” after his or her name.

Reinsurance

A transaction between a primary insurer and another licensed (re) insurer where the reinsurer agrees to cover all or part of the losses and/or loss adjustment expenses of the primary insurer. The assumption is in exchange for a premium. Indemnification is on a proportional or non-proportional basis.

Reinsurer

A company assuming reinsurance risk.

Relocation

In the context of juvo:

The return of a member to the Host Country following a Crisis Evacuation; or the dispatch of alternative member(s) to the Host Country provided that the total number of member(s) involved in any such Relocation does not exceed the total number subject to the Crisis Evacuation.

Relocation Assessment expenses

In the context of juvo:

The costs, up to the sub-limit specified in Item in the Schedule, of initial assessment and specialist advice in preparation for Relocation.

Relocation expenses

In the context of juvo:

The cost of economy class fares on any licensed common carrier operating from a published timetable in the course of Relocation, provided always that such costs and expenses so incurred shall not be payable where incurred beyond a period of one hundred and twenty days from the completion of the Crisis Evacuation.

Repatriation of Remains

A benefits that pays for covered charges for the preparation and the air transportation of the mortal remains of an insured person from the place of death to the home country.

Resident Country

In the context of juvo:

The country in which the Insured Person(s) is ordinarily resident.

Revolution

In the context of juvo:

The overthrow of a regime or political system by its citizens.

Riots

In the context of juvo:

A violent disturbance by a group of persons assembled together for a common purpose which threatens the public peace.

Room and board

The Reasonable and Customary Covered Charges for the cost of a ward, semi-private or private Hospital room and associated costs.

Second Opinion for Surgery

A benefits are that is payable for a second opinion by a Specialist if the Insured Person is due to undergo a major Surgery. If the second opinion differs from the first opinion, benefits will also be payable for a third opinion by a Specialist.

Sexually Transmitted Diseases

The following are defined as sexually transmitted diseases: syphilis, gonorrhea, lymphogranuloma venereum, chancroid, granuloma inguinale, chlamydiosis, pelvic inflammatory disease, trichomoniasis, genital candidiasis, genital herpes, genital warts, amebiasis, viral hepatitis, scabies, crab lice, cervical dysplasia, and bacterial vaginitis.

Sickness

An illness or disease or body impairment, which is not a consequence of an Accident and which requires Treatment.

Specialist

A Physician who is classified by the country’s health authorities as a Physician with superior or special expertise in specified fields of medicine or dentistry.

Spouse

Husband or wife of the employee who is neither divorced nor legally separated. For the purpose of this policy (International Health Insurance, Preferred & Preferred Plus plans), a Civil Partner or a cohabitant as defined above is considered Spouse.

Strikes

In the context of juvo:

A work stoppage to enforce demands made on an employer or to protest against an act or condition.

Student Health Center

A medical facility operated by an Educational Institution for the care and treatment of its students, faculty and administration.

Surgery

Incision, excision and suturing of wounds (excluding removal of suturing), electrocautery, cryocautery, laser and ultrasonic techniques, reduction of a fracture and dislocation by manipulation or endoscopic procedures.

Terrorism

In the context of juvo:

An act or series of acts, including the use of force or violence, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organisation(s) committed for political, religious or ideological purposes including the intention to influence any government and/or to put the public in fear for such purposes.

Third Party Administrator (TPA)

A third-party administrator (TPA) is an organization that processes one ore more of the following services for a separate entity (insurance company); claims, assistance, customer support, emergency response, and underwriting. A legal entity entrusted by the Insurer to carry out legal actions, services or specific activities on its behalf.

Travel Outside Your Geographical Area

A benefit on Nomad Health Insurance plans that is payable for covered charges received outside Your Geographical Treatment Area for new incidents of Accidents and Illnesses, which you would not have reasonably expected prior to traveling. Each period of travel covered by this Benefit is subject to the trip being for no more than 30 days in total duration from the date you leave Your Geographical Treatment Area to the date that you return to Your Geographical Treatment Area. The benefit is limited to a maximum of €50,000 per insured person, per trip.

Travel Warning; Emergency Travel Advisory

Published statement or website document issued by the UK FCO, US Department of State, Bureau of Consular Affairs, Centers for Disease Control and Prevention, United Nations, World Health Organization or similar government or nongovernmental agency of the Insured Person’s Home Country, warning that travel to specified countries, regions or locations poses serious risks to safety and security or exposes the Insured Person to a greater likelihood of life-threatening risks, including, without limitation, US Department of State Travel advisory levels “3 – Reconsider travel” and “4 – Do not travel”.

Travel costs

In the context of juvo:

The cost of travel out of or within the Host Country by the most appropriate mode of transport in the prevailing circumstances of the Crisis Evacuation.

Treatment

In the context of International Health Insurance (Preferred & Preferred Plus plans):

Medical procedure necessary to cure or to alleviate illnesses or injuries.

In the context of Nomad Health Insurance (Select, Primary+& Primary  plans):

The Medically Necessary Treatment, Surgery, Advice, provision of medication, provision of medical procedures under the direction a Physician or Specialist to cure or relieve an Accident or Illness.

Underwriter

Insurance underwriters assume the risk involved in a contract with an individual or entity.

The underwriter for World Explorer Travel Insurance plans (Triptime) is Point Comfort Underwriters, an approved Coverholder for Lloyd’s, London and as such, has authority to quote, bind and administer a range of insurance products on their behalf.

The underwriter for Nomad Health Insurance plans provided by Expatriate Healthcare is Guardrisk Insurance Company Mauritius Ltd PCC, authorized and regulated by the FSC in Mauritius (Registrationnumber: C142417/C1/GBL).

Urgent Care Center

In the context of International Health Insurance (Preferred & Preferred Plus plans):

A medical facility that can provide medical treatment for a disease/injury which is urgent but not life-threatening.

In the context of Nomad Health Insurance (Select, Primary+ & Primary plans):

A stand-alone facility, or a facility located inside a Hospital that staffs Physicians. Urgent Care Centers provide medical services for Injuries and Illnesses that are not life-threatening. Urgent Care Centers have onsite x-ray equipment and provide treatment for more severe urgent care services, such as broken bones, burns and other non-emergent conditions that Walk-in Clinics are unable to treat.

Vacinnations

In the context of International Health Insurance (Preferred & Preferred Plus plans):

Injections required by the Health Authorities of the country of expatriation or the country of origin. Consulting fees and purchasing fees of vaccinations are covered.

Waiting period

Period during which a Member is not entitled to some benefits.

Walk-in Clinic

A medical facility that provides medical services for minor Injury or Illness. The clinics are often found in or near retail establishments or pharmacies. The staff providing medical services are usually nurse practitioners and Physician assistants.

War

In the context of juvo:

Declared or undeclared hostile action between two or more nations or states.

juvo

A membership program that provides features and services outside of an insurance policy. It is a fully funded, prepaid, fully indemnified program of benefits for a 12 months period that grants access to airport lounges via instaPass and Priority Pass, cybersecurity benefits, crisis response and evacuation benefits, mental health and virtual health services, perks and discounts.

subrogation

An insurer’s rights at law to take over the insured’s rights, following a claim payment to recover the payment from a third party responsible for the loss.