Glossary of Common Health Insurance Terms

Pre-existing conditions

Pre-existing conditions are defined as: An illness or injury that has displayed symptoms or is known to the policyholder prior to the time of application for the plan. Pre-existing conditions can potentially affect an insurance company’s decision to provide coverage.

There are a number of options that we can offer in regards to pre-existing conditions.

Cover after a waiting period – A moratorium of usually 24 months is offered. If, during this time there is no treatment (check ups, medications prescribed, or symptoms displayed) sought for the condition, it may be reconsidered for cover.

Cover with a premium loading – Some conditions may be considered for coverage at the expense of a higher premium. The type of condition will affect the decision to offer coverage and some conditions cannot be covered by loading the premium.

Exclusion – In some cases, an insurance company will offer coverage but exclude the pre-existing condition and “all consequences” of that condition. If, for example, a policyholder enters a plan having declared a pre-existing condition, the insurance company will not cover any treatment related to that condition.

Group coverage – In a group with 20 or more members it is possible for all pre-existing conditions to be covered. In large groups the insurance company can decide to disregard the medical history.

Waiting Period

Some benefits of an international health insurance plan are linked to a waiting period. Waiting periods are the time from a start of a plan until the time that you can claim for a particular benefit. If, for example, the waiting period for orthodontic treatment is 10 months, then you must wait 10 months from the start of your policy before making any claims on orthodontic treatment.

Coverage options such as psychiatric, maternity, new born cover and dental will usually have waiting periods attached. Waiting periods for maternity are usually between 10 and 12 months from the start of a plan. New born cover will usually also has a waiting period of 10 to 12 months from the start of the policy.

Waiting periods will change between insurance companies and are subject to the policy conditions. When you join a plan it is important to know which benefits have a waiting period and how long the waiting period will last. Our team of experts can help you to choose plans with comprehensive cover and will advise you on any waiting periods that your coverage may have.

In-patient

In-patient treatment is defined as: Treatment at any medical facility or hospital where an overnight stay is deemed medically necessary. In-patient coverage is the core of any health insurance plan. Many in-patient plans will allow you to seek treatment from the doctor or medical facility of your choice, giving you the ability to control the quality of care that you receive. In-patient coverage will typically include:

  • Accommodation at a hospital or medical facility.
  • Costs associated with accidents and emergencies, intensive care, and surgeries.
  • All medications and prescriptions while in hospital.
  • Organ transplants.
  • Prosthesis.
  • X-rays, pathology, diagnostic tests and procedures.
  • Ambulance transportation.
  • Accidental damage to natural teeth.
  • MRI, PET, and CT scans.
  • Oncology tests, drugs, and cover for chemotherapy and radiotherapy
  • All post hospitalization treatment received within 90 days of being discharged.
  • Physiotherapy from a registered physical therapist when referred by a medical practitioner, consultant, or specialist.

Out-patient

Adding an out-patient option to a plan allows a policy holder to extend their level of cover beyond the core policy. Out-patient treatment is defined as: Treatment provided in the practice or surgery of a therapist, specialist, or medical practitioner, that does not require an overnight stay in a hospital or medical facility.

On most international health insurance plans, out-patient coverage is not included as a standard option, but this benefit can be added to a policy for increased annual premiums. Generally any plan with an out-patient option will also include in-patient coverage as well. An overall maximum benefit is usually placed on a plan with an out-patient option.

An out-patient plan will typically include, in addition to in-patient benefits, coverage for:

  • Primary consultations and treatment, including prescribed medicines, drugs, dressings, and medical practitioner fees.
  • X-rays, pathology, diagnostic tests and procedures.
  • Psychiatric treatment after 12 months of continuous cover.
  • Complementary medicine when referred by a qualified medical practitioner in the form of, osteopathic, chiropractic, homeopathic and acupuncture treatment.
  • MRI, PET, and CT scans.
  • Out-patient surgical operations.
  • Oncology tests, treatments and drugs, including Chemotherapy and Radiotherapy.
  • Physical therapy by a registered physiotherapist when referred by a medical practitioner, consultant, or specialist.

Overall Maximum Benefit

The total amount of money that an insurance company will spend on coverage is known as an overall maximum benefit. An overall maximum benefit can usually be found on many international health insurance plans. There are two types of overall maximum benefit

Annual maximum benefit
The insurer will put a limit on the cost of treatment for an insured person per insurance year. This amount will be renewed with every policy anniversary date. With an annual maximum benefit it does not matter how much is spent on medical treatment throughout the year as long as the limit is not reached.

Lifetime maximum benefit
During the entire lifetime of a policy this is the total amount that an insurer will spend on treatment. Once the lifetime maximum benefit is reached the insurance company will not pay for any further medical treatment.

Payment Options

International Health Insurance plans can be extremely flexible when it comes to payment. The policyholder can choose the currency, frequency of payment, and the method used to pay. Policies can be paid for in USD, EUR, GBR, and RMB, and payment can be in the form of a bank transfer, credit card, cheque, or cash.

To make payment easy, many international health insurance plans will offer you the choice of paying monthly, quarterly, semi-annually, or annually. However, many insurers, as a way of encouraging annual payments will increase the premium by up to 7% if you choose to spread the cost of the plan throughout the year. There may also be a slight increase in a plans premium if you choose to pay by credit card.

Some insurance companies will give a policyholder a few weeks from the start of a plan to pay the premiums, whilst other companies will not issue the policy until it has been paid for. If you are having difficulty paying for a plan, or need time to arrange your finances, we can help advise you on suitable solutions.

Chronic Conditions

Chronic conditions are defined as: A Disease or illness that has no recognized cure, is continuous over a long period of time or that remains with an individual indefinitely. Once an individual is diagnosed with a chronic condition they are likely to require treatment for the rest of their life. Chronic conditions can be severe as in the case of cardiovascular difficulties, or innocuous, such as allergies or skin conditions. Chronic conditions are among the most common and preventable medical issues. As individuals age the likelihood of being diagnosed with a Chronic Condition is higher; it is recommended that, if you are an older person, you consider buying a health insurance plan that provides protection for chronic conditions.

If an international health insurance plan covers a chronic condition in full it will be more expensive than a plan that offers only partial or no cover. Some international health insurance plans exclude chronic condition cover to keep premiums low, these plans are often attractive to young people who have less reason to be concerned about contracting a chronic condition; however, other plans will put a lifetime or annual limit on coverage. Many chronic conditions are pre-existing when a person enters a policy. We can help find a plan that will offer protection for most pre-existing or chronic condition.

Geographic Coverage

International health insurance plans will protect you anywhere in the world. There are usually two options when it comes to geographic coverage

  • Worldwide
  • Worldwide excluding the USA and Canada

Plans that include cover for North America will be more expensive as medical costs there are high. However, plans that exclude cover in North America will generally still provide protection in the USA and Canada in the event of an emergency. The exclusion only pertains to elective surgery or treatments in those countries. Plans that provide coverage in the USA are also subject to American insurance regulations.

If you do not live in, or travel to, North America it is advisable to choose a plan that excludes coverage in that region. Choosing not to have cover in North America can help keep your premiums low.

Deductibles or Excesses

A deductible is the amount of money that a policyholder will pay towards the cost of any medical treatment. When you make a claim, the deductible is subtracted from the total amount of money that you will be reimbursed. Deductibles will change with insurance plans, with some plans offering higher amounts and other plans offering lower amounts.

There are three main types of deductibles:

Per condition:
This type of deductible is applied on all treatment for a single condition or illness, and is the most common form of deductible.

An example of per condition would be: an individual has a deductible of $100. The person has an illness that forces them to go and see the doctor 3 times for a total cost of $300. The insurance company will reimburse that individual $200 for the treatment.

Annual:
A policyholder will pay a deductible on a yearly basis. After the deductible has been reached, all further medical expenses that year will be paid for by the insurance company.

Example: A policyholder has a deductible of $500. The total medical costs for a year were $2,000. The insurance company will reimburse the client $1,500.

Percentage (co-payment):
With a percentage deductible the policy holder is reimbursed a percentage of any claims made.

Example: A plan has a co-payment deductible of 15%. The policyholder is therefore responsible for 15% of the total bill. If the total cost for treatment comes to $1,000, the insurance company will reimburse the policyholder $850.

Deductibles can make a lot of difference in your plans premium. Choosing a deductible can be confusing. Our staff can help make sure that you choose the deductible that best fits your needs, and give advice on the impact that different deductibles will have on your plan.

General Exclusions

International health insurance plans will often have exclusions attached to the coverage. There are a number of standard exclusions for an international health insurance plan which we will illustrate here. It is advisable to talk to a qualified insurance intermediary when purchasing your plan in order to better understand any exclusions that may be relevant in you specific situation. 

International health insurance will generally exclude all pre-existing conditions. A pre-existing condition is said to be any disease, illness, or injury that has been diagnosed or presented symptoms prior to or at the time of application for insurance that may be known to either the insurer or the insured. Pre-existing conditions can only be covered with the approval of the insurance company at the time of application.

1 COMMENT

  1. Hi, I am looking for a PHI cover (I already have private medical insurance). My gross annual salary is about $35,000 USD and I need short-term disability insurance (wait period of 6 months), and long-term disability cover (to provide an income for me until my retirement age of 65 years old. I need cover for disability due to accident or illness. I am working in Hong Kong.

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