Insurance plans can be complex at the best of times, but when insurance companies start to throw in all these different terms, sometimes it can become a mini mine field trying to navigate through everything.
That is why we have created the eStudent insurance terms section to help you understand what all these words means.
Your insurance premium is the amount you will need to pay in order to actually purchase the policy. Travel insurance plans are full payment plans, which means you will need to pay the full cost of the policy upfront in order to receive coverage. Student health insurance plans however sometimes offer monthly payment options along with full payment options.
A deductible is the first dollar amount you will need to pay before you insurance plan will actually kick in and start to pay your insurance benefits. For most plans you have the option to select what deductible you would like, with many plans offering options from $0 up to $2,500, and as you increase your deductible your insurance premium will decrease. There are two main types of deductible, either a “one time payment deductible” where you pay the deductible once per policy period, and a “per injury/illness” deductible that you will need to pay for each new injury and illness you receive medical care for.
A copay is similar to a deductible, but a little different. It is still an amount you need to pay but is typically paid for every visit. For this reason copays tend to be smaller amounts.
When you have coinsurance on an insurance plan, this is the percentage amount that the insurance plan will cover for your expenses. For example, it is common on many plans to have an 80/20 coinsurance, which means the insurance will pay 80% of expenses and then the remaining 20% will need to be covered by you. If you have 100% coinsurance, then the insurance plan will pay all your eligible expense under the policy.
A provider is any medical facility or medical professional where you can seek medical care from. For example, the most common types of providers are doctors, walk-in clinics, urgent care centers and hospitals.
Your insurance network is a list of providers that will accept your insurance plan. In many cases, your insurance network will also facilitate direct billing (meaning you will not have to pay out of pocket, apart from your deductible or copay) and the fees for their services are often negotiated with the insurance company ahead of time. Other names you might hear this being called are “Provider Network”, “PPO Network” or “In-Network Provider”.
Typically an insurance benefit period is the period of time you have under the insurance plan to receive benefits. With travel health and student health insurance plans, benefit periods tend to be the time from the onset of a new injury/illness from which you can receive coverage under the insurance plan. For example if your travel plan has a benefit period of 3 months, then you can receive benefits for that injury or illness for 3 months from the initial date of first treatment, even if your insurance plan has expired. As benefit period wording does vary by insurance plan, please make sure to read your specific policy as each one is slightly different.
A pre-existing condition is any condition for which you have sought medical care for in the past. Most insurance plans will limit the look-back on this, so a pre-existing condition will be defined as one if you have sought any medical care within the last 2 years for example. All insurance plans vary, however, so you will want to make sure you read your specific wording to see how they define a pre-existing condition.
This is a requirement that you contact your insurance company as soon as possible, or within a certain time frame (normally 48 hours) of any major injury or illness. Some plans also require you, under this wording, to contact them before you can activate certain benefit (like evacuation or repatriation).
A hospital indemnity benefit will pay you the set amount as listed in the benefit table for each day you are hospitalized.
Usual, Reasonable and Customary expenses are the average cost of medical care for the geographic region that you are currently in. For example, if you are in Miami and the URC cost for a set condition is $5,000, the insurance company will pay up to this amount. Different insurance plans may calculate this slightly differently, so you will want to make sure you know what this is for your insurance plan.