Our glossary explains some common health insurance jargon.
The world of insurance can seem a scary place to the uninitiated. Health coverage, life insurance, premiums, co-payments, deductibles, the list goes on. All this insurance jargon can make shopping for and understanding your insurance plan very daunting.
For expats and their families health insurance is usually a necessity, whether provided by your employer or bought yourself. So, what exactly are you getting?
While there are people who are familiar with insurance words and terminology used by insurers, there are many others who don’t know their deductibles from their co-insurance provision.
Read on for a list of some common insurance terms explained in simple terms:
Aggregate benefit maximum
This is maximum amount an insurer will pay out over the entire duration of a policy. Note the difference between this and a policy year maximum – this is the maximum your insurer will pay per year. Once you hit your policy year maximum your cover will cease until the next coverage year. If the aggregate benefit maximum is reached, you will no longer be covered under any circumstances.
Ancillary products
Additional products such as dental insurance or maternity cover which can be added to the plan for an additional fee.
Co-insurance
This charge is usually only applied after you have satisfied any deductible or co-payment obligations. This amount is expressed as a percentage of the allowable charge for a medical service. For example, your insurance provider may cover 80% of the cost of a particular treatment and you will be obliged to pay the remaining 20%.
Co-payment (co-pay)
This is a specific charge your insurer may require you to pay for certain treatments or services. For example you may have to pay €15 towards a doctors visit or a brand name drug and your insurance will pay the remainder of the cost.
Deductible
This is the amount of money you will have to pay each year yourself before your insurance will reimburse you. The exact details vary between policies so double check your deductible details.
Dependent coverage
Health coverage which has been extended to cover the policyholder’s spouse and/or children. The extent of coverage may depend on the age of the children.
Drug formulary
A list of drugs and medications available on your health plan. Your insurance may only pay for the medication specified on this list.
Out of pocket costs
These are what you pay for medical services, drugs etc. over your monthly premium. Co-payments, co-insurance and deductibles come under this label.
Pre-existing condition
A health condition that existed before you took out your insurance policy. Common ones include diabetes, high blood pressure, asthma, heart disease and cancer. In some cases an insurer may provide cover for treatment related to a pre-existing condition.
Premium
Typically charged monthly, this is the amount you pay for your health insurance. If your insurance is through your employer they will be responsible for paying your premiums.