Important Insurance Terms
Finding an affordable student health insurance plan can be difficult, especially if there are insurance terms you don't understand. Simply having the basic understanding of insurance definitions can make the difference between having a plan that will cover you for the majority of your medical expenses and one that leaves you paying thousands of dollars.
Listed below are some of the most important definitions to know when searching for a health insurance plan.
This is the actual cost of your insurance plan. Keep in mind that the higher the premium, the higher your coverage and thus, the less you will have to pay in medical bills throughout the year.
The Deductible is the amount that you must pay out of your own pocket before the insurance company will begin paying towards any covered expenses. The deductible affects how much money you will pay to the doctor or hospital, and is typically paid at the time of treatment.
Depending on the plan, the deductible may be paid once per calendar year or once per new condition:
- Once per Year
- Once-per-calendar-year deductibles are paid once for the entire year and don’t need to be paid again until you renew for an additional year.
- Once per Condition
- Once-per-condition deductibles are paid each time you visit the doctor, unless it’s a follow-up visit for the same condition.
Like a deductible, this is the amount of money you must pay out of pocked before the insurance company begins to pay for your eligible expenses. Typically this is required instead of a deductible or coinsurance, and requires you to pay a set fee for a specific visit.
Coinsurance is a percentage of what the insurance will pay to cover your health care cost after any deductibles or copays have been met.
If you have an insurance policy with a 80% coinsurance and a medical bill of $1,000, the insurance will pay 80% or $800 and your share of the cost would be 20% or $200 (assuming there is no deductible or copay on the plan).
Provider network (also known as an in-network provider) is a group of medical providers that have contracted with the insurance company to provide health care services. In-network providers typically charge less for the same service compared to non-network providers, so using an in-network provider can save you money and they will usually accept direct payment from your insurance company.
Usual, Reasonable and Customary
Usual, Reasonable and Customary (also known as URC) is the average cost for a particular treatment in a particular geographic area. It is the amount that insurance companies use to describe the limit on how much they will pay for covered expenses.
If most providers usually charge $5,000 for a particular procedure in Chicago, the insurance company will not pay a doctor $10,000 for the same procedure. Instead, they will limit their payment amount to "Usual Reasonable and Customary" - in this example, $5,000.
Pre-existing conditions include any injury or illness that you may have prior to getting the insurance plan. The definition can vary by plan so it’s important to check with your plan to see the exact definition.
Repatriation of Remains
On most insurance plans, repatriation of remains covers the cost of returning the
insured’s body back to their home country in case of death.
Emergency Medical Evacuation
Emergency Medical Evacuation provides medically necessary transportation to the nearest qualified medical
facility, not necessarily your home country.
To learn more about Repatriation and Emergency Medical Evacuation, please read Emergency Evacuation and Repatriation Insurance.
This is the person who would receive any insurance benefits in case the policy holder was to pass away while on the insurance plan.
Return back to our "Insurance Explained" section for more information and help