JMMB

Acute
Occurring over a short time, usually a few minutes or hours

Anaesthetist
A physician, nurse or technician trained to administer anesthetic, that is drugs or other agents that cause insensibility to pain.

Anesthetic
Drugs that cause loss of sensation to pain or awareness.

Anniversary date
Twelve months from effective date of plan, and the same date in each year thereafter.

Annual benefits
The amount that the insurer will pay for a specific service within any year. The allocation will renew on the policy anniversary

Antiselection
The tendency of people with a greater-than-average likelihood of loss to apply for or to continue insurance cover to a greater extent that other people. Also called adverse selection or selection against the insurer.

Basic benefit
In a Blue Cross policy refers to the annual benefits

Broker
A person who arranges insurance business with insurers on behalf of prospective policyholders or who in any manner solicits, negotiates or procures insurance or the renewal or continuation thereof on behalf of insurers

CAT Scan
Computerized Axial Tomography Scan – X-ray imaging that forms a full 3-Dimensional computer model of a patient’s insides. Doctors can even examine one narrow slice at a time to pinpoint specific areas

Chemotherapy
Drug treatment for cancer. It is usually a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body.

Chronic
Occurring over a long period of time, several weeks, months or years e.g. persons who are hypertensive have a chronic illness

Claim
A request for payment under the terms of an insurance policy

Claimant
The person who submits a claim. This may be the policyholder, beneficiary, or a person acting on behalf of the policyholder or beneficiary. Health insurance – the insured is the person who submits the claim form.

Co-insurance
A provision that requires the insured to pay a percentage of all eligible medical expenses, that result from sickness or accident.

Consultation
First visit to a consultant physician or specialist on recommendation from another doctor

Deductible
The portion of medical expenses that the insured must pay before the insurance company makes any benefit payment under a health insurance policy. The deductible is per insured per policy year.

Dread disease coverage
A type of specified expense coverage that provides benefits for medical expenses incurred by an insured who has contracted a specified disease.

Due date
Date on which a premium is due to be paid

ECG
Electrocardiogram – records the electrical activity of the heart from the surface of the chest using electrodes placed on each arm, leg and chest. Gives doctor information about the heart rate, heart rhythm, blood supply, heart attack, enlargement of the heart etc.

Endoscopy
A method used to examine the internal parts of the body, by using tubes (rigid or flexible) with a scope at the end e.g. colonoscopy-examination of the colon, laproscopy – examination of body cavity -look at ovaries etc

EOB
Explanation of Benefits – explanation of claim payments usually sent to customer with cheque representing reimbursement.

Health Insurance
A type of insurance that provides protection against the risk of financial loss resulting from the insured person’s sickness, accidental injury, or disability.

Inoculation
Immunization

Insured
The policyholder and / or all other persons whose life or health is insured under an insurance policy

Insurer
Means a company carrying on insurance business

Lapse
Termination of a policy because of non-payment of renewal premiums.

Lifetime Benefit
This refers to a maximum benefit per individual in the life of a health insurance plan. The benefit reduces with each claim made against the plan and may be exhausted.

Maternity on individual
YES —women on individual plans will have their maternities covered as per contract. No – women on an individual plan will not have maternity covered.

Major Medical [mm]
Usually a substantial lifetime benefit from which all claims are paid, except the annual (or basic) benefits. However, once some annual benefits are exhausted, future claims are paid from the major medical after the deductible is satisfied.

Medical visits
Doctors visit during an hospitalization. Sometimes called hospital medical visit.

MRI
Magnetic Resonance Imaging. Imaging technique used to diagnose many tissue defects and abnormalities, by using magetic pulses.

Outpatient
Patient who is treated at a hospital but not admitted. Will not stay overnight in hospital.

Overage dependent
Children on health plan usually over the age of 18. To stay on their parents plan must be between ages 19-23 and a full time student in a tertiary institution.

Overseas Non-Emergency
A provision that allows for procedures that cannot be accessed locally and where overseas treatment is recommended, for some or all of the clients eligible medical costs to be paid, if permission was granted by the local provider.

Overseas Emergency
Overseas emergency benefits may be accessed while overseas for thirty days or less, if a life threatening illness or condition, or accident occurs within that period of being overseas.

Prescribe Drugs
Drugs prescribed by a licensed physician for or during a course of treatment, while not confined to bed as a patient in private or public hospital.

Policyholder
Mean the person who for the time being has legal title to a policy (the owner).

Premium
A specified amount of money that the insurer receives in exchange for its promise to provide a policy benefit when a specific loss occurs.

Radiotherapy
The treatment of disease with ionizing radiation. In radiotherapy, high-energy rays are often used to damage cancer cells and stop them from growing and dividing. Radiation treatment is usually specific to the area being treated.

Reinsurance
A type of insurance that one insurance company (the ceding company) purchases from another insurance company (the reinsurer), in order to transfer risks on insurance policies that the ceding company issued.

Reinstatement of lifetime maximum
Where the lifetime maximum under a policy has been exhausted, this might be reinstated, by submitting new application forms, for the company to determine eligibility.

Renal Dialysis
Renal-having to do with the kidney. Dialysis-the process of cleansing the blood by passing it through a special machine. Dialysis is necessary when the kidneys are not able to filter the blood.

Renewal premiums
Premiums that are payable after the initial premium and that are a condition for continuation of the policy.

Renewal provision
A health insurance provision that describes the circumstances under which the insurer has the right to refuse to renew or to cancel the coverage and describes the insurer’s right to increase the policy’s premium rate.

Risk
The possibility of injury, disease or death. For example, for a person with measles, the possibility of death is one in one million.

Specialist visit
Visits to a consultant physician or specialist physician after the first consultation.

Subscribers
Members of a health insurance plan.

UCR
Usual, Customary and Reasonable charges -the maximum dollar amount of a covered expense that is considered eligible for reimbursement under a major medical policy.

Ultrasound
High-frequency sound waves. Ultrasound waves can be bounced off of tissues using special devices. The echoes are then converted into a picture called a sonogram. The ultrasound imaging, allows physicians and patients to get an inside view of soft tissues and body cavities, without using invasive techniques.

Vasectomy
A surgical procedure designed to make a man sterile by cutting or blocking both the right and left vas deferens, the tube through which sperm pass into the ejaculate.

Waiting period
A specific period after commencement of a health insurance policy before some benefits are paid.