Insurance Definitions & Glossary

If you're wondering what something means then check out this article. We've put together a list of some of the common terms you’re likely to encounter when purchasing medical insurance in the UAE.

Acute Condition - A disease, illness or injury that is likely to respond to treatment which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery. 

Application Form - The form that you complete and send to us for submission to your insurer of choice. Any declarations that you make during your enrollment for yourself and any beneficiaries (dependents) (for example declarations on pre-existing conditions) will be included in the application form. 

Beneficiary - Any other people covered by your policy, as named on the insurance certificate. 

Benefits Provider (also referred to as Network Provider) - The recognized medical practitioner, hospital or clinic, or any other service provider, which is covered in your insurance plan’s network list and provides you with any covered benefits.

Cancer - A malignant tumor, tissues or cells, characterized by the uncontrolled growth and spread of malignant cells and invasion of tissue.

Certificate of Continuity (also referred to as a COC) - A certificate or letter given by a health insurance company of a cancelled health insurance policy. It states the details of the insurance policy along with the period of health insurance coverage.

Certificate of Insurance - The certificate issued by the insurance company which shows the policy number, start date, the outpatient copays (if applicable), details of who are covered and any conditions that are covered (if applicable) at an additional premium. 

Clinics - A health care facility which is registered or licensed in the country in which it is located, primarily to provide care for outpatient treatment and where care or supervision is by a medical practitioner. 

Complementary Therapist - Such as an acupuncturist, homeopath, reflexologist, naturopath or Chinese medicine practitioner who is fully trained and legally qualified and permitted to practice by the relevant authorities in the country in which the treatment is received. 

Congenital Condition - Any condition present at birth, whether diagnosed or not.

Copay - This is the amount you pay to your healthcare provider every time you visit them for treatment. This is typically calculated either as a flat fee or as a percentage of your treatment bill. You pay your copay amount, your insurance company pays the rest.

Country of Nationality - The country of nationality specified by you in your application form or as advised to us or your insurer in writing, whichever is the later.

Country of Residence - The country of residence specified by you in your application and shown in your insurance certificate, or as advised to us or your insurer in writing, whichever is the later. The country you specify must be the country in which the relevant authorities (such as tax authorities) consider you to be a resident of for the duration of the policy.

Covered Benefits - The medical treatments and benefits shown as covered in your health insurance plan. 

Day-Patient -  A patient that is required, as part of their medical treatment, to stay in a hospital bed only during the day (not at night).

Dependents - Any other people covered by your policy, as named on the insurance certificate. Examples would be your spouse or your children.

Diagnostic Tests - Investigations, such as X-rays or blood tests, to find the cause of your symptoms. 

Dietician - Practitioners must be fully trained and legally qualified and permitted to practice by the relevant authorities in the country where the treatment is received.

Direct Billing - An arrangement between the insurance company and a medical provider (hospital or clinic), where the medical provider sends bills for services directly to your insurance company. This means that you do not have to put in a separate claim with your insurance company. In order to get treatment on a direct billing basis you need to visit a medical provider that is within your network of coverage in your insurance plan. 

Doctor - A person who is legally qualified in medical practice and is licensed to practise medicine in the country where the treatment is received. 

Emergency - A serious medical condition or symptoms resulting from a disease, illness or injury which arises suddenly and, in the judgement of a medical practitioner, requires immediate treatment, generally within 24 hours of onset, and which would otherwise put your health at risk. 

Epidemic - An outbreak of a contagious and infectious disease that spreads quickly, affecting more persons than expected in a given time period, in a locality where the disease is not permanently prevalent or its normal prevalence has been exceeded. 

Geographical Scope of Cover - The area or countries where you are covered by the health insurance provider. 

Health Plan - Any insurance plans listed on our website that can be changed from time to time. 

Hospital - A centre of treatment which is registered, or recognized under the local country's laws, as existing primarily for carrying out major surgical operations, or providing treatment which only specialists can provide. 

Injury - A physical injury.

Inpatient -  A patient that is required, as part of their medical treatment, to stay in a hospital bed overnight or longer or to receive more than eight hours of continuous care in a hospital.

Intensive Care Unit (ICU) - Intensive care includes; High Dependency Unit (HDU): a unit that provides a higher level of medical care and monitoring, for example in single organ system failure. Intensive Therapy Unit/Intensive Care Unit (ITU/ICU): a unit that provides the highest level of care, for example in multi-organ failure or in case of intubated mechanical ventilation. Coronary Care Unit (CCU): a unit that provides a higher level of cardiac monitoring. 

Medical Practitioner - A doctor or a specialist who is registered or licensed to practice medicine under the laws of the country in which the treatment is provided, and who is not a beneficiary under this policy or a family member of a beneficiary under this policy. 

Medically Necessary - Treatment, medical service or prescribed drugs/medication which is: (a) consistent with the diagnosis and medical treatment for the condition; (b) consistent with generally accepted standards of medical practice; (c) necessary for such a diagnosis or treatment; (d) not being undertaken primarily for the convenience of the member or the treating medical practitioner 

Network - List of Hospitals or similar facilities, or medical practitioners that have an agreement with your health insurance provider to provide you with eligible treatment on a direct billing basis. To confirm if a provider is in your network please visit the website of your insurer as they will always have the most up to date information. .

Outpatient - A patient that receives medical treatment  at a hospital, consulting room, doctor's office or out-patient clinic where they do not stay overnight or as a day-patient to receive treatment.

Palliative Care - Treatment that does not cure or substantially improve a condition but is given in order to alleviate symptoms. 

Pandemic - An epidemic occurring over a widespread area (multiple countries or continents) and usually affecting a substantial proportion of the population.

Plan Limit - This is the overall maximum amount to be paid in total for all benefits, for each person, in each policy year. 

Physiotherapists, Osteopaths and Chiropractors - Practitioners must be fully trained and legally qualified and permitted to practice by the relevant authorities in the country where the treatment is received.

Policy - The contract of insurance between you and your insurance company.

Policy Year (Policy Period) - The 12 month period for which your policy is effective, as first shown on your insurance certificate and, if the policy is renewed, each 12 month period which follows the renewal date.

Policyholder - The main applicant set out in the application form and typically the first person named on the insurance certificate.

Pre-Existing Condition -  Any medical condition (including chronic conditions) declared in your application form or any disease, illness or injury for which you received medication, advice or treatment, or you had experienced symptoms of regardless of whether the condition was diagnosed or not, before the initial start date of your insurance policy and prior to becoming a member.

Prophylactic Surgery - Surgery to remove an organ or gland that shows no signs of disease, in an attempt to prevent development of disease of that organ or gland.

Psychiatric Treatment - Treatment of mental conditions.

Psychologist and Psychotherapist - A person who is legally qualified and is permitted to practice as such in the country where the treatment is received.

Qualified Nurse - A nurse whose name is currently on any register or roll of nurses maintained by any statutory nursing registration body in the country where the treatment is received.

Reasonable and Customary - The 'usual', or 'accepted standard' amount payable for a specific healthcare treatment, procedure or service in a particular geographical region, and provided by benefits providers of comparable quality and experience.

Rehabilitation - Treatment in the form of a combination of therapies such as physical, occupational and speech therapy aimed at restoring full function after an acute event such as a stroke.

Reimbursement - This is when you pay for your treatment costs and submit a claim to your insurance company to reimburse you for these costs. 

Renewal Date - Each anniversary of the date you joined your health plan.

Serious Acute Illness - A medical condition, or symptoms resulting from a disease, illness or injury which arises suddenly and in the reasonable opinion of the attending physician and our medical consultants, requires immediate treatment, generally within 24 hours of onset, and which would otherwise put your health at serious risk.

Specialist - A surgeon, anesthetist or physician who is registered or licensed to practice medicine under the laws of the country in which the treatment is provided, and who is not a beneficiary under this policy or a family member of a beneficiary under this policy. 

Speech Therapist - Practitioners must be fully trained and legally qualified and permitted to practice by the relevant authorities in the country where the treatment is received.

Spouse - A policyholder's legal husband or wife, who has been accepted for cover by the insurance company.

Surgical Operation - A medical procedure that involves the use of instruments or equipment.

Therapists - An occupational therapist or orthoptist, who is legally qualified and is permitted to practice as such in the country where the treatment is received.

Treatment - Surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure disease, illness or injury.

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