Insurance policies are complex. And expat medical insurance plans are no different. As a broker, one of our main jobs at RIVIERA EXPAT is to help our customers understand the cover they are buying and match it precisely to their needs.

To help, we’ve listed some of the key terms you’ll come across in your policy wordings and other documents, and explained them in easy to understand language.

Out-patient Treatment
When your medical treatment is administered during the day and no overnight stay is required, you’re referred to as an out-patient.

In-patient Treatment
When your medical treatment requires an overnight stay, you’re referred to as an in-patient.

Pre-existing conditions
Any existing medical conditions that you have when you apply for a new health insurance policy. It’s important to declare all pre-existing conditions when applying for cover from a new insurer.

An insurer’s network of medical facilities and consultants. Insurers will encourage you to seek treatment in one of their network facilities that they have an agreement with. To encourage you they will offer you incentives – such as direct settlement of your bills with the medical provider.

Occurs when your insurer decides that the treatment you need is not available locally. This may happen when for example, in an emergency if you have been involved in an accident in a remote location. You may also be evacuated when you have contracted a specific condition that requires you to be moved (under medical supervision) to a different country to access the care you need.

Occurs when you choose to have your treatment in your home country. Terms vary by insurer but typically international private medical insurance allows you to access the treatment you need in your home country. In reality, this option is rarely chosen due to the effort of travelling home and the typically high standard of treatment that can be obtained locally. It’s worth noting that special circumstances apply for policyholders wishing to be repatriated to the USA.

Cash benefit
Some aspects of treatment such as hospital stays, come with the option to choose a cash benefit over the standard policy benefit. If your policy provides for a private hospital room, for example, you may be able to choose a per-night cash benefit if you stay in a semi-private ward instead.

Annual Plan Limit
The maximum amount of money your insurer will pay out for your treatment in any one policy year. Annual plan limits for international private medical insurance tend to be very high so the limit is not often reached.

Benefit Level
Individual benefits under a plan will have their own annual pay-out limits. This can come in the form of a monetary amount or a maximum number of sessions. The number of sessions limit is commonly used for treatments such as physiotherapy.

Chronic Conditions
Medical conditions that recur frequently, are long lasting or permanent. Diabetes, cancer and HIV are examples of conditions that fall under this category. Chronic conditions should always be declared when you initially apply for your insurance cover.

Waiting Period/Moratorium
This refers to the period of time from the start of the policy when the policy doesn’t cover a particular treatment. For example, with maternity cover you usually have to wait 10 months from the start of your policy until you can make a claim.

Usual Country of Residence
The country where you usually live/spend most of you time.

Deductibles and Excesses
Deductibles and Excesses can make a big difference to the level of cover you receive and the premium you pay.
A deductible is the upfront amount that you have to pay before your insurer will cover the cost of treatment (in your year of cover). So if you have opted for a £1,000 deductible, and your first two claims cost £500 each, you’ll need to cover all of these costs yourself. However, once you’ve paid out the £1,000, the insurer will cover the full cost of any subsequent treatment – even minor claims – until your cover expires.
Excesses are the amount paid by you out of your own money each time you claim for a particular treatment during your policy year. The insurer will usually pick up the remainder of the cost. So, for example, if you have an excess of €100 on your policy and your medical treatment costs €2,000, you will need to pay the first €100 and the insurer pays the remaining €1,900.

These are just a few of the terms you’ll come across when reviewing your International Private Medical Insurance policy wording or dealing with your insurer when making a claim. Although the language used can be a little confusing at times, it’s worth remembering that your broker should always be on hand to help you understand your policy and make the most out of your cover.