Health Insurance Vocabulary

Vocabulary related to health insurance can be complex and confusing. Health insurance includes a wide range of terms that are essential to understand before choosing the plan that best suits your needs.

Before delving into key terms, it’s important to remember that health insurance is divided into two main categories:

1. Network Health Insurance: These plans allow you to access a network of specific doctors and healthcare centers that are part of the insurance.
2. Reimbursement Health Insurance: With these insurances, you have the freedom to choose any specialist or medical center, and the insurance company will reimburse you a percentage of the consultation cost.

Now, let’s explore some essential terms you should know:

1. Insurer: The insurer is the company you contract the insurance with, and it is responsible for paying healthcare professionals and hospitals.
2. Waiting Period: The waiting period refers to the period of time, starting from the insurance start date, during which certain specific coverages are not available. A common example is the waiting period for childbirth.
3. Coverage: Coverages are the services and treatments that the insurance promises to pay for. These are detailed in the policy.
4. Copayment (Copay): Copayment is a fixed amount that the insured must pay each time they receive medical services. Insurances can be with or without copayments.
5. Health Declaration: This form collects information about the insured’s health status and circumstances that may affect the insured risk.
6. Policy Term: Health insurances generally have an annual term. You can cancel the contract with one month’s notice before the end of the period.
7. Actuarial Age: Actuarial age is based on the insured’s nearest age at the policy start date.
8. Formal Elements of Health Insurance: These elements include the application and the policy, which regulate the relationship between the parties and detail rights and obligations.
9. Personal Elements of Health Insurance: The parties involved in the insurance contract are the insurer, the policyholder (who purchases the insurance), and the insured (who receives medical assistance).
10. Preexisting Condition: It refers to health conditions that exist before purchasing the insurance and may be excluded from coverage.
11. Premium: The premium is the cost of the insurance, typically paid monthly or through other agreed-upon methods.
12. Effective Date: It is the moment when the insurance coverages start to be effective, usually when the first premium is paid.

We hope this vocabulary helps you better understand health insurance and make more informed decisions when choosing your health coverage.