Insurance jargons – 7 essential insurance terms you must know

If you’re an HR professional in the UAE, here are the 7 top essential medical insurance terms you should know.

Medical insurance is mandatory in Dubai and Abu Dhabi, which means that the HR professionals are responsible to answer insurance benefits questions along with other HR tasks. While it can be challenging to know medical insurance inside out, it sure helps knowing what the most commonly used terms mean. We have compiled a list of seven insurance jargons that every HR professional in the UAE should know.

Co-pay: It is the flat fee that the customers must pay at the time of a treatment or service. For example, if your co-pay amount is AED 50 for a physician’s visit, then you must pay AED 50 each time you visit the doctor. You are still responsible for the deductibles and coinsurance. Do note, co-pay is not included in every health insurance plan.

Deductibles: This the amount you pay before your health insurance provider begins to share in the cost of the covered benefits. If you have a yearly deductible of AED 500, you must pay that amount before your health insurance plan starts to pay. Your monthly premiums do not contribute to the deductible amount.“The doctors and providers in this list are called in-network which means they will accept your health insurance and charge you as per the details in your plan.”

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Co-insurance: This is the percentage of the medical costs you pay after the deductibles have been met. For example, if you have a co-insurance of 20% and the deductibles have been met already, you will pay only 20% of the next medical bill while the insurance company covers the remaining 80%.

In-network and out-of-network: With the purchase of every health insurance plan, you will receive a network list. The hospitals and clinics mentioned in your network list are contracted with and approved by the insurance company. The doctors and providers in this list are called in-network which means they will accept your health insurance and charge you as per the details in your plan. Any hospital or clinic that is not included in the network list is called out-of-network. In such cases, you end up paying out of pocket for the treatment or service and must file claims for reimbursement.

Pre-existing condition: Any personal illness or health condition that was known and existed before the writing and signing of health insurance is a pre-existing condition. Typically, insurance companies do not provide coverage for a pre-existing condition until a period has elapsed, or in some cases, insurers do not provide coverage at all.

Out of pocket maximum: The most you must pay from your pocket for covered services in a year is the out of pocket maximum. You spend this amount on deductibles, co-insurance and co-pay after which, your health insurance covers the entire cost of the covered benefits.

Exclusions: Anything that is not covered by your policy is called an exclusion. No insurance plan can cover all the treatments and services; exclusions are a must in every health insurance policy. Exclusions can be in the form of certain treatments, waiting period where you cannot make any claims related to a policy benefit until a certain time has passed or excluded hospitals and clinics.

Insurance can be overwhelming to understand, but it is important to remember that the basics of insurance remain the same, whether that is corporate, individual or family insurance in the UAE. Make sure you do your research and talk to your insurance provider or broker if you have any questions or queries specific to your group health insurance plan.