常用詞彙

The Alea Glossary

Accident

Any physical injury not intended by the insured person, arising from an abrupt, sudden and violent action of an unexpected and unpredictable nature with an external cause.

Accommodation Room Type

The accommodation room type selected by the insured person in respect of the policy.

Acute Medical Condition

A medical condition that is likely to respond quickly to treatment, has a definite end point and can be cured by treatment.

Add-on Plan

A plan available in addition toan existing plan that has the same plan start date as the insured person's existing plan.

Advice

Any consultation or discussion with a medical practitioner or specialist, including check-ups and the issue of any prescriptions.

Anesthetist

A Physician who is licensed and registered under an Anesthesiology of Specialist Register of an applicable medical council of a country or territory.

Annual Health Assessment

An age and gender-appropriate health review package to screen for the presence of medical conditions, where the screening is not required due to signs or symptoms, or in relation to a diagnosed medical condition. The package may include medical advice, physical examinations, and/or tests and diagnostic procedures.

Appliances

Prosthetic or surgical appliances implanted to form permanent parts of the body.

Application

The document which a person must complete and sign to agree to the terms of the health insurance plan plus any supporting information given in connection with it.

Area of Coverage

The country or territory, or part of the world in which the insured person is covered by his/her insurance.

Assisted Conception

A pregnancy that is conceived following fertility treatment, which generally includes pregnancies conceived through Intrauterine Insemination (IUI), In Vitro Fertilisation (IVF) or any other Assisted Reproductive Technology.

Beneficiary

The person, if any, designated by the policyholder as the recipient of death benefits payable at the insured person's death.

Benefit

The cover provided by the insured person's plan and shown in the benefits schedule, subject to any conditions or exclusions in the product literature or shown on the certificate of insurance.

Benefits Schedule

The document that details the benefits available under the policy and the limits available for those benefits.

Bonesetting Expenses

Charges incurred by an insured person for bonesetting treatment provided by a Chinese Medicine Practitioner as a result of injury or sickness.

Broker

A licensed intermediary that sells, solicits, or negotiates insurance on behalf of a client for compensation.

Certificate of Insurance (COI)

Document which the insurer issues to the policyholder confirming cover and specifying the insured persons, the effective date and the benefits and packages selected.

Chiropractor

A person trained and professionally qualified in the practice of chiropractic including the practice of the prevention, diagnosis and treatment of functional disorders of the human body through manipulation of the joints, particularly of the vertebral column and peripheral joints, including the pelvis; and is legally licensed and registered in a country or territory in which chiropractic treatment is rendered.

Chronic Condition

A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time and needs long-term monitoring including consultations, check-ups, examinations and tests.

Claim

The insured person's request for the insurer to cover the costs of treatment or services under the plan.

Close Family Member

A son, daughter, stepson, stepdaughter, legally adopted son, legally adopted daughter, spouse, partner, parent, step-parent, legally adoptive parent, parent-in-law, grandparent, grandchild, brother, sister, brother-in-law, sister in- law, son-in-law, daughter-in-law or legal guardian.

Coinsurance

The percentage of costs shown in the benefits schedule that an insured person has to pay towards an eligible claim.

Commencement Date

The date shown on the certificate of insurance on which the cover provided by this policy starts.

Complementary Medicines

Therapeutic services rendered by qualified or registered practitioners which may include (but isn't limited to) the following disciplines: Acupuncture, Ayurveda, Chinese medicine, Chiropractic, Homeopathy, Hypnotherapy, Naturopathy, Osteopathy, and Podiatry.

Complications of Pregnancy

This may include: Acute nephritis, nephrosis, cardiac decompensation, missed abortion, spontaneous abortion, missed miscarriage, still birth, heavy bleeding in the hours and days immediately after childbirth (post-partum haemorrhage), afterbirth left in the womb after delivery of the baby (retained placental membranes), gestational diabetes, ectopic pregnancy, puerperal infection, pre-eclampsia, eclampsia, toxemia, or hydatidiform mole and complications following any of the above conditions. It also includes a condition whose diagnosis is distinct from pregnancy but is adversely affected or caused by pregnancy, and which requires confinement or surgery prior to the full term of pregnancy to avoid the threat of permanent damage to the life or health of the mother.

Congenital Abnormality

Any genetic, physical, biochemical or metabolic defect, disease or malformation, which may be hereditary or due to an influence during gestation, and which may or may not be obvious at birth.

Congenital Conditions

Congenital Conditions means medical abnormalities existing at the time of birth, regardless of whether they are known or unknown to the insured person. They generally include (but not limited to the exclusion of others which may medically be regarded as congenital conditions), strabismus (squint), hydrocephalus, undescended testicle, Meckel’s diverticulum, flat foot, heart septal defect and indirect inguinal hernias.

Continuous Transfer Terms (CTT)

Continuation of the same underwriting terms, including any special exclusions, that applied with the previous insurer. CTT generally entails that the person is not subject to any new personal underwriting terms. Cover will still be governed by the benefits, terms and conditions of the plan.

Continuous Transfer Terms (CTT) previously FMU

Continuation of the full medical underwriting terms with a previous insurer. Cover will still be governed by the benefits, terms and conditions of the plan.

Continuous Transfer Terms (CTT) previously MORI

Continuation of the moratorium start date if the insured person had moratorium underwriting terms with a previous insurer. Cover will still be governed by the benefits, terms and conditions of the plan.

Country of Nationality or Home Country

The country or territory of the passport or identity document of insured persons listed on the application or notified to the insurer.

Country of Residence

The country or territory in which the insured person spends the greatest amount of time during the period of insurance; generally six consecutive months of the year.

Date of Joining

The date when the insured person is first enrolled, or re-enrolled if there is a break in cover.

Daypatient / Daycare

When treatment is received following admission to a hospital bed or daycare unit. A medical professional discharges the patient after the treatment and the patient does not stay overnight.

Deductible

A fixed amount the insured person pays for covered health services before the insurance plan starts to pay. Most deductibles apply per year, per person.

Dental Practitioner

A person who: - has attained primary degrees in dentistry and/or dental surgery by attending a dental and/or medical school recognized by a relevant accredited professional body, and - is licensed by the relevant authority to practice dentistry and/or dental surgery in the country or territory where the treatment is given.

Dependent

The insured person's spouse under the law of the country or territory of residence or the de facto partner; and the insured person's children. Adult children in full time education are generally covered up to 20-26 years old depending on the insurance product.

Diagnostic Tests and Procedures

Medically necessary tests and procedures prescribed by an attending physician to investigate the cause and nature of symptoms of a disability. These tests and procedures generally include (unless otherwise stated on the benefits schedule): laboratory tests and pathology, CT scan, PET Scan, MRI, ultrasound, ECG, endoscopic exams, and x-ray.

Dietitian

A person, other than the Person Insured who is legally qualified as a dietitian licensed and permitted to practice in the country or territory where treatment is received.

Direct Billing

Where the insurer settle costs of outpatient treatment or services directly with a medical provider in the insurance provider's medical provider network.

Disability

An illness or injury, and any symptoms, sequelae, or complications thereof. In the case of injury, it means all injuries arising from the same event or series of contiguous events.

Double Occupancy Room

A hospital room having two (2) patient beds per room and shared bath or shower room, whether both beds are occupied or not.

Elective Cesarean Section or C-section

A cesarean section operation for delivery of a baby, which is not as a result of medical intervention, necessity or recommendation.

End Date

The last date the insurer covers a person under an insurance plan.

Evacuation and/or Repatriation

Moving the insured person to another hospital which has the necessary medical facilities either in the country or territory where taken ill or in another nearby country or territory (evacuation) or bringing the insured person back to the principal country or territory of residence or home country or territory (repatriation). The service generally includes any medically necessary treatment administered by the international assistance company appointed by the insurer whilst they are moving the insured person.

Excess

A defined amount the insured person pays for covered health services before the insurance plan starts to pay. Most excesses apply per year, per person.

Exclusion

An exclusion can be general and apply to all insured persons. This is a provision within an insurance policy that eliminates coverage for certain acts, types of health care or treatments, and/or conditions. An exclusion can also be specific and apply to individual insured persons based on underwriting and declared health conditions. Such individual exclusions are generally mentioned in the certificate of insurance (COI) and/or the insurer’s offer letter.

External Prosthesis

An artificial device that replaces a missing body part and is worn externally.

Foreseeable

A medical condition that, in reasonable opinion, could be reasonably anticipated.

General Advice

Any medical opinion or medical recommendation from a relevant accredited professional body in relation to a medical condition or treatment.