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  • Effective Date

    The date your coverage begins, which is usually when your application has been accepted or received.

  • Sub-limit

    Some healthcare companies have limits on certain medical conditions. Therefore, they may only pay up to a certain amount for a treatment even though the condition incurred has a higher cost. In thi...

  • Annual limit

    Some healthcare plans place a limit on certain or all of the plan’s benefits each year. This means a maximum amount of money the insurance company will pay for your treatments or a maximum number o...

  • Benefit

    A benefit is any service (for example a doctor visit, laboratory test, surgical procedure, etc.) or supply (such as prescription drugs, durable medical equipment, etc.) covered by your plan. You may...

  • Maternity Coverage

    This is the coverage you get while you are pregnant. Depending on your plan, this covers all or part of the pregnancy and birth. The coverage tends to be split into outpatient and inpatient care. O...

  • Out of Network

    Most commonly in the USA, your healthcare provider will have a network of providers that you are permitted or encouraged to use for your healthcare. When seeking treatment in these care facilities,...

  • Pre-existing Condition

    A pre-existing condition is any illness or injury, physical or mental condition, that you have suffered before the effective date of your health insurance coverage. Many health insurance providers ...

  • Guarantee of Payment

    A Guarantee of Payment (GOP) defines the charges your insurance company has agreed to pay for medically necessary services and clearly indicates any co-payments, co-insurance or deductibles, which a...

  • Waiting Period

    The waiting period is the amount of time specified in your policy which must pass before   you can receive cover for some or all of your health-care benefits. There are waiting periods for pre-existi...

  • Emergency

    An emergency is a condition that begins/gets worse suddenly and that threatens the patient's life.