Glossary

A 12-month period beginning each January 1 at 12:01 a.m. Eastern Time.

A certificate disclosing information relating to your creditable coverage under a healthcare benefit program.

The treatment of malignant conditions by pharmaceutical and/or biological antineoplastic drugs.

A duly licensed chiropractor who treats disorders of the musculoskeletal system, including the back and the neck.

Notification in a form acceptable to the insurer that a service has been rendered or furnished to you. This notification must include full details of the service received, including your name, age, sex, identification number, the name and address of the provider, an itemized statement of the service rendered or furnished, the date of service, the diagnosis, the claim charge, and any other information which the insurer may request in connection with services rendered to you.

The benefit payment calculated by the insurer, after submission of a claim, in accordance with the policy benefits.

A clinical laboratory that complies with the licensing and certification requirements under the applicable federal, state, and local laws.

The percentage of covered expenses the insured is responsible for paying after the applicable deductible is satisfied and/or copayment paid.

The amount of coinsurance (see above) each insured person incurs for covered expenses in a calendar year.

Conditions requiring hospital confinement (when the pregnancy is not terminated), whose diagnoses are distinct from the pregnancy, but are adversely affected by the pregnancy. This includes, but is not limited to acute nephritis, nephrosis, cardiac decompression, missed abortion, pre-eclampsia, intrauterine fetal growth retardation, and similar medical and surgical conditions of comparable severity. Complications of pregnancy also include termination of ectopic pregnancy and spontaneous termination of pregnancy, occurring during a period of gestation in which a viable birth is not possible. Complications of Pregnancy do not include elective abortion, elective cesarean section, false labor, occasional spotting, morning sickness, physician prescribed rest during the period of pregnancy, hyperemesis gravidarum, and similar conditions associated with the management of a difficult pregnancy not constituting a distinct complication of pregnancy.

Consecutive days of in-hospital service received as an inpatient or successive confinement for the same diagnosis, when discharge from and readmission to the hospital occurs within 24 hours.

The dollar amount of covered expenses the insured person is responsible for paying.

Surgery performed to change the appearance of otherwise normal looking characteristics or features of the patient's body. A physical feature or characteristic is normal looking when the average person would consider that feature or characteristic to be within the range of usual variations of normal human appearance.

The insured person’s country of domicile.

The date on which your coverage begins.

Medically necessary services or supplies that are listed in the benefit sections of an insurance plan and for which the insured person is entitled to receive benefits.