Glossary of Health Insurance Terms in Latin America

Policy jargon can seem like a foreign language, especially to those who are not as well versed in the world of health insurance. Acquainting yourself with the most common health insurance terms can go a long way in making yourself feel more empowered when buying a health insurance plan.  

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Acute condition

Acute conditions tend to arise suddenly and unexpectedly, but usually respond quickly to treatment. 

Benefit level 

This refers to the maximum amount a health plan covers for a specific benefit. 

Chronic conditions

Chronic conditions tend to be ongoing, and there is usually no cure for it. Treatment is thus focused on controlling and monitoring the condition, as well as its symptoms. 

Claim

A claim is a formal request by the policyholder (see definition below) to seek reimbursement for a covered loss/event. 

Direct billing

Direct billing occurs when healthcare providers send their bills directly to the insurance provider for services rendered to a policyholder. 

Excess

An excess is the portion of an insurance claim that the policyholder must pay themselves. 

Exclusion

Exclusions are what a policyholder's health insurance policy won't cover.

Inpatient care

Inpatient care generally refers to any treatment requiring an overnight hospital stay. Every private health insurance plan in the UK will at least cover inpatient care. 

Moratorium

A moratorium is a period of time in which policyholders must wait before specific coverage benefits apply. 

Outpatient care

Outpatient care refers to treatment that does not require an overnight stay at a hospital or inpatient facility. Not all private medical insurance policies cover outpatient care as standard.

Policyholder

A person or entity who owns an insurance policy. 

Pre-existing condition

This describes any health conditions that you've had and received treatment for prior to taking out your health insurance policy. 

Premium

This is the amount policyholders must pay either annually, bi-annually, semi-annually, or monthly for their health insurance policy. 

Underwriting

Underwriting is the process that insurers follow to evaluate an applicant in order to determine the right premium (see definition above) for their health coverage.