Health Insurance Glossary

Additional Insured: Anyone covered under your health plan that is not named as an insured in your documentation from the insurance company. Primarily used in Property and Casualty Insurance.

Application: Legally, this is an offer from you to an Insurance Company to provide you health benefits as prescribed in the Outline of Coverage for a quoted price you obtained from an agent or an online service. It is imperative that you be truthful in providing information and that you provide current contact information for anyone that has provided medical services to anyone for whom coverage is requested. See Underwriting for the actions taken by the Carrier.

Benefit: The dollar amount your insurance carrier will pay when you file a claim for a covered loss.

Benefit Period: The interval during which you will be eligible for benefits. Generally, your benefit period will begin with the first medical service you received for a specific illness and end after you have not been treated for that condition for 60 days.

Cafeteria Plan 125: A plan set up by the Employer that excludes certain expenses from Income Tax and FICA. Health Insurance Premiums are eligible expenses, and are deducted from the employee gross pay before Income Tax and FICA are calculated on the remaining income. In essence, the employees save the amount they would have to pay on income tax and their portion of FICA for these eligible expenses. The employer saves FICA on the portion of the premiums paid by the employee.

Caps on Coverage: Major Medical Plans have a Lifetime Maximum Benefit. This is a cap on the amount the Carrier will pay in claims over a personýs lifetime. We prefer a plan have $Five Million or more.
Beware of benefit caps on specific benefits that may be on some policies, but not on others; like: Annual Prescription expenses, on Certain Surgeries-particularly transplants, and that limit the number of certain procedures like transplants. Such a plan may be of use to you, but you should be made aware of those restrictions when considering them.

Carrier: The insurance company you receive your health plan from.

Certificate of Insurance (the Policy): This is the printed description of your benefits and coverage limits that forms a contract between you and your carrier. It spells out precisely what will be covered, what wonýt, and the dollar maximums.

Claim: This refers to any request to your insurance company for benefits.

COBRA: This acronym refers to the Consolidated Omnibus Budget Reconciliation Act of 1985. The law requires group medical plans covering twenty employees or more to offer participants the option to receive continued healthcare benefits for up to eighteen months after the cancellation of their group plan.
States may have a continuation plan that extends coverage for an additional period-usually six months.
Call McClish Insurance Agency to discuss options of possibly replacing COBRA with an individual plan.

Coinsurance: The amount you will be required to pay for a particular medical expense. Coinsurance is measured as a percentage of the total medical bill. Important: for Network Plans, there will often be different In and Out of Network Coinsurance percentage amounts with the associated Major Medical Coinsurance Limit. Once past that limit, allowable expenses are paid at 100% for the rest of the year up to the policy limit. But there can be surprises when you use Non-Network Providers:
Different Coinsurance Percentage Amounts/Limit Maximum: the Out-of-Network amount applied toward the Percentage/Limits may be based on your carrierýs average price that they have negotiated with their providers. This may be considerably less than what you are charged by the Out-of-Network provider-leaving you owing the difference!
The expenses often accrue to Different In and Out-of-Network Deductible and Coinsurance Accounts. If you mix in and out providers during the year, not all of the allowed expenses are going into one account, meaning that you have to satisfy separate amounts on each category of service provider. People are often surprised when they think they have satisfied the 100% Limits so that allowable expenses will be fully paid for the rest of the year-and they find that the expenses were divided between In and Out-of -Network accounts.

Complications of Pregnancy are conditions not considered as a normal delivery. In most states, including Texas, a Major Medical Policy will pay for those benefits, even if it had no Pregnancy Coverage.
Most states, including Texas, have laws that extend Complication of Pregnancy benefits to female dependents of the insured (the insured may be a female and have a pregnant daughter). This is the reason the applications ask if any dependent is currently pregnant, and the Carrier will reject the application-even without pregnancy coverage, if that is the case.
C-Section: Some think that all C-Sections are considered Complications of Pregnancy. There have been some rulings in Texas where a C-Section was deemed a normal delivery, and not a Complication-so no benefits were paid as a Complication of Pregnancy when Maternity Benefits were not included in the policy. This is one reason to consider a policy with maternity benefits if a pregnancy is contemplated.

Co-payment: This is a cost-sharing arrangement in which you will be responsible for a specific charge for a specific medical service ($20.00 per office visit, or $10.00 per generic prescription).
Important: For Provider Network Plans like a PPO, Office Visit copays usually apply only to In-Network physicians. Out of Network physician charges accrue to the main deductible, and will not be paid until the deductible is met that year-and then will be reimbursed at the average level the Carrier pays for that service in that area; probably not the amount you were charged.

Coverage Rider: This is a rider adding some benefit to an insurance policy for an additional fee.
See Maternity Benefits in this Glossary for a common Coverage Rider.
There are some Carriers who market Hospital Plans with additional coverage riders that resemble a Major Medical Insurance policy. McClish Insurance Agency does not offer them since they have holes in the benefits that are not obvious to the average consumer. Another concern is that these plans may be offered to unsuspecting consumers who often think they are purchasing/replacing a Major Medical Policy.

Covered Expenses: The various medical procedures that your insurer has agreed to provide you coverage for. There can be major differences in the amount a PPO carrier will pay for Non-Network service providers: see Coinsurance, Co-Payment and Deductible.

Creditable Proof of Coverage: This is a statement provided by Insurance Carriers and Employers for employees who had qualifying Health Insurance Benefits as defined by the federal Department of Health and Human Services. This document is used to indicate the person had prior coverage, and if there is no gap in coverage for more than 60 days, gives protection for pre-existing conditions.
If that person is moving to another qualifying Group Health Plan within the 60-day window, their pre-existing conditions will be covered immediately by the new plan (a pro-rata is involved if the employee only has proof for less than one year of prior coverage).
Unfortunately, this does not apply to preexisting conditions as expected when a person applies for an Individual Policy with this proof. The Individual Carrier can reject the applicant outright. They can waive (not cover) a condition-and related conditions-permanently or temporarily. So, this Proof really does not help in the Individual Market.
It is our opinion that this Portability Issue needs to be resolved through the private insurance industry, but with a federal government subsidy of the higher rating.

Deductible: The amount you will be required to pay for healthcare expenses before your insurance plan will begin to reimburse you. There are usually different deductibles for In-Network and Out-Of-Network expenses, and the Out-of-Network amount applied toward that deductible may be based on your carrierýs average price that they have negotiated with their providers. This may be considerably less than what you are charged by the Out-of-Network provider!

Exclusion: A specific circumstance or condition that is not covered by your policy. Some Common Circumstances that are not covered are when someone incurs an injury while intoxicated, under the influence of drugs, or in the commission of a felony. Maternity is not covered under most individual policies. Some policies will cover it with a rider with restrictions that the pregnancy has not already occurred. Read your outline of coverage for exclusions that may not be common in the industry.

Effective Date: This refers to the date on which your insurance coverage will actually begin to cover you.

Fee-for-Service: This is a payment system for healthcare where your provider is paid for each service after it is performed. You receive reimbursement after you file a claim.

Flexible Spending Account: See Cafeteria Plan in this Glossary.

Health Plans: When you hear this term without Insurance, this plan is not an insurance policy. Essentially, you are paying a fee to obtain In-Network Rates when you see a Medical Provider. There are situations where these plans may fit your needs, but beware of anyone who intimates it is compatible with any type of Insurance Policy: See The Different Types of Health Insurance Plans

Health Savings Accounts (HSAýs) are IRS approved Savings Accounts that are to be used to pay for a personýs health care costs not covered by insurance. The taxpayer deducts the contribution to these funds when they file their taxes in the same manner done with an IRA. Where someone may not be able to contribute to an IRA due to their high income, there are no such restrictions for HSAs.
Essentially, no income or FICA taxes are paid on the funds when used for IRS approved Medical Expenses. If the funds are not used, they roll over until used at the discretion of the owner. Some people think the funds are forfeited if not used that year, but that applies to contributions to a Flexible Spending Account. There are penalties up to age 59ý if the funds are not used for approved medical expenses. The funds may be used for retirement income after 59ý, but are taxable. The HSA is normally placed with a bank (with associated fees) that issues a debit card for fund access.
A qualified HSA-Compatible Health Insurance Policy must be in force before a Health Savings Account can be opened, and must continue to be in force for additional contributions to be made to the HSA. The Insurance Policy must have an IRS mandated high deductible. The HSA is used to pay the deductible on the health policy as expenses are incurred. Then, the policyýs benefits kick in after the deductible with the HSA still available for incidental expenses not covered by the policy.
One complaint of those who have enrolled in HSA insurance policies is that the policy pays no benefits until the high deductible has been met: that includes doctor visits, drugs, etc. Recently, some plans have become available that pay for any Preventative Services before the deductible is met. Call the McClish Agency for information.
HSA funds may be used for any IRS approved health expense, which includes Over the Counter medications, and benefits that you may not have insurance for; such as eyeglasses and vision, hearing, dental, etc.

HIPPA Privacy Laws were enacted by the Federal Government to protect our Private Records from those who should not have access to them. They have had a massive impact on Health Care and all related industries. They have had a huge impact on hiring practices. For example, an employer cannot ask your age on an employment application and cannot pry into your health condition other than as required for job performance. The intent is to protect the individual from unfair practices based on private information. Insurance agents must take great care in handling client information. The McClish Insurance Agency makes sure we protect your information and we shred all private information before discarding it.

Hospital Plan: These plans provide coverages for hospital stays, usually for day surgery, and usually some limited doctor visits and perhaps limited prescriptions out of the hospital. They usually do not cover rehabilitation and other follow-up care. Those who surf the web for their health insurance without agent assistance often purchase these plans, thinking they are getting a Major Medical Plan for a great price. These and other plans will have RED Lettering on the front of the policy when they receive it, stating that the plan does not meet all of the guidelines of a Major Medical Policy in their state.

HMO: Health Maintenance Organization. HMOs are popular health benefit programs in which you will pay monthly premiums in return for managed coverage for your checkups, hospital stays, doctors visits, surgery, emergency care, preventive care, lab tests, and X-rays. If you join an HMO, you will have to select a Primary Care Physician who will be responsible for coordinating your healthcare and making any referrals to specialists that you require. Youýll also have to use doctors, hospitals and clinics that are members of your HMO plan network. Individual (non-group) HMO Plans for non-Medicare individuals are very rare.
Medicare beneficiaries have access to HMOýs, along with several other types of plans through the Medicare Advantage program

Indemnity Plan: These are insurance plans that are very different from Major Medical, Hospital, HSA Compatible and Limited Benefit plans where you pay up front costs, like deductibles and coinsurance and the medical plan pays for the rest of the covered costs up to the maximum on the policy for that condition. An Indemnity Plan pays a specified amount for a specified medical service, usually with no deductible. For example, it may pay $50 for an office visit: you have to pay the difference. It may pay $5,000 for heart surgery: you pay the difference. They will only pay for the conditions specifically listed in their Schedule of Benefits, which is more restrictive than a Major Medical Plan that includes the coverages mandated by the state for a Major Medical Plan. If they are affiliated with a network, you will get a discount from the network medical providers. These are the Plans advertised on TV and on temporary roadside signs that seem too good to be true. There is a niche for these plans, particularly for someone who has conditions that prevent them from obtaining a medical policy, or economic reasons. But you should be aware of the restrictions and the difference in a Medical Plan where you pay first and the Carrier covers the amount above that according to their contract.

In-network: Healthcare facilities or providers who are members of your health plan. It is critical that you make sure that all your health care is through an In-Network Provider. We inform our clients that it is not uncommon that they will pay more that 50% of the costs of Out-of-Network providers, rather than what they are expecting to pay. Be sure to call every provider who is involved, like an anesthesiologist for surgery, and have them confirm that they are in your network before they provide care for you. Make sure your Primary Care Physician refers you to In-Network Specialists, and even then, call that specialist to verify they are in the network.
You must accept your responsibility to verify everyone is currently in your network, and the best one to verify it is the Claims Processor at the Provider. Online Network Directories are notoriously out of date. That provider may have just dropped out of that network, and it hasnýt had time to get to the online directory you have access to, or the directory at the Insurance Carrier. And, a Network Provider may refer you to someone they think is in the Network, but is no longer a member. See Network Directories in this Glossary.

Lifetime Limit: This refers to the maximum level of covered benefits available through a policy for the lifetime of an insured person.

Long Term Care refers to care for a condition that is not expected to improve and the condition is such that the afflicted person can no longer function on their own. Many have the mistaken impression these benefits are covered by Medicare. The Long Term Care benefit from Medicare is for short term conditions expected to improve and rarely does Medicare pay for anything close to the maximum benefit of around 60 days. Medicaid will cover Long Term Care-after the person and spouse have spent down much of their assets-usually to less than $2,000.
The statistics of Long Term Care are staggering. This includes the likelihood of needing care, which is over 60% for someone past age 65. And the cost of facility care ranges from $110/day in a few rural areas of Texas to around $200/day in the Houston area (2009 figures).
The McClish Insurance Agency is urging people in their 40ýs and 50ýs to consider coverage while they are healthy and can obtain the best rates based on that good health.
In 2004, Medicaid established a Partnership program that states could choose to participate in that had been tested earlier in a few states. Texas has joined that Partnership. Essentially, a person applying for Medicaid can exempt assets from the $2,000 asset qualification limit up to the amount paid out by an insurance policy for Long Term Care Benefits-to a maximum of $500,000. The intent is to lessen the number of people who apply for Medicaid as soon as they need Long Term Care, and have spent down their assets to qualify. The program has been very successful in lessening the Long Term Care expenses on Medicaid in the test states. The effects of the partnership have made the purchase of LTC insurance much more attractive to people with assets that are co-owned by a spouse, or that they want to pass on to children. The McClish Insurance Agency is associated with the very best and most competitive insurance companies for LTC, and will be honored to help you make a decision that meets your needs.

LOS: This is an acronym for the term Length of Stay. Insurance carriers, case managers, and other healthcare professionals use this term to describe the length of time any individual spends in a hospital or an in-patient care facility.

Major Medical Policy Mandates: The state where a policy is issued has mandated coverages and requirements for a policy designated as a Major Medical Plan. If a plan does not include those mandates, the Carrier has to include a statement on the front page of the policy in red lettering indicating, -This plan does not meet the minimum standards prescribed by that state board of insurance-. McClish Insurance agency places some of these plans for specific situations, after explaining the differences to the client and why that policy fits their needs. It greatly concerns us that there are companies who market such plans without ever mentioning that they are not Major Medical Plans to their clients while comparing their premiums with a true Major Medical Plan.

Maximum Out-of-Pocket Expenses: The most you will have to pay during one year ý in the form of deductibles and coinsurance fees. The carrier may split accounts between In and Out-of-Network providers with similar results as discussed in the Out-of-Network section of this Glossary.

Managed Care: This term refers to an increasingly broad assortment of health plans that manage healthcare costs and usage. There are three major types of managed health plans: HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations) and POS (Point-Of-Service plans).

Maternity Benefits on Individual Medical Insurance: Maternity Benefits are not a mandated coverage in Texas for Major Medical Insurance Policies. If maternity were required to be covered, everyone would pay a higher premium for those that use maternity.
Some plans offer a Coverage Rider at an additional cost for those anticipating a pregnancy. An insured person cannot be pregnant at the time the policy is written. The additional premium over the time up to birth approximates the In-Network costs of a normal pregnancy. This should not be a surprise since the only people who take the coverage are the ones planning to have a child quickly. Then, they cancel the rider after the birth unless they are planning to have another child immediately.
Major Medical Policies in Texas must cover Complications of Pregnancy (in this Glossary). But not all C-Sections are considered as Complications any more. An advantage of taking out a Maternity Rider is that the C-Section should be covered (make sure of this provision on the policies you consider). 
Note: See Newborn Baby Coverage for important information.

Medicaid: This is a joint state/federally funded health insurance program that is administered by the state. It provides health coverage for low-income individuals, especially pregnant women, children and the disabled. McClish Insurance Agency has some training materials required for our Long Term Care Certification that provides some valuable information on the Medicaid System.

Medicare: This is a federally sponsored healthcare program that offers coverage for medical and hospital care, primarily to those over the age of 65. McClish Insurance Agency represents a full range of plans including Medicare Supplements and Medicare Advantage Plans. We can provide you with a system on how to use the Medicare Site to choose your Medicare Prescription Drug Coverage.

Network: This refers to the groups of doctors, hospitals and other medical professionals who have been contracted to provide discounted healthcare services to your insurance carrierýs customers. See In-Network and Out-of-Network in this Glossary for valuable, money saving information.

Network Directories: Those who are proficient in using the computer can usually establish an online account with the Carrier. Then when they search for a provider, it is assured those providers are currently listed in the directory for the plan you have with the Carrier. However, Online and particularly printed directories are often out of date because a provider may have just dropped out, and that has not percolated down to the directories. If that provider dropped out very recently, the service department at the Carrier may not yet be aware of that.
You must accept responsibility to, if at all possible, call the provider and speak to the Claims processing department to verify if they are still in that Carrier Network for your Plan.
If you are dissatisfied with what you find in a directory, call the Customer Service number on your ID card: they may be able to direct you to a new provider.

Newborn Baby Coverage: The Newborn Baby of an insured Texas mother is automatically covered for the first 30 days of life-whether or not the mother has Maternity benefits. It is imperative that you notify the Carrier as soon as possible after the birth if you want to add that baby to the coverage-for the regular premium for a child less than one year of age. If you do add the baby to the policy within that time frame, the baby is guaranteed to be accepted irregardless of whatever conditions the baby may have, or develops. All of any conditions are covered as they are for any healthy person on the plan.
McClish Insurance Agency very strongly recommends that you add the child as soon as possible. The child may appear healthy, but conditions and infections may change quickly. Major Medical Plans have mandated benefits for newborns and on up in age to cover vaccinations, etc.

Out-of-Network: This term typically refers to any doctors, hospitals or other healthcare providers considered to be non-participants by your insurance plan (HMO, POS, or PPO). Depending on your planýs guidelines, services provided by out-of-plan providers may not be covered, or only covered in part. You can end up paying more that 50% of the costs because your policy probably has a higher deductible, coinsurance and such. And your company will base their payment on what their negotiated rate is for that care in that area. That may be much less than what the Non-Network Provider will charge.
Also be aware that your Carrier probably has not only different deductibles for Non-Network, but also has separate deductible accounts: they will accumulate expenses in one account for In-Network and another for Out. If you mix expenses between In and Out, you have to satisfy the deductibles separately before benefits will start being paid for that classification.
Most Co-Pays for doctor visits and such are only for In-Network Providers. So, if you go to a Non-Network doctor and expect to pay, for example, a $35 office copay for a visit that doctor charges $200 for; your insurance company will take their Network price for that visit-lets assume $120, and apply it to the Non-Network Deductible Account. If all of your Non-Network expenses have not yet reached your deductible, you owe the doctor the entire $200.
Understand why you need to stay in your network?

Policy Replacement: Never, never, never cancel an existing policy until you have the new policy in your hands. You can normally adjust the new policy to a later effective date to prevent overlap. This is why it is imperative to provide the current contact information on the application for the health care providers who have treated you-to prevent undue delays in requests for information.

Portability: What a controversial subject! This refers to the ability for someone who has health insurance, and loses it through no fault of their own, to obtain reasonably priced health insurance even if they have serious health conditions that prevent them from obtaining Individual coverage at all, or have to accept Waivers on those conditions. It is tragic that a responsible person who has had health insurance all their life loses that coverage-either Individual or Group-COBRA-due to a loss of income and accessibility to another plan.
Mr. McClish believes he has an answer to this dilemma that he will share with you at your request. It keeps the coverage within the private sector that is proven to be able to manage the system, but uses government assistance. It shares the responsibility and cost amongst the individual, the employers, the insurance companies, the health care providers, and the federal government. Mr. McClish believes it would cost much, much less than full federal involvement in health care.

POS: Point-of-Service Plan. A POS is a managed healthcare plan that combines the features of a Health Maintenance Organization and a Preferred Provider Organization. These plans allow you to decide whether or not youýll use an in-network provider or an out-of-network provider.

PPO: Preferred Provider Organization. PPOs are networks of healthcare providers who have negotiated discount contracts with health insurance carriers. Your healthcare provider decisions will be up to you, but there are generally financial incentives for you to select providers within your PPO network. See Glossary sections on Copay, Coinsurance, Deductible, In-Network and Out-of-Network. Warning: you may pay 50% or more of the expenses of a Non-Network provider!

Pre-existing Conditions: This refers to any healthcare issues you had prior to your insurance planýs effective date. Many policies will refuse to cover pre-existing conditions, while others refuse coverage only for a short time. If you divulge a condition on your application that the Carrier does not attach a Waiver to, the condition will be covered after a state mandated period of time (One year in Texas). If you had a Proof of Creditable Coverage Certificate, the disclosed, non-waived condition will be covered in a shorter period of time-perhaps immediately-depending on the length of time you had the prior coverage.

Pregnancy caused a rejection of my application: I applied for coverage for myself only. Why did the Insurance Company reject my application because a female dependent (wife or dependent daughter) is pregnant? Most state law, including Texas, requires that Complications of Pregnancy extend to any dependent of the insured, even if they are not included in the policy coverage. Coverage for a Newborn Baby may also be guaranteed for 30 days. People will try to take advantage of this law when a complication of pregnancy is evident.  

Preventative Care: Health services such as physical exams, immunizations, diagnostic tests and mammograms that are designated as Preventive Care rather than Diagnostic Care. Preventive Care generally applies when there has been no evidence of a medical condition. Diagnostic Care generally applies when symptoms are present and the same types of tests are being used to diagnose the condition or treatment regimen. Some newer plans are including much better Preventive Care benefits with the theory that catching things early means less patient stress and lower Carrier expenses. The McClish Agency will discuss the pros and cons of these plans with you.

Premium: The dollar amount youýll pay on a monthly basis in exchange for your insurance coverage.

Primary Care Physician (PCP): Most HMOs and POS plans will require you to select one family physician, pediatrician or internist to monitor your health, treat most of your health problems, and refer you to specialists when necessary. Some PPO plans require you to get a referral from your Primary Care Physician. Many PPO plans allow you to go directly to a specialist with no PCP referral, but usually at a higher office copay than your PCP.

Provider: This term refers to any individual (nurse, physician, or specialist) or institution (clinic, hospital, or laboratory) that provides you with care.

Rider Restricting Coverage: This refers to any policy attachment that makes additions or changes to your original insurance plan. They limit some normal benefit of the plan. See Coverage Rider for riders that add coverage for an additional fee.

Short Term Health Insurance: This type of healthcare plan is purchased to provide you with benefits during coverage gaps between jobs, after a move, or while you are traveling overseas, where your current plan may have very limited or no benefits.

Small Business Health Insurance: This is a type of healthcare coverage that is available to businesses employing between two and fifty employees. Coverage cannot be denied if the business meets the criteria of a bona fide business, and a minimum percentage of eligible employees subscribe to the coverage. The premium can only be determined when all of the completed Employee applications have been evaluated by the Carrierýs Underwriting Department. The premium will range from the Base Rate to one that can be capped out at 66% higher than the Base Rate. Be aware that agents calling on businesses virtually always quote the Base Rate, and may leave the impression that will be the final rate without knowing anything about the health of your group. Always ask for the base rate and then you will know the maximum it can be is 66% above that.
The HIPPA Privacy laws put the employer and the agent in a vexing position where they cannot pry into the health conditions of employees. So, the agent cannot give a firm quote. In fact, neither the agent nor the employer should examine the health portion of an employee application without express written consent of the employee. You should make absolutely sure you do not cancel one policy before you have a firm commitment from the Carrier on a new application. That means you should start an application process for a small business at least 6-8 weeks before the anticipated effective date.
The portion of the premium paid by the employer is tax deductible as of July 2009. Often, the employer activates a Cafeteria Plan that gives the employer and the employees tax advantages by excluding the premium from income and FICA taxes.

Travel Health Insurance: This insurance is purchased to provide you with coverage when youýre traveling abroad. Many people mistakenly believe that their USA health policy will cover them abroad. Check and make sure what the benefits are on your existing plan.

Underwriting: is the process whereby a Carrier evaluates whether they wish to accept your offer (the application) to provide the requested policy benefits for a price quoted by an agent or online system. They may reject the offer and return your money. (Look for companies that do not cash your down payment until the policy is put in force-then they can return your check without cashing it if you are rejected. Otherwise you may have to wait several weeks for them to refund your money.)
If the Carrier accepts your application, they will put the policy in force and send a copy to you. You have 60 days in Texas to return the policy and get your money back-assuming you had no claims.
They may counter-offer: perhaps at a higher price due to health conditions, waive (not cover) a health condition and related conditions permanently or for a set period of time, or a combination of higher price and waiver. They may ask to exclude one person from the policy.
On all counter-offers, you can either accept the offer and its terms, or reject it, and the Carrier will terminate the application and refund your payment.

Waiting Period: This refers to a pre-specified time period during which you will not be covered by your insurance (for a particular healthcare issue). Be on the lookout for plans that have Waiting Periods for some conditions (like tonsillitis on some plans) that are not standard in the industry. Your agent should point these out to you on any plan you are considering.