How to Read an Insurance Policy

Insurance plans can be daunting to read - until you know how to read them! In this article, we cover the basics to help you get covered.

Nov 8, 2016, 08:00 AM

When was the last time you read your insurance policy? Would you know which benefits are provided and which are excluded in certain circumstances?

There may be parts of your policy wording — also known as your certificate of insurance, certificate wording and/or insurance contract — that you don’t fully understand. This is probably true for many insurance policies you have, including travel medical insurance.

Although reading a travel medical insurance policy may not be as exciting as the “Harry Potter” series, doing so will take some of the mystery out of your medical coverage and may put more magic into your trip — or, at the very least, will give you peace of mind during your travels.

At International Medical Group® (IMG®), we work hard to help our insured members understand their coverage. To make things even easier, we’ve put together this guide on how to read an insurance policy, including what each section of the policy means and the most commonly misunderstood insurance definitions.

How to Read International Health and Travel Medical Insurance Plans

Breaking It Down

Below are some of the sections you may find in a typical IMG travel medical insurance policy, and what’s included in each of them:

  • Schedule of Benefits/Limits: This is a comprehensive list of the services and benefits that are provided under a specific plan. This section of the insurance policy is essential to read because it outlines your coverage.
  • Conditions and General Provisions: This section explains the terms and conditions of the insurance contract, including the rights and responsibilities of the insured member and IMG.
  • Eligibility: These are the requirements that an individual must meet in order to participate in the insurance plan. There are different requirements for various products, so it is important to read this section on each plan you purchase to ensure your eligibility.
  • Precertification Provisions/Requirements: Precertification is a requirement under your certificate for certain medical services. This section of your insurance policy provides a list of services which require precertification, and how you or your physician/health care provider can initiate precertification.
  • Eligible Medical Expenses: This is an explanation of most of the items that were listed in the Schedule of Benefits.
  • Exclusions: This section explains what is not covered in the insurance policy. This is one of the most overlooked sections of an insurance contract. Just as it is essential to understand what is covered under your plan, it is also important to understand what is not covered.

What Does It Mean? 

Insurance policies are full of terms you may not understand. To help, we provide the definitions of commonly misunderstood terms you need to know:

  • Coinsurance: This is an arrangement in which the insurer and insured will share the cost of a payment made against a claim. For instance, IMG pays a percentage of the amount, based on the terms of the insurance policy, while the insured pays the remaining percentage.
  • Precertification: As mentioned above, precertification is a requirement under your certificate of insurance for certain medical services. During the precertification process, medical professionals review the planned medical services against standard medical criteria to ensure that the services are within accepted medical standards and are medically necessary. Precertification may be initiated by you, your representative or your medical provider. It’s important to understand that precertification is only a determination of medical necessity, not an assurance of coverage, verification of benefits or a guarantee of payment. All medical expenses must meet usual, reasonable, customary, and eligible payment guidelines.
  • Pre-Existing Condition: This is one of the most misunderstood terms in an insurance policy. A pre-existing condition is commonly defined as an injury, illness, sickness, disease or other physical, medical, mental or nervous disorder, condition or ailment that existed at the time the insured applied for the insurance policy. In some cases, a pre-existing condition may be excluded from coverage even if you didn’t know you had it.
  • Usual, Reasonable and Customary: This is the “typical and reasonable” reimbursement for similar services, medicines or supplies in the area in which the charge is incurred.
  • Waiting Periods: This refers to the time the insured must wait before their coverage begins.
  • Declaration of Coverage: The declaration is proof of coverage under the insurance contract, and is a statement of the effective date of coverage.
  • Deductible: The dollar amount of eligible medical expenses that the insured member must pay prior to receiving benefits or coverage under their plan.
  • Explanation of Benefits: If you file a claim, once your claim has been processed, you will receive an Explanation of Benefits (EOB). The EOB will detail how your claim was paid and/or request additional information needed to review and process your claim.

With everything outlined above, it’s easy to understand why you may have avoided reading your insurance policy in the past. However, we hope this guide will help you next time you purchase insurance.

If you’re traveling, working or living internationally and you’re interested in purchasing a plan, check out IMG's travel medical insurance plans or call +1.866.240.4144.

If you’re already an IMG insured member, don’t forget that you can view a copy of your insurance policy at MyIMG

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