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To help you to better understand A+ health plans, we have provided some definitions.

Please contact us or consult the General Conditions if you need more information.

1. Accident
2. Chronic conditions
3. Complementary medicine practitioner
4. Co-payment (co-insurance)
5. Day surgery and day-patient care
6. Deductible
7. Dependant
8. Doctor (or physician)
9. Eligible medical expenses
10. Home country
11. Host country
12. Inpatient
13. Insurance year
14. Intensive care unit
15. Maximum annual reimbursement
16. Medical consultant
17. Medically necessary
18. Outpatient
19. Policyholder
20. Pre-existing conditions
21. Prescription drugs
22. Reasonable and customary
23. Special conditions
24. Standard private room
25. Surgery
26. Treatment or Medical treatment


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Surgery : Any of the following medical procedures:
• to incise, excise or electro cauterize any organ or body part, except for dental services;
• to repair, revise, or reconstruct any organ or body part both invasive and non-invasive;
• to reduce by manipulation a fracture or dislocation;
• use of endoscopy to remove a stone or object from the larynx,
bronchus, trachea, oesophagus, stomach, intestine, urinary bladder, or urethra.
Standard private room: A private room is a room with one bed. A ‘standard’ private room is the lowest rate (regular) private room available in a hospital.
(Deluxe, Executive rooms and Suites are not covered.)
Prescription drugs: Drugs/medicines, which are necessary to treat a confirmed medical diagnosis or medical condition, and which are not available without prescription by a doctor (excluding OTC-drugs).
Pre-existing conditions: Medical conditions or any related conditions, for which symptom(s) has/have been shown at some point during the five (5) years prior to commencement of cover, irrespective of whether any medical treatment or advice was sought.
Any such condition or related conditions about which the insured or his/her dependants know, knew or could reasonably have been assumed to have known, will be deemed to be pre-existing.
Policyholder: The employer or the individual expatriate taking out the insurance for the benefit of the insured, having to pay the appropriate premium to the insurer on behalf of the insured. The name of the policyholder is mentioned in the special conditions.
Medical consultant: A doctor appointed by the insurer to decide, based on the candidate’s medical questionnaire, upon acceptance of the candidate-insured into the insurance, and assigned to assess the medical situation of the (candidate)-insured.
Maximum annual reimbursement: Benefits payable in respect of expenses incurred for treatment provided to the insured during the period of insurance shall be limited to overall annual limits as stated in the schedule of benefits irrespective of type/types of disability. In the event that the overall annual limit has been exhausted, no further payments shall be made for the remaining period of the insurance year.
Host country: Country where the insured is expatriated to, as declared in the application form.
Home country: Country where the insured normally resides or used to reside and out of which he/she is expatriated to another country, as declared in the application form. If the home country cannot be named according to this definition, it is the country of which the insured has the nationality and is holding a passport from.
Doctor (or physician): Person who graduated from a recognised medical school as listed in the WHO Directory of Medical Schools and who is licensed to practise medicine in the country where the treatment is received. Family doctor or GP (general practitioner): a doctor providing medical treatment not requiring a specialist’s training.
Specialist doctor: a doctor having a specialised qualification in the field of, or expertise in, the treatment of the illness or injury being treated.
Dependant: The legal spouse (or legal partner) and/or unmarried children, until their 26th birthday, of the Insured, who are financially dependent on the Insured.
Deductible: The (first) part of the (eligible) medical expenses, not reimbursed by the insurer and deducted from the amount (of eligible medical expenses) on which the reimbursement is calculated.
Co-payment (co-insurance): Percentage of the (eligible medical) expenses to be paid by the insured himself/herself, not reimbursed by the insurance plan.
Treatment or medical treatment: Medical examinations and/or medical procedures needed to restore health, performed or prescribed by a doctor.
Special conditions : Document issued with each insurance policy, stating:
• the identity of the policyholder and of the insured;
• the cover opted for, and the term of the policy;
• any particular agreement or any deviations from the general
conditions.
Reasonable and customary: Medical expenses will be considered ‘reasonable and customary’ if they correspond to the charge usually made by the health care provider for a similar service or supply and do not exceed the normal charge made under the best prevailing conditions for such a service or supply in the locality where the service or supply is received.
If usual and prevailing charges cannot be determined because of the unusual nature of the service or supply, the claims handler will on behalf of the insurer determine to what extent the charge is reasonable, taking into account:
• the complexity involved;
• the degree of professional skill required;
• all other pertinent factors.
Outpatient: Outpatient care or treatment is medical treatment for which the patient does not have to stay overnight in a hospital.
Medically necessary: A medical service which is:
• consistent with the diagnosis and customary medical treatment for a covered condition, and
• in accordance with standards of good medical practice, consistent with current standard of professional medical care, and of proven medical benefits, and
• not for the convenience of the insured or the physician, and unable to be reasonably rendered out of hospital (if admitted as an inpatient), and
• not of an experimental, investigational or research nature, preventive or screening nature and for which the charges are fair and reasonable for the condition.
Intensive care unit: A section within a hospital that is designated as an intensive care unit, and which is maintained on a twenty-four hour basis solely for the treatment of patients in critical condition and which is equipped to provide special nursing and medical services not available elsewhere in the hospital.
Insurance year: A twelve months period, starting on the effective date of coverage as stated on the Special Conditions
Inpatient: Inpatient care or treatment is treatment for which, for medical reasons, the patient has to stay in hospital overnight.
Eligible medical expenses: Medically necessary expenses incurred due to a covered illness, accident or maternity but not exceeding the limits in the benefits overview.
Day surgery: Surgery requiring the use of a conventional operating theatre and performed on an in-and-out same-day basis without an overnight stay.

Day-patient care: treatment in a hospital or medical day-care center, for which the patient does not have to stay overnight. It excludes any ambulatory treatment.
Complementary medicine practitioner: An acupuncturist, chiropractor, homeopath or osteopath who is legally qualified and allowed to practice complementary medicine by the authorities in the country in which the treatment is received.
Chronic conditions: Sickness, illness, disease or injury which has one or more of the following characteristics:
• is recurrent in nature;
• is without a known, generally recognized cure;
• is not generally deemed to respond well to treatment;
• requires palliative treatment;
• requires prolonged supervision or monitoring;
• leads to permanent invalidity.
Accident: A sudden, unexpected event, the cause of which is situated outside the victim’s body, that results in bodily injury. The following events are also considered to be accidents:
• a rescue attempt of persons or goods in peril;
• gas or vapour inhalation and the absorption of poisonous or
corrosive substances;
• dislocations, distortions, ruptures and muscular lacerations
provoked by a sudden effort;
• freezing;
• drowning.
If your country is not listed here, please contact us.