When you authorise (assign) that the provider can directly receive your benefits from the insurance company. It is recommended to review charges being submitted on your behalf.

A request for your health insurer or plan to review a decision or a complaint again.

See Usual & Customary (U & C). In Cayman, see SHIF.

The Usual & Customary payment levels that the insurance will consider. Also called Usual, Customary & Reasonable (UC&R) or allowable charge – usually based on geographic norms. In Cayman, see: SHIF.

These are the highest amounts your health insurance company will pay a provider for the services you receive. In the Cayman Islands this is set by the Health Insurance Commission: a look-up tool of SHIF can be found at: dhrs.gov.ky – then click on HIC and Standard Fees. Providers may charge you higher than the SHIF and can bill the patient for the additional amounts; thus you are encouraged to verify charges and coverage levels before services are rendered.

A condition that exists before your health insurance went into effect. These may be limited within your coverage depending upon your portability and your Policy provisions.

Always in USA and sometimes in other countries: a network of medical providers who are under contract with your insurance company for accepting assignment of covered benefits and usually provide discounts on costs. Be sure to use the PPO when available for best coverage levels.

A health care professional (usually a physician) who is responsible for monitoring an individual’s overall health care needs. Typically, a PCP serves as a “quarterback” for an individual’s medical care, referring the individual to more specialized physicians for specialist care.

Refers to entities (persons or facilities) who provide medical, dental, vision or pharmacy services.

A modification made to a Certificate of Insurance regarding the clauses and provisions of a policy (usually adding or excluding coverage).