The chance of loss, the degree of probability of loss, or the amount of possible loss to the insuring company. For an individual, risk represents such probabilities as the likelihood of surgical complications, medications’ side effects, exposure to infection, or the chance of suffering a medical problem because of a lifestyle or other choice. For example, an individual increases his or her risk of getting cancer if he or she chooses to smoke cigarettes.

It is a medical opinion provided by a second physician or medical expert, when one physician provides a diagnosis or recommends surgery to an individual. Individuals are encouraged to obtain second opinions whenever a physician recommends surgery or presents an individual with a serious medical diagnosis.

These are now standard benefits in many health insurance plans. It is an opinion provided by a second physician, when one physician recommends surgery to an individual.

The dollar amount of claims filed for eligible expenses at which point you’ve paid 100 percent of your out-of-pocket and the insurance begins to pay at 100%. Stop-loss is reached when an insured individual has paid the deductible and reached the out-of-pocket maximum amount of co-insurance.

The company that assumes responsibility for the risk, issues insurance policies and receives premiums.

The average fee charged by a particular type of health care practitioner within a geographic area. The term is often used by medical plans as the amount of money they will approve for a specific test or procedure. If the fees are higher than the approved amount, the individual receiving the service is responsible for paying the difference. Sometimes, however, if an individual questions his or her physician about the fee, the provider will reduce the charge to the amount that the insurance company has defined as reasonable and customary.

A period of time beginning with a policy’s effective date during which a health plan may not pay benefits for certain benefits or conditions.

Spouse or children eligible for coverage on an Insurance policy. In Cayman, eligible dependants include: spouses legally married or living together as man & wife for 5 or more years (proof of co-habitation is usually required); children, step-children and adopted children up to age 18 or 19 (depending upon policy), up to age 24 if attending school, and if financially dependent, up to age 30. For over 18 or 19 yr. old children: to remain eligible, it is necessary to provide your insurance company with information on an annual or semi-annual basis. Married and/or employed children do not usually count as eligible dependants and should go on their own policies.

An individual (patient) who receives health care services (such as surgery) on an outpatient basis, meaning they do not stay overnight in a hospital or inpatient facility. Many insurance companies have identified a list of tests and procedures (including surgery) that will not be covered (paid for) unless they are performed on an outpatient basis. The term outpatient is also used synonymously with ambulatory, to describe health care facilities where procedures are performed.

The date on which your coverage begins.