Basic Concepts Medical Expense Insurance

Deductible: It is the first expense to be borne by the Insured and is the fixed amount stipulated in the title page of the policy, which will apply for each illness or accident covered in terms of the conditions in force in the Contract. Once this amount is exceeded, the insurer's obligation begins.

Coinsurance: It is the second expense borne by the Insured and is the percentage stipulated in the title page of the policy that the Insured will pay of the total expenses covered by the policy, once the contracted deductible has been deducted.

Pre-existing conditions: Any illness or condition that has been declared before the contract is signed will be considered pre-existing.

Accident: An event caused by an external, unforeseen, fortuitous, and violent cause that injures the Insured causing bodily harm(s).

Uncovered Period: This is the time interval during which this Contract is canceled. It is generated by the non-payment of premiums or by not having requested the renewal of the policy.

Waiting period: Uninterrupted time that must elapse from the contracting date of each Insured, in order for certain illnesses to be covered by the policy.

Cover of the policy: Document that contains the general data of identification and schematization of the rights and obligations of the parties.

Hospitalization: It is the continuous stay of the Insured for more than 24 hours in a verifiable and justified clinic, hospital, or sanatorium for the care of an illness or accident. It begins with admission and ends with discharge granted by the treating physician.

Medical emergency or medical emergency: It is an unforeseen, sudden and fortuitous illness or injury that endangers life, an organ, or a function and requires immediate medical attention.

Sum insured: It is the maximum limit of liability of the insurer stipulated on the title page of the policy, it will apply according to what is indicated on the title page of the policy. Generally independently for each contracted coverage, as well as illness and/or accident with its consequences and complications occurring within the validity of the policy.

Medical fees table: List of medical and surgical procedures, which specifies the maximum amount to be paid by the insurer for each of these.

Notice from the hospital: It is the benefit that some insurers offer to the insured, which consists of the authorization of direct payment that your insurer will make to the service providers with whom it has entered into an Agreement, prior assessment, and opinion, notifying the origin or Refusal to authorize this benefit to the insured during their stay in the Hospital.