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Insurance Definitions

Claim:
A request for payment for Benefits received or services rendered.
Co-insurance:
The amount you are required to pay for medical car in a fee-for-service plan after you have met your deductible.  The coinsurance rate is usually expressed as a percentage.  For example, if the inusrance company pays 80 percent of the claim, you pay 20 percent.
Copay:
A flat fee every time you receive a medical service (for example, $15 for every visit to the doctor).  The insurance company pays the rest after the deductible is paid by you.
Deductible:
The amount of money you must pay each year to cover your medical care expenses before your insurance policy starts paying.
Exclusions:
Specific conditions or circumstances for which the policy will not provide benefits.
Inpatient:
Service provided after the Member is admitted to the hospital.  Inpatient stays are those lasting 24 hours or more.
Maternity Care:
Services that generally include prenatal care, normal delivery services and routine newborn nursery care.
Maximum Out-of-Pocket:
The most money you will be required to pay a year for deductibles and coinsurance.  It is a stated dollar amount set by the insurance company, in addition to regular premiums.
Network:
The doctors, clinics, hostpitals and other medical providers the insurance company contracts with to provide health care to its Members at negotiated rates.
Outpatient:
A Member who is receiving care at a hospital, physician’s office or other health facility without being admitted overnight to the facility.  The term “ambulatory” is often used to describe Outpatient care.
Preferred Provider:
A doctor who is referred by your insurance company.  When you use the doctors and hospitals that are preferred providers, you can have a larger part of your medical bills covered.  You can use other doctors, but at a higher cost.
Preexisting Condition:
A health problem that existed before the date your insurance became effective.
Primary Care Doctor:
Usually your first contact for health care.  This is often a family physician of internist, but some women use their gynecologist.  A primary care doctor monitors your health and diagnoses and treats minor health problems, and refers you to specialists if another level of care is needed.
Provider:
Any person (doctor, nurse, dentist) or institution (hosptial or clinic) that provides medical care.
Urgent Care:
Services received for an unexpected illness or injury that is not life threatening but requires immediate Outpatient medical care and cannot be postponed.  An urgent situation requires prompt medical attention to avoid complications and unnecessary suffering or severe pain.
Usual, Customary and Reasonable:
The amount charged or the amount determined to be the reasonable charge, whichever is less, for a particular Covered Service in the geographical area in which it is performed.

Frequently Asked Questions

Where and when can I buy IU health insurance?

If you are a new or continuing student for the Spring semester, you will be automatically enrolled in the IU health insurance plan, starting January 1 and ending August 14, after you register for classes.  If you are a new student for the Summer semester, you will be automatically enrolled in the IU health insurance starting May 1 or June 11 and ending August 14, after you register for classes.  If you are a new or continuing student for the Fall semester, you will be automatically enrolled in the IU health insurance starting August 15 and ending December 31, after you register for classes.

Where can I find more information about the IU health insurance plan?

For information on the current IU health insurance, visit our health insurance page.

Can I bring the health insurance from my home country instead?

You may apply for a waiver if you have insurance coverage provided through one of the following:

  • your sponsoring organization
  • a national health care plan (that covers you fully in the US)
  • an employee benefits package for you or a family member
  • insurance you purchased before coming to IU