Claim Form
A written request by the insured individual for the insurance company to pay for a cost incurred and covered under the insurance policy. Many doctor's offices request that you pay at the time of service and you send your receipt to the insurance company for reimbursement. See backside of insurance card for claim filing instructions or contact the Hurtado Health Center for claim form information.

Covered Medical Expense
Specific medical expenses for which the insurance policy will cover the cost.

Deductible
A fixed dollar amount that the insured person is responsible for paying for each accident/illness before the Insurance Plan 1 will begin to pay for a covered medical expense. The Insurance Plan 1 deductible is $250 per accident or illness. This deductible is waived for services the Insured Person gets at the University Student Health Center.

Dependent
The spouse, domestic partner, or child of the primary Insured Person (for the Insurance Plan 1, the primary Insured Person would be the student or scholar).

Elective Surgery and Elective Treatment
Any surgery or treatment that is not covered by the insurance plan but which the Insured Person nonetheless chooses to have. Individuals must pay the full cost of any elective surgery or treatment they choose to have.

Exclusion or Limitation
Any condition or treatment not covered under the terms of the insurance policy. The insurance company does not pay for any of these of costs.

Hospital or Medical Facility
A licensed or properly accredited medical facility which is open at all times and has a primary purpose of providing medical services for sick or injured persons by certified physicians and nursing staff.

Injury
Bodily harm of an Insured Person.

Inpatient
A patient confined in a medical facility as an overnight bed patient. Some medical procedures require the patient to spend one or more nights in a medical facility, while other procedures do not. (See "Outpatient," below.)

Insured Person
A person who is actively enrolled in an insurance plan.

Intensive Care
A designated area in a hospital where the highest level of medical care for the most serious medical conditions is provided.

Lapse in Coverage
After an initial insured period, the period of time during which an individual is uninsured, usually because of failure to pay the insurance premium within a specified time.

Medical Emergency
Any condition that could result in permanent injury, disablement, or death or which otherwise requires immediate medical attention.

Medical Equipment
Equipment that is used for direct treatment of a medical condition.

Medically Necessary
Covered services and supplies that are essential to treat a particular medical condition.

Outpatient
A patient treated and released by a medical facility without staying as an overnight patient.

Policyholder
The Insured Person in whose name the insurance policy is written.

Physician (M.D.), Registered Nurse (R.N.), Nurse Practitioner (N.P.)
Individuals who are licensed to medically treat a person.

Pre-existing Condition
An illness, condition or symptom that existed anytime within the 6 months prior to the Insured Person's effective date of coverage under a new insurance policy; or, any illness, condition or symptom which originates, is diagnosed, treated or recommended for treatment within the 6 months prior to the Insured Person's effective date of coverage under the new policy. Most insurance policies do not cover any costs associated with pre-existing conditions for some amount of time into the policy coverage period. (The Insurance Plan 1 policy does not cover costs for pre-existing conditions until the Insured Person reaches 6 months of coverage under the policy.) Note: because pregnancy is considered to be a medical condition, it is also considered to be a pre-existing condition if an Insured Person has been treated for the pregnancy before the policy goes into effect.

Prescription Drugs:
Any drug or medicine prescribed by a physician to treat a medical condition. The Insurance Plan 1 policy does not offer prescription coverage of any kind for the plan purchased through Rutgers.

Referral Form
A form that is given by a physician to an Insured Person for the purpose of referring the Insured Person to a specialized physician for covered medical treatment.

Sickness/Illness
A sickness, disease, medical condition, or pregnancy.

Usual and Customary
A medical charge which is common (usual and customary) when compared with (1) charges for similar services and supplies in the same locality as the policyholder; and (2) insurance payments made to others with similar medical conditions in the same locality as the policyholder. No payment will be made under the Insurance Plan 1 policy for any expenses which, in the judgment of the insurance company, exceed usual and customary charges.