Glossary Page

Glossary

A
Term	Full Definitions
Acute	Having or experiencing a rapid onset and short but severe course of illness.
Accepted Amount	A specific amount received officially.
Accident	A sudden, unexpected, violent external event, causing a severe physical bodily Injury, which is usually visually identifiable and is documented by a competent authority such as a law enforcement officer or Physician. An unforeseen and unintended event.
Accident related Constructive Surgey	The Coverage under this policy would be restricted only for the cases resulting from Accidents incurred during the validity of the policy and may be extended to the insured whose continuity of Coverage is proven and accepted by the Company before hand.
Accident related Dental Treatment	The Coverage under this policy would be restricted (1) to sound natural teeth and (2) only for the cases resulting from Accidents incurred during the validity of the policy treatment taken within 72 hours of accidental impact and restricted to pain management only.
Active at Work	An employee who is (1) employed on a full-time basis by the Policyholder and is currently being paid a full-time salary, or (2) is on formal paid or unpaid leave from the Policyholder.
Additional Information Request Form	Form to request extra information/ details of the medical condition of the patient to decide the coverage.
Administration Fee	Amount paid for the processing or the execution of something.
Administrative Procedure	How to manage and implement a procedure related to an insurance policy.
Administrative Services Only (ASO)	The provision of third-party administration services for a set fee for a group which is carrying its own risk. This may include all functions related to the group’s plan, except assumption of risk. In other words a third party wherein company handles all/part of administrative works.
Admission Date	The actual date of admission to the hospital.
Aging	The length of time during which a claim stayed in the specific process.
Allergy	Hypersensitivity reaction to a particular allergen; symptoms can vary greatly in intensity.
Alternative treatments	Any of a range of medical therapies not regarded as conventional by medical profession, e.g. homeopathy and reflexolgy.
Ambulance Services	An ambulance service means and includes the ability, skills and resources to bring care directly to people in their homes or at the scene of the incident and also includes transporting to and from the hospital.
Amendment	A statement that is added to or revises or improves a proposal or document.
Application	A verbal or written request for assistance in any matter-here in our case maybe for issuance of policy.
Arbitration	The hearing and determination of a dispute by an impartial referee agreed to by both parties.
Authenticate	Establish the truth or genuineness or validate.
Authorization	Official permission or approval.
Authorization Effective Date	The date from which the authorization becomes valid.
Authorization Expiry Date	The expiry date of the authorization validity.
Authorization Letter for Hospitalization:	A guarantee of coverage for covered person hospitalization and/or an out of hospital service that may need prior approval under Daman Plan.
Authorization No.	The number assigned to the authorization.
Authorization Request for Hospitalization Form	A set of required information by Daman, provided in a certain format to the Participating Provider. It must be completed and submitted by the Participant Provider to the Authorization Department prior to an admission or Day care service of a Covered Person.
	Top
B
Term	Full Definitions
Balance Billing	The practice of a provider billing a patient for all charges not paid for by the insurance plan.
Basic insurance	The health insurance policy pursuant to which basic healthcare services are offered to the categories set out under the Implementing Regulations.
Batch Code	A set of letters and numbers used to reperesent claims/claim coming at one time or taken together.
Benefit	The extent or degree of service Covered Persons are entitled to receive based on their contract with the Company.
Benefit Category	A Benefit Category is a specific area of plan coverage that may include features different from the plan's base options.
Benefit Plan	The combination of all Benefits that Covered Persons are entitled to receive based on their contract with the Company.
Best Practices	Actual practices, in use by health care providers following the latest treatment modalities that produce the best measurable results on a given dimension.
Billing Month	The month an act of preparing or sending out a bill or invoice from a provider.
Billing Period	The interval of time a bill or an invoice received from the provider.
Body Mass Index	An index that expresses adult weight in relation to height. Body Mass Index (BMI) is used to estimate healthy weight of average people.
Benefit Period	It refers to the time period for which payments for benefits of an insurance policy are available.
Beneficiary	Person covered by health insurance.
Breach	Act in disregard of laws, rules, contracts, or promises/ failure to perform something promised.
Broker	The broker offers advice and arranges the insurance normally as agent for the insured and is usually remunerated by a commission from the insurer.
Bypassed Rules	rules which are circumvent to finish processing an invoice.
	Top
C
Term	Full Definitions
Cancellation	A termination of a policy before its normal expiration date.
Cancellation due to non payment and or delayed payment of Premium	A clause which enables the insurer to cancel the policy on account of delay in payment of premium exceeding the grace period allowed or due to failure of payment of premium.
Calculated & Valid	A status of an invoice which shows it is ready for reporting.
Case Number	A number assigned to a definite and separate case or illness.
Cash Compensation	Cash benefit is an option benefit in health insurance policy where a sum is paid by insurer if insured member took treatment free of cost.
Cessation	A pause or stopping of coverage/benefit.
Charity health program	Organisations or institutions helping those in need of health care.
Chronic	Being long-lasting and recurrent or characterized by long suffering.
Claim Administration	The process of receiving, reviewing, adjudicating, and processing claims.
Claim Form	A form which must be completed by the attending Physician in order for the Covered Person to obtain Coverage for treatment.
Claim Review	A process which monitors the claim, its appropriateness and ensures that it is not excessive.
Claim Examiner	A professional who considers all the information pertinent to a claim and make decisions about the payment of the claim.
Claim Investigation	The process of obtaining all the information necessary to determine the appropriate amount to pay on a given claim.
Claim Type	This identifies to what kind or division a particular claim belongs.
Claims Characteristics	The type/ nature of claim whether Emergency/ Road traffic accident/ Work related accident/ others.
Claims Invoices	A set of numbers generated by the system for a specific claim.
Claims Registry	A place where all the number of claims received from different providers and beneficiary holders are kept.
Claims Reimbursement	An amount being claimed by a beneficiary for services done outside the provided network.
Class	The category of accommodation eligible for the insured member.
Clerical error	A mistake committed while copying or writing out some document or a part of it.
Clinic	Health facility to treat the outpatients.
Clinical Judgement	Diagnosis & Treatment plan derived from the application of information based on actual observation of a patient combined with subjective & objective data.
Covered Services	Benefits that are covered under the terms & conditions of the policy.
Conditions	A part of an insurance policy that states your obligation and those of your insurance company.
Conditions for Termination of a Covered Person's Coverage under the Policy	A clause in policy wordings stating the circumstances during which insured member policy can be terminated. For example allowing other to use his/her card.
Conditions for Termination of This Entire Policy	A clause in policy wordings stating the circumstances under which entire policy can be terminated after giving required period of notice. For example non payment of premium or misrepresentation of material facts.
Co-insurance	The percentage of Eligible Expenses in addition to the Premium, which Covered Persons are required to pay for certain Health Services provided under the Policy. Covered Persons are responsible for the payment of any Co-insurance directly to the Provider.
Complaint	A health plan member's expression that his expectations regarding the product or the services have not been met.
Compliance	Acting according to certain accepted standards.
Complications	Any disease or disorder that occurs during the course of (or because of) another disease.
Computation of Premium	An amount policy holder pays in order to avail health Insurance. Calculation of premium is based on age,number of persons,claims history,past and present medical Conditions.
Confinement	An uninterrupted overnight stay following formal admission to a hospital.
Congenital diseases	A disease or disorder that is inherited genetically.
Contribution	If an insured is covered under two plans for same risk, a ratable proporion of losses are shared among insurers on the basis of their liabilities.
Controlling document	A document which has the power to check and direct some activity and thus regulate the Act.
Conformity with Statutes	Any provision of the Policy which on its Effective Date, is in conflict with the requirements of governmental statutes or regulations (of the jurisdiction in which delivered) is hereby amended to conform to the minimum requirements of such statutes.
Congenital Anomoly	An anatomical or physiological defect disease or malformation … etc which may be either hereditary/familial/genetic or due to an influence occurring during gestation up to birth, and may or may not be obvious at birth.
Consultation	A service done in a medical facility where a meeting with a physician to evaluate a patient's case and treatment takes place.
Contractual Year	A binding legal agreement for a year.
Co-Payment
Coordination of Benefits(COB)	An agreement to prevent double payment for services when a subscriber has coverage from two or more sources. Agreement determines which organization has primary responsibility for payment and which organization has secondary responsibility.
Coordination of Benefits Applicability	A provision in the contract that applies when a person is covered under more than one health insurance plan. It requires that payment of benefits be coordinated by all plans to eliminate over-insurance or duplication of benefits.
Cosmetic procedures	Procedure intended to improve physical appearance or for restoring or enhancing the normal appearance- a procedure generally not required medically.
Coverage or Covered	The entitlement by a Covered Person to Health Services provided under the Policy, subject to the terms, conditions, limitations and exclusions of the Policy.
Covered Condition	A state of health which is accepted as per the policy by an insurance company.
Coverage Category	Classifications of employees within an employer group, who are eligible for different levels of Benefits. These Coverage Categories, if any,are listed in the Corporate Policy.
Coverage for a Newly Eligible Primary Insured	Coverage of person start from the date of their eligibility provided it is informed to Daman within specified period of time mentioned in policy.
Coverage for New Dependants (Except Newborn Children)	Coverage of person start from the date of their eligibility provided it is informed to Daman within specified period of time mentioned in policy.
Custodial care	Treatment under care of some person or institution or organisation.
	Top
D
Term	Full Definitions
Daman card	The identification card the Company issues for every member covered under this health insurance scheme.
Daman Plan	The combination of all Benefits that Covered Persons are entitled to receive based on their contract with Daman.
Day treatment	Medical treatment which must be provided in the Hospital, but which does not require confinement.
Day Care	A service or medical treatment that must be provided in the hospital, but it does not require an overnight stay in the hospital.
Declination	Rejection by a Health insurance company of a Health insurance application.
Declaration	A part of insurance policy that states the name and address of the policyholder, medical conditions, treatment and medical facilities where he/she is having treatment.
Deductible	In health Insurance, a fixed monetary amount paid by the Insured for a defined benefit.
Denial of Already Approved Services	If the Company first approved a treatment and at a later stage the condition is discovered as a Non-covered condition, in such a situation the Company has the right to decline this case from beginning or the maximum liability of the Company shall be up to.
Dependant	A person who relies on another person for support (especially financial support).
Dental Benefits	A benefits which is pertaing to dental is covered under the policy (if benefit selected).
Dental Claim	The request for dental treatment.
Dental Claim Form	The form to use when filing a dental claim.
Designated Facility	A Hospital, named by the Company as a Designated Facility, which has entered into an agreement with or on behalf of the Company to render Covered Medically Necessary and Medically Appropriate Health Services for treatment of specified diseases or condition.
Deviation	A departure from what was laid down or expected.
Diagnosis	Identifying the nature or cause of an illness/ailment.
Direct Payment	Settlement of the cost of service of the insured member directly to the provider by Daman.
Discrepancy Notification	A written or printed notice of difference or inconsistency.
Dispute resolution	Means of resolving a dispute or a disagreement.
Domiciliary care	Treatment undertaken at home or residence under professional medical supervision and assistance.
Donor	A person alive or deceased from whose body one or more organs have been extracted with the intention to transplant them (totally or partially) in the body of another person (the Recipient) via an Organ Transplant.
Durable Medical Equipment	Medical equipmentused externally from the human body which: (1) can withstand repeated use; (2) is not designed to be disposable; (3) is used to serve a medical purpose; (4) is generally not useful to a person in the absence of a Sickness or Injury.
	Top
E
Term	Full Definitions
Earned Premium	The proportion of premium related to the period of insurance that has already elapsed.
Effective date of coverage	The date on which coverage becomes effective, which may be either the Enrollment date of a person or the date on which the coverage renews/is renewed.
Effective Date of Coverage for Confinement	The date on which health insurance coverage start for inpatient or day care case patient.
Effective Date of Coverage for Newborn Children	Newborn childs are eligible for coverage from date of their birth if born in UAE and request of addtion received within 30 days of their birth. In case of a childs born outside UAE effective date shall be from date of entry within UAE.
Elective diagnostic services	Those diagnostic services which are sought without them being medically necessary at that particular time.
Eligibility conditions	Some basic requirements based on which the rights conferred are decided.
Eligible Expenses	Reasonable and Customary Charges for Covered Health Services, incurred while the Policy is in effect.
Eligible Person	(1) An employee of the Policyholder who is Active at Work or (2) Other person who meets the eligibility requirements specified in both the application and the Policy. Furthermore, the definition of “Eligible Person” must be in accordance with the Mandator.
Employer	Any Person or entity employing resident expatriate in UAE including resident expatriate on work or resident permits.
Emergency	A sudden unforeseen crisis (usually involving danger) that requires immediate action.
Emergency Case	It’s a sudden and serious medical situation that arises, and demands immediate medical attention. Failure to get treatment could put the covered person’s life in danger or cause serious harm.
Emergency Health Services	The health care services and supplies necessary for the treatment of an Emergency.
Emergency Health Services by Network Providers	The company provides coverage of eligible expenses for medically necessary emergency health services, subject to the terms, conditions, exclusions, and limitations of its issued policy.
Emergency Health Services by Non-Network Providers	The health care services rendered by Non-Network providers in emergency cases where the network cannot be approached or the services are not available at the nearby Network Provider.
Emergency Outpatient Health Services	Health Services for stabilization or initiation of treatment of Emergency conditions provided on an outpatient basis at a Hospital.
Entitled	Qualified for, by right, according to law.
Entire Policy	Whole policy or complete policy.
Enrolled Dependant	Dependent of principle enrolled in the policy.
Enrollment Date	The original Effective Date of Coverage for a Covered Person.
Epidemic	A widespread outbreak of an infectious disease in which many people are infected at the same time.
Estimated Cost	Cost that has been calculated approximately for a particular service/ treatment.
Estimated LOS	Approximate period of confinement of a patient to a health care facility for the treatment of an illness.
Examination of Covered Persons	In the event of a question or dispute concerning Coverage for Health Services, the Company may reasonably require that a Network Physician acceptable to the Company examine Covered Persons at the Company’s expense.
Excluded health care services	The health care services which are not covered by the health insurance policy.
Exclusions	Items or conditions that are not covered by the general insurance contract.
Exempted	Grant relief or an exemption from a general rule or requirement.
Ex Gratia Payment	Done voluntarily, out of kindness or grace. In law, an ex gratia payment is a payment made without recognizing any liability or legal obligation.
Expatriate	A person living away from one's own native country.
Experimental	A medical, surgical, diagnostic, or other health care services, technologies, supplies, treatments, procedures, drug therapies or devices that the Company determines as experimental, subject is of an ongoing clinical trial, not demonstrated through prevailing pre-reviewed medical literature to be safe and effective for treating or diagnosing the condition or illness for which its use is proposed.
Experimental, Investigational or Unproven Services
Expiration	End of a contract period.
Expiry Date	The day (at 00:00 midnight local time), month and year from which the Policy expires.
	Top
F
Term	Full Definitions
Filing Claims	Submission of claims for payment in reimbursement case.
Filing Claims for Reimbursement of Eligible Expenses from Non-Network Providers	Filing of claims for reimbursement for eligible expenses from non network provider is cover if plan covers reimbursemt received from non network.
Final Settlement	A decisive agreement reducing or resolving the differences.
Fraud & Abuse	Any unnlawful act/ medical misuse which results in the inappropriate billing of the services by a health care provider.
Full-Time Employee	An employee who is on a permanent pay roll of the Employer and having full time employee status.
	Top
G
Term	Full Definitions
General Exclusions	The health Benefits and services excluded from Coverage that are listed in Section 11 of this Policy and apply to all Covered Persons.
	Top
H
Term	Full Definitions
Hazardous activity	A circumstance or activity that increases the likelihood or probable severity of a loss.
Healthcare providers	Organisations and institutions providing health care and authorised to do the same.
Health Services	The health care services and supplies Covered under the Policy, except to the extent that such health care services and supplies are limited or excluded.
Health Services Covered Under the Policy	These are the services which are agreed to be paid as per eligibility and other conditions applicable under a health insurance plan. Sechedule of benefit describe the benefits which are payable under the plan.
Health Services Rendered by Network Providers	Mentioning of services which are rendered by network provider. Generally network department enter into aggreement with provider relating to their services and prices.
Healthcare Facilities	A facility concerned with the maintenance or restoration of the health of the body or mind.
High Cost Case	A patient whose condition requires large financial expenditures or significant human and technological resources.
High Risk Case	A patient who has a complex or catastrophic illness or injury or who requires extensive medical interventions or treatment plans.
Hospitalization	Any hospital confinement for a period not less than 24 hours due to any non-excluded health service or condition which cannot be performed on an out of hospital basis.
Hospitalization Class	The class of hospital room and services, indicated in the Schedule of Benefits, to which the covered person is entitled according to Daman Plan.
Illness	A bodily disorder, disease, physical sickness or functional nervous disorder of a person.
	Top
I
Term	Full Definitions
Impairment	The condition of being unable to perform as a consequence of physical or mental unfitness.
Inception	An event that is a beginning; a first part or stage of subsequent events.
Incident No.	A number assigned to a definite and separate occurrence of a specific case or illness.
Incurred but Not Reported(IBNR)	Claims or benefits that occurred during a particular time period, but that have not yet been reported or submitted to an insurer.
Indemnity	Payment made to compensate the Insured for their Illness or Injury.
Infringement	Act contrary to or in violation of law that disregards an agreement or a right.
In Hospital Benefits	Hospitalization or day care services inside the Hospital that can not be carried out on out of hospital basis.
Injury	Bodily damage other than Sickness including all related conditions and recurrent symptoms.
Inpatient	Hospital Confinement requiring an overnight stay.
Inpatient Benefit	Hospitalization or Day Treatment or Observation / Treatment in an Emergency Room / Facility which cannot be carried out on out patient basis.
Inpatient Hospital and Related Health Services	Treatment received by a patient in a hospital involving an overnight stay
Insurance	Promise of reimbursement in the case of loss; paid to people or companies that have made prepayment to insurance companies against these risks.
Insurer	The party in an insurance agreement who undertakes to pay the losses.
International Assistance Services	A benefit which is provided to insured member in case of emergency.
International Network Claims	Claims coming from an affiliated healthcare/medical facilities of the insurance outside the UAE.
International Network Provider	An affiliated healthcare/medical facilities of the insurance outside the UAE.
International Outpatient Claim Form	The form to use when filing an international outpatient claim.
Intermediary	A negotiator who acts as a link between parties.
Irreversible	Incapable of being brought back to original form or incapable of undoing that which has been done.
Issue Date	Date on which an authorization is issued/ registered in the Mednext.
	Top
J
Term	Full Definitions
	Top
K
Term	Full Definitions
	Top
L
Term	Full Definitions
Large Group	A large group may be defined as more than 11 employees and in some policies 25 employees and above.
Lesion	An injury to living tissue (especially an injury involving a cut or break in the skin) or Any localized abnormal structural change in a bodily part.
Liable	Legally bound under an obligation, the term is more used in a pecuniary sense.
Limits	The maximum amount paid by the policyholder under the terms for a given policy year.
Limitation of Action	If a dispute between Daman and the Parties (includes Policyholders and / or Covered persons on behalf of Policyholder) dealing in business with it arises out of or is related to any Agreement, the concerned Party and Daman shall meet and negotiate in good.
Limitations on Selection of Providers	Restriction on selection of medical service provider, for example a non network provider.
Local Currency	Pertains to something that is used as a medium of exchange (money) for a specific country.
Loss Ratio	The ratio of losses(claims) paid and outstanding to premiums.
Loading	Administration costs paid upon purchasing insurance.
	Top
M
Term	Full Definitions
Material Facts	A fact that would influence the judgment of a prudent underwriter in deciding whether to accept a risk for insurance and on what terms.
Maternity Benefit - Inpatient	Includes charges for a vaginal delivery, a medically necessary cesarean section, any complication of pregnancy or delivery, and legal abortion.
Maternity Benefit - Out patient	Includes charges for all outpatient pre-natal and post-natal physician visits, including investigations & treatment.
Maternity Services	Services related to maternity benefit. It include outpatient and inpatient maternity services.
Malicious	A desire to do wrong or to do evil.
Mandatory	Required by rule, or made compulsory by law.
Maximum Authorized Amount	The maximum amount that can be authorized by Daman for a particular benefit. Any amount exceeding the limit will not be paid by Daman.
Mediation	The act of intervening for the purpose of bringing about a settlement.
Medical Appliances and Medical Equipment	Medical equipment is designed to aid in the diagnosis, monitoring or treatment of medical conditions, and medical appliances are devices used to perform a specific medical function or to have a specific therapeutic effect.
Medical Check-up	Refer to physical examination which includes a variety of tests depending on the age, gender and health of the person to detect a disease in individuals without signs or symptoms of that disease, tests are performed on those without any clinical indications.
Medical Claims Processing	A systematic series of actions from receiving, reviewing, encoding and processing of claims.
Medical Condition	Any disease, sickness or injury that currently exists or has existed prior to the commencement of the policy.
Medical Coordinator	Dentist or para-medical staff working in the authorization department.
Medical emergencies	Any condition which required immediate or prompt medical action failing which may result into endangering the life of the person who requires such attention.
Medical Encoding	Process of converting information from the physical claims to the system using the ICD 9CM, DRG, CPT.
Medical History	A record pertaining to or giving evidence of the state of one's health.
Medical Information	A knowledge communicated or received concerning the state of one's health.
Medical Officer	Medical Practioner working in the authorization department.
Medical Review & Evaluation	To look over, study and judge carefully the case and the necessity and appropriateness of treatment given based on medical practice and insurance policy.
Medically Appropriate	Based on the prevailing standards of medical practice relative to a specific condition.
Medically necessary	A service given at a provider that should be in consistent with the diagnosis, be in standards of good medical practice and not be for the convenience of the patient or the family members.
Medical Underwriting	The evaluation of health questionnaires submitted by all proposed plan members to determine the insurability of the group.
Member Query	A feature in Mednext which shows all the informations about the member.
Misleading information	Any wrong or misleading information given to the insurer, which may affect underwriting decision.
Misrepresentation	A wilful perversion of facts.
	Top
N
Term	Full Definitions
National	A natural person who is holding the nationality of the State in accordance with applicable laws.
Negotiate	Confer with another in order to come to terms or reach an agreement.
Network	A group of health care providers under contract with a insurance company within a specific geographic area.
Network Benefits	Benefits available for Covered Health Services when provided by a Network Provider. Health Services provided by a non-Network Provider are considered Network Benefits when such Health Services are approved in advance by the Company or are Emergency Health.
Network Claims	Claims submitted by affiliated healthcare facility.
Network Provider	It is used to describe a Provider of Health Services that has a participation agreement in effect with Daman, to provide Health Services to Covered Person i.e.: Doctors, Pharmacies, Diagnostic Centers, Primary health care Centers and Hospitals.
Network Provider Observation	A remark, comment, or statements based on what was noticed about the practices of a specfic provider affiliated with Daman.
Net Payable	Amount that the insurance will pay to the provider.
Non-Acceptance Letter	Letter stating reasons for refusing to accept a claim.
Non-Covered Services	Any services, products, or supplies which are not covered under Daman Plan that the covered person has to pay directly to the participating provider. E.g. telephone and cafeteria bills, rejected cases, and any services mentioned in the General Exclusion l.
Non-Emergency Hospitlaization	Any Confinement which is not as a direct result of Emergency Health Services.
Non-Network	A healthcare facility outside the list of affiliated medical facilities of Daman.
Non-Network Benefits	Coverage available for Health Services obtained from non-Network Providers. Health services provided by a non-Network Provider are considered Network Benefits when such Health Services are approved in advance by the Company or are Emergency Health Benefits.
Non-Network Provider	It is used to describe a Provider of Health Services that doesn’t have a participation agreement in effect with Daman, to provide Health Services to Covered Person.
Notice	A written notice to the insurer by an insured person claiming a benefit or recovery under the terms of the insurance contract.
Notification Information	The details of service notification to Daman by the provider.
Notification of Coverage Changes	The Policyholder shall notify the Company in writing within 31 days of the Effective Date of enrollments, terminations, or other changes.
Notifying Person	Person/ Deaprtment who notifies a Medical service.
	Top
O
Term	Full Definitions
Obesity	Abnormal or excessive fat accumulations that presents a risk to health.
Obligations	A legal agreement specifying a payment or action and the penalty for failure to comply.
Occupational diseases	A disease or a chronic ailment that occurs as a result of work or occupational activity.
Omission of Eligibility	In case of a discontinuation of the eligibility requirements stated in the Mandatory Health Insurance Law for Expatriates and respective Bylaws, as set forward by the Health Authority of Abu Dhabi (HAAD) and/or other relevant authorities.
Open Access	A provision that plan members may self-refer to a specialist, either at full benefit or at a reduced benefit, without first obtaining a referral from a primary care provider.
Organ Transplant	An operation of moving an organ from the Donor to the Recipient.
Optical	Related to refractive errors.
Optional	Possible but not necessary; left to personal choice.
OR Date	Operating Room Date / Date of Surgery.
Orthodontics	The branch of dentistry dealing with the prevention or correction of irregularities of the teeth.
Out-of-Pocket Limit	A predetermined amount of money that an individual must pay before insurance will pay 100% for an individual's health-care expenses.
Outpatient care	Any health care service provided to a patient who is not admitted to a facility. Outpatient care may be provided in a doctor's office, clinic, the patient's home or hospital outpatient department.
Outpatient Claim Form	A form which is mandatory to be filled and completed by the participating provider on each patient visit or follow up to the out-patient department. This form provides information concerning the patient chief complaint, past-history, the positive clinical.
Outpatient Prescription Drugs	Medicine prescription given as a result of an out-patient visit wher the patient does not require an overnight stay or daycare treatment.
Out of Hospital Benefits	Benefits offered under this cover are the services that are carried in out-patient department without jeopardizing the insured health or do not require hospitalization/Day care treatment or necessitate specialized medical attention and care inside the hospital.
Paid Amount	Amount that the insurance paid.
Participation and Contribution	Participation and contribution rules concern with complying with policy terms and conditions. For Example as per participation rules maternity coverage must be taken for all married female residing in Abu Dhabi. Contribution rules may be participation in health insurance by paying a portion of premium. It may also refer to an event where an insured member/policy holder has either participated or contributed in fraud and abuse.
Past Medical History	Information on the past illness of an insured member including his/her major illnesses, any previous surgery/operations,any current ongoing illness eg: diabetes.
Patient Consent	Permission of the patient to receive a perticular treatment.
	Top
P
Term	Full Definitions
Payable Amount	The sum total capable of being or liable to be paid.
Payment and Reimbursement upon Termination	Upon any termination of this Policy, the Policyholder shall be and shall remain liable to the Company for the payment of any and all Premiums, which are unpaid at the time of termination.
Payment for Health Services Incurred after the Date of Termination	The Policyholder will be responsible for reimbursement to the Company for payment of any Health Services obtained by a Covered Person using their Daman Card after Coverage termination.
Payment of Stamps and Taxes required by Government Entities	The Policyholder shall be liable for payment of any stamps or taxes required by government entities on the provision of health care Benefits.
Payment of the Premium	Amount to which an applicant is obliged to pay for health insurance coverage.
Pending Claims	Invoices which are not yet processed or settled.
Performance-enhancement drugs	Drugs used to enhance or improve the performance - those that are not medically necessary.
Physician	Any practitioner of medicine who is duly licensed and qualified under the laws of the country in which treatment is received.
Physical Claim	A hardcopy of the claims submitted by the providers, also known as paper claims.
Place of Service	Place from where the medical service is given to the patient.
Policy	The Corporate policy, the application of the Policyholder, any individual Primary Insured applications, Amendments and Riders which constitute the agreement regarding the Benefits, exclusions and other conditions between the Company and the Policyholder.
Policy Administration	How to manage an insurance policy according to its SOB.
Policy Charge	Any charges in addition to the Policy Premium that are payable by the Policyholder.
Policy Coverage	A written contract for insurance between the insurance company and the policyholder stating details of coverage.
Policy holder	Policy holder is a person or an entity that sponsors the policy or in other words pays the premium for the policy.
Policy period	The period of time (typically one year) from the Effective Date of Coverage, to the termination of coverage prior to renewal.
Pre-authorization	Prior approval or official permission taken before certain procedures which according to the terms of the policy require to be taken for claiming the cover.
Pre-existing condition	Existing previously or before something, Exist beforehand or prior to a certain point in time.
Premium	The price payable by an insured person under any type of insurance policy.
Prescription	Written instructions from a physician or dentist to a pharmacist concerning the form and dosage of a drug to be issued to a given patient.
Prescription Date	Date of prescription.
Prescription Drugs	Pharmaceuticals which can only be obtained through a prescription written by a licensed physician.
Preventive	Remedy that prevents or slows the course of an illness or disease.
Premium Refund	This insurance is non-transferable. Premium will be refunded on the basis of short term basis on cancellation.
Primary Insured	An Eligible Person who is properly enrolled for Coverage under the Policy. The Primary Insured is the person (who is not a Dependant) on whose behalf the Policy is issued to the Policyholder.
Primary health care	Essential health care based on practical, scientifically sound and socially acceptable methods made accessible to the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development.
Principal Insured Member	Main beneficiary holder.
Prior Approval	Condition placed in the policy wording.
Prior Approval Procedure	The process of review and assessment of the medical necessity and appropriateness of hospital admissions, Day care procedures, and certain out of hospital services; prior to providing the service.
Prior Approval Does Not Guarantee Benefits	Prior approval or getting pre-authorisation does not guarantee that the entire service so obtained shall be paid for or reimbursed 100% by the insurer. Prior approval only ensures the coverage for the service subject to the eligibility and other terms.
Processing Unit	A unit in the Claims department responsible for encoding, checking the price and reporting to finish a claim.
Professional Fees for Surgical and Medical Services	Professional fees for surgical services and other medical care provided by or through a Physician.
Prosthetic Device	An artificial device, either external or implanted, that substitutes for or supplements a missing or defective part of the body, e.g. artificial limbs and pacemakers.
Provider	Any person or entity providing health care services, including hospitals, medical centres and clinics. Usually licensed by the state.
Provider Code	A set of letters and numbers used to reperesent a medical facility.
Provider Invoice No.	A set of numbers/letters or combination in the invoice used by the provider to pursue a claim.
Provider Manual	A document that contains information concerning a provider's rights and responsibilities as part of a network.
Procedure	A particular course of action intended to achieve a result.
Pro-rata premium	Proportionate amount collected for coverage for a partial period which is less than the cover generally extended.
Prosthetic devices	an artificial device, either external or implanted, that substitutes for or supplements any part of the body.
Provisions	A stipulated condition.
Psychiatry	A mental condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological, social, or work performance of the individual.
Pursuant	In conformance to or agreement with.
	Top
Q
Term	Full Definitions
	Top
R
Term	Full Definitions
Recipient	A covered person who received or is receiving an organ transplant covered under this policy.
Receiving Unit	A unit in the Claims department responsible for receiving, tracking and distributing claims.
Reconstructive surgery	Surgery incidental to an injury, sickness or congenital anomaly with the primary purpose of is to improve the physiological functioning of the involved body part.
Recommended Treatment Plan	The treatment plan that is suggested for a diagnosis.
Records	An account, as of information or facts, set down especially in writing as a means of preserving knowledge or serve legal purpose.
Recreational	Engaged in as a pastime, source of enjoyment.
Referral	A person whose case has been referred to a specialist or professional group/ A recommendation to consult the person or group to whom one has been referred.
Referral Health Services Rendered by Non Network Providers	Health services rendered by Non-Network Providers on referral from the Network Providers, the reason being the services sought being unavailable at the Network Providers facilities.
Referral Letter	The form that must be used by the participating providers to refer the covered person to another provider for further evaluation, treatment, consultation, or admission, etc. This form must be attached to each claim submitted to Daman for settlement.
Reimbursement	Compensation paid (to someone) for covered benefits availed at a non-network provider.
Reimbursement of Eligible Expenses from Network Providers	Network Providers are responsible for submitting a request for payment of Eligible Expenses directly to the company. In the event a Network Provider charges any fees other than Deductible or Co-insurance, the Covered Person should contact the Company.
Reimbursement of Eligible Expenses from Non-Network Providers	The Company shall reimburse Covered Persons for Eligible Expenses incurred with non-Network as per terms & conditions of the policy.
Reinsurance	An insurance company that protect against the risk of losses of other insurance companies.
Rejection Letters	A written or printed communication addressed to a provider/beneficiary for something that is rejected.
Rejection Letter for Hospitalization	Notification letter of the rejection of a requested service or hospitalization for the covered person determined by the benefit contract.
Relationship among Parties	The relationships between the Company and Network Providers and relationships between the Company and Policyholders are solely contractual relationships between independent contractors. Network Providers and Policyholders are neither agents nor employees.
Renewal	New coverage under a new Policy following a previous term and the acceptance of a Premium for a new Policy Period.
Renewal Date	The annual date on which the experience of an existing policy is scheduled to be reviewed.
Renewal of the Policy	Policy can be renewed for a new Policy period if the Company and Policyholder agree to the renewal. The renewal is effective only upon the renewal date specified by the Company and subject to payment of premium.
Repatriation	In case the insured member has passed away the Mortal Remains will be sent back to his/her country of origin.
Resubmission	The act of submitting back the claims for reconsideration.
Resubmission Form	A form filled by those who wants to submit back the claims for reconsideration.
Rescind	Cancel or terminate officially.
Restrictions	Restriction means to limit the extent of something. Insurance restriction refers to limiting the benefits or services in insurance.
Return of Daman Cards and Claim Forms upon Termination	Upon Termination of Coverage for any Covered Person, it is the Policyholder’s responsibility to insure that terminating Primary Insured return all Daman Cards to the Company.
Revocation	The state of being cancelled or annulled /The act (by someone having the authority) of annulling something previously done.
Riders	Any attached rider to a policy maybe subject to payment of additional premiums and are subject to all conditions, limitations and exclusions of the Policy unless specifically amended.
Risk	Risk means uncertainty of financial loss.
Risk Factors	Things about you that affect your risk (e.g., older age, smoking, heart disease, occupation.
Routine examinations	Medical examinations which are done on a regular basis just as a preventive measure without them being medically necessary at that point of time.
	Top
S
Term	Full Definitions
Schedule of benefits	A summary of the details of cover extended, the territorial limits and also the terms and conditions of coverage.
Scheme	In insurance “scheme” refers to different kind of plans with certain specific benefits, in view to target certain segment or achieve some pre specified objectives.
Screening Programme	Preventive care programs designed to determine if a health condition is present even if a member has not experienced symptoms of the problem.
Second Opinion	Where Surgery is recommended, taking second opinion from other doctor for given medical condition.
Second Opinion Policy	This is an opinion provided by a second expert physician, where opinion is already given by one expert physician on the line of treatment and which is generally surgery.
Service Date	Time or period to which the act or manner of service took place.
Settlement	A conclusive resolution of a matter and disposition of it /Something settled or resolved; the outcome of decision making.
Short Term Cancellation	A cancellation by the insured of an insurance policy for which the returned, unearned premium is diminished by administration costs incurred when the insurance company places the policy on its books.
Short Past History	Past Medical History in short.
Short Stay Medical (SSM)	Unit that cares adult patients on day care basis.
Short Stay Pediatric (SSP)	Unit that cares pediatric patients on day care basis.
Sickness	Physical illness or disease. The term "Sickness" as used in this Policy does not include Mental Illness or substance abuse, except those mentioned in Section 11.
Specific Exclusions	Non-Covered services or Benefits which are specific to the Covered Person being insured.
Sponsor	Any person or entity that sponsor the resident expatriate for the of working,residing, whether temporarily or otherwise in Emirate of Abu Dhabi.
Small Group	In Daman policy it is generally composed of 10 or less employees irrespective of size of members for which health coverage is provided by the group sponsor.
Standard Of Benefits	It explains the coverage, benefits and limit of policy. See the schedule of Benefits.
Standard Of Care	A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance.
Submission Mode	A manner or way of transferring claims.
Submission Protocol	Set of rules determining the format or way of submitting claims.
Subrogation	When an insurer indemnifies an insured,it's permitted to take over the right of the insured to recover any amount payable from other parties who might be liable for the loss.The insured is said to have subrogated their right to the insurer.
Supplementary insurance	Coverage provided by non-profit charity health care program.
Suspended Claims	An invoice status which cannot be finished due to some technical problems.
Suspended Invoice	An invoice status which cannot be finished due to some technical problems.
	Top
T
Term	Full Definitions
Termination	A coming to an end of a contract period, or the act of ending something.
Termination of Provision	A provider contract clause that describes how and under what circumstances the parties may end the contract.
Terms and conditions	The basis on which the contract is formed, benefits are granted and the rules governing the coverage of the policy.
Territorial coverage	The area or territory over which the cover is extended under a policy.
Territory of Occurrence	The country where the claimed expenses are incurred.
Therapeutic	Relating to or involved in therapy, A medicine or therapy that cures disease or relieve pain.
Third Policy Administration(TPA)	It refers to system where the processing of claims is outsourced to another company but the risk of loss remains with the insurer or the employer.
Tracking Sheet	A piece of paper with informations that is used to pursue a claim.
Tranquilizer	A drug used to reduce stress or tension without reducing mental clarity.
Transplant	An operation where an organ is transferred from the donor to the recepient.
Transplant Center	A Hospital with a specialized unit that performs Organ Transplants.
Traumatic	Of or relating to a physical injury or wound to the body, Psychologically painful.
Treatment Date	Time or period to which the act or manner of treating took place.
	Top
U
Term	Full Definitions
Underwriter	The individual trained in evaluating risks and determining premiums and coverages for them.
Undeclared Pre-existing Condition	Any Pre- Existing Condition known to the Covered Person or Policyholder, which is not declared on the medical questionnaire or Policy application in case a medical underwriting has been applied.
Underwriting	The process of selecting risks for insurance and classifying them according to their degrees of insurability so that the appropriate rates may be assigned.
UnderwritingImpairment	Factors that tend to increase an individual's risk above that which is normal for his or her age.
Underwriting Manual	A document that provides background information about various underwriting guidelines and suggests the appropriate action to take if such an impairment exists.
Unearned Premium	That part of the premium or reinsurance premium applicable to the unexpired portion of the policy.
Usual, customary, and reasonable (UCR) fee	The amount commonly charged for a particular medical service within a particular geographic region.
	Top
V
Term	Full Definitions
Validity	The quality of having legal force or effectiveness.
Verification of Participation Status	Verification of participation status of a Physician, Hospital or other Health Services by insured members from time to time as participation status of a Provider may change.
Violation	An act that disregards an agreement or a right - resulting in right to revoke the contract or take legal action against the offending party.
VIP	One big (not less than 20 m2) single bed for the patient fully equipped with oxygen and suction, electric bed, bedside table, Wardrobe, special table for patient food, separate bathroom, TV, fridge and Saloon Seats for visitors.
	Top
W
Term	Full Definitions
Ward	Block forming a division of a hospital shared by patients who need a similar kind of care. More than 2 beds room for the patient – each patient compartment can be separated by a curtain - fully equipped with oxygen and suction, electric beds, bedside tables, special table for patient food for each bed, one bathroom inside or shred bathroom outside the room and chairs for visitors.
Work Related Accident	An accident that has happened to an employee at his place of work or while travelling to or from his place of work.
Work Related Case	An instance of disease or injury that was acquired at work.
Workers' compensation	A state-mandated insurance program that provides benefits for healthcare costs and lost wages to qualified employees and their dependents if an employee suffers a work-related injury or disease.
Workers' compensation indemnity benefits	Benefits that replace an employee's wages while the employee is unable to work because of a work-related injury or illness.
Waiting period	The time which must pass before policyholder can collect insurance benefits.
	Top
X
Term	Full Definitions
	Top
Y
Term	Full Definitions
	Top
Z
Term	Full Definitions
	Top

Terms And Conditions | Privacy | Disclaimer

This website is best viewed with a resolution of 1024x768 pixel settings.

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

Q

R

S

T

U

V

W

X

Y

Z