By Diana Sanchez | 15 Feb 2024

Important insurance terms and what they mean

Do you know what a deductible is? Or understand how Pre-Authorisation may affect you? Learn about these terms and more in this handy explainer.


Depending on your circumstances, having an international health insurance plan may be an essential part of your life.

But when applying for and using your health plan, you'll encounter many insurance-specific terms, conditions, and jargon that may leave you scratching your head. While we'll always try to keep things as simple as possible for you, compliance and regulatory requirements mean there's little we can do about using such terms in many instances.

But what we can do is explain what these terms mean.

Read on to learn everything you need to know about some of the most common insurance terms you’ll encounter.


Benefits are the medical treatments covered under your plan. If there are any additional benefits or restrictions on your cover, these will be mentioned in your Certificate of Insurance.

Accessing your benefits is always subject to your premium having been paid.

Benefit Schedule

Your Benefit Schedule is a table of benefits showing your maximum coverage levels across your health plan.

You can find your Benefit Schedule in your Member Handbook.

Certificate of Insurance

Your Certificate of Insurance is an important document that highlights:

  • Who the planholder is.
  • Everyone insured under the plan.
  • The period of cover.
  • The underwriters of the plan.
  • The entry (start) date of the plan.
  • Your level of cover.
  • Any endorsements that may apply.


Co-Insurance refers to an uninsured percentage of your medical costs, which you must pay towards the cost of your claim.

For example, if you have a “20% Co-Insurance” plan, that means you’re responsible for 20% of any applicable medical bills, with the other 80% covered by us, subject to plan limits.

If you have a Co-Insurance plan, this element typically only kicks in after you have paid any deductible.


Your deductible is an uninsured amount payable towards in-patient and day-patient expenses before any of your plan benefits are paid.

Your deductible will be specified in your Certificate of Insurance and applies per insured person per period of cover.

Opting for a higher deductible may help to reduce the cost of your premium, but you should consider whether you can afford the cost before committing to this.

Chronic condition

We define a chronic condition as a disease, illness or injury which has at least one of the following characteristics:

  • It needs ongoing or long-term monitoring through consultations, examination, check-ups, drugs and dressings and/or tests.
  • It needs ongoing or long-term control or relief of symptoms.
  • It requires your rehabilitation or for you to be specifically trained to cope with it.
  • It continues indefinitely.
  • It has no known cure.
  • It comes back or is likely to come back.

Your coverage for chronic conditions will depend on your plan. However, most of our plans cover chronic conditions - subject to plan limits - should you develop the condition while a Now Health International member. In some cases, we may also cover pre-existing chronic conditions, subject to underwriting.

Acute condition

Our Member Handbook defines an acute condition as “a disease, illness or injury that is likely to respond quickly to treatment which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery.”

While we don’t define specific acute conditions in our terms, your plan will cover you for any treatment you need for such conditions per your level of coverage.

Day-patient, in-patient and out-patient

Some of the most significant differences between our plans relate to how you can receive treatment and the level of coverage you have around these options.

  • Day-patient – You are a day-patient if you’re admitted to a hospital or a day-patient unit for a consultation, examination, or period of medically supervised recovery, but do not stay overnight.
  • In-patient – You are an in-patient if you are admitted to hospital and stay overnight, or for a period of time, for medical reasons.

All our plans cover day-patient and in-patient care; coverage under our SimpleCare plans is subject to plan limits, while WorldCare members enjoy full cover.

  • Out-patient – You are an out-patient if you attend a hospital, consulting room, telemedicine appointment or out-patient clinic but are not admitted as a day-patient or in-patient.

Most of our plans offer at least some cover for out-patient medical practitioner fees, while most plans also offer an optional out-patient per visit excess and a co-insurance option for out-patient treatment.

You can compare all of our private health plans here.


We define a dependent as one spouse or adult partner (considered to be a husband, wife, civil partner, or a permanent co-habiting partner) and/or unmarried children who are not more than 18 years old and residing with you at the start date or any subsequent renewal date of your plan. We can cover unmarried children up to the age of 28 if they're in full-time education, but please note we may require written confirmation from the educational institute they attend.

All dependents must be named as insured persons on the Certificate of Insurance to access coverage under your plan.

As part of our commitment to providing exceptional value for money to our clients, we offer various discounts for families where a spouse and at least one child are added to the plan in addition to the primary insured person.

Get a quote now to discover how much you could save on a family plan.

In network medical provider

An in network medical provider is a facility contracted with your plan that provides you services at specific pre-negotiated rates.

We work with these providers to keep your premium to a minimum, as well as minimise any out-of-pocket costs you may incur while you hold a private health plan with us.


Pre-Authorisation is a process whereby you must seek approval from us before undertaking specific types of treatment or incurring costs.

The Benefits that require you to seek Pre-Authorisation will be noted in Section 4 and within the Benefit Schedule of your Member Handbook.

Pre-Authorisation is another process that enables us to keep your premium as low as possible.

Learn more about Pre-Authorisation here.

Refer to your Member Handbook for more information

All these terms and more are outlined in your Member Handbook.

Access yours by logging in to your Secure Online Portfolio or by visiting our Document Library, and remember that if you have any questions or concerns, our award-winning customer service team is available 24/7 to assist you.