Deductible A deductible is the amount of out-of-pocket expenses the insured person (you) must pay for health services before benefits become payable by the insurance carrier. Co-Payments Co-payments are payments made by the insured person (you) toward the cost of a particular benefit. For example, an insurance plan might require a $20 co-pay for each 31 day supply of a prescription medication. An emergency room visit might have a $50 copay per visit plus 80% of preferred and allowable expenses. Coinsurance Coinsurance means the insured person (you) and the insurance carrier share costs according to a specified ratio (e.g. 80%: 20%) of the hospital or medical expenses resulting from a sickness or injury. Covered Illness/Sickness A covered illness/sickness is any disease, infection, or condition other than injury that is first treated or diagnosed by a doctor on or after the effective date of coverage under the insurance plan, unless pre-existing condition waivers apply. Covered Injury A covered injury is an accidental body injury that causes loss – directly and independently of all other causes – and is sustained on or after the effective date of coverage under the plan, unless pre-existing condition waivers apply. PPO PPO stands for Preferred Provider Organization. These are networks formed from different health care providers and facilities who agree to accept a discounted payment level for charges incurred by patients insured under a plan with that specific PPO. The campus-endorsed plan uses Blue Cross Blue Shield of North Carolina as their PPO because it has the highest number of providers and facilities in their network Pre-Existing Condition A pre-existing condition is an injury, illness, or pregnancy for which medical care or treatment or diagnosis or medical advice was received or recommended or medication was prescribed prior to the effective date of the insured person’s coverage under the insurance plan. United Healthcare’s pre-existing condition reads: Except for individuals who have been continuously insured under the school’s student insurance policy for at least 12 consecutive months; The pre-existing condition exclusionary period will be reduced by the total number of months that the insured provides documentation of continuous coverage under a prior health insurance policy which provided benefits similar to this policy. Referral A referral happens when students require services that cannot be provided in the Meredith College Student Health and Wellness Center. The Student Health and Wellness Center staff arranges the referral with service providers in the student insurance’s PPO network, if possible.