Crew Insurance

Allowed Amount:
Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance,” or “negotiated rate.” If your provider charges more than the allowed amount, you may have to pay the difference. (See Balance Billing.) Under a yacht crew insurance plan, the allowed amount determines how much the crew medical policy will reimburse.

Appeal:
A request for your health insurer or plan to review a decision or a grievance again. Yacht crew members covered under crew medical insurance may file an appeal if a claim is denied.

Balance Billing:
When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services. Under yacht crew insurance, balance billing can occur when treatment is received outside the approved network.

Co-insurance:
Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount. Yacht crew insurance policies may apply different co-insurance levels for international or offshore care.

Co-payment:
A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. Yacht crew medical insurance plans may include co-payments for physician visits or prescriptions.

Complications of Pregnancy:
Conditions due to pregnancy, labor, and delivery that require medical care to prevent serious harm to the health of the mother or the fetus. Morning sickness and a non-emergency caesarean section aren’t complications of pregnancy. Coverage for pregnancy-related care under yacht crew insurance depends on policy terms.

Deductible:
The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services. Yacht crew insurance plans often include annual deductibles per crew member.

Durable Medical Equipment (DME):
Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include oxygen equipment, wheelchairs, crutches, or blood testing strips for diabetics. Under yacht crew insurance, DME coverage is subject to medical necessity and plan limits.

Emergency Medical Condition:
An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid severe harm. Yacht crew insurance policies typically provide worldwide emergency medical coverage due to international cruising itineraries.

Emergency Medical Transportation:
Ambulance services for an emergency medical condition. Yacht crew insurance may include medical evacuation benefits for crew members working in remote or offshore locations.

Emergency Room Care:
Emergency services you get in an emergency room.

Emergency Services:
Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.

Excluded Services:
Health care services that your health insurance or plan doesn’t pay for or cover. In yacht crew insurance, exclusions may include certain elective procedures, experimental treatments, or non-medically necessary services.

Grievance:
A complaint that you communicate to your health insurer or plan. Crew members covered under yacht crew insurance may file grievances regarding claims handling or benefit determinations.

Habilitation Services:
Health care services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who isn’t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities in a variety of inpatient and/or outpatient settings.

Health Insurance:
A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium. Yacht crew insurance is a specialized form of health insurance designed for maritime professionals employed onboard yachts.

Home Health Care:
Health care services a person receives at home.

Hospice Services:
Services to provide comfort and support for persons in the last stages of a terminal illness and their families.

Hospital Outpatient Care:
Care in a hospital that usually doesn’t require an overnight stay.

Hospitalization:
Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. An overnight stay for observation could be outpatient care.

In-network Co-insurance:
The percent (for example, 20%) you pay of the allowed amount for covered health care services to providers who contract with your health insurance or plan. In-network co-insurance usually costs you less than out-of-network co-insurance. Yacht crew insurance networks may extend across multiple countries.

In-network Co-payment:
A fixed amount (for example, $15) you pay for covered health care services to providers who contract with your health insurance or plan. In-network co-payments usually are less than out-of-network co-payments.

Medically Necessary:
Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine. Medical necessity is a key requirement for reimbursement under yacht crew insurance policies.

Network:
The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services. In yacht crew insurance programs, networks often include international providers to support crew members working in multiple cruising jurisdictions.

Non-Preferred Provider:
A provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a non-preferred provider. Check your policy to see if you can go to all providers who have contracted with your health insurance or plan, or if your health insurance or plan has a “tiered” network and you must pay extra to see some providers. Under yacht crew insurance, using non-preferred providers may result in higher out-of-pocket costs.

Out-of-network Co-insurance:
The percent (for example, 40%) you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance or plan. Out-of-network co-insurance usually costs you more than in-network co-insurance. Yacht crew insurance policies may apply different co-insurance levels for international or offshore treatment.

Out-of-network Co-payment:
A fixed amount (for example, $30) you pay for covered health care services from providers who do not contract with your health insurance or plan. Out-of-network co-payments usually are more than in-network co-payments.

Out-of-Pocket Limit:
The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges, or health care your health insurance or plan doesn’t cover. Some health insurance or plans don’t count all of your co-payments, deductibles, co-insurance payments, out-of-network payments, or other expenses toward this limit. In yacht crew insurance, the out-of-pocket limit protects crew members from excessive medical expenses during the policy year.

Physician Services:
Health care services a licensed medical physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates.

Plan:
A benefit your employer, union, or other group sponsor provides to you to pay for your health care services. In a maritime context, the yacht owner or management company may sponsor the yacht crew insurance plan.

Preauthorization:
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval, or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.

Preferred Provider:
A provider who has a contract with your health insurer or plan to provide services to you at a discount.

Premium:
The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly, or yearly. In yacht crew insurance programs, premiums are typically paid by the yacht owner or management company on behalf of crew.

Prescription Drug Coverage:
Health insurance or plan that helps pay for prescription drugs and medications.

Prescription Drugs:
Drugs and medications that by law require a prescription.

Primary Care Physician:
A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for a patient.

Primary Care Provider:
A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law, who provides, coordinates, or helps a patient access a range of health care services.

Provider:
A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), health care professional, or health care facility licensed, certified, or accredited as required by state law.

Reconstructive Surgery:
Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries, or medical conditions.

Rehabilitation Services:
Health care services that help a person keep, get back, or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt, or disabled.

Skilled Nursing Care:
Services from licensed nurses in your own home or in a nursing home.

Specialist:
A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions.

UCR (Usual, Customary and Reasonable):
The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service.

Urgent Care:
Care for an illness, injury, or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.