Glossary of Terms

Wardenburg Health Center is accredited by the Joint Commission, a national accrediting body. The health center is a convenient on-campus facility with medical expertise to handle your primary health care and pharmaceutical needs. The staff is comprised of board-certified physicians and nurse practitioners and other dedicated health care professionals.

Wardenburg Campus Care Plan

A health plan that provides affordable, convenient on-campus health care services at Wardenburg Health Center. You must be covered by health insurance for services off campus to select this plan. (This plan does not cover prescriptions, sports medicine, psychological health and psychiatry, or off-campus services)

Student Gold Health Insurance Plan

A health insurance plan that provides complete coverage at Wardenburg Health Center and also coverage for services off campus. The Student Gold Health Insurance Plan includes prescription benefits.

Claim

The medical invoice submitted to the insurance company.

Coinsurance

An arrangement that requires you to pay a certain percentage of the cost of your health care after paying the deductible.

Co-payment

The amount that you must pay a health care provider at the time of service.

Covered Charges

Those health care expenses covered by the health plan. These charges may be subject to a co-payment or a deductible.

Covered Medical Expenses

Covered Medical Expense means reasonable charges that are
1) not in excess of usual and customary charges,
2) not in excess of the maximum benefit amount payable per service as specified in the Schedule of Medical Benefits,
3) made for services and supplies not excluded under the policy,
4) made for services and supplies which are a medical necessity,
5) made for services included in the Schedule of Medical Benefits, and
6) in excess of the amount stated as a deductible.

Covered Medical Expenses will be deemed "incurred" only
1) when the covered services are provided, and
2) when a charge is made to the insured person for such services.

Covered Services

The services and supplies covered by the health plan. The insurance company has an obligation to pay for these under the terms of the plan.

Deductible

A specified amount of expense for covered services that must be paid within each plan year before the insurance company provides a benefit payment.

Dependents

Dependents refer to biological or legally adopted children. Dependents must be financially dependent upon you. See also Who is considered an eligible dependent?

Hospital Confined

Hospital confined/hospital confinement means confined in a hospital for at least 24 hours by reason of an injury or sickness for which benefits are payable.

In-Network Providers

Specialists and other outside providers who participate in the Student Health Insurance plans. A written referral from Wardenburg Health Center is required to use these providers within a 50-mile radius of the health center. Also called preferred providers.

Maximum Coverage Limit

The maximum amount that the insurance company will allow for all services provided under the medical plans.

Medical Emergency

Medical Emergency means the occurrence of a sudden, serious, and unexpected sickness or injury. In the absence of immediate medical attention, a reasonable person could believe this condition would result in:

• Death
• Placement of the insured's health in jeopardy
• Serious impairment of bodily functions
• Serious dysfunction of any body organ or part
• In the case of a pregnant woman, serious jeopardy to the health of the fetus

Expenses incurred for Medical Emergency will be paid only for sickness or injury that fulfills the above conditions. These expenses will not be paid for minor injuries or minor sicknesses.

Out-of-Network Providers

Specialists and other outside providers who do not participate in the Student Health Insurance plans. A written referral from Wardenburg Health Center is required to use these providers within a 50-mile radius of the health center.

Outpatient Services

Services provided that do not require an overnight stay in the hospital.

Pre-Existing Condition

Any condition for which you
1) incurred charges,
2) received medical treatment,
3) consulted a health care professional, or
4) took prescription drugs within the 6 months immediately prior to the effective date under the policy. It does not include pregnancy.

Primary Care Provider

A physician or facility that directs all your health care needs. Wardenburg Health Center is the primary care provider for the Student Health Insurance plans.