Visitor Insurance Terms Explained: Deductible, Coinsurance, Overall Limit and More
These words decide what a visitor insurance plan pays and what stays with you. Each entry answers its question in the first sentence, then says what to check.
What is a deductible?
The deductible is the amount you pay before the plan starts paying. A higher deductible usually lowers the price but raises your first bill. In one carrier's sample policy, the choices run from $0 to $2,500; check which your quote uses. [1]
What is coinsurance, or 'your share'?
Coinsurance is the percentage of each covered bill you pay after the deductible. In one carrier's sample policy, the plan pays 100% in network and 90% out of network (10% is yours), in addition to the deductible; check both percentages. [1]
What is a copay?
A copay is a flat amount paid at a clinic visit; it is not the deductible. In one carrier's sample policy, urgent care has a $25 copay and a walk-in clinic $15; neither is subject to the deductible. [1]
What is the overall limit (policy maximum)?
The overall limit, or policy maximum, is the most the plan pays for the whole trip; anything above it is yours. In one carrier's sample policy, the choices are $50,000 to $1,000,000 through age 69, $50,000 or $100,000 at ages 70 through 79, and $10,000 at 80 and older. Check the limit at the traveler's age. [1]
What is a per-benefit limit?
A per-benefit limit is a smaller maximum for one kind of care inside the overall limit; past it, that bill is yours. In one carrier's sample policy, prescription drugs are limited to $250,000 on the $500,000 and $1,000,000 plans, and emergency evacuation for an acute onset of a pre-existing condition to $25,000. [1]
What does in-network mean?
In-network means the doctor or hospital belongs to the plan's network, the group of providers the plan has an agreement with. In one carrier's sample policy, the plan pays 100% in network and 90% outside it. Check whether the hospitals near you are in it. [1]
What is 'usual, reasonable and customary'?
Usual, reasonable and customary is the amount the plan treats as typical for that care in that area. Charges above it can be left to you, especially out of network. In one carrier's sample policy, covered expenses are limited to this amount. [1]
What is a pre-existing condition?
A pre-existing condition is a health problem that existed before the plan started; most visitor plans exclude treatment for it. In one carrier's sample policy, it is any condition that existed at application or in the 3 years before the start date, known or not, and its charges are excluded. [1]
What is acute onset of a pre-existing condition?
Acute onset is a sudden, unexpected flare-up of a condition the traveler already had. Some plans add a narrow benefit for it, not the condition itself. In one carrier's sample policy, the traveler must be under 70 and treated within 24 hours, and the condition must have been stable for at least 30 days before the start date with no change in treatment; a chronic or gradually worsening condition does not count. [1]
What is the effective date, and what is the period of coverage?
The effective date is the day coverage starts; the period of coverage runs until it ends. In one carrier's sample policy, coverage starts on the later of the chosen date and the day the traveler leaves home, lasts 5 days to 12 months, and ends on the end date or when the traveler returns home, whichever is first. [1]
What is pre-certification?
Pre-certification means contacting the plan before certain treatments, such as a hospital stay, to confirm they are medically necessary; it is not a promise to pay. In one carrier's sample policy, that must happen before the treatment, or within 48 hours of an emergency admission, or covered charges for it are cut by 50%. [1]
What are the declaration and the certificate?
The declaration is the document showing your parent's choices: overall limit, deductible, start and end dates. The certificate is the full plan wording. In one carrier's sample policy, the chosen limit, deductible and dates all appear on the declaration. Check it against your quote; keep both. [1]
What is a claim?
A claim is your request for the plan to pay a bill or pay you back. In one carrier's sample policy, a complete claim needs the plan's form for each new illness or injury plus original bills and receipts, filed within 180 days of when the cost was incurred. [1]
Your next step
Get quotes using your parent's exact age and travel dates, then find each term above in the quote and certificate. Ask about anything unclear before paying.
Compare visitor insurance plans
Related guides
Sources
This IMG sample policy illustrates the wording. Terms differ by plan; your parent's own policy documents determine the benefits. The amounts, percentages and day counts quoted from the sample are not a quote or a promise of payment, and this page uses no invented example numbers.