THE AD MEDILINK GLOSSARY

Accident (Accident): an involuntary physical injury caused by factors and events beyond your control.

Accident or Illness (Sinistre): event, illness or accident involving the warranty, while the contract is in force.

Acupuncture (Acupuncture): Acupuncture is a branch of traditional Chinese medicine considered to be alternative medicine. Acupuncture consists of pricking with needles at specific points on the surface of a patient’s body, to treat various diseases or cause an analgesic effect.

Additional CFE cover: this international cover allows you to complete your basic cover subscribed with the Caisse des Français de l’Etranger

Affiliation: attachment of an insured person to an organization paying social benefits. All people living in France are affiliated to a social protection scheme, such as the general scheme or the scheme for self-employed workers.

Amendment (Avenant): any modification made to the initial contract.

Applicant (Adhérent): person signing the membership form and designated as the holder of the insurance policy. The subscriber is not necessarily the Insured. Indeed, a parent can hold health insurance for their child.

Area of Coverage (Zone de couverture): the country or part of the world in which you are covered by your insurance.

Beneficiary (Bénéficiaire): persons designated on the subscription form of the additional health contract who can receive the benefit of the guarantees in said contract.

Broker (Courtier): insurance specialist, independent from insurers, who helps you choose and sign the contract that best suits you.

Certificate of Insurance (Attestation d’assurance): a document given to the Member, confirming his adhesion to the insurance contract and mentioning in particular the Insured, the effective date, the guarantees and the selected formulas. Also called Insurance Certificate. 

CFE: the Caisse des Français de l’Etranger (CFE) is an organization which provides the benefits of the Social Security System for French citizens living abroad. You can join it within three months of leaving France. For more information, read our guide to CFE here.

Civil Liability (Responsabilité civile): insurance which covers your costs when you cause physical injury, material or immaterial damage to someone else.

Complementary Medicines (Médecines complémentaires): complementary medicines include practices that are not usually considered to be part of conventional medicine. For example: acupuncture, homeopathy, naturopathy, osteopathy, chiropractic, etc. They may be covered by certain health insurance contracts.

Contact lenses (Lentilles de contact): contact lenses are corrective, cosmetic or therapeutic lenses placed on the cornea of the eye. They replace glasses and improve vision in the same way.

Contract (Contrat): an insurance contract is a legal document which includes:

– general provisions (or conditions) which describe the guarantees and indicate the conditions of validity of the contract,

– special (or personal) provisions (or conditions), which adapt the contract to the specific situation of the insured,

– any annexes.

Country of Nationality (Pays de nationalité): the country where your passport was issued and of which you hold citizenship.

Country of Residence (Pays de résidence): the country where you live for, at least, six consecutive months of the year.

Day-patient treatment (Traitement de jour): a planned treatment carried out in a hospital or a care establishment during the day and which does not require the patient to spend the night there.

Day Surgery (Chirurgie ambulatoire): medical treatment or an outpatient procedure at the hospital.

Deductible (Franchise): the part of your medical expenses that you agreed to pay yourself. When you request a reimbursement, all costs higher than this excess will be reimbursed by your insurer.

Dependent (Ayant droit): a family member of the primary insured. He can thus benefit from the guarantees subscribed by the main insured and is legally covered by the same policy.

Direct Billing (prise en charge): it allows the insured to avoid having to advance the costs.

Effective Date (Date d’effet): date from which the contract begins. It is indicated on your Certificate of Insurance.

Emergency (Urgence): a serious medical event, such as illness or bodily harm, which requires immediate attention.

Excluded Countries (Pays exclus): depending on events that may take place there, coverage for certain countries is excluded.

Exclusion (Exclusion): all events which are not guaranteed by the insurance contract are considered to be an exclusion. These exclusions can be general (applying to all) or specific (applying to your contract only). Examples of general exclusions: plastic surgery, off-piste skiing; examples of specific exclusions: diabetes, breast cancer.

Expatriate (Expatrié): a person who lives and works permanently outside their country of origin.

Hospital (Hôpital): any approved health establishment legally recognized as a hospital in the jurisdiction in which you are located.

Hospitalization (Inpatient Care): any stay in a public or private healthcare establishment when this stay is for the observation, medical or surgical treatment of an illness or injury resulting from an accident.

Indexation/Inflation (Indexation/Inflation): when your insurer adjusts its level of coverage according to medical inflation and changes in the consumption of medical care for all contract members registered during the year elapsed.

Insurance Policy (Police d’assurance): a contractual document which lays out the terms of engagement of the insurer with regard to the insured or a group of insured. This is proof of the contract between the insurer and the insured.

Insurance year (Année d’assurance): period of twelve consecutive months starting from the effective date of the contract (also known as the contract anniversary date).

Insured Member (Assuré): the person or persons guaranteed by the contract and designated as covered by the insurance policy.

Letter of Guarantee (Lettre de garantie): An agreement to cover your medical costs which is sent to your health facility by your insurer or Social Security System.

Maternity (Maternité): maternity guarantees are linked to pregnancy status, termination of pregnancy, childbirth, postpartum as well as the pathological complications linked to these events.

Medical Imaging (Imagerie médicale): medical imaging is a set of techniques, consisting of imaging different regions or different organs of the body, used for clinical purposes in order to be able to offer a diagnosis or treatment. There are several medical imaging techniques: radiography, ultrasound, MRI, endoscopy, scanner, laser, etc.

Medical Questionnaire (Questionnaire de santé): a series of questions about your health that your insurer asks before confirming your request for health coverage.

Orthodontics (Orthodontie): orthodontics is a dental specialty aimed at correcting bad positions of the jaws and teeth using dental appliances.

Osteopathy (Ostéopathie): osteopathy is based on the manipulation of the joints. It is mainly interested in functional disorders of the human body. Certain health insurances can take charge of this type of care under the Complementary medicine category.

Outpatient treatment (Ambulatoire): a treatment or intervention provided in the medical office of a doctor, therapist or specialist which does not require hospitalization.

Policyholder (Souscripteur): person who signs and pays the contract contributions. Please note that the policyholder is not always the insured or the beneficiary.

Portability (Portabilité): the fact that an international health insurance policy offers portability means that you can keep it no matter where you move in the world (some countries may be excluded).

Pre-authorization (Entente préalable): before initiating certain types of care or services, you must first obtain the insurer’s consent.

Preexisting Condition (Condition préexistante): a medical condition that developed before the date of signing your membership application (Health Questionnaire). Any condition which you were aware of, or you could reasonably have been aware of when you signed up for a health insurance contract, is considered to be a pre-existing disease.

Premium (Cotisation): amount that you regularly pay to your insurer, in exchange for the promise that in the event of needing medical attention, they will cover your expenses.

Private room (Chambre privée): as part of a hospitalization, healthcare establishments can offer the patient a private room. Its cost varies according to the establishments. Generally, there is only one patient per private room.

Real Costs (Frais réels): this is the amount you actually paid for a treatment. When your complementary health insurer informs you that it reimbursed you for “real costs”, this means that they reimbursed you for the total amount that you paid for your care.

Reimbursement basis: tariff serving as a basis for reimbursement by the compulsory scheme of fees and care provided by all health professionals.

Remaining balance (Reste à charge): share of health expenses which remains your responsibility after reimbursement by your healthcare provider.

Renewal (Renouvellement): the renewal date is usually the anniversary date of the contract, i.e. at the end of twelve consecutive months. Some contracts are automatically renewed while others can only be renewed with the explicit agreement of the subscriber.

Service Transfer (Transfert): when you assign another broker in writing to advise and represent you to insurers. This has no impact on your insurance policy.

Spouse (Conjoint): the husband or wife of the insured, neither divorced nor separated or in a civil union (Civil Solidarity Pact: Article 515-1 of the French Civil Code) with the latter, in force on the date of the Claim. The common-law partner of the main insured may be considered as a spouse, if the request is made.

Termination (Résiliation): when you, your employer or your insurer decides to terminate your insurance policy.

Third-party payer (Tiers payant): mechanism to exempt the insured from the advance of costs, covered by the health plan and the complementary health insurance.

Unforeseen Illness (Maladie inopinée): any deterioration in health noted by a competent medical authority which is sudden and unpredictable.

Waiting period (Délai de carence): this is the period during which you are not yet covered by your health insurance contract or certain guarantees. The following guarantees are often subject to a waiting period: maternity, optics and dental.

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