Glossary - Argus Gibraltar
Selected Healthcare Terminology
An unexpected, unusual and unforeseen event that happens without intention or design, excluding known complications or side effects of medical or dental treatment.
Activities of Daily Living
Activities that most people can perform for themselves during the normal course of a day, such as eating, getting dressed, bathing, personal hygiene, transferring from bed and chair, and moving inside the home.
Bermuda Fee Schedule
A fee schedule for any benefit listing the amounts payable for any surgical, anaesthetic, medical, diagnostic or dental procedures provided in-hospital and approved by the Minister of Health.
An insured person normally resident in Bermuda for at least six months in any calendar year or for whom a subsidy is payable under the Health Insurance Act.
The following classifications are used to describe the level of coverage provided:
2 Hospital accommodation
3 Hospital accommodation
4 Hospital accommodation (Employer Groups only)
A Employee or individual policyholder insured for self only
B Employee or individual policyholder insured for self and non-working dependent spouse only
C Employee or individual policyholder insured for self, non-working dependent spouse and dependent child(ren
D Employee or individual policyholder insured for self and dependent child(ren)
Terminology for Employer Group Health Insurance customers
E Employee insured for self and working dependent spouse only, subject to the proviso that the employee's dependent spouse is insured elsewhere as an employee for Act Benefits
F Employee insured for self, working dependent spouse and dependent child(ren), subject to the proviso that the employee's dependent spouse is insured elsewhere as an employee for Act Benefits
G Employee insured for Act Benefits only
H Employee and dependent spouse insured for Act Benefits only
An evaluation provided at the request of another physician with the goal of recommending a course of care or determining if the patient's condition warrants transfer to specialty services.
The care and assistance, including room and board, that is given principally for personal hygiene or for assistance in activities of daily living and can, according to generally accepted medical standards, be performed by persons who have no medical training.
Examples of custodial care include help in walking, getting in and out of bed, bathing, dressing, feeding and use of toilet facilities, food preparation and supervision of medication that does not entail or require the continued presence of trained medical personnel.
A dependent child is an unmarried natural child, step-child, child of a dependent spouse, or legally adopted child who is under age 19, or under age 26, if enrolled in and in full-time attendance at, a recognised school, college or university, or over the age of 19, but is incapable of self support due to a mental or physical handicap.
Such child must be dependent on the insured parent for support.
A legally married spouse or a person who is living with the insured person in a recognised conjugal relationship, and has so lived for at least 12 months.
Procedures or laboratory measurements that can help reveal a diagnosis.
A negotiated reduction in the fees that a service provider would normally charge for services rendered.
The actual expenses incurred by an insured person that are reasonable for medically necessary care and services, are administered, prescribed or ordered by a physician or other recognised provider of service, and at least a portion of which is considered to be an eligible expense under the policy.
Initial treatment, ordered or provided by a physician or dentist, of a traumatic bodily injury resulting from an accident, or an acute, unexpected or unforeseen sickness requiring immediate non-discretionary medical care, and of such a nature that failure to render immediate care could reasonably result in placing the insured person's life in jeopardy, or cause serious or permanent impairment to the bodily function of the insured person.
Emergency Overseas Treatment
Emergency care provided to an insured person while resident or travelling outside Bermuda.
Experimental and/or Investigational Treatment
Procedures, drugs, devices and supplies that have not yet gained acceptance by the medical community as standard care and treatment at the time the service is rendered.
Such care and treatment may include any treatment that is undergoing clinical investigation and is not generally recognised by the medical community in Bermuda, the United States and Canada as established and accepted practice, has not yet been approved by the Pharmacy and Poisons Act in Bermuda, the Food and Drug Administration (FDA) in the United States, Health and Welfare - Canada (Food and Drug), and any other governmental agency in these jurisdictions for the purpose for which it is being prescribed, or is of uncertain therapeutic benefit, restricted to use in clinical trials, or of questionable safety and effectiveness for the insured person's condition.
Any physician who is not a specialist.
Health Insurance Act1970
The Health Insurance Act 1970, its regulations, orders, rules and any amendments or additions thereto.
Health Insurance Act Benefits
Benefits detailed in the Health Insurance Act 1970.
Bodily injury caused by an accident occurring while the insurance policy is in force with respect to the insured person.
An eligible Employee or Dependent who applies for coverage under this policy following the 31-day period of first becoming eligible for insurance.
Licenced, Certified or Registered
A provider of service who is currently licenced, certified or registered to practise the profession or provide the service, by the appropriate licencing or registration authority in the jurisdiction in which the services of such practitioner are rendered, and who is practising within the scope of such profession.
LifetimeLifetime, as used in reference to benefit maximums and limitations, is understood to mean while insured under the health insurance policy and will not be interpreted to mean the lifetime of the insured person.
LocalTreatment & Services
Services rendered, or provider of services or another organisation located, in Bermuda.
Medically Necessary Care & Services
Care, treatment, services and supplies, other than personal comfort items, which are widely accepted by the medical profession as effective, appropriate and essential in the prevention, diagnosis and treatment of the particular sickness or injury and the most appropriate level of treatment consistent with the diagnosis or symptoms of such sickness or injury, based on generally recognised and accepted standards of healthcare.
Such care and services are not intended primarily for the convenience of the insured person, his physician, hospital or any other healthcare provider and are not conducted for research purposes.
Care, services and supplies are not “medically necessary” solely on the grounds that they have been prescribed, ordered, recommended or approved by a physician.
Mental & Nervous Disorder
A clinically significant behavioural or psychological syndrome that is associated with distress, impairment in one or more important areas of functioning, or with sufficiently increased risk of suffering death, pain, disability, or an important loss of freedom.
Services rendered, or provider of services, located outside Bermuda.
A doctor of medicine who is duly licenced to prescribe and administer medical and/or surgical treatment within the scope of his licence.
The first policy year is the period of time commencing on the Policy Effective Date and ending on April 30th next following such date. Any subsequent policy year is the 12-month period commencing on each Policy Renewal Date.
Preferred Provider Network
A healthcare benefit arrangement designed to supply services at a discounted cost by providing incentives for members to use designated healthcare providers who contract with the preferred provider network at a discount.
Steps that can be taken to help ensure wellness, including the use of appropriate vaccinations and encouraging healthy lifestyle habits.
Provider of Service
A licenced, certified or registered facility or practitioner of the healing arts who is acting within the scope of his licence and provides medical and/or dental care, treatment, services or supplies.
An insured person 's illness or disease.
A physician who is properly qualified in the speciality by virtue of training and/or experience in the speciality and appropriate certification by an internationally recognised speciality.
The Worker's Compensation Act 1965
The Act that enables workers who are injured on the job to receive compensation from their employers.
A state of incapacity caused by bodily or mental injury, or sickness that requires the regular and personal attendance of a physician and prevents an insured person from performing or engaging in any gainful occupation or work for remuneration or profit, or performing at least three of the activities of daily living.
Usual & Customary Charge
A charge, which is not higher than the usual charge made by a service provider, and does not exceed the general level of charges made by providers of similar standing in the locality or geographical area where the charge is incurred.
Selected Pension & Investment Terminology
Additional Voluntary Contributions
Contributions over and above a member's required contributions that provide additional benefits.
This class of investments combines several strategies that have low correlation to traditional asset classes (e.g. bonds and equities). Fund managers seek to deliver positive returns that are independent of the general direction of the market.
The person who receives periodic payments under the terms of an annuity contract.
A series of payments made at stated intervals until a particular event occurs. This event is most commonly the end of a specified period or the death of the person receiving the annuity payments.
A person entitled to a benefit under a pension plan, or who will become entitled on the happening of a specified event, usually the death of the member.
Evidence of loans to corporations and governments. The borrowers promise to repay the loan by a certain date and to pay interest regularly to the investors in the interim.
An increase in the market value of money or property.
Shares of ownership in a corporation; normally referred to simply as “Stock.”
An annuity that commences at a future date.
Defined Contribution Plan
This is a type of insurance plan in which the employer, employee or both make contributions on a regular basis. The future benefits fluctuate on the basis of investment earnings.
Spreading of risk by putting assets in several categories of investments.
Dollar Cost Averaging
The systematic investment of a fixed dollar amount at regular time intervals.
The conditions that must be met for a person to be a member of a pension plan.
Emerging Markets Equity Fund
World Emerging Markets Equity Funds seek growth by normally investing in equity securities from emerging markets of multiple, normally less developed countries. For example, the following exceptions usually apply: U.S., Canada, Japan, Hong Kong, Singapore, Australia, New Zealand and Western European countries.
Ownership interests possessed by shareholders in a corporation—stock, as opposed to bonds.
Fixed Income Fund
A fund specialising in investments that can produce current income and dividends.
The strategy or fund selected for the purpose of investment of contributions (e.g. Conservative, Balanced or Aggressive.)
Reflects a fund's investment results.
Invest in both U.S. and foreign securities.
A fund that focuses on capital appreciation rather than income as its investment goal.
Refers to an investment's actual return from income over a given period measured from the beginning of the period.
Earnings, generally from interest or dividends, that are credited or paid to an investor.
A benchmark, such as the Standard & Poor's 500 Composite Index or the Morgan Stanley Capital Index World Index, against which performance is measured.
Invest in securities around the world.
The stated goal of a fund. It helps determine the types of securities in which a portfolio invests, the expected returns and the level of risk.
Joint Life Last Survivor Annuity
An annuity payable until the last of two annuitants dies.
Large-cap (Capitalisation) Stocks
Companies with outstanding shares valued at $6 billion or more.
The ease with which an asset can be turned into cash. It is a central objective of money market funds.
The current price of an asset, as indicated by the most recent price at which the asset was traded on the open market.
Money Market Fund
Seek to provide current income and maintain a stable net asset value by investing in short-term, high-grade securities. Investments in the fund are not guaranteed.
An investment company that invests the money of its shareholders in a (usually) diversified group of securities to achieve a specific objective over time.
National Pension Scheme Act 1999
The National Pension Scheme Act 1999 states that all employers, whether local, international or exempted, must provide, at a minimum, a private pension for every employee who is a Bermudian or a non-Bermudian spouse of a Bermudian (23 years of age or older) who works a minimum of 720 hours per calendar year. This pension scheme can be offered only by approved registered financial institutions, such as Argus.
Net Asset Value (NAV)
The market price of a mutual fund's total assets (after deducting liabilities) per share. It is the price at which a shareholder would sell a fund's shares.
Occupational Pension Scheme
Under a defined contribution scheme, you accumulate your own Retirement Account, and you make the investment decisions relating to that Retirement Account yourself. At retirement, your accumulated Retirement Account is used to provide you with an income for life. Under a defined contribution scheme, the level of benefit you receive will be determined largely by the level of contributions made by your employer and/or yourself and the investment performance of your chosen investment option.
Offshore is an international term meaning out of your country (jurisdiction) of residence or citizenship.
The stocks, bonds and other assets owned by a mutual fund or other investor.
An individual or an institutional investor responsible for deciding which securities to buy, hold or sell.
Price-to-Earnings (P/E) Ratio
The amount investors pay for a stock in relation to the company's earnings per share of outstanding stock.
Represents an investment's original invested amount.
Describes the history, background of its managers, objectives, financial statements, eligible investments, charges and other essential facts an investor would need to make an informed decision concerning a fund.
Rate of Return
The percentage change in the value of an investment over a period, taking into account both the income from it and the change in its market value.
The periodical adjustment of an individual's investments to align them with allocations determined by the individual or otherwise at the discretion of the fund manager.
Using dividend or capital gain payments to purchase more shares instead of taking payments in cash.
A form of ownership in an investment that can be bought and sold. Examples include stocks, bonds and money market obligations.
A unit of ownership in a fund or a stock.
Owns shares of a mutual fund or a stock.
Small-cap (Capitalisation) Stocks
Issues with outstanding shares valued at $2 billion or less.
Specialised Equity Funds invest in securities of a specific industry or economic sector. Sectors include technology, real estate, gold, precious metals utilities, etc. The fund could be limited to one or more regions and/or countries.
Generally seek to produce an increase in the value of their shares. Their objectives can range from moderate growth and moderate current income to long-term growth with income being incidental.
U.S. Government Securities
Securities issued by the U.S. government. Examples include Treasury notes, Treasury bills and Treasury bonds.
The percentage rate of return based on the annual dividends paid on a stock, a bond or a mutual fund.
Selected Property & Casualty Terminology
Accidental Damage is damage caused by external means which is not expected by you and not deliberately caused by you.
The date your insurance policy actually begins and date when it ends. This is shown on your Schedule.
An endorsement is a change to the pre-printed policy wording that reflects your individual terms and conditions.
The amount you pay as the first part of any claim before Argus pays anything under the policy.
Causes of loss or damage that are not covered under your insurance policy and are set out in your policy document.
Liability to the Public
This is your legal liability to third parties; for example if your litigious brother-in-law slips down your steps on a rainy day and injures himself (Buildings section) or if he trips over a loose rug (Contents section).
Limit of Insurance
The maximum amount payable in the event of a claim under your home insurance policy.
Any information that would influence the acceptance, premium or terms of the policy and which you must disclose as the policyholder.
New for Old
Lost or damaged items will be replaced with the closest equivalent new item. Some other policies may only pay the current value of the item which may be lower. Always check the cover provided by your policy.
No Claims Discount
A reward for claim free driving. Every year you hold a policy in your own name without making a claim, you build up a no claims discount which saves you money. If you go on to accept a policy with us, you will be asked to provide proof of your earned no claims discount. This proof should be a renewal notice from your previous Insurance Company, or a letter on headed paper from the Insurance Company. In certain circumstances we may be able to obtain this for you.
A peril is the cause of loss or damage. The policy wording will specify each peril that is covered.
Contents insurance only covers your personal belongings when they are inside your home*. If you would like cover for items that you take outside the home, you will need to add Personal Possessions insurance to your policy. This is normally an optional cover. This gives you peace of mind for the items you normally carry in everyday life whilst out and about, for example, spectacles, mobile phones, laptops or jewellery.
*Please note that for items over a certain value insurers will require you to tell them about these items, even though you may not take them outside of the home. With Argus's contents policy, policyholders must tell us if they have any items worth over $1,500, and these will be shown separately on the policy.
The person in whose name the policy is taken out. There is normally an option for more than one person to be shown as a policyholder.
A document that forms part of your insurance policy. It contains details of you, the sums insured, premium period of insurance, and sections and endorsements that apply.
Wear & Tear
Wear & Tear is the deterioration of an item over time through normal usage. Things prone to 'wear and tear' can include flat roofs, fascia boards, drain pipes on a building, tires on a car—and these should all be checked regularly. In the home, this includes the finish of carpets, curtains and other soft furnishings or appliances.