1. Annual Benefit Limit (ABL) – refers to the optional benefit of having a single aggregate limit for all disabilities per year (sickness or accident).
2. Annual Physical Examination (APE) – refers to the optional benefit of a nationwide APE from ETIQA’s list of APE-accredited clinics. (Section VI: Benefits).
3. Benefits for Reimbursement Only (BRO) – refers to the 7 current exclusions that became PC’s optional BRO benefit. BRO is Purple Cow’s contribution to ETIQA’s expanded reimbursement capabilities. (Section VI: Benefits).
4. Congenital Conditions – refers to medical conditions that existed before birth. Purple Cow provides 100% Congenital Conditions coverage, up to MBL. (Section VI: Benefits).
5. Dental (DEN) – refers to the optional benefit of nationwide Dental HMO coverage from HEALTH PARTNERS DENTAL ACCESS. (Section VI: Benefits).
6. Excess of Benefits (EOB) – refers to any amount that exceeds the Plan Member’s Schedule of Benefit, which must be settled by the Client on behalf of their Plan Members. (Section VIII: Money Matters).
7. Exclusions – refers to the 12 standard PC exclusions that remain from ETIQA’s 22 MP+ exclusions (Corporate Health Program Agreement) and ETIQA’s 21 MP exclusions (Group Health Insurance). (Section VII: Exclusions).
8. Independent of PhilHealth (IPH) – refers to the optional benefit of a Plan Member not having to file for PhilHealth. The standard benefit is ‘on-top-of’ PhilHealth, which requires having to file for PhilHealth. (Section V: PhilHealth).
9. Inner Limits – refers to any MED plan limit (cost/benefit/terms) within a Plan Member’s maximum/annual benefit limit that stops the Plan Member from receiving full benefits, even after proving medical necessity. (Section VI: Benefits).
10. Life & Accident (L&A) – refers to the optional benefit of worldwide Life & Accident coverage from ETIQA. L&A has separate ETIQA policies/riders for GYRT/TPD/PA (+provoked M&A), with MED age eligibility. (Section VI: Benefits).
11. LOG (Letter of Guarantee) – refers to the form needed by Plan Members to access ETIQA’s medical network on a no-cash-out basis. The LOG is ETIQA’s guarantee that it will pay for all eligible expenses incurred by Plan Members.
12. Maximum Benefit Limit (MBL) – refers to the total amount of benefits a Plan Member can receive per disability (sickness or accident) per year.
13. Medical (MED) – refers to the standard benefit of nationwide Medical coverage from ETIQA. PC’s standard MED benefits & optional DEN/APE/L&A/BRO/ABL/IPH benefits are outlined in this Agreement. (Section VI: Benefits).
14. Medical Network – refers to the nationwide network of doctors, hospitals & clinics accredited by ETIQA, wherein Plan Members can avail of emergency, inpatient & outpatient services on a no-cash-out basis, through an LOG.
15. No-Cash-Out – refers to the 1st of 2 ways Plan Members can access healthcare: as a card-holding healthcare patient for no-cash-out when using the medical network. (Section IV: Dual Access to Healthcare).
16. No-Fault Coverage (NFC) – refers to the 7 former ETIQA MP+ Exclusions that became part of PC’s standard MED benefit. NFC is Purple Cow’s contribution to ETIQA’s goal of ‘Humanizing Insurance.’ (Section VI: Benefits).
17. Plan Member (or Member) – refers to the Principals and/or Dependents that a Client enrolls in an insured Premium or self-insured TPA plan.
18. Pre-Existing Conditions (PEC) – refers to medical conditions that existed before healthcare coverage, whether or not life-threatening. Purple Cow provides 100% PEC coverage, up to MBL. (Section VI: Benefits).
19. Premium Plan – refers to the 1st of 2 types of health plans: a fully-insured health plan in which Client pays premiums to ETIQA as Insurer, and ETIQA pays their claims.
20. PURPLE COW (PC) – refers to a unique product that stands out in a field of black & white products (Seth Godin). Also refers to the IC-licensed General Agency that sells Purple Cow through insurance Brokers, Agents & Referrers.
21. Reimbursement – refers to the 2nd of 2 ways Plan Members can access healthcare: as a private patient for reimbursement at the accredited rate, when not using the medical network. (Section IV: Dual Access to Healthcare).
22. Room & Board (R&B) – refers to the type of room accommodation assigned to a particular class or rank, regardless of peso limit (e.g., Ward, Semi-Private, etc.).
23. Schedule of Benefits (SOB) – refers to the Client’s summary of benefits & limits for the different classes/ranks of their Plan Members. (Section XII: Schedule of Benefits).
24. Special Procedures/Modalities – refers to alternative medical procedures that are not invasive, or do not involve surgery. Purple Cow provides 100% Special Procedures coverage, up to MBL. (Section VI: Benefits).
25. Telemedicine (TEL) – refers to the nationwide Telemedicine coverage from DOCTOR ANYWHERE that became part of PC’s standard MED benefit. (Section VI: Benefits).
26. TPA (Third Party Administration) plan – refers to the 2nd of 2 types of health plans: a self-insured health plan in which Client sets up a TPA fund with ETIQA as Third Party Administrator, and Client pays their own claims.