Glossary of Health Insurance Terms India

Health Insurance Glossary

Agent: He is a person appointed by the insurer to work on behalf of the insurer.

Assignee: It is that person who gets the benefits of a policy.

Claim: A request filed by an insured to the insurance company to pay for services obtained from a health care professional.

Certificate of Insurance: The description of the benefits and coverage provisions forming the contract between the carrier and the customer. Discloses what is covered, what is not and the cash limits.

Cumulative Bonus: cumulative bonus is similar to no claim discounts. For every claim free year, the sum insured will progressively increase by 5%. However, the cumulative bonus is subject to an amount that can never exceed 50 percent of the Capital Sum Insured and that the policy was renewed continuously.

Deductible: The amount of loss borne by the insured. This loss can be a certain money amount or a percentage of the claim amount. Bigger the deductible, lower is the premium.

Dependents: Spouse and/or unmarried children (whether natural, adopted or step) of an insured.

Exclusions – These are those conditions or circumstances for which an insured will not be given any benefit.

Insurer: The insurance company that assumes responsibility for the risk, issues insurance policies and receives premiums.

Long-Term Care Policy: Insurance policies that cover specified services for a specified period of time. Long-term care policies (and their prices) vary significantly. Covered services often include nursing care, home health care services, and custodial care.

Long-term Disability Insurance: Pays an insured a percentage of their monthly earnings if they become disabled.

Premium: The monthly amount you or your employer pays in exchange for insurance coverage.

Policy – It is a legal document which acts as a contract between the insurer and insured. It contains conditions of the insurance.

Pre-existing condition: A medical condition of an individual is excluded from coverage if the condition is believed to have existed prior to obtaining the policy from a particular insurance company.

Network: A group of doctors, hospitals and other health care providers contracted to provide services to customers of the insurance companies for less than their usual fees. Provider networks can cover a large geographic market or a wide range of health care services. Insured individuals typically pay less for using a network provider.