Are You Aware with These Common Terms of Health Insurance?

Health Insurances 159 views

Before asking for the best health insurance plan, it is important to become an informed consumer by keeping yourself updated with the commonly used health insurance terms and definitions. Well, read this article further to understand the common terminology being widely used in health insurance.

Agent

An agent is someone who has been appointed by the insurer in order to conduct the business on the behalf of the health insurance company. He needs to have a license being issued by IRDA.

Claim

It is a process, wherein the insurer applies for the reimbursement to the expense incurred by the treatment. Generally, this process is handled by the insurance provider and is known as a third party administrator.

Cashless Claim

Well, as the name itself suggests. The insured can make a claim without even paying the cash in upfront. Moreover, the insured can get himself admitted to any network hospital and get the treatment without doing the cash payment in the hospital at the time of discharge.

Coverage Amount

Coverage amount is nothing but the maximum amount payable in the event of the claim. You can also name it sum assured or sum insured. The premium of your health insurance policy is completely depends on the coverage amount decided by you.

Insurance

An insurance is a contract in which an entity or individual pays to the insurance company in return the company bears the risk of loss against the specific condition. Against the losses, the individual gets the reimbursement from the insurance company.

Premium

Premium is known as the amount being paid by the insured to the insurer in order to avail the benefits of the policy. You can say it is a cost of the health insurance policy.

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Policy

It is a stamped document with an evidence of the contract between an insured and insurer. This document also contains the benefits and features of the policy.

Network Hospitals

The network hospitals are basically such nursing homes and hospitals which have the tie-ups with the third party administrator. Through this network of hospitals cashless claim is facilitated.

Reimbursement

If the insured makes the claim, the cost of numerous hospital charges like lab tests, bed charges, medicines fees etc are paid back to the insured by the insurance company.

Third Party Administrator

Third party administrator is the authorized claim settling agent of the insurer. His main role is to scrutinize all the expenses incurred vis-a-vis coverage under the health policy. For the claim settlement, the insured needs to be in touch with them.

IRDA

Stands for Insurance Regulatory and Development Authority, IRDA was formed in 1999, under an act of parliament to regulate the insurance industry in India.

Cumulative Bonus

Each claim free year provides you with the benefit that is known as cumulative bonus, somewhere similar to no claim discounts. However, the only difference is that instead of offering an upfront discount, the insurer adds more benefits for the same premium being paid.

Exclusions

These are those medical conditions and diseases for which the medical expenses are not covered under the policy.

No Claim Discount

If the insured does not make any claim on his insurance policy, he gets a discount for every claim free year on the basic premium.

Proposal

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It is the proposal forms that provide the insurance company all the particulars of the risk against which the protection is required. A proposal form is the base of the health insurance policy.

Proposer

A proposer is insured who wants the protection against the loss he may suffer because of contingency.

Renewal

When it comes health insurance policies, they are basically the annual contracts. Yes, at the end of the policy period, insured needs to renew the policy by the insurer. There should be continuous policy renewable, and if there is any break, the insured would loss all the benefits of its insurance policy.

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