Common Health Insurance Terms And Abbreviations
As there are a lot of companies and individuals selling health insurance plans in India, selecting one can be one of the daunting tasks, especially when you have to come across the intimidating jargons during the process. So, below are some common health insurance terms and abbreviations that might help you understand the idea better:
Agent- An agent is someone who the insurer appoints to carry operations on his/her behalf.
Assignee- An assignee is the one who avails the policy benefits.
Claim- It is a request that a policyholder submits to the insurer so that he/she gets paid for the services availed by a professional in healthcare.
Certificate of Insurance- It is a document used to provide information related to benefits and provisions for coverage. It verifies health insurance and discloses information on types and limits of coverage, the insurance company, policy number, the name of the insured and policy’s effective periods.
Co-payment- Co-pay is a fixed amount of the full claim amount that the insured and the insurer agree on and that the insured will pay in case of claim before the insurer comes into the scene.
Cumulative Bonus- It is like no claim discount. The sum insured will be increased by a specified percentage for every no-claim year. It is subject to a maximum limit without any additional premium.
Dependents- Dependents in health insurance include a husband/wife and/or unmarried children of the primary member insured. Children can be naturally born, adopted or step.
Exclusions- Specific conditions, services or treatments for which are not covered in health insurance.
Insurer- An individual or company who, through a contractual agreement, takes responsibility of the risk. It issues health insurance policies and collects premiums.
Long-Term Care- It is the care policy provided continuously for the chronically ill or disabled. It can be provided on an inpatient basis (at a long-term care facility) or in the home setting.
Long-term Disability Insurance- It protects an insured from loss of income in the event that he/she is unable to work because of illness, injury or a long period of time. You may also like to read: Myth busted! Health insurance for differently-abled
Premium- The amount the insured or his/her employer has to pay monthly in exchange for the health insurance coverage.
Policy- Policy is defined is a legal document assuring contract between the insurer and the insured. It is issued by an individual or an insurance company and specifies the insurance conditions.
Pre-existing condition- It is any medical condition for which a patient has already taken medical advice or treatment before enrolling in a new health insurance policy.
Referral- Process through which a patient is authorized by his/her primary care physician to seek diagnosis or treatment of a certain condition. It happens under a managed care health insurance plan.
Sum Insured- It is a pre-decided amount that an insurer is liable to pay to the policyholder in case an ‘insured’ event happens. It works on the principle of indemnity. For instance, if for a certain health insurance policy, the sum insured is of INR 3 lakh. If the insured gets hospitalized and his expenses turn out to be 2 lakh, the insurer is liable to pay him/her INR 2 lakh.
Underwriting- It is a process by which an insurer determines whether it will accept an application for insurance considering the risk factors and projections through which monthly premium amount is determined.
Waiting period- It is that period of time which must pass before some or all of our health care coverage can begin. So, it is that period when a claim cannot be admitted. An insured can only enjoy some benefits if he/she has completed the waiting period. Conditions and coverage vary in waiting periods and rules. For instance, the usual waiting period for pre-existing conditions is 4 years. Generally, the waiting period is of 30 days to 90 days in most of the health insurance companies.
Also, Read
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Benefits of A Long-Term Health Insurance Plan Explained
Insurancedekho.com is one of the leading brokers of health insurance across the country that offers a number of health insurance plans. To get in touch, you can write to us anytime at customersupport@insurancedekho.com. Our experts will get back to you and help you get the best health insurance according to your needs. So, get the best deal for yourself and your dear ones in just a few minutes!
