Glossary

Every though health insurance word made easy

Agent

A person appointed by and working on behalf of the insurer.

Agent vs Aggregator

An insurance agent is nothing but a sales representative of an insurance company. An aggregator is a platform where a buyer can see and compare several plans to suit his/her needs.

Assignee

A person that gets the benefits of the policy.

Beneficiary vs Nominee

A beneficiary is a person or entity that gets the insurance proceeds when the insured dies. And a nominee is the person that receives the insurance proceeds when the insured dies. Here, the nominee receives the proceeds but may not be able to use it.

Claim

It is a notification a doctor or hospital sends to the insurance company. It is a kind of bill.

Co-payments

It is a provision by which a policyholder agrees to pay a part of the medical expense out of his/her pocket. The insurer covers the rest.

Certificate of Insurance

A contract between the carrier and the customer carrying the description of benefits and coverage provisions.

Co-pay vs Co-insurance

Both co-pay and co-insurance are out-of-pocket expenses that are needed to be borne by the insured. The difference, however, is that while co-pay is a fixed sum that needs to be paid, co-insurance is a fixed percentage of the entire claim amount.

Cumulative Bonus

For every claim-free year, the sum insured progressively increases in the form of a cumulative bonus.

Coverage

The amount of risk covered by the insurer for an individual or entity.

Critical Illness

A health-related medical condition that is serious. A critical illness insurance plan guards against the expenses that occur on the diagnose of critical diseases like cancer, kidney failure, heart attack, etc.

Deductible

The amount a policyholder has to pay before the insurance company pays the balance amount.

Dependents

Your legal spouse and children are your dependents under a single policy.

Domiciliary Hospitalization

Medical treatment that requires hospitalisation, which is done at the house of the insured because of reasons like non-availability of hospital space for treatment or criticality of the medical condition.

Exclusions

The conditions or circumstances for which an insured is not given any benefit.

Free-look period

If you buy a policy and realise that you do not want it, you may return the policy and get a refund under the free-look period.

Grace period

You may get a grace period to renew your policy in case you miss to renew it.

Group Insurance

Health Insurance offered to a group of people without taking any medical examination. Group insurance is typically issued to the companies.

Hospital Cash Cover

It provides for the daily cash that an insured may need for compensating medical expenses arising during the hospital stay.

Insurer

The health insurance company that takes responsibility for the risk. An insurer issues an insurance policy and receives premiums.

Long-Term Care Policy

Insurance policies covering specific services for a stated period. Services covered often include home health care services, nursing care, and custodial care.

Long-term Disability Insurance

Pays the insured a percentage of their monthly earnings if he/she becomes disabled.

Lifetime Renewability

Insurers may deny the renewal of a health plan because of the insured’s deteriorating health condition. Lifetime renewability allows the insurer to cover the health risks irrespective of age and health condition.

Maternity expense

Health insurance plans often cover maternity-related costs. It can have a waiting period of up to 48 months.

Network

A group of hospitals, doctors, and health care providers contracted to provide services to insurance company customers for less than their usual fees.

No Claim Bonus

A benefit extended to the insured for a claim-free year.

Out-of-Pocket Medical Expenses

Expenses that the insured need to pay from his/her pocket for any medical care agreed in the co-payment ratio.

Premium

The amount a policyholder periodically pays to an insurance company for maintaining the cost of coverage.

Proposer

A proposer is a policyholder. The insurance company pays out claims to the proposer.

Portability

Portability is the right accorded to a policyholder to transfer his/her credits if he/she switches from one insurer to another.

Pre-existing disease

Any condition, ailment or injury of which you had symptoms, were diagnosed, or received medical treatment within 48 months before policy issuance falls under pre-existing disease.

Policy

A legal document that acts as a contract between the insurer and the insured.

Reasonable Charges

Insurers prefer to pay claims that are reasonably charged by the hospital.

Rider

An additional benefit that you can buy by paying an additional premium.

Restoration of Sum Assured

The rebuilding of health cover once it is exhausted because of unanticipated medical requirements. The policy regains the cover without additional paperwork and such formalities.

Sum insured

The amount a health insurance company pays to a policyholder in case of any hospitalisation or medical expenditure.

Sub-limits

It is the extent to which an insurance company bears the cost arising from extra medical expenditures like room rent, post-hospitalisation, etc.

Sum Assured vs Sum Insured

Sum assured is a pre-defined amount that is to be paid in case of an eventuality. Life insurance works on the sum assured. While sum insured is the upper limit of the pay-out an insurer is liable to pay in case of any eventuality to the insured. Health insurance works on the sum insured.

Super Top-Up

A health plan that covers an aggregate of the annual medical bills in a year, and not just a single hospitalisation bill.

Top Up

A top-up health policy offers additional coverage to those who already have a base health plan. A top-up plan covers medical expenses arising due to an illness/injury above the limit of the actual cover.

Waiting period

The period for which an insured person waits before availing policy benefits.