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Health Insurance Terminologies A-Z

Posted by Royal Sundaram on 17 Aug 2018


When it comes to health insurance, it is important to gather all the knowledge you possibly can. Health Insurance terminologies can be tricky business. To choose the right policy and make the best of your policy

A –

Agent is a person who has been appointed by the insurer to work on behalf of the insurance company.

B –

Beneficiary is an individual designated to receive the proceeds of a health insurance policy.

Breach of Condition is when a condition in the contract has been broken by the insured.

C –

Coverage is the scope or protection provided under contract of your insurance policy.

Chronic condition is a human health condition that has long-lasting effects. It includes arthritis, diabetes, cancer, diabetes, etc. Chronic condition requires long-term monitoring through examination, consultation, etc.

Co-payment is a fixed amount paid by an insured person for a covered healthcare service.

Cumulative bonus is an increase in the sum insured by a few percentage for every claim-free year.

D –

Domiciliary Hospitalization refers to the situation where the patient takes medical treatment at home due to the non-availability of room in a hospital.

E –

Effective Date is the date on which the Health Insurance coverage begins.

Exclusions such as treatments, charges, products and other services that are not covered under the insurance policy.

Emergency care is an immediate care provided by the medical practitioner to treat severe illnesses or to prevent death of the insured person.

Intensive care unit is a special department of a hospital that provides specialised treatment to patients who are acutely ill and need medical care.

F –

Family Floater plans are those plans that cover your entire family in the same health insurance. Some plans offer specific cover for individuals as well as a group family coverage.

G –

Group Health Insurance is offered to those part of an organisation. This plan provides health insurance benefits to a group of people.

Grace period is the amount of time given for the policyholder to renew his/her health insurance policy

H –

Hospitalisation is when the insured is admitted in the hospital for treatment and usually involves an overnight stay.

I –

Individual plans are those taken for the individual in particular.

Inpatient care is a medical treatment for which the policyholder has to get admitted to a hospital for more than 24 hours.

M –

Maternity Benefits is an inclusion in most comprehensive health insurance plans where the mother receives benefits such as cover up to 2 deliveries and new born baby cover.

N –

Network is a group of clinics and health care providers that are associated with the health insurance company.

No Claim Bonus is the benefit you receive if you have not made any claims on your health insurance policy. This comes to use when you want to renew or transfer your health insurance.

Notification of claim is the process in which an insured person informs an insurance company about the loss that has occurred and intends to ask for money in return.

O –

Outpatient is someone who receives care but is not required to stay overnight in a hospital

OPD treatment is a treatment that involves the patient visiting the doctor’s clinic or hospital upon the advice of a medical practitioner. The insured person is not admitted as an in-patient or day care.

P –

Premium is the amount you pay to receive the coverage your insurance policy provides.

Preferred Provider is one who has a contract with your health insurance company and will provide services at a discount.

Pre-existing condition is that medical condition where a person is excluded from the health coverage for a specific period of 3 or 4 years, if the condition is believed to exist before obtaining the policy from the insurance company.

Pre-hospitalization medical expenses are the charges incurred before the hospitalization of an insured person.

Post-hospitalization medical expenses are the charges incurred by the insured person just after his/her hospitalization.

R –

Renewal is the process by which you can renew your health insurance policy once it lapses.

Renewal Premium is the premium assigned to the policyholder at the time of policy renewal depending on age and health condition.

S –

Sum insured is the limit under and insurance company’s liability under an insurance policy

Sum insured enhancement is the process of increasing your sum insured and can be done at the time of renewal

Subrogation is a legal right held by insurance companies. It allows an insurer to recover the expenses it has paid for a loss by taking actions against the party that has caused the loss.

T –

Third party Administrators are hired by an employer to handle claims processing, pay providers for health insurance policies.

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