Health Insurance Glossary

By  ,  Onlymyhealth editorial team
Feb 04, 2013

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Agent: He is basically an individual who is selected by the insurer to work on the behalf of an insurer. An agent’s authenticity can be checked by only by IRDA.


Assignee: It is basically an individual who obtains the advantages of a policy.


Claim: It is an appeal filed by an insurer to the Health Insurance Company or policy makers to reimburse for the services attained from a health care professional. Typically, this procedure is dealt by a person who is providing service to the health insurance company. “Third Party Administrator” is what this service provider is called as.


Certificate of Insurance: It is certificate which describes the advantages and coverage procedures which forms as a contract between the carrier and the individual who has claimed for the policy. It reveals the amount covered and related cash limits.


mulative Bonus: It is quite identical to no claim discounts. The amount insured will increase by 5 percent in every claim free year. But, the cumulative bonus is a subject matter to the expense that cannot go beyond 50 percent of the Capital Sum Insured and that the plan was renewed constantly.


Cashless Claim: As the term indicates, it is a person who is insured and can make claims without compensating for any cash upfront. The insurer is linked to a huge network of medical organizations such as nursing homes or networks of hospitals. This is also called as ‘network hospitals’.  The policy holder can get himself or herself admitted in the policy-mentioned network of hospitals and can obtain treatment without paying a single penny at the time of getting discharged.
However, one must note that cashless mediclaim settlement is an issue which is limited to various limits and sub-limits.


Coverage Amount: It is the utmost sum total which is payable in the event of a claim.  It can also be called as ‘sum insured’ and ‘sum assured’. Depending on the amount chosen by you and the coverage amount, one can choose the premium of a health insurance policy.


Critical Illness Policy: It is a grave possible terminal disease, which is stringently explained by the insurer. Multiple sclerosis, cancer, major organ transplant are some of the diseases which can be labeled as ‘Critical Illnesses’. Many policies of critical illness offer the payment of a lump sum advantage if an individual who is holding the policy is examined suffering from the diseases mentioned under the specified terminal conditions.


Cumulative Bonus: An advantage known as ‘cumulative bonus’ is identical to ‘no claim discount’ in their basic theme. Every claim free year makes certain that you’ll get this benefit. The difference between ‘cumulative bonus’ and ‘no claim discount’ is that the health insurance company adds to more advantages for the same premium paid. One must note that by and large these benefits won’t exceed a definite set of percentage as mentioned in the policy.


Disability Insurance: It is a form of insurance which pays a monthly amount to the policy holder in cases where he suffers from partial or total disability. The cause of this disability can be due to illness or injury, however it affects his ability to work and therefore earn.


Domiciliary Hospitalization: Domiciliary hospitalization accounts to the kind of hospitalization where a patient is treated at home, when he or she is not in a condition to be shifted to the hospital. It is also relevant in other cases, when a patient has no available accommodation in t...

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