22 Health Insurance Terms That You Need to Understand before Buying One

  • January 8, 2018

Looking forward to invest in a health insurance policy? Well, before the agent or company steps in, it is important that you gain complete knowledge about some common terminology of the plan.

Here’s what you need to know:

1. Agent

An individual appointed by the insurance company on behalf of the insurer.

2. Assignee

The term is used for the individual who gets the benefits of a health insurance policy.

3. Claim

The term explains a request filed by an insured to the insurance organization to pay for services obtained from a medical professional.

4. Certificate of Insurance

It is a description of the coverage and benefits provisions that make up for the contract between the policy holder and insurance company. It generally discloses things covered within the policy, exclusions, and cash limits.

5. Cumulative Bonus

This term is used to describe bonus received by policy holder under certain circumstances. Here, for each claim free year, the sum insured will gradually increase by around 5 per cent or as per the company policy. However, this bonus is subject to an amount that will never exceed 50 per cent of the Capital Sum Insured. To avail of the benefit, the insured must renew the policy each year without fail.

6. Co-payment

In case, the insured files a claim, he/she must bear certain part of claim out-of-pocket before the insurance company steps in. This expense fraction is referred to as co-payment. Co-payment is usually displayed as proportion of the total claim amount.

7. Dependents

It is used to describe unmarried children and / or spouse of an insured. The children may be natural, adopted or step children of the policy holder.

8. Age Limits

It is the required minimum and maximum ages for a health insurance policy below and above which the provider will not accept any applications or may not even renew the plan.

9. Deductible

The term describes the amount of loss borne by the health insurance policy holder. The loss can be a specific money amount or a percentage of the entire claim amount. As per a general rule, bigger deductible will be followed by lower premium.

10. Coverage

It is the range of protection provided by insurance company under a contract of policy which also includes numerous risks covered by a policy.

11. Network

This term is used in health insurance policy to explain a group of hospitals, doctors, and other health care providers. These professionals are contracted to provide services to buyers of the health insurance companies for less than the actual (general) fees charged. Network of providers can cover a huge expanse of geographic market. They are also capable of covering a wide range of health care services. The policy holders pay less which is a benefit they get for using a network provider.

12. Long-term Disability Insurance

The benefit will pay health insurance policy holder a percentage of their monthly earnings in the event they become disabled.

13. Lapsed Policy

This is health insurance plan that has expired and is no longer in force. It happens due to failure of payment of the premium due by the policy holder.

14. Misrepresentation

An act of creating, issuing, circulating or causing to be issued an estimation or illustration of any kind that does not denote the correct policy terms, the title or name for any policy.

15. Exclusions

As with any insurance policy, these are certain conditions or situations for which an insured will not be provided benefits.

16. Nomination

The term is used to explain an act by which the policy holder empowers another individual to take delivery of the policy cash/benefits.

17. Premium

It is a regular payment of a specific policy that requires being paid by the policy holder for a contract of insurance. Premium is paid by the insured in exchange for the coverage he/she gets.

18. Pre-existing Condition

The term explains a medical condition of an individual excluded from coverage in case; the condition is known to have existed before obtaining the policy from a specific insurance company.

19. Salary Saving Scheme

The scheme offers payment of premiums through deduction of money from the salary of the employees by their employers.

20. Sum Insured

This health insurance term is used to describe amount of payout insurer is liable to pay to the insured in the event of an eventuality. Sum insured works on the principle of indemnity.

21. Surrender Value

The term refers to the value payable to policy holder when he/she decides to terminate the policy prior to maturity of that specific policy.

22. Waiting Period

The term is used when an individual signs up for a new health insurance policy. The fixed period of time after which certain benefits of the health plan comes in effect. An example is the usual waiting period for pre-existing conditions in health insurance plan is around four years.



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