Health insurance glossary

A provision that sets certain conditions under which an insurance policy would be kept in force by the insurer without the payment of premiums. A waiver of premium is typically only granted in cases of permanent and total disability.

An agreement under which a member agrees to waive coverage for specific pre-existing conditions or for specific future conditions.

An organisation that processes insurance claims of the insurer on behalf of insurance company. It scrutinises the expenses incurred vis-à-vis coverage under the policy and ensures compliance of the policy terms and conditions and warranties and subject to the limit of sum insured. The insured needs to interact with the TPA for settlement of claims. [...]

Health insurance policies are usually annual contracts. At the end of the policy period, the policy has to be renewed by the insurers. If there is a break in insurance, the insured would lose the benefits of insurance in the event of any contingency.

Under a Health Insurance policy, the cost of various hospital charges (such as bed charges, medicines, lab tests, surgeon’s fees, etc.) are paid back to the insured who makes the claim.

The insured who seeks protection against loss he/she may suffer due to happening of a contingency.

A form used to give the insurance company full particulars of the risk against which insurance protection is desired. It is the basis of the insurance policy. Any misrepresentation or non-disclosure of facts would make the insurance null and void.

The amount paid by the insured (the buyer) to the insurer for the policy. It’s generally calculated based upon the age, duration, sum assured and type of policy.

Any ailment or disease that a person is already suffering from at the time of purchasing health insurance.

The 12-month period commencing from the date of inception of the policy.