Common Definitions in Health Insurance

Family Floater Policies:

The sum insured floats among the family members. Family floater covers husband,wife,children,parents and parents in law.The eligibility as per the age factor varies from insured to insurer,from as young as 3 months to 80 years and above.

Group Health insurance policy :

This policy available to groups/associations/institutions/corporate bodies and provides insurance protection. The employees are not a direct party to the insurance contract. Insurance company issues one master policy covering all the members of the group.

Domiciliary Hospitalization :

Certain insurers offer Domiciliary Hospitalization benefit. This refers to medical treatment for a period exceeding 3 days, for want of accomodation in a hospital or the condition of patient does not permit transfer to a hospital.

The premium is based on age & sum assured selected.

Cashless Facility :

Costs of treatment are directly made to the network provider by the insurer

Free look in period of 15 days is applicable

30 days Grace period is allowed for renewal

Common Definitions in Health Insurance

Inpatient :
Insured who undergoes treatment after getting admitted in the hospital

Outpatient:
Insured who undergoes treatment without getting admission/staying in the hospital

Day care centre:
Diseases do not require more than a day's stay in the hospital or less than 24 hrs at times Eg.cataract

Third Party Administrator(TPA):
It means any person who is licensed under the IRDA(Third Party Administrators - Health Services) Regulations, 2001 by the Authority, and is engaged for a fee or remuneration by an insurance company, for the purposes of providing health services.

Network Provider:
Hospitals enlisted by an insurer of or by a TPA & Insurer together

Portability:It is the right of the policy holder to transfer the policy with the same conditions from current insurer to the new insurer.

Pre existing Condition(PED): Existing illness before taking the policy with the same conditions from current insurer to the new insurer

Senior citizen:
Who has completed 60 yrs or above