Glossary
Accident and Health Insurance – Coverage for accidental injury, accidental death, and related health expenses. Benefits will pay for preventative services, medical expenses and catastrophic care, with limits.
Accidental Death and Dismemberment (AD & D) Benefit – A supplementary life insurance policy benefit that provides for an amount of money in addition to the policy’s basic death benefit. This additional amount is payable if the insured dies as the result of an accident or if the insured loses any two limbs or the sight in both eyes as the result of an accident.
Actual Cash Value – A form of insurance that pays damages equal to the replacement value of damaged property minus depreciation.
Accident and Sickness Insurance – Term used to denote a personal accident insurance policy, which is extended to cover sickness benefits also. However benefits relating to sickness extension will be restricted to weekly compensation for temporary total disablement and for reimbursement of medical expenses towards treatment in a hospital or a nursing home for all sickness other than those which are excluded. The cover will be subject to a period exclusion and a maximum period limit in respect of any one sickness A policy like this which was in existence in the Indian Market was discontinued after nationalization of general insurance. It is possible that in the current scenario some companies introduce a similar insurance cover with the approval of the regulatory authority. (See also "Accident Insurance").
Age limits – Stipulated minimum and maximum ages below and above which the company will not accept applications or may not renew policies.
AIDS – Acquired immune deficiency syndrome.
Assignee – Assignee is the person to whom the benefits under a life policy are assigned.
Agent – An insurance company representative licensed by the state, who requests, negotiates or effects contracts of insurance, and provides service to the policyholder through the insurer.
Beneficiary – The person(s) or entity(ies) (e.g. corporation, trust, etc.) named in the policy as the recipient of insurance proceeds upon the death of the insured (Life).
Bail Bond – Covers the bail amount, applicable if arrested or detained by the police or judicial authorities for any bail able offence while abroad.
Claim – A request for payment of the contractual benefits by the insurer that is made as soon as the contingency covered by the policy arises. A written request is made by the insured or the nominee for the insurance company to cover the incurred loss, which is submitted on a standard form provided by the insurance company.
Claim Amount – It is the amount payable by the insurer under a policy on a claim arising.
Coverage – The scope of protection provided under a contract of insurance, any of several risks covered by an insurance policy.
Death Benefit – A payment made to a beneficiary upon the death of the insured person.
Deductible – The amount of loss paid by the policyholder, either a specified dollar amount, a percentage of the claim amount, or a specified amount of time that must elapse before benefits are paid. The bigger the deductible, the lower the premium charged for the same coverage.
Dental Insurance – A type of health insurance that covers dental care expenses.
Doctor – A medical professional/practitioner who is duly qualified and appropriately licensed to practice as a doctor to give medical treatment.
Exclusions – Specific conditions or circumstances for which the policy will not provide benefits.
Family Benefit Coverage – A type of supplementary benefit rider offered in conjunction with a life insurance policy that insures the lives of the insured’s spouse and children. Also known as dependent life insurance and spouse and children’s insurance rider.
Hospital – ‘Hospitals’ are institutions that are duly registered and actively supervised by a registered medical practitioner, where one can get indoor treatment for sickness and/or injuries. There are few essential criterions to qualify as a ‘Hospital’; they are as follows:
- At least 15 beds for patients
- Fully equipped operation theatre to conduct surgery
- Qualified doctors and
- Qualified nursing staff round the clock
Hijack – Illegal seizure or forceful exercise of control of any Carrier with violence, committed for any reason (political, religious or ideological) by any person or a group, whether acting alone or on behalf of any organization or Government.
Insurance – Social device for minimizing risk of uncertainty regarding loss by spreading the risk over a large enough number of similar exposures to predict the individual chance of loss.
Insured – The person whose life is covered by a policy of insurance.
Illness – means disease/ sickness/ ailment affecting the normal soundness and health of the insured person. It is also a condition that may cause impairment of physiological which first manifests during the Risk period / Policy period and requires medical treatment while the insured person is abroad.
Immediate Family Member – means the Insured person’s legal spouse, parent, parent-in-law, grand parent, grandparent-in-law, brother, sister, brother-in-law or sister-in-law, niece or nephew.
Medical Evacuation – When, in the opinion of the Assistance Company’s medical panel, it is judged medically appropriate to move You to another location for treatment or return You to India, the Assistance Company will arrange the evacuation, utilizing the means best suited to do so, based on the medical evaluation of the seriousness of Your condition, and these means may include air ambulance, surface ambulance, regular airplane, railroad or other appropriate means. All decisions as to the means of transportation and final destination will be made by the Assistance Company.
Medical Expenses – means those reasonable and customary medical expenses that an insured person has necessarily and actually incurred for medical treatment during the Risk Period or Policy Period and on the advice of a doctor following an accident or illness.
Policy – Is the legal document that has the conditions of the insurance contract.
Policy Period – The period during which a Policy contract affords insurance.
Policy year – Period between a Policies anniversary dates.
Premium – Premium is the amount paid to secure an insurance policy.
Repatriation – The Assistance Company agrees to make the necessary arrangements for the return of your remains to India in the event you die while this service agreement is in effect as to you.
Spouse – Means the insured person’s legally married spouse as long as she continues to be married to him.
Term – Term is the period for which insurance coverage is given.
Travel Insurance – Insurance to cover problems associated with traveling, generally including trip cancellation due to illness, lost luggage and other incidents.
TPA – TPA means Third Party Administrator, approved by Insurance Regulatory and development authority (IRDA). They provide service with respect to coordination of treatment in hospitals/settlement of bills on behalf of Insurance Companies. Every Insurance company offers this cashless settlement facility. Even if TPA settles the bill with hospital you may have to submit your bill to TPA with respect to bill for 30 days prior to hospitalization and 60 days to post hospitalization.