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Glossary

Every insurance term you need, in one place.

Agent

Agent is appointed by the insurer to procure business for which he is given a licence by the IRDAI

Cashless Claim

SHAI provides cashless settlement to alleviate the problems of payment of hospitalization expenses of the insured by resorting to Cashless Settlement of the Claim. In this claim process, SHAI has tie-up with network of hospitals in metros and non-metros whereby the insured can get themselves admitted in the specified network hospitals and take treatment for the disease contracted without payment of any money to the hospital. However this is subject to the limits and sublimits which is subject to the sum insured of the policy.

Cumulative Bonus

The limits of benefits under the policy are cumulatively increased by specified maximum percentage in respect of each claim free year of insurance, but the overall amount of such increase will not exceed certain percentage as specified in the policy. In case of a claim, the earned bonus would be reduced as given in the policy at the time of renewal.

Endorsement

Endorsement is a document issued on the policy, facilitating the insurer to make amendments in the subject matter of insurance.

Floater Policy

A floater Policy is issued with a single sum insured covering number of individuals. Eg., Unlike in an Individual policy, where a family (Husband/Wife) is covered for the Sum Insured so desired, independent of each other, and pay the premium accordingly, in a Family Floater - the family is covered for a fixed amount and anyone in the family can avail of the benefit till the limit is exhausted.

Group Insurance

A firm or an association may affect a policy to insure members of a group. For example a Company may take a policy to cover its employees.

No Claim Discount

No Claim Discount is a discount on the Basic Premium if there is a claim free year of the policy.If the insured does not make any claim on his policy, then he gets a discount from 5% to 25% on basic Premium for every claim free year.

Overseas Mediclaim Policy (OMP)

An OMP is issued to persons who undertake bonafide trips abroad for

1. Business or pleasure
2. Corporate employees who undertake frequent travel abroad
3. Educational purpose

PA Policy

Personal Accident Policies are issued as fixed benefit policies whereby specified sums are paid on the happening of specified contingencies in accordance with the scale of benefits incorporated in the policy

Policy

Policy is a stamped document which provides an evidence of the contract of insurance between the insurer and the insured.

Premium

Premium is the actual amount of money charged by insurance company for active coverage.

Proposal

Proposal forms are a means of communicating an offer to the insurers. Proposal form is to give the insurer full particulars of the risk against which insurance protection is desired.Proposal form is the basis of contract. Any misrepresentation or non disclosure of facts would make the insurance null and void.

Proposer

Proposer is the insured who seeks protection against loss he may suffer due to happening of a contingency.

Reimbursement

Under Health policies, the cost of various hospital charges (such as bed charges, medicines, lab tests surgeons fees etc) are reimbursed. In other words, the insured has to pay the (hospital) expenses incurred and seek reimbursement from the insurance company.

Reinsurance

Reinsurance is an arrangement whereby the original insurer transfers or cedes a part of the risk to another insurer called reinsurer.

Renewal

General insurance policies are annual contracts. Policies are generally issued for one year, and some for shorter periods. At the end of the policy period, the policy has to be renewed by the insurers. But renewing a contract of insurance is at the discretion of the insurer. There should be continuous renewal of the policies. If there is a break in insurance, the insured would lose the benefits of insurance in the event of any contingency.

Third Party Administrator (TPA)

Third Party Administrators are the authorized claim settling agents of the Insurer.Settlement of claims involves proper scrutiny of loss vis-a-viz coverage under the policy and compliance of the policy terms and conditions and warranties and subject to the limit of sum insured.

Underwriting

Underwriting refers to the transaction of the insurance business. Underwriting deals with principles and practices concerning the acceptance or rejection of risks, fixing of rates and terms, the total amount of acceptance and retention for insurer's own account and reinsurance of the balance amount.

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