Insurance Glossary

Accident Cover

Accident cover is a specialized insurance policy or benefit rider that provides financial compensation to an employee or their beneficiaries in the case of accidental injury, permanent or temporary disability, or death resulting from a…

Adjudication

Adjudication is the formal process where an insurance company or a Third Party Administrator reviews a submitted medical claim to determine its validity, check it against policy terms, and calculate the final payout amount.

AYUSH Treatment

AYUSH treatment refers to medical care and hospitalization under recognized traditional systems of medicine, including Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy.

Bariatric Surgery

Bariatric surgery is a medically necessary weight-loss operation covered by health insurance when severe obesity poses a direct, life-threatening risk to a person’s health.

Beneficiary

A beneficiary is the specific person, group, or organization you name in an insurance policy to receive the payout or financial benefits if an unfortunate event or death occurs.

Broker

An insurance broker is an independent, licensed intermediary who represents the policyholder to compare, negotiate, and manage insurance plans across multiple insurance companies.

CD Balance (Cash Deposit Balance)

A CD (Cash Deposit) balance is a pre-funded float an employer keeps with the insurer or TPA in a group health policy. Mid-term additions — new joiners, newborns, dependents — are debited from it, so cover starts immediately.

Claim

A claim is a formal, official request made by a policyholder or a healthcare provider to an insurance company asking for payment or financial compensation for a covered medical event or loss.

Claim Settlement Ratio (CSR)

The claim settlement ratio (CSR) is the percentage of total claims an insurance company successfully pays out compared to the total number of claims it receives within a financial year.

Copay / Co-payment

A copay (co-payment) is the fixed percentage of an admissible claim that the insured person pays out of pocket, with the insurer paying the rest. In group health, a copay clause lowers premium but shifts some cost to employees.

Coverage

Coverage is the specific scope of protection, financial limits, and list of medical benefits provided to an employee under an active insurance contract.

Critical Illness

A critical illness is a severe, life-threatening medical condition, such as cancer, heart attack, or kidney failure, that triggers a fixed, one-time lump-sum financial payout upon confirmed medical diagnosis.

Daily Hospital Cash Benefit

Daily hospital cash pays a fixed cash amount for each day of hospitalisation, regardless of the actual bill, to cover incidental costs. In group health it is usually an add-on paid over and above the sum insured.

Deductible

A deductible is a fixed, predetermined amount that a policyholder must pay out of pocket before the insurance company begins to cover any medical or hospital expenses.

Dependents

Dependents are immediate family members of an employee who are eligible for medical coverage under the same corporate health plan.

Domiciliary Hospitalization

Domiciliary hospitalization refers to hospital-level medical treatment administered to a patient at home for a minimum of three consecutive days because they cannot be moved to a hospital or because a hospital bed is unavailable.

EDLI (Employees’ Deposit Linked Insurance)

EDLI is a statutory life-insurance benefit under the EPF & MP Act, 1952. The employer funds it for every EPF member at no cost to the employee, and the nominee receives a lump sum if the member dies in service.

Endorsement

An endorsement is an official legal amendment or certificate issued by an insurance company that modifies, updates, or alters the terms, coverage, or member list of an active baseline insurance contract.

GIPSA

GIPSA (General Insurance Public Sector Association) is the body of India’s four public-sector general insurers, best known for the PPN network of hospitals that agree standardised package rates for cashless treatment in group health insurance.

Health Card

A health card is a physical or digital document issued by an insurer or TPA that serves as proof of identity and active insurance coverage at network hospitals.

Health Insurance

Health insurance is a contract where an insurance company covers your medical and surgical expenses, including hospitalization, day-care procedures, and treatments, in exchange for a regular premium payment.

Health Insurance Policy

A health insurance policy is a legally binding contract between an insured individual (or group) and an insurance provider that covers medical and surgical expenses in exchange for regular premium payments.

Hospital

A hospital isn’t just any medical clinic; it is a registered institution that meets specific criteria (like bed count and 24/7 nursing) to be eligible for insurance claims.

Injury

An injury is physical damage to the body caused solely by a sudden, external, visible, and accidental event.

Insurance Agent

An insurance agent is a licensed professional who officially represents an insurance company to sell policies, explain coverage options, and assist clients with policy management.

Insurance Fraud

Insurance fraud is any deliberate deception, exaggeration, or misrepresentation committed by an individual, employee, or healthcare provider against an insurance company to secure unlawful financial gain or claim approvals.

IRDAI

IRDAI is the official government regulatory body that manages, licenses, and oversees the entire insurance industry in India to ensure the protection of policyholder interests.

Liability

Liability is the legal responsibility or financial obligation of an individual or an organization to compensate another party for bodily injury, property damage, or financial loss caused by negligence, errors, or omissions.

Moratorium Period

The moratorium period is a fixed timeframe of continuous policy renewals after which an insurance company cannot reject a medical claim on the grounds of past non-disclosure or misrepresentation, except in cases of proven fraud.

Nominee

A nominee is a trusted individual officially chosen by a policyholder to receive the financial payouts or medical claim benefits if the insured person passes away.

Policy

A policy is a formal, legally binding contract issued by an insurance provider that outlines the terms, conditions, coverage limits, and exclusions of the insurance agreement.

Policy Lapse

A policy lapse is the complete termination of an insurance contract due to non-payment of premiums within the specified due date and grace period.

Policy Migration

Policy migration is the process of switching from one health insurance plan to another within the same insurance company without losing your accumulated waiting period credits.

Policy Renewal

Policy renewal is the process of extending an active insurance contract for an additional term by paying the required premium before the current coverage expires.

PPN (Preferred Provider Network)

A Preferred Provider Network (PPN) is a panel of hospitals empanelled by an insurer or TPA that agree standardised package rates for cashless treatment — making claims in group health insurance faster and more cost-predictable.

Premium

A premium is the specific amount of money an individual or an employer pays regularly to an insurance company to keep an insurance policy active and maintain financial coverage.

Preventive Health Check-up

A preventive health check-up in group insurance is an employer-sponsored corporate wellness benefit consisting of routine diagnostic tests aimed at catching employee health risks early, before they lead to serious illnesses or major…

Redressal of Grievances

The redressal of grievances is a structured regulatory and administrative framework that allows policyholders to file formal complaints and seek official solutions for disputed insurance claims or poor service.

Reimbursement

Reimbursement is an insurance claim track where the policyholder pays their medical bills directly to the hospital out of pocket and later submits the original documents to the insurer to get refunded.

Riders

A rider is an optional add-on provision or amendment that attaches to a base insurance policy to provide extra benefits, extended coverage, or specialized protections at an additional premium cost.

Room Rent Limit

A room rent limit is the maximum daily amount or the specific room category that an insurance policy will cover for your hospital stay.

Sum Insured

The sum insured is the maximum amount an insurer will pay for covered claims in a policy year. In group health insurance, the employer sets the sum insured per employee, either as an individual limit or a shared family floater.

Teleconsultation

Teleconsultation is a remote medical appointment where a patient interacts with a registered doctor via video call, voice call, or online chat for diagnosis and prescriptions without physically visiting a clinic.

Top-up Health Insurance

Top-up health insurance is an additional policy that provides extra medical coverage once your healthcare expenses cross a specific pre-set threshold limit known as a deductible.

Underwriting

Underwriting is the backstage risk-evaluation process where an insurer analyzes an applicant’s profile to decide if they can be insured, under what terms, and at what premium rate.