The document defines key terms related to health insurance: An agent works on behalf of an insurer to assist customers, while an assignee receives the benefits of a policy. A claim is a request for payment of health services. A certificate of insurance discloses what is and isn't covered along with limits. Cumulative bonus increases coverage amounts for claim-free years up to 50% of the sum insured. A deductible is an amount of loss borne by the insured, reducing premiums for higher deductibles. Dependents include spouse and children. Exclusions specify conditions without benefits. Insurers issue policies and receive premiums in exchange for assuming risk. Long-term care and disability policies provide coverage for specified periods. A premium is

1. Health Insurance Glossary
Agent: He is a person appointed by the insurer to work on behalf of the
insurer.
Assignee: It is that person who gets the benefits of a policy.
Claim: A request filed by an insured to the insurance company to pay for
services obtained from a health care professional.
Certificate of Insurance: The description of the benefits and coverage
provisions forming the contract between the carrier and the customer. Discloses
what is covered, what is not and the cash limits.
Cumulative Bonus: cumulative bonus is similar to no claim discounts. For
every claim free year, the sum insured will progressively increase by 5%.
However, the cumulative bonus is subject to an amount that can never exceed
50 percent of the Capital Sum Insured and that the policy was renewed
continuously.
Deductible: The amount of loss borne by the insured. This loss can be a certain
money amount or a percentage of the claim amount. Bigger the deductible,
lower is the premium.
Dependents: Spouse and/or unmarried children (whether natural, adopted or
step) of an insured.
Exclusions These are those conditions or circumstances for which an insured
will not be given any benefit.
Insurer: The insurance company that assumes responsibility for the risk, issues
insurance policies and receives premiums.
Long-Term Care Policy: Insurance policies that cover specified services for a
specified period of time. Long-term care policies (and their prices) vary
significantly. Covered services often include nursing care, home health care
services, and custodial care.
Long-term Disability Insurance: Pays an insured a percentage of their
monthly earnings if they become disabled.

2. Premium: The monthly amount you or your employer pays in exchange for
insurance coverage.
Policy – It is a legal document which acts as a contract between the insurer
and insured. It contains conditions of the insurance.
Pre-existing condition: A medical condition of an individual is excluded from
coverage if the condition is believed to have existed prior to obtaining the
policy from a particular insurance company.
Network: A group of doctors, hospitals and other health care providers
contracted to provide services to customers of the insurance companies for less
than their usual fees. Provider networks can cover a large geographic market or
a wide range of health care services. Insured individuals typically pay less for
using a network provider.