Know about Health Insurance, Health insurance,like other forms of insurance, is a form of collectivism by means of which people collectively pool their risk, in this case the risk of incurring medical expenses.

2. Know Insurance
 The person or business that gets compensated if the
loss occurs is known as the Insured.
 The company that agrees to pay the compensation
is known as the Insurer.
 The money that is paid by the Insured(person) to the
Insurer(company) is called the
Premium.

3. Health Insurance
 System of assurance to make contingencies of
health care expenses.
 To provide protection against financial loss by
unforeseen sickness.
 To meet cost of good medical care.
 Relieves anxiety and tension.

4. Definition
Health insurance: Like other forms of
insurance, is a form of collectivism by
means of which people collectively pool
their risk, in this case the risk of
incurring medical expenses.

5. Principles of Insurance
 Utmost good faith
 Insurer and the insured should have good faith to each
other
 Insurer must provide complete & accurate information
 the insurance contract must be signed by both parties
(i.e insurer and insured) in an absolute good faith or
belief or trust.

6.  Insurable interest
 Insured must have insurable interest in the subject
matter of the insurance
 For example :- The owner of a taxicab has insurable
interest in the taxicab because he is getting income
from it. But, if he sells it, he will not have an insurable
interest left in that taxicab.

7. Continues..
 Principles of indemnity
 Indemnity means security, protection and
compensation given against damage, loss or injury.
 According to the principle of indemnity, an insurance
contract is signed only for getting protection against
unpredicted financial losses arising due to future
uncertainties.

8.  Principle of Subrogation
 Subrogation means substituting one creditor for
another.
 Principle of loss minimization
 It is the duty of the insured to take all possible step to
minimize the loss to the insured items on the happening
of the uncertain event

9. Continues..
 Principle of “Causa Proxima”
 The loss of the insured property can be caused by more
than one cause in succession to another
 The property may be insured against some causes and
tot against all causes
 In such causes the proximate/nearest cause of loss to
be considered

10. Health Insurance
 It is contract between an health insurance
company and an individual or his sponsor (e.g. an
employer).
 The contract can be renewable annually or
monthly.
 The type and amount of health care costs that will
be covered by the health insurance company are
specified in advance, in the member contract or
"Evidence of Coverage" booklet.

11. Terminologies – Health
Insurance
 Premium: The amount the policy-holder or his sponsor
(e.g. an employer) pays to the health plan each month
to purchase health coverage.
 Deductible: The amount that the insured must pay out-
of-pocket before the health insurer pays its share.
 Coinsurance: Instead of, or in addition to, paying a
fixed amount up front (a co-payment), the co-
insurance is a percentage of the total cost that insured
person may also pay.
 Exclusions: The insured person is generally expected to
pay the full cost of non-covered services out of their
own pocket.

12. Continues..
 Coverage limits: Some health insurance policies only
pay for health care up to a certain amount.
 Capitation: An amount paid by an insurer to a
health care provider, for which the provider agrees
to treat all members of the insurer.
 In-Network Provider: (U.S. term) A health care
provider on a list of providers preselected by the
insurer.
 Explanation of Benefits: A document sent by an
insurer to a patient explaining what was covered for
a medical service, and how they arrived at the
payment amount and patient responsibility amount.

13. Thank You.