Group health insurance protects a group of people from expenses related to any illness or medical issues. It also allows companies, banks, organizations, and housing societies to protect their entire staff, workforce, and members from medical expenses by procuring health insurance for them.
If you are about to buy a group health insurance policy, knowing the terms related to health insurance is crucial. When you know the terminologies included, it becomes easier to assess the quality of the policy, and this helps you make smarter decisions. Once you are well acquainted with the terms, you can go ahead with a comprehensive healthcare plan.
Below you will find the most common group health insurance terms:
- Administrator: any third party engaged by the insurer for providing policy and claims facilitation to the insured.
- Accumulation period: a period that begins just after purchasing a group insurance plan whereby the insured (policyholder) is not eligible to claim any cover from the policy, except for accidents.
- Any single illness: this term means any continuous period of illness which may include relapse within 45 days of the discharge from the place where treatment has been taken.
- Benefit: the amount which is payable by the insurance company to the policyholder.
- Beneficiary: any individual or entity who/that has been named in the policy as the insurance benefit recipient on the policyholder’s death.
- Co-payment: Co-Payment refers to the portion of the claimed amount that the insured needs to pay for certain medical expenses.
- Critical illness benefit: it means the maximum amount which the insurer is liable to pay for any critical illnesses.
- Deductible: the fixed amount of money a policyholder is required to pay each year before the insurance company starts paying. It is generally a fixed amount and does not depend upon any expense.
- Dependent child/children: a child, including a legally adopted one, who is financially dependent on the insured, aged between 3 months and 23 years, and is unmarried.
- Domiciliary hospitalization: when professional care is received at home because the insured cannot leave the house.
- Effective date: the date on which the coverage of the insured begins.
- Family: it includes the insured, his/her spouse, legal and dependent children, dependent siblings, and dependent parents.
- Group: an association of people who come together for a common purpose, like employees of a company. Associations without employer-employee relationships, like in the case of customers of a business where insurance is an add-on, also form part of a group.
- Hospitalization: means the insured’s admission to a hospital due to a disease or injury for 24 hours or more.
- Insurer: refers to an insurance providing company that provides cover for the medical expenses incurred by their policyholder.
- Insured: insured means a group of person/company/institute/organizations covered under the group insurance policy. He is the person who can file a claim in the event of hospitalization.
- Outpatient department: Also known as OPD, when the policyholder visits a clinic or other ambulatory care facility for treatment instead of visiting a hospital.
- Premium: the fixed amount payable annually to the insurance provider to avail the insurance policy.
- Pre-existing conditions: any injury or ailment for which the insured had symptoms 48 months prior to the availing of the policy.
- Policy period: the term commencing from the date of the policy and ending with the expiry date of the policy.
- Proposal: an application form to be filed by the insurer with the insured by duly signing it.
- Schedule: it is a part of the policy that sets out the details of the insured, the type of insurance cover, sum insured, and the policy period.
- Sum insured: refers to the specified amount that forms the maximum liability for all claims of the insurer. The premium payable for the policy also depends upon the sum insured.
- Waiting period: the period during which the policyholder cannot claim any benefit, usually until 30 days from the first policy issue date. For diseases that are pre-existing, the waiting period is 4 years, and 30 days for illness hospitalization.
The Bottom Line
Now that you are well versed with the group health insurance terms, you are prepared to choose the best policy for all your employees.
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