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Retail Glossary

Ambulance Cover

Coverage for the expenses towards moving the injured or the ailing to a network hospital by ambulance. It is applicable in case of emergency as well as planned hospitalisation and includes on-the-spot paramedic treatment for the insured person.

Admissible Claim

The amount of claim that is eligible to be paid under the policy.

Cashless Facility

A facility provided by the Insurance company to the Insured where the payments of the costs of treatment undergone by the Insured are directly made to the hospital. This facility requires the treatment to be taken in a network hospital and pre-authorised by the insurance company.

Chronic Diseases

Chronic Diseaseis an illness or ailmentthat shows one or more of the following characteristics: • Recurs and continues indefinitely • Needs constant monitoring and check-up • Needs on-going treatment for relief or rehabilitation • Requires the insured to be specially trained to cope with it • Has a high likelihood of reoccurrence

Claim

A formal request made by the insured to the insurance company for a payment under the terms and conditions of the policy.

Claim Amount

Total amount approved by the insurance company to be paid to the hospital or the insured under his policy, in towards the cost of his medical treatment.

Claims History

A record of number, amount and type of claims made by an insured during a specific period of insurance (usually one policy period)

Comprehensive Hospitalisation

Comprehensive Hospitalisation refers to the coverage of all expenses incurred while the insured is hospitalised as an in-patient for 24 hours or more. It includesroom rent, medical expenses, doctor visits, diagnostic tests, etc.

Congenital Anomaly

A condition(s) which is present since birth, and which is abnormal in term of form, structure or position. It could be internal or external.

Co-Payment

A cost-sharing requirement under a healthinsurance policy that provides that the policyholder will beara specified percentage of the admissible claim amount. A co-paymentdoes not reduce the Sum Insured.

Critical Illness

A major illnesses, sickness or disease including but not limited to Cancer, Kidney failure, Stroke, Heart Attack, CABG, Multiple Sclerosis

Day Care Treatment

Specific treatments administered or surgeries conducted in the In-Patient department of the hospital but requiring less than 24 hours of hospitalisation. Treatments and procedures commonly covered include Cataract operation, Dialysis, and Chemotherapy.

Dependent Child

A child(by birth or legal adoption) who is financially dependent on the insuredand does not have an independent source of income of his/her own.

Disability

A condition in which an individual is physically unfit to perform basic day-to-day activities.

Domiciliary Treatment

Medical care given to patients at home. This benefit is paid only when there is lack of accommodation at the hospital or the patient's condition is such that he/she cannot be shifted to a hospital.

Emergency Care

Prompt medical treatment or attention given in case of an unexpected ailment or injury.

Exclusions

The risks or eventualities specifically not covered by the health insurance policy.

Family Floater Insurance Plan

A plan that allows the policyholderto cover his/her entire family under a single policy and a single sum insured.The Sum Insured represents the maximum amount payable under the policy during the policy period in respect of any or all the claims made under the policy by all insured persons put together.

Grace Period

Specified period of time immediately following the premium due date during which premium can be paid to renew or keep a policy in force, without suffering a break in cover or the loss of continuity benefits.

Hospital Cash Cover

A daily cash benefit paid to the insured person in the event of his/her hospitalisation of more than a stated period (usually 24 hours). The maximum number of days for which this benefit can be paid during a policy period, is specified in the policy.

Individual Cover

A simple health insurance policy that covers one individual.

Inpatient Care

Care or treatment for which the Insured Person has to stay in a Hospital for more than 24 hours, for an injury or illness covered by the policy.

Maternity Benefit

Payment of medical expenses relating to childbirth (including complicated deliveries and caesarean sections) incurred during hospitalization and expenses towards lawful medical termination of pregnancy.

NoClaim Bonus

Also known as No Claims Discount. It isa discount available to a policyholder on renewal of the policy, if no claim has been madeduring the policy period. The percentage of discount increases every claim-free year, up to a maximum limit.

Organ Donor

Any person whose organ has been donated for use by the insured, in compliance with the Transplantation of Human Organs Act, 1994.

Personal Accident

Personal Accident refers to an unforeseen event caused by violent, external and visible means,which results in bodily injury or death of the insured.

Pre Hospitalisation Expenses

Medical Expenses incurred immediately before the Insured Person is hospitalised, provided the expenses are incurred for the same condition for which the Insured Person was hospitalised and the In-Patient hospitalisation claim is admitted by the insurance company.

Post Hospitalisation Expenses

Medical Expenses incurred immediately after the Insured Person is discharged from the hospital, provided the expenses are incurred for the same condition for which the Insured Person was hospitalised and the In-Patient hospitalisation claim is admitted by the insurance company.

Pre-Existing Condition

Any condition, ailment or injury or related condition(s) for which the insured had signs or symptoms, and/or was diagnosed, and/or received medical advice/treatment within a specified period prior to the first policy issued by the insurance company. Pre-Existing conditions are excluded from the policy.

Proposer

Any individual or entity which makes an application (proposal) to an insurance company for obtaining an insurance policy. The proposer must have insurable interest in the health of the person proposed to be covered by the insurance policy.

Rent Capping

Placing a limit on the amount of room rentthat one can claim under the health insurance policy.

Room Rent

Amount paid for occupying a bed in a hospital or nursing home for 24 hours.

Self-Inflicted Injury

Any physical damage inflicted by the insured person on himself/herself with the intention to harm. It includes injuryor ailments due to abuse of intoxicating substances, suicide, etc.,and is excluded from health insurance coverage.

Sub-Limits

Alimit/capon claim placed by the insurance company in respect of certain treatment, disease or item of expense. It may appear as a monetary limit or a percentage of Sum Insured.

Sum Insured

The amount stated in the policy for each insured person separately for Individual Sum Insured policy, and aggregately for all insured members for a Floater policy, which represents the maximum amount payable as claim under the policy during the policy period.

Tax Exemption

Deduction Under Section 80D of the Income Tax Act, in respect of premium paid by an individual for medical insurance for himself, spouse, dependent parents and children, subject to a limit specified in the Act.

Third Party Administrator

A service provider named in the schedule of the Policy who is licensed by the Insurance Regulatory Development Authority and is engaged by the insurance company for a fee or remuneration to provide claims and other services under the Policy.

Add-On Covers

The optional extra protection that can be availedover and abovethe standard Own Damage coverage provided in a comprehensive motor insurance policy. These covers are available on payment of extra premium. Add-On Covers are not available for Motor ThirdParty insurance policies.

Anti-Theft Device

The auto accessories such as car alarms, immobilisers, steering and tire locks, and kill switches,that prevent or deter theft of vehicles. Presence of such devices is considered a favourable feature by insurance companies.

Broker

A marketing specialist who represents buyers for insurance and who deals with either companies in arranging for the coverage required by the customer.

Cashless Claim Facility

A feature that allows the insured vehicle to be serviced at a network garage without a direct payment from the vehicle owner. Once the claim documents are filed,the insurance company pays the admissible expenses directly to the network garage.

Cashless Garage Network

A country-wide network of garages created by insurance companies, to carry out cashless repairs of insured vehicles andto deliver other accident/emergency services.

Certificate Of Insurance

A document issued by the insurance company, certifying that an insurance policy has been issued by certificate covering the vehicle identified in the certificate. The Certificate of Insurance mentions the vehicle registration number, name of the insured person, the effective date of insurance, type of insurance coverage and the sum insured or limit of liability.

Comprehensive Motor Insurance Policy

An Insurance Policy that covers Own Damage of the insured vehicle as well asits Third Party Liabilities.

Compulsory Deductible

A fixed amount stated in the policy schedule,that needs to be first borne by the policyholder in each and every claim. In practice, this amount is deducted from the final claim amount paid by the insurance company.

Cover Note

A temporary insurance document issued by an insurance company, confiming that an insurance cover has been granted to the insured person in respect of the vehicle mentioned, for the period mentioned therein. It also specifies the type of insurance and amount of cover. A Cover Noteserves as a proof of insurance tillan insurance policy document is issued.

Deduction For Depreciation

A vehicle is an asset that depreciates each year. This annual decrease in value is accounted by insurance companies by making a fixed percentage of deduction from the amount claimed. The schedule of depreciation is mentioned in the policy.

Discount For Restricted Area Usage

Discount on the premium can be availed in case the vehicle is to be driven within a particular geographical area only. Generally, vehicles that are used exclusively in the regions that have better roads and good driving conditions are eligible for this discount.

Exclusions

The risks or eventualities specifically not covered in the motor insurance policy.

Grace Period

Specified period of time immediately following the premium due date during which premium can be paid to renew or keep a policy in force, without suffering a break in cover or the loss of continuity benefits.

Gross Vehicle Weight

The maximum loaded weight that a single vehicle is designed for, as specified by its manufacturer.

Immediate Repairs

Reasonable and necessary repairs carried out by the policyholder to the insured vehicle at the site of the accident, immediately after the incident. These expenses can be reimbursed to the extent provide in the policy, against original receipts.

Insured Declared Value

The value of selected by the insured for insurance of his /her vehicle. IDV isexpected to be the current market value of the vehicle, obtained by applying appropriate depreciation tothe listed current market value.It represents the maximum liability of the insurance company in case of a total loss of the vehicle.

Key Replacement Cover

This cover provides cost of replacing the keys in case of irrecoverable loss of keys of the insured vehicle. In case of security threat to the vehicle due to lost keys, some policies may also pay for the cost of replacing the locks. Insurers may also cover the cost of hiring a replacement car for the insured as well as atow servicesfor the stranded vehicle.

Liability Only Policy / Act Only Policy

Known as Third Party Liability Insurance, itis a mandatory insurance cover that safeguards the insured financiallyin case the insured vehicle causes death, bodily injury or damage to property of a Third Party.

Nil Depreciation Cover

Also known as Zero Depreciation Cover, allows the policyholder to claim the entire amount of loss without deductions on account of depreciation.

No Claim Bonus (NCB)

Also known as No Claims Discount. It is a discount available to a policyholder on renewal of the policy, if no claim has been made during the policy period. The percentage of discount is 20% of your Own Damage Premium in the first year and increases every year @5% to a maximum of 50%.

No Claim Refund

A certain fixed amount of the premium paid back by the insurance company to the policyholder at time of policy renewal,if no claim has been made in the entire policy.

Own Damage Cover

Insurance Cover that financially safeguards the insured against cost of damage due toaccidents, floods, fire, earthquake, etc.to the insured vehicle. It also provides compensation for personal injuries caused by an accident covered by the policy.

Post-Accident Assistance

Services rendered after an accident, such ascollection of vehicle, assessing the level of damage and communicating with the network garage for repairs.

Predefined Depreciation

The fixed depreciation that is applied to the claim on a vehicle. Thisrate is defined by the insurance companyat the time of issuing the policy.

Preferred Garage

Please see Cashless Garage Network

Renewal of Lapsed Car Policy

Renewalof a car insurance policy that has expired. Renewal of such policies, when completed within a defined time period allows the policyholder to enjoy continuity of cover. Insurers will prescribe a process for renewal of lapsed policies, which may include an inspection of the vehicle and/or a written declaration by the policyholder.

Roadside Assistance Cover

As an optional extension to the insurance policy which provides roadside assistance (accident/breakdown), towing of stranded vehicle, alternate transportation, changing a flat tire, unlocking thecar, etc. The range of benefits and the cost of cover varies from insurer to insurer.

Salvage Of Damaged Parts

The scrap value of the parts damaged in the accident and replaced during repairs. If the damaged parts are not surrendered to the insurance company, an appropriate salvage value is deducted from the claim amount. In case of total loss, salvage value refers to the value of the wreck of the vehicle.

Third Party

Any entity other than the insured and the insurance company.

Third Party Legal Liability

Known as Third Party Liability Cover, it is a mandatory insurance cover that safeguards the insured financially in case the insured vehicle causes death, bodily injury or damage to property of a Third Party.

Voluntary Deductible

An additionalcompulsory deduction that the insured can opt for while buying the policy. This reduces the liability of the insurance company in every claim, in consideration of which,the insured is given with a discount in the premium.

Annual Multi Trip Cover

A travel insurance that covers more than one overseas tripsundertaken by the insured, during the policy period. The cover attaches on the insured’s departure from his country of residence and suspends on his return.

Checked-in Baggage

The baggage handed-over by the Insured and accepted by a common carrier for international transportation in the same vehicle/aircraft as the Insured, and for which the carrierhas provided a baggage receipt.

Common Carrier

Any civilian land or water conveyance or scheduled aircraft, operated under a valid license, for the transportation of passengers, for hire.

Condition Precedent

A policy term or condition of the policy which is necessary to be met, for the insurer to admit his liability under the policy.

Contingency Travel Benefits

In case of bodily injury or illness during travel, leading to the insured’s hospitalisation for more than specific number of consecutive days, the insurer pays emergency hotel expense for the insured’s family member to visit the insured. The compensation amount is limited to the sum insured. Some travel insurance companies offer this as an add-on.

Daily Allowance/ Hospital Cash

Aspecified amount of benefitpaid per day to the insured following his/her hospitalisation due to illness or accident. This cover is usually subject to a sub-limit and is paidup toa fixednumber of days per year.

Delay Of Baggage

If thechecked-in baggageis delayed or misdirected. In such cases, the insurance company reimburses the cost of necessary person effects/baggage. For a claim to be paid, the checked in baggage ticket Issued by the common carrier should be in the name of the insured. The claim is subject to the limit stated on the policy.

Emergency Medical Expenses

In case of unexpected illness or injury to the insured during the policy period, the insurer will reimburse the cost of Emergency Medical Expenses subject to the limit stated on the policy.

Hijack

Any unlawful seizure or exercise of control, by force or violence or threat of force and with wrongful intent, of Common Carrier in which the Insured is travelling.

Maximum Trip Duration

The maximum time allowed for any singleinsured trip during a year. The cover for the trip attaches at the time the Insured departs from the country of residence and ends on the insured’s return or at the end of the period defined as Maximum Trip Duration, whichever occurs first. This provision is applicable to annual travel insurance policies.

Overseas Administrator

The person or organisation named in the policy schedule, who has been appointed by the Insurer to provide administrative services on its behalf.

Overseas Travel Insurance Policy

Insurance policy that coversthe policyholder against financial losses due to unforeseen events such as injury, illness, baggage loss while travelling abroad.

Permanent Disablement

The event where, due an injury, ailment or illness, the insured is unable to work independently in any occupation. The disability should be consistent in nature and would restrict the insured to carry out daily activities such as walking, climbing stairs, etc.

Personal Liability

Damages (awards by the court) for claims legally filed on insured against property damage and medical expenses to others as a result of bodily injury caused by insured in an accident.

Compassionate Visit Cover

In case the insured person is hospitalised for more than 7 consecutive days, the Insurance company pays for a round-trip economy class air ticket and accommodation expenses for an immediate family member to attend to the insured person.

Pre-Departure Services

Services provided by the Service Provider to students under overseas travel insurance for students, which include assistance/information on banking facilities, car rental in foreign country, destination information, foreign exchange, hotels, vaccination requirements, travel advisory, visa and weather. The range of services offered may vary from insurer to insurer.

Sponsor Protection Cover

In the event of injury to the Insured Person’s Sponsor resulting in Death or Permanent Disablement, the insurance company reimburses the insured person the Tuition Fee incurred for the remaining period of this education upto the maximum limit stated in the policy schedule.

Student

A person attending an accredited college or university either as a part-time or a full-time student in the country mentioned on the policy, following the effective date of the policy.

Study Interruption Cover

Policy provision to pay specific costs such as tuition fee in the event of interruption of study of the insured student due to his/her diseases, injury or terminal illness. The compensation paid is subject to the limit mentioned on the policy.

Terrorism

Any actual use of or threatened use of force or violence directed at any individual, property or governmentwith an objective of pursuing economic, ethnic, nationalistic, political, racial or religious interests, regardless of such interests being declared.

Trip Cancellation

The event in which the insuredtrip getscancelledfor reasons of natural calamities, acts of terrorism, delay caused by breakdown of the foreign carrier or personal contingencies of the insured.

Trip Curtailment

Cutting short of the insuredtrip due to personal or medical emergencies of the insured or the foreign carrier being delayed due to natural disasters, hijack, breakdown etc. The cover pays for the cost of cancellation of unused tickets, hotel bookings etc. up to the limit stated in the policy.