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.

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.

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.

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.

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.

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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.

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

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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

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.

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.

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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.

Thank You.