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Heath Insurance


Know about the basic terminologies health Insurance. – PowerPoint PPT presentation

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Updated: 28 January 2015
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Title: Heath Insurance

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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.

  • 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
  • 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

  • Principles of indemnity
  • Indemnity means security, protection and
    compensation given against damage, loss or
  • 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
  • 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

  • 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
  • The contract can be renewable annually or
  • 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
  • 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.

  • 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

Thank You.
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