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Glossary Of Terms Used By Health Insurance Companies

​​​With more and more people buying health insurance policy and the sector seeing a sudden boom, it is always important to understand the terms associated with health insurance policy and their definitions in layman’s language. Here we try to bring you certain terms with are very common and which are related to health insurance.

Agent or TPA

It is also called Third Party Administrator and is appointed by the Health Insurance companies to act as a liaison between the Company and the policy buyer. All claims are settled through TPA.


The application for reimbursement of the expenses incurred on hospitalisation is called filing a claim. The application is duly filled in a form as prescribed by the Insurance provider.

Cashless Claim

This is the facility offered by the Insurance provider in the network of hospitals associated with the company wherein the policy holder doesn’t have to pay anything to the hospital for the treatment being offered. 

Critical Illness

As the name suggests, critical illness is a serious terminal disease for which the cost of medical expenses is very high and which includes certain diseases like renal failure, cancer, major organ transplants etc. A lump sum amount is provided to the policy holder in lieu of the expenses incurred in event of hospitalisation.

Domiciliary Hospitalisation

As the name suggest, domiciliary hospitalisation is a term used when the treatment is carried out at home under the recommendation of the doctor. Some of the health insurance companies do not cover domiciliary hospitalisation.


As the word suggests, it means certain diseases which are not covered by the policy. There are certain types of ailments which are not altogether covered like AIDS or HIV or there are certain diseases which are not covered in the first year of the policy.

Group Insurance

It is the type of insurance where the entire group is provided the cover and only single premium has to be paid. A firm or a corporate house buys such policies to cover all their employees. Some companies provide cover to the family members of the employees too.

Family Insurance

Here the coverage is provided to the entire family of the policy holder and no individual policy has to be bought for each and every member of the family. Only one premium has to be paid for the family policy which covers all the members.

Pre-existing conditions

Some people may suffer from Diabetes or High BP or other heart related ailments. Such diseases are considered as pre-existing diseases and some of the insurance companies do not provide coverage for same, whereas some companies provide the coverage but they do charge a heavy premium.

Network Hospitals

Network Hospitals are nursing home and hospitals associated with the insurance provider. Usually they are useful for cashless mediclaim​.

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