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Here's everything you must know about settling health insurance claims
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Planning to change your health insurer? Here’s how to port a health policy
Transcript
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How to decide which insurance scheme one should go for
Anil Rego | Anil Rego, Founder & CEO, Right HorizonsOct 11, 2017 11:00
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Find out all you want to know about Insurance
Lovaii Navlakhi | MD & Chief Financial Planner, International Money MattersOct 11, 2017 12:00
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All you want to know about health insurance
Ramalingam K | Director and Chief Financial PlannerOct 11, 2017 14:00
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Which insurance should one choose?
Pankaj Mathpal | CFP & MD, Optima Money ManagersOct 11, 2017 15:00
Faq
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There is no return under Term Plan then why should I take Term Plan?
Remember that nothing is free of cost. Even if you take ULIP plans, Money Back Plans, Endowment Plans or Whole Life Plans every plan attracts mortality charges which you have to pay. If you take term plan then in very small amount you can take higher sum assured. -
Can anyone become or set up an Insurance Repository?
No, only entities approved by Insurance Regulatory and Development Authority (IRDA) can become an Insurance Repository.
Insurance Companies cannot set up an Insurance Repository on their own nor can they hold more than 10% stake in any Insurance Repository.
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What is Term Insurance?
Term Insurance covers “Risk” and Risk means “Death”. Here a lump sum amount is payable only if death occurs during a selected period. If the insured survives till the end of the selected period, nothing becomes payable.
Source: SBI Life Insurance -
Which Insurance Policies can be held in electronic form?
The following types of insurance policies are eligible to be held in electronic form:
(a) All individual life insurance policies including health and pension policies. Policies issued to groups by registered life insurance companies can also be held in electronic form.
(b) All general insurance policies held by individuals including group policies
(c) Any other class of insurance policies that may be notified by IRDA u from time to time
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How much does life insurance cost?
The cost of buying an insurance policy depends on the following factors:
The insured person’s age, health and his nature of work
Type of policy selected
Sum assured
Policy terms
Term for paying premium and payment frequency
Riders (if any) attached to the policy -
How do I collect the maturity amount from the insurance company?
Insurance companies send information in advance to the policyholder regarding the maturity of the policy. The policyholder will be required to fill-up the forms along with the documents attached as per requirement. If the paper work is done properly and verified then the payment is either sent by post or directly credited in your bank account. -
What type of insurances should I have?
To ensure you are safe, you should ensure that you have Health insurance, - Life insurance, Accident Insurance, Automobile insurance, - Home insurance -
What should be the duration (term ) of my insurance policy?
The term of your insurance policy should be ideally equal to the number of years your family will be dependent on you financially. However, one also needs to ensure that insurance payment period is also equal to the number of years you plan to work. -
How do I open an e Insurance Account (eIA)?
To open an e IA, you need the fill out an account opening application form of the Insurance Repository along with the necessary supporting documents. Application Forms would be available in all offices of the Insurance Repository, once they are operational. They can also be downloaded from the respective website or you can fill out an application online at the website). You can also contact your Insurance Advisor (Agent) for an application form. You can submit the signed e IA application form at any Insurance Repository office. If you are applying to open an e IA at the time of buying a new Insurance Policy, it may be best to hand over the e IA form, along with the insurance proposal form, to the Insurance Company.
To open an e IA, you need to necessarily have either a PAN or Aadhar number. When submitting your e IA application, please ensure that you provide copies of your PAN or Aadhar, Address Proof and proof of date of birth, along with a passport size photograph. You also need to show the original of address proof for verification (the list of acceptable address proof documents is given elsewhere).
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What do I get if I survive the term of the policy?
The policy holder may not receive any money from the insurance company upon maturity in case he survives the policy term. However, some insurance companies offer a term policy with return of premium amount or the sum assured upon maturity. Some companies also offer policies along with bonus or profits and policy holder upon surviving the term of the policy would receive the sum assured along with the accumulated bonus.
insurance glossary
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Abstract
A brief history of title to land -
Accelerated death benefit
A percentage of the policy?s face amount, discounted for interest, that can be paid to the insured prior to death, under specified circumstances. This is in lieu of a traditional policy that pays beneficiaries after the insured?s death. Such benefits kick in if the insured becomes terminally ill, needs extreme medical intervention, or must reside in a nursing home. The payments made while the insured is living are deducted from any death benefits paid to beneficiaries. -
Accident & Accidental Death Benefit
In the context of life insurance, accident or accidental death is defined as a sudden and unforeseen happening that causes disability or death of the policyholder. -
Accident and health insurance
Coverage for acci-dental injury, accidental death, and related health expenses. Benefits will pay for preventative services, medical expenses, and catastrophic care, with limits. -
Accidental death benefit
An endorsement that pays the beneficiary an additional benefit if the insured dies from an accident. -
Accidental Death Insurance
Accidental Death Insurance provides coverage in the event of death due to accidental injuries, but not illness. In the event of death, payment is made to the insured\'s beneficiary. And most of these covers provide for cases for bodily injury (e.g., the loss of a limb), where the insured receives a specificed sum. -
Accounts receivable (debtors) insurance
Indemnifies for losses that are due to an inability to collect from open commercial account debtors because records have been destroyed by an insured peril. -
Accumulation Period
The time interval between the commencement of the policy and the time when benefits are paid out. It is established by the insured. -
Activities of daily living
Activities-such as eating, bathing, toileting, dressing, and continence-that trig-ger payment in a long-term care insurance policy, if at least some of them cannot be performed by the insured. -
Acts of god
Perils that cannot reasonably be guarded against, such as floods and earthquakes. -
Actual cash value
A form of insurance that pays damages equal to the replacement value of damaged property minus depreciation. -
Actual loss ratio
The ratio of losses incurred to premiums earned actually experienced in a given line of insurance activity in a previous time period. -
Actuarial cost assumptions
Assumptions about rates of investment earnings, mortality, turnover, salpatterns, probable expenses, and distribution or actual ages at which employees are likely to retire. -
Actuarial Cost Method
A method that determines contributions that would be made under an insurance plan. -
Actuary
An insurance professional skilled in the analysis, evaluation, and management of statistical information. Evaluates insurance firms? reserves, determines rates and rating methods, and determines other business and financial risks. -
AD&D
Accidental Death and Dismemberment Benefits -
Additional insureds
Persons who have an insurable interest in the property/person covered in a policy and who are covered against the losses outlined in the policy. They usually receive less coverage than the pri-mary named insured. -
Additional living expenses
Extra charges covered by homeowners policies over and above the policy-holder?s customary living expenses. They kick in when the insured requires temporary shelter due to damage by a covered peril that makes the home temporarily uninhabitable. -
Adjustable Life Insurance
A facility allowing a life insurance policy owner to change the insurance plan, increase or decrease the premium and make changes in the protection period. -
Adjuster
An individual employed by a property/cas-ualty insurer to evaluate losses and settle policyholder claims. These adjusters differ from public adjusters, who negotiate with insurers on behalf of policyhold-ers, and receive a portion of a claims settlement. Inde-pendent adjusters are independent contractors who adjust claims for different insurance companies. -
Admitted company
An insurance company licensed and authorized to do business in a particular state or country. -
Adverse selection
The tendency of those exposed to a higher risk to seek more insurance coverage than those at a lower risk. Insurers react either by charging higher premiums or not insuring at all. In the case of natural disasters, such as earthquakes, adverse selection concentrates risk instead of spreading it. Insurance. works best when risk is shared among large numbers of policyholders. -
Affinity sales
Selling insurance through groups such as professional and business associations. -
Affirmative warranty
An agreement between an insurance company and an agent, granting the agent authority to write insurance from that company. It specifies the duties, rights, and obligations of both parties. -
After Tax Rupees
This refers to the disposable income that the policy holder has in his hands after paying all tax dues during a particular financial year under the Income Tax Act. -
Age Limits
The maximum and minimum ages above or below which an insurance company will not accept applications for insurance from or will not renew a policy with a person. -
Agent
Insurance is sold by two types of agents: inde-pendent agents, who are self-employed, represent several insurance companies and are paid on commission, and exclusive or captive agents, who represent only one insurance company and are either salaried or work on commission. Insurance companies that use exclusive or captive agents are called direct writers. -
Agent (Life Advisor)
A representative of an insurance company authorized to sell insurance policies. -
Aggregate deductible
A type of deductible that applies for an entire year in which the insured absorbs all losses until the deductible level is reached, at which point the insurer pays for all loses over the specified amount. -
Aggregate limits
A yearly limit, rather than a ?per occurrence? limit. Once an insurance company has paid up to the limit, it will pay no more during that year. -
Aleatory contract
A legal contract in which the outcome depends on an uncertain event. Insurance contracts are aleatory in nature. -
All-risk agreement
A property or liability insur-ance contract in which all risks of loss are covered except those specifically excluded; also called ?open perils policy.? -
Alternative dispute resolution (ADR)
Alternative to going to court to settle disputes. Methods include arbitration, where disputing parties agree to be bound to the decision of an independent third party, and mediation, where a third party tries to arrange a settlement between the two sides. -
Alternative markets
Mechanisms used to fund self-insurance. This includes captives, which are insurers owned by one or more non-insurers to provide owners with coverage. Risk-retention groups, formed by members of similar professions or businesses to obtain liability insurance, are also a form of self-insurance. -
Ancillary charges
In hospital insurance, covered charges other than room and board. -
Annual statement
Summary of an insurer?s or rein-surer?s financial operations for a particular year, including a balance sheet. -
Annual-premium annuity
An annuity whose purchase price is paid in annual installments. -
Annuitant
: An individual receiving benefits under an annuity. -
Annuity Certain
An insurance contract that provides an annuity for a certain number of years, irrespective of whether the insured is alive or dead. -
Annuity Consideration
The payment that an annuitant makes for an annuity. -
Annuity units
A measure used in valuing a variable annuity during the time it is being paid to the annui-tant. Each unit?s value fluctuates with the performance of an investment portfolio. -
Apportionment
The dividing of a loss proportion-ately among two or more insurers that cover the same loss. -
Appraisal
A survey to determine a property?s insura-ble value, or the amount of a loss. -
Arbitration
Procedure in which an insurance company and the insured or a vendor agree to settle a claim dispute by accepting a decision made by a third party. -
Arson
The deliberate setting of a fire -
Assessable policy
A policy subject to additional charges, or assessments, on all policyholders in the company. -
Asset-backed securities
Bonds that represent pools of loans of similar types, duration and interest rates. Almost any loan with regular repayments of principal and interest can be securitized, from auto loans and equipment leases to credit card receivables and mortgages. -
Assign
To use life insurance policy benefits as collat-eral for a loan. -
Assignee
Assignee is the person to whom the title, rights and benefits under a life policy are assigned. -
Assignor
Assignor is the policyholder who transfers the title, beneficial interest and rights under the policy to another individual. -
Asymmetric information
An insured?s knowledge of likely losses that is unavailable to insurers. -
Attained Age
It is your current age.Your attained age is one of the factors life insurance companies use to determine your premiums. As the older you are, the probability of death during the period of insurance cover i.e life insurance risk increases and so does the premium. Higher the risk, higher the premium. -
Authority
The Insurance Regulatory and Development authority, IRDA established under sub-section (1) of section 3 of the Insurance Regulatory and Development Authority Act, 1999 is the regulator for the insurance sector. -
Auto insurance premium
The price an insurance company charges for coverage, based on the frequency and cost of potential accidents, theft and other losses. -
Automatic coverage
An insurer agrees to cover accidents from all machinery of the same type as that specifically listed in the endorsement. -
Automatic treaty
An agreement whereby the ceding company is required to cede some certain amounts of business and the reinsurer is required to accept them. -
Average adjusters
A name applied to claims adjusters in the field of marine insurance. -
Aviation insurance
Commercial airlines hold prop-erty insurance on aeroplanes and liability insurance for negligent acts that result in injury or property damage to passengers or others. Damage is covered on the ground and in the air. The policy limits the geographical area and individual pilots covered.




