Insurance terms

Insurance letters use words with exact meanings. Below are terms you are likely to meet in an Indian claim, each in one line with a link to the page that explains it properly. In a standard wording, a word defined in the definitions section carries that meaning wherever it appears in the policy — not the everyday meaning.^[1]

• Bima Bharosa: IRDAI's online grievance system, where you can register and track a complaint — what it is.^[2]
• Cashless and reimbursement: The insurer pays the hospital directly, or you pay and claim back — how each works.
• Co-payment: The share of an admissible claim you pay yourself — co-payment.
• Customer Information Sheet: The short summary of your policy, with clause numbers — the CIS.
• Day care: In one standard wording, treatment under anaesthesia that takes less than 24 hours and would otherwise have needed a longer stay — short stays and OPD.^[1]
• Deductible: A fixed amount you bear before the insurer pays — deductible.
• Depreciation (motor): The reduction for wear on replaced parts — depreciation deducted.
• Discharge summary: The hospital's account of your stay — why it matters.
• Endorsement: A written change to your policy after it is issued — endorsement.
• Exclusion: Something the policy does not cover at all — reading an exclusion.
• Free-look period: The window to return a new policy you do not want — free look.^[3]
• Grace period: The time after the due date in which a late renewal keeps your cover's continuity — grace period.^[4]
• Grievance Redressal Officer: The person at the insurer who handles complaints — finding your insurer's GRO.
• IDV: The sum insured for your vehicle — Insured Declared Value.
• Insurance Ombudsman: The forum that hears complaints such as delayed or rejected claims, once you have complained to the insurer in writing — when the Ombudsman can help.^[5]
• Intimation: Telling the insurer about a claim — late intimation.
• Moratorium period: The point after which non-disclosure can no longer be raised, except fraud — moratorium.^[4]
• Network hospital: A hospital tied up with your insurer for cashless treatment — outside the network.^[1]
• No Claim Bonus: The reward for claim-free years — NCB.
• Nominee, appointee, assignee: Who receives, who receives for a minor, and who holds rights in the policy — the three roles.
• Portability and migration: Moving your cover to another insurer, or another product with the same insurer, with your credits — portability.^[4]
• Pre-existing disease: A condition diagnosed, or for which advice or treatment was given, before the policy began, within a set window — PED.^[4]
• Proposal form and material facts: Your application, and what you had to disclose — material facts.
• Repudiation: The insurer's refusal of a claim — repudiation.
• Room rent limit: A daily cap that can reduce the whole bill — proportionate deduction.
• Sub-limit: A cap on one expense or treatment — sub-limit.
• Sum insured and sum assured: A ceiling on reimbursement, and a fixed promised amount — the difference.
• Surveyor: The assessor appointed to examine and assess a motor loss — questioning a survey report.
• TPA: The third party administrator that processes health claims for the insurer — TPA decisions.
• Waiting period: Time from the start of cover during which some conditions are not paid for — waiting period.^[6]
• Zero depreciation: A motor add-on that removes depreciation on replaced parts — nil-dep cover.

If a word in your own policy or letter is not here, its definitions section is the place to look first. Deductible vs co-pay vs sub-limit is a good place to start if you are reading a settlement letter.