Glossary beginning with A

Glossary

Accident

When an accident leads to an injury, it may require hospitalization. Accidental coverage includes coverage for treatment of injuries sustained, partial or complete disability or amputation. Cigna TTK Health Insurance provides special fixed benefits for accident coverage. Click here to know more of these products.Example:Raj is at home and is cleaning out his garage. He comes across a bowling ball that he hasn't used for years. Raj drops the heavy ball on his head and faints. His family rushes him to the hospital and Raj is hospitalized for the accident that has occurred.Using Cigna TTK Health Insurance'’s fixed benefit product, Raj can be treated with minimal or no expenditure.

Accidental Death

A death that occurs due to an accident. Having an accident plan implies that Cigna TTK Health Insurance would pay the insurance amount stated in the policy to the beneficiaries.

Accredited

An official approval by Cigna TTK Health Insurance for the standard of facilities, systems and processes being used in a hospital.Examples of accredited hospitals include Apollo, Max and Fortis hospitals amongst others.

Accumulation Period

It is the time frame after purchasing the policy during which no claim can be made to Cigna TTK Health Insurance under the policy. Example:Raj opts for a health insurance policy for his family and completes all the formalities on June 1. The accumulation period for the policy purchased is 30 days. Now imagine that Raj’s wife falls ill on the 3rd of June. Raj would have to pay for this unexpected expense although he already purchased the health insurance product, as his policy is still within the “accumulation period”. Only after June 31st, will Raj be able to use the coverage from his insurance.

Actuary

A math and statistics professional who calculates and understands risks and uncertainty – concepts used to determine insurance premiums based on age, lifestyle, and gender amongst several other factors.Example:Raj requests for insurance from Cigna TTK Health Insurance. An actuary will first assess Raj's insurance request and decide on the insurance amount for Raj's health plan. The actuary will then decide insurance coverage based on age, lifestyle, and gender and other factors.

Add-on

Add-ons are additional benefits over and above those covered within insurance products. Cigna TTK Health Insurance add-ons are critical illness cover, hospitalization and maternity benefits amongst several others.

After Care

It is an insurance plan for a person who has met with an accident/injury and can't go back to work (as he/she is recuperating). ‘After care’ coverage implies that all expenses related to the care needed after treatment is taken care of by Cigna TTK Health Insurance.

Age Limit

It sets the age restrictions for a policy. In Cigna TTK Health Insurance'’s case, the age limit to enroll for a policy is 65. Note that there is no age limit on renewal.

Agent

A person from Cigna TTK Health Insurance who explains the policies and procedures. Cigna TTK Health Insurance agents are available on phone/ email or at your doorstep, to take you through the details and explain each step, as per your convenience.

Allowable Amount

Maximum amount on coverage for covered health care services.Example:Raj's insurance has a limit of Rs. 2 lakhs for the amount the policy benefits will cover. The Rs. 2 lakhs is the allowable amount for the health care services in his plan.

Allowed Cost

It is the amount that needs to be paid for each covered procedure as per the insurance policy.Example:Raj injured his knee in a sporting event and needs to get a minor surgery done. The allowable amount for Raj’s insurance is Rs. 5 lakhs, the allowed cost though for surgeries in Raj’s plan may be Rs. 3 lakhs.

Ambulatory Care

They are medical procedures, surgeries or treatments that do not require 24 hour hospitalization.Some of Cigna TTK Health Insurance's products cover ambulatory care.

Annual Deductible

It is the insurance amount a policy holder pays before Cigna TTK Health Insurance contributes any amount towards health related expenses.Members opt for such an option, if they wish to take care of expenses to some extent, before seeking protection from their insurer.This helps reduce the health insurance premium, since the policy holder is bearing some risk along with Cigna TTK Health Insurance. Example:Assume that Raj has opted for a Rs. 1 lakh annual deductible.Now imagine that this particular year Raj undergoes a cataract surgery which costs a total of Rs. 3 lakh. Raj would need to pay Rs. 1 lakh first, while his policy with Cigna TTK Health Insurance would pay for the balance Rs. 2 lakh. If Raj had not opted for an annual deductible, he would have not have incurred the Rs. 1 lakh expense. However, he’d have to bear a relatively higher annual insurance premium.

Annual Limit

It is the limit on the insurance amount that Cigna TTK Health Insurance would cover over one year. Example:The annual limit in Raj's policy is around Rs. 2 lakhs every year.
However his medical expenses have been almost Rs. 3 lakhs this year. Cigna TTK Health Insurance will only pay to the extent of Rs. 2 lakhs as per Raj's insurance policy. Raj would have to bear expenses worth the balance Rs. 1 lakh.

Appeal

An appeal generally applies in case an insurance claim has been denied. An appeal for reconsideration can be made by the policy holder if he/she feels that the claim has been wrongly or erroneously denied

Assignment of Benefits

It is a legal agreement between the insurer and Cigna TTK Health Insurance for reimbursement amounts to be sent directly to the Doctor.

Authorization

The process of confirming the details and benefits of the insurance policy with Cigna TTK Health Insurance.For authorization, the hospital or care provider confirms with Cigna TTK Health Insurance whether the services and treatment slated to be provided are covered in the insurance plan and to what extent.