Glossary beginning with P

Glossary

Paper Claim

A formal request from a policy holder on paper to Cigna TTK Health Insurance to help with payments.

Payment Bundling

It is when different health care providers treating for the same/similar conditions are paid a total amount for the services.Example:Raj went to a primary care Doctor and was told to get an X-ray for the ankle pain he’s experiencing. Raj was then referred to a secondary care Doctor (Orthopedic) who told him to undergo surgery. Raj is charged for the costs before surgery and after. The payment bundling option will accumulate all the payments and consolidate a final bill to avoid unnecessary expenses, errors and duplication of tests.

Permanent Exclusions

It is the conditions in which Cigna TTK Health Insurance holds the right to not provide coverage for certain treatments. For example, direct/indirect contracting of sexual diseases, treatments related to altering pregnancy, fertility, treatments by unlicensed physicians, etc.

Personal Accident

The insurance covers the hospital expenses of a policy holder after an accident. The payments are cleared with a lump sum amount. Note that this benefit only applies to those who have purchased this fixed benefit plan or their existing policy purchase had a personal accident protection clause.Example scenario: Raj makes Rs. 12,500 per month as salary. One day, Raj injures his back while fixing a drainage pipe. He is unable to walk or stand and can’t work for the next 10 months. Raj used his CignaTTk policy to claim his personal accident insurance and received Rs. 1 lakh (nearly 80% of his regular income) during his recovery to take care of his expenses.

Plan Administration

The act of administering the benefits of the plan as per the policy document. Plan administration is a purview of Cigna TTK Health Insurance and encompasses providing services to policy holders, connecting with network hospitals, dealing with re-imbursements and customer service.

Policy

Simply put, the insurance plan related documentation and rules are collectively referred to as policy. In other words, the set of papers an individual receives after paying their premium is referred to as policy document.

Policy Deductible

Same as deductible or annual deductible.

Policy Holder

The person(s) who opted for insurance coverage

Policy Schedule

It is a framework of the policy cover and shows details of the policyholder, coverage amount, limits, and insurance amount.

Policy Year

It is the time period of 12 months from the date when the insurance cover began. The time period for which the insurance coverage is valid, unless the policy holder has taken a two-year policy.

Portability

A provision by which policy holders can change their insurance provider at their own discretion. This usually happens if the policy holder is not satisfied with the service quality of their current insurance provider, or the coverage is not enough or appropriate for the premiums being paid.

Post-Hospitalisation

It is treatments and expenses after getting discharged from the hospital which may be follow-up visits to the doctor, medications, etc.

Pre-admission review/Pre-admission testing

Part of the hospital admission process where a review is done for a policy holder. Physicians or doctors at the hospital examine the policy holder’s health condition and past records before he/she is admitted in the hospital.

Pre-authorization

Applies in case the policy holder goes for admission to a network hospital. A person from the hospital staff confirms from Cigna TTK Health Insurance about details of the policy and assesses what procedures are covered and for what amount.Example scenario: Before getting admitted in the hospital for treatment, the hospital staff will contact Cigna TTK Health Insurance to confirm if Raj is eligible for insurance. Once pre-authorization is done Raj can get admitted and treatment can begin.Also see a short video explaining the cashless claim process.

Pre-existing Condition

A health condition or disability the policy holder has had prior to applying for health insurance.Typically, pre-existing conditions are not covered by insurance policies for a period of several months.

Pre-hospitalization

It is the medical expenses taken into account before a policy holder is hospitalized.

Pregnancy Care

Insurance for expecting mothers covering expenses such as tests, checkups, medicines.

Premium

The amount paid for health coverage each year to Cigna TTK Health Insurance. Simply put, the annual price for availing the health insurance protection.

Prescription Drug

Drugs which are prescribed by a practicing physician or healthcare specialist and not available ‘over-the-counter’.

Preventive Care

It is medical care that focuses on preventing diseases and illnesses through early detection via tests, immunization programs and educating about health.

Primary Care Doctor

It is the family doctor/the first doctor you contact when seeking treatment.

Primary Care Provider

It is a physician who helps treat any diseases or injuries.

Prior Authorization

See pre-authorization.

Provider

Another name for hospitals, clinics and others who provide health care services.