1. Insurance:- Insurance policy are not sold. Prospect has to apply first to buy an insurance product. Then it is sold / buy based on information & eligibility and T&C. It is an agreement between Insurer and policy holder. For Health Insurance it is an indemnity.

2. Prospect:- A Prospect is a potential buyer of Insurance Product. Prospect is still NOT an existing client but a potential candidate to buy an insurance product.

3. Free Look Period :- A Free Look Period is a time period which make Policy Holder enable to review the Policy's Terms & Conditions even after buying an Insurance Product and Policy Holder may cancel it if it does not meet policy holder's requirement. it vary from 15/30 days period. (Example:- Mr. Chatur Ramalingam (fictitious name) has applied & purchased a policy today. After buying a policy he reviews the Terms & Conditions of that policy he purchased. Now he can cancel it through written communication to Insurer within Free Look Period without any penalty. But written communication should be clearly indicated as "Free Look Cancellation". Guidance from concerned Advisor may be obtained).

4. Who is Insurer? - Insurance Company is called Insurer from which Policy Holder purchased the insurance policy.

5. Who is Policy Holder:- Policy Holder is person who purchased the policy for insured persons in his family members or Insurable Interest persons. A policy holder him/herself can be insured person also.

6. Insurable Interest Person(s):- In Insurance, Insurable Interest shall have to be maintained. It is very important. Insurable Interest person mean the persons (spouses, parents, children, business partners and those who are financially dependent / has relations / interests / has connection with) the Policy Holder (who purchased the policy). A person cant buy the policy for anyone (insured person) with whom he/ she has no Insurable Interest.

7. Who is Insured Person:- Insured Persons mean the persons came under the coverage of Insurance.

8. Third Party Administrator (TPA):- A TPA (Third-Party Administrator) is an IRDAI-licensed intermediary hired by insurers to manage health claims. They usually handle processes like cashless (and reimbursement) claims, pre-insurance check-ups, and hospital coordination etc. 

9. In House Settlement:- In-house claim settlement is a system where a health insurance company in India processes and settles policyholders' claims directly, without involving a Third-Party Administrator (TPA). This approach is increasingly favored by some health insurers as a way to gain greater control over the claims process and improve customer experience. Key Advantages for Policyholders (The primary benefits of an in-house claims department revolve around speed and direct communication):

• Faster Turnaround Time (TAT): By eliminating the TPA middleman, the decision-making process is quicker. Claims and queries are often resolved faster, which is critical during a medical emergency.

• Better Customer Experience: Policyholders deal directly with the insurer, leading to a single, consistent point of contact. This can result in a more personalized and empathetic service.

• Greater Control: The insurer has full control over the process, allowing them to implement specific customer-centric policies or offer special features

10. What is Grace Period:- The grace period is the extra time granted after the premium due date during which I can still pay my renewal premium without losing coverage. If I miss my premium due date, the grace period is the additional time I am given to make the renewal payment. It is not a good practice to pay the premium during Grace Period. During the grace period, I, being a policy holder, am only permitted to pay the overdue premium. However, any claims arising during this period will not be entertained unless specifically allowed by the policy's Terms and Conditions (T&C). Additionally, the Policy Holder may also need to declare to affirm at the time of payment during Grace Period that there has been no adverse health event (like an accident, injury, or disease onset) since the premium's original due date. [ Example:- Suppose My Insurance Premium Due Date is:- 1st November; Then Grace Period would be 30th November; the period i am only allowed to pay the premium. And I am paying my Premium on 10th November i.e. during Grace Period. Now From 2nd November to 10th November 2025, I am, as an insured person, is not under any Insurance Coverage. And may require to declare that any adverse health event did not occur after 1st November to at the time of payment]

11. Difference Between Consumable Items and Durable Items in Health Insurance:- Consumable Items are single-use medical supplies like gloves, syringes, and masks popularly known as Non Medical Expenses (prescribed 68 items), while Durable items are reusable medical equipment, (Ex:- crutches or wheelchairs etc). In this regard, the expense of Bed, which a Durable item as well, is merged with Room Rent expense. It is better not to be confused.

Agents or Advisors do not settle claims; the Insurer is responsible for processing claims according to the policy's Terms and Conditions (T&C). Therefore, One, who wants to apply for the Policy, must read and understand the policy wording carefully first. While the Advisor's support role is crucial, the Policy Holder must first fully understand their coverage. Do not hesitate to ask any policy questions to your Agent or Advisor.