TPA is engaged by an insurer for - i. Providing an identity card to the policyholder which is proof of his insurance policy and can be used for admission into a hospital ii. Providing a cashless service at network hospitals iii. Processing of claims
Co-payment is the concept of the insured bearing a portion of each and every claim under a health policy. These could be compulsory or voluntary depending on the product
Deductible / Excess - it is the fixed amount of money the insured is required to pay initially before the claim is paid by insurer.the deductible in a policy is Rs. 10,000,if the claim is for Rs. 80,000, the insured bears the first Rs. 10,000 and the insurer pays Rs. 70,000.
Selection of risks refers to the process of evaluating each proposal for health insurance in terms of the degree of risk it represents and then deciding whether or not to grant insurance and on what terms.
Anti-selection (or adverse selection) is the tendency of people, who suspect or know that their chance of experiencing a loss is high, to seek out insurance eagerly and to gain in the process
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