Coinsurance: This refers to the acceptance of a risk by more than one insurer. Normally, this is done by way of allocating a percentage of the risk to each insurer. Thus the policy may be accepted by two insurers say, Insurer A with a 60% share and Insurer B with a 40% share.
Group insurance is mainly underwritten based on the law of averages, implying that when all members of a standard group are covered under a group health insurance policy, the individuals constituting the group cannot anti-select against the insurer.
Stakeholders in claim process - Customer, Owners of Insurance Company, Underwriters, Regulator (IRDAI), TPA,Insurance Agents / Brokers, Providers/Hospitals
A claim may be serviced either by the insurance company itself or through the services of a Third Party Administrator (TPA) authorized by the insurance company.
Cashless claim - customer does not pay the expenses at the time of admission or treatment.
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