Terms used in Insurance Policy that you should know

Friday, January 13, 2023

The terms in insurance policy are used to communicate the different types of coverage offered by insurance companies. The terms used in an insurance policy can help you understand your coverage and take steps to make sure you understand what you’re getting into, so let’s take a look at these terms that are important for homeowners.

Deductible

Deductible is the amount an insured person pays out of his own pocket in case of a claim. It is also called policy excess. The deductible is what you have to pay before your insurance company starts paying for damages or injuries that occur on the property where you are insured.

Co-Payment/Co-Insurance

A co-payment is a fixed amount the insured pays each time he visits a doctor or other healthcare provider.


A co-insurance is a percentage of the total cost of the treatment that the insured pays.

Maximum Limit of Benefits

The Maximum Limit of Benefits is the maximum amount paid by the insurance company in case of a claim.


The Maximum Limit of Benefits is also called the Maximum Benefit Limit or Sum Insured.


It’s not the same as your Sum Insured, which is what you have to pay out if you make a claim against your policy.

Limitations on Benefits

Limitations on benefits are the maximum amount of money that an insurance company is willing to pay for a certain type of claim. Limitations on benefits are also known as benefit caps or annual benefit maximums.


Limitations on Benefits may include:


  • Medical expenses – This includes payments made to physicians, hospitals, clinics and other medical providers directly involved in providing health care services to you or your family members (and their dependents). It does not include payments made by third party payors such as Medicare or Medicaid programs; nor does it include any costs related to treatment administered outside the United States unless specifically required by law.
  • Durable goods such as furniture and appliances – These items are usually replaced at no cost from your policy under certain conditions listed below. If they’re damaged beyond repair after being repaired at least once during that period then you’ll have to pay for them yourself before any claim can be paid out under this section which limits how much coverage there really is when compared against other types of damage caused by events such as storms/flooding etcetera…

Out-of-Pocket Maximum

Out-of-pocket maximum is the most an insured person must pay for covered services during a policy period before the insurance company pays its share of the expenses. In other words, if you have $1,000 in medical bills and your deductible is $1,500, then you have to pay $500 out of pocket before your insurance company pays anything.


The out-of-pocket maximum is different from other out-of-pocket limits such as those imposed by health care providers or hospitals (a total limit on what a patient may be charged). You can find more information about these types of caps in our article about cost sharing rules.

Out of Network

Out of network is when you go to a doctor or hospital that is not part of your insurance network. Your insurance company may cover some of the cost, but you will have to pay the rest.


In this situation, it’s important for you to make sure that you understand what out-of-network services are covered by each plan so that when it comes time for an emergency visit or surgery, there are no surprises!

In Network

In network means that the doctor, hospital or other providers have agreed to provide care at a negotiated rate. If your insurance company is in network, this means you will be able to use these providers without having your insurance premiums go up. You can also tell if a particular doctor or hospital is in network by looking at their website and reading their participating provider list (if they have one).


If you know which doctors and hospitals are in your plan’s “network,” this information should be listed on its website along with all other benefits and services offered by that insurer.

Insurance Terms

Insurance is a contract between an insurance company and the insured. The insurance company agrees to pay for damages that result from covered events, such as theft or fire.


Insurance terms are used in writing policies and contracts related to the various types of insurance available in Canada. These terms can be found on your homeowners’ policy, car insurance policy, life insurance policy and more!


Insurance companies use different definitions for their products so it’s important that you know what each one means before making decisions about which one would suit your needs best. Some examples include: auto (car), boat (yacht), property damage/personal injury liability coverage on buildings; umbrella liability coverage against bodily injury caused by an accident involving other vehicles involved in an accident with yours; motorcycle rider’s medical coverage which provides medical care regardless if injured person has no health care plan coverage or has only limited benefits through Medicare etc…

Conclusion

The key takeaway is that the insurance industry is large, complex and ever-changing. Insurance agents should be able to help you understand these terms so that you can make informed decisions about your policy.

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