What is Claim Settlement in Health Insurance? - Ditto

Health Insurance Glossary

In health insurance, "claim settlement" refers to the act of an insurer paying money to an insured for hospitalization expenses.

The status of a policyholder's claim is indicated by a claim settlement.

However, it does not provide a complete picture of whether the insurer paid the entire claim amount or only a portion of it. Claim settlement also does not indicate the time spent by the insurer in processing the request from the policyholder.

If a claim settlement is rejected or partial, one must investigate the reason for rejection and, if necessary, write to the grievance team for further review.

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A

Accident Accumulation Period Acute Care Add-on Covers Age Limit Agent Ambulance Cover Annual Renewal Date Any One Illness Automatic Restoration AYUSH Treatment

B

Beneficiary Benefit Blacklisted Hospitals Broker

C

Cancer Insurance Cashless Claims/Treatment Cashless Facility/Hospitalization Certificate of Insurance Claim

Claim Settlement

Claim Settlement Ratio Co-insurance Co-Pay or Copayment Comorbidities/Pre-Existing Diseases Complimentary Health Check-ups Convalescence Benefit Critical Illness Cumulative/No-Claim Bonus

D

Daily Hospital Cash Day Care Treatment Deductible Dependents Domiciliary Hospitalization

E

Eligibility Emergency Care Exclusions

F

Family Floater Policy First Diagnosis Free Look Period

G

Grace Period Group Health Insurance

H

Health Insurance Tax Benefits Hospitalization

I

Illness Individual Health Insurance Inpatient Care Insurer IRDAI

L

Lapse Long-Term Care Policy

M

Maternity Expenses

N

Network Provider/Hospital No Claim Bonus (NCB)Nominee Non-Network Provider/Hospital

O

Out-Patient Department (OPD)/Treatment

P

Personal Accident Cover Policy Coverage Policy Document Policy Period Portability Post Hospitalization Expenses Pre Existing Disease (PED)Pre Hospitalization Expenses Premium Primary Insured Private Room Psychiatric Cover

R

Refill Sum Insured Reimbursement Renewal Restoration Benefit Rider Room Rent Limit

S

Senior Citizen Health Insurance Specific Illness Waiting Period Sub-Limit Sum Insured

T

Terminal Illness Third-Party Administrator (TPA)Top-up Plans

W

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