Rashtriya Swasthya Bima Yojna: 2010 Guidebook - Health Systems ...

Glossary of Terms• Beneficiary/Insured – a person who is covered to receive benefits under ahealth insurance policy• Benefit limit/Amount – amount payable by an insurer to a beneficiaryunder a health insurance policy• Benefit Limits – the maximum amount of benefits payable under a healthinsurance policy• Cashless Treatment/Service – means that the patient will not have tospend any amount (subject to the available limit of coverage) for takingtreatment or hospitalisation. The expenses incurred on the hospitalisationshall be claimed by the hospital from the insurance company• Congenital external disease – is an abnormality of the structure of a bodypart by birth• Coverage – benefits provided by a health insurance policy for which abeneficiary is covered• Covered Charges – expenses eligible for payment for medical care orsupplies, when incurred by a beneficiary under the health insurancepolicy• Covered Person – any beneficiary eligible for benefits under a healthinsurance policy• Day care Surgery – procedures that require surgical intervention that canbe performed on a beneficiary on a out-patient care basis• District Kiosk – facilitation centres established by the third partyadministrator (TPA) to assist covered beneficiaries after smart card hasbeen issued. Assistance provided by a district kiosk pertains tomodification in the existing cards, splitting of cards and issue of new cardsin lieu of lost or damaged cards• Eligibility – provisions of the health insurance policy, upon satisfying ofwhich, beneficiaries become eligible to avail benefits under the policy• Eligibility Date – the date from which the beneficiaries under a healthinsurance policy stand covered for availing the benefits covered under it2010 RSBY Guidebook Page 19