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This section outlines some common/important insurance terms that are used across our website. To make your journey with JW Seagon easier, we have underlined these terms and a simple explanation can be found by hovering your cursor over the term you require.

All risksA type of insurance coverage that automatically covers any risk that the contract does not explicitly omit.
Area of coverThe geographical region specified in a health insurance policy where you can have medical treatment.
BenefitThe health care items or services covered under a health insurance policy.
Benefit LevelThe maximum amount that will be paid for a specific benefit under the policy.
Benefit PackageA description of the services and items that an insurance company covers for members of a specific insurance plan.
ClaimA request to an insurance company for payment relating to an accident, illness, damage to property, or any other loss that is covered by the policy.
Claims adjusterA person who settles insurance claims. This typically involves investigation of the loss and a determination of the extent of coverage.
Co-PayA fixed amount a health insurance beneficiary pays for medical services with the remaining balance covered by the insurance.
CoverageInsurance coverage helps you financially recover from sudden, unexpected, and accidental things that may happen.
DeductibleA pre-agreed amount you pay each year for eligible treatment before your health insurance policy starts to pay any benefit
IndemnityThe concept of indemnity is based on a contractual agreement made between two parties in which one party (the indemnitor) agrees to pay for potential losses or damages caused by the other party (the indemnitee).
In-Patient TreatmentAny medical service that requires admission into a hospital.
Insurance ExcessA pre-agreed amount of money that you need to pay to the insurer in the event of a claim.
Insurance LimitThe maximum amount of money an insurer will pay towards a covered claim.
InsuredThe person(s) protected under an insurance contract.
InsurerThe insurance company that undertakes to provide cover for losses and perform other insurance-related operations.
KYCKnow Your Customer, the process of customer identity and address verification.
LiabilityThe obligation to pay a monetary award for injury or damage caused by one’s negligent or statutorily prohibited action.
Out-Patient TreatmentAny medical service that does not require admission into a hospital.
Permanent total disabilityThis is an individual’s loss of the use of limbs, due to injuries preventing the policyholder from being able to work in the same capacity as they had before the injury.
PolicyA document detailing the terms and conditions of an insurance contract.
PolicyholderThe person who owns the insurance policy.
Pre-authorizationA decision by the insurer that a policy benefit can be used.
Pre-existing conditionsAny health condition that a person has, or has had, prior to enrolling for health insurance.
PremiumThe amount of money an insurer charges to provide the coverage described in the policy.
Provider networkInsurance companies have networks of medical providers (hospitals, clinics, doctors etc.) If you use a network provider the cost of treatment will be settled directly by the insurer. If you don’t use a network provider you have to pay for treatment and submit a claim for reimbursement.
RenewalThis is the continuation of coverage. The policyholder extends their contract with the insurance company to continue their current coverage for a specified period.
RiskThe chance something harmful or unexpected could happen.
Sum assuredThe amount of money that the company will pay out to the policyholder or nominated beneficiary in case of the member’s death.
UnderwriterA professional who evaluates and analyzes the risks involved in insuring a person or asset.
WIBAWork Injury Benefits Act (WIBA) is an employee benefit plan enforced by the Kenya law that guarantees your employees get financial compensation when, by accident, they suffer injury, become disabled or die while at work.