Policy (Contract)

A policy, also referred to as a contract, is the legally binding agreement between an insurance company (the insurer) and the policyholder that defines the terms, conditions, and obligations of coverage. It outlines what is insured, the benefits provided, the premium amount, exclusions, and the responsibilities of both parties. Once the insurer accepts the application and the first premium is paid, the policy becomes active and enforceable.

‍

In health, dental, life, or disability insurance, the policy (or master contract in group insurance) is the governing document that determines how claims are processed and benefits are paid. It may also include riders or endorsements that add, modify, or limit specific coverages. The policy serves as the ultimate reference for resolving disputes, confirming eligibility, and verifying what services or expenses are covered.

‍

Example:

‍

If you purchase an individual health insurance policy, the insurer provides a written contract specifying your effective date, premium amount, coverage details, and claim submission requirements. The insurer must honor all terms stated in that contract as long as premiums are paid and the policy remains in force.

‍

What to Watch For:

‍

Read your policy carefully to understand its provisions, including definitions, exclusions, and renewal terms. Keep the original document and any amendments in a safe place. In group insurance, employees receive a certificate of insurance summarizing the policy, but the master contract held by the employer contains the full legal wording that governs all benefits.