An insurance adjustment reflects the amount of compensation claimed by an insurance policy holder after deducting compensation which is not provided for by the insurance agreement. The way in which insurance benefits are paid out when claims are made is determined by the adjustment clauses of insurance policies, as interpreted by claims adjusters.
Example: After receiving medical treatment worth 7000 Swiss francs, you send the bills to your compulsory health insurance provider for payment. A claims adjuster reviews the bills and determines that only 4,500 francs of your healthcare expenses are covered by your insurance policy – after deducting the costs of uncovered treatments, treatment received abroad, your deductible and your coinsurance payment. The insurance company pays out an adjustment of 4500 francs towards the cost of the treatment. The remaining 2500 francs of expenses must be covered by a supplemental insurance policy or paid out of your own pocket.