- Sum Insured – Simply put, this is the amount of cover that one can opt for. This is the maximum amount up to which the insured can get benefits in the event of a claim during a single policy year. How this works: Let us suppose that you take a cover for 5 lakhs sum insured. At the time of making a claim, if you use only 2 lakhs of that cover, then the remaining 3 lakhs can still be used by you during the remaining policy period.
- Premium – This is the amount paid to insurance company when you purchase a health insurance policy. The premium to a great extent depends on the sum insured you have chosen, apart from other factors like your age, medical condition and physical fitness at the time of taking the policy. You can compute the premium of your desired plan instantly with the help on an online health insurance premium calculator.
- Pre and Post Hospitalization Expenses – Most health policies also compensate you for expenses that you would incur prior to getting hospitalized for a treatment, as well as for the recovery treatment post being discharged. These are for consultations, medicines, investigations, etc. related to the illness for which hospitalisation has occurred. The duration for which this cover is given should be checked while you are taking the policy.
- Deductible – This is a fixed amount which the insured needs to first bear for each claim. The insurance company’s liability starts over and above this amount.
- Ambulance Charges – This is an additional benefit offered by most health insurance policies. It compensates you for the charges that you incur when availing an ambulance service in case of an emergency to take the patient from home to hospital or from one hospital to another. The amount of cover provided differs from policy to policy.
- Day-Care procedures – Due to growing medical advancement, certain surgical procedures do not require 24 hours of hospitalisation (the basic requirement when one needs to avail a health insurance claim for treatment). These are called day-care procedures and these days health policies cover many such procedures as well, which is an added benefit. View the extensive day care procedures list for which you can file an insurance claim.
- Network Hospitals – Most insurance companies empanel, or tie-up with hospitals across the country to provide better medical services to their customers during their time of need. These hospitals are referred to as network hospitals. The advantage of getting treatment in these hospitals is that one can avail cashless facility. It is necessary that the insurance company is informed of the hospitalisation so that they can authorize the hospital to not charge the customer.
- In-House Claims Team v/s TPA – The insurance company’s own claim settlement team is called an in-house claims team, while TPA refers to outsourced claims team. An in-house claims team enables the insurance company to directly deal with health insurance claims and provide the customer better service.
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Frequently Used Terms in Health Insurance
It’s not enough to just get a health insurance policy. It is also important to know what the different terms in the policy mean and what they do for you. Let’s start with some of the basic terms that you must know about:
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