Important Definitions & Meanings in Health Insurance

While shopping around for a health insurance policy, you need to come across as an informed customer and understand the basics of your policy. Understanding health insurance would remain incomplete without knowing the health insurance terminology. For example, you need to be clear about the terms such as cashless claims, critical illness policy and exclusions while deciding on the benefits of the policy and finding which health insurance plan best meets your needs. Here is a brief glossary of the most commonly used health insurance terms. Medical Insurance: Medical insurance policy, also known as health insurance policy, covers the expenses of medical treatment up to the sum assured in case you are hospitalized due to an illness / accident. Sum Assured: Sum assured or the coverage amount refers to the pre-defined benefit paid by the insurer to the policyholder in case the insured event takes place. The premium of the health insurance policy depends on the sum assured. Critical Illness Policy: Critical Illness policy is a benefit policy that insures an individual against serious illnesses such as cancer, coronary heart disease, kidney failure, etc. In case the policyholder is diagnosed with a critical illness mentioned in the policy, he receives a lump sum of the sum insured. This can be used for medical care and any lifestyle changes. Exclusions: Exclusions refer to the medial conditions and diseases for which medical expenses are not covered by the health insurance policy. Pre-existing Disease: It refers to the ailments or diseases that a person was suffering from prior to purchasing a health insurance policy. Network Hospital: The hospitals which have a tie up with your insurer would come under the category of network hospital. The network hospital provides cashless facilities to the insured on approval by the insurer. Family Floater Policy: A policy where a single sum insured covers all the members of the family. So with one floater family health insurance policy and one premium, multiple individuals are covered. Pre - Hospitalization Expenses: Expenses incurred during a certain number of days prior to hospitalization. This would include doctor’s consultation fees, medication, medical tests, etc. Post - Hospitalization Expenses: The expenses incurred by a policyholder 60 days immediately after he/she is discharged from hospital. This includes medical tests, physiotherapy, medication, doctor’s fees, etc. Top up plan: With a top up medical insurance plan a policyholder can get cover over and above the health insurance policy and thus increase the sum assured. Cashless Facility: A cashless facility allows the insured to make a claim without having to pay cash upfront. The policyholder can get admitted at any network hospital across the country and take treatment without having to pay cash to the hospital at time of discharge. The insurer through its Third Party Administrators or in-house claims team arranges direct payment to the network hospital. It is important to note that expenses beyond the limits and sub-limits or expenses not covered by the policy have to be settled by the policyholder. Hospital Daily Cash Allowance: The provision of fixed daily sum insured for each day of hospitalization. Claim: When the insurer applies for reimbursement of expenses incurred for treatment. Reimbursement: The cost of various hospital charges are paid back to the insured who makes the claim. Third Party Administrators: Third Party Administrators (TPA) are the authorized claim settling agents of the insurer. A better understanding of the medical insurance terminology is sure to help you while purchasing a policy for yourself and your family. There are different types of health insurance policies to suit individual needs. To find the best cover for yourself, check out our health insurance plans.