10 Must Know Health Insurance Terminologies in India

Why Read the Health Insurance Terms and Conditions ?

Often people do not realize that being healthy is a lifestyle and not a one-time thing. Most of the time people do not take their health conditions seriously until some emergency happens. However, in this pandemic, there has been an improvement. In such times it is important to take care of both body and mind. Hence, a health insurance plan is a necessity. Having medical insurance in place will give you peace of mind. When buying a health insurance policy, you will come across terminologies that can be difficult to understand. Sometimes, it might be possible that you are not aware of those terms. So, before you decide to buy a comprehensive health insurance plan, we have discussed some important health insurance terms that you need to know.

Important Health Insurance Terms

Here are some of the important health insurance terms that will help to make an informed decision:

Pre-Hospitalization / Post-Hospitalization:

It includes any expense incurred before or after the hospitalization such as blood tests, doctor visits, operations, etc. Understand the terms and conditions related to this medical insurance coverage carefully.

Pre-existing Diseases:

There are health comorbidities such as diabetes, hypertension, cardiovascular issues, kidney problem, and various other underlying diseases. These could be considered significant to the risk factors regarding the health insurance plan. Any individual with any other stated pre-existing medical conditions is subject to higher risk leading to a higher health insurance premium.

Add-on Riders/Covers:

As the word suggests the add-on riders in a health insurance policy are the additional features. It is often referred to as optional covers as well. It offers additional financial cover against any unknown medical emergency that involves high medical costs. The add-on riders can be included in the base health insurance plan. Some of the common add-on rider options offered are rent waiver, maternity cover, critical illness cover, etc.

Day Care Procedures:

Check whether daycare procedures are covered in the health insurance policy or not. Mostly the insurer considers the policyholder to be hospitalized only when the person has stayed for 24 hours and more. There are specific treatments that are covered in a day. So, check with the insurer whether any such treatment is covered under medical insurance.

No-claim Bonus (NCB):

No Claim Bonus is the bonus offered to the policyholder when no claim is made during the health insurance policy term. It is offered every year throughout the tenure of your health policy. It is like an incentive for the policyholder for maintaining their health.

Critical Illness:

When we say critical illness it means a life-threatening medical condition. Some of the life-threatening diseases are cardiovascular disease, cancer, kidney failure, and so forth. There are specific disease plans available that cover such diseases. You can also check with the insurance company if there is any add-on cover available for the same.

Room Rent:

It is the hospital room rent charge that is incurred while you are hospitalized and undergoing treatment. Room rent charges by every hospital are different. More sophisticated rooms may have higher room rents. Therefore, your health insurance policy should have higher allowances for the room rents.

Co-payment:

With the co-payment clause, the policyholder has to pay an amount that is pre-fixed in case of hospitalization. This implies that a considerable part of the expenses incurred for medical treatment has to be borne by the policyholder. In case you decide to opt for it, study it carefully.

Network Hospital:

The health insurance companies have tie-up with certain hospitals across the country. These hospitals are referred to as network hospitals. The network hospital is the place where treatment can be availed without paying the bills. The insurance company directly settles the bill up to the coverage limit. Also, when the insurer directly bears the cost it is known as the cashless claim service.

Waiting Period:

In a medical insurance policy, there is a fixed period before, which one cannot avail of the coverage benefits. Health insurance claims cannot be admitted during the waiting period. It is also important to understand that the waiting period for various health conditions and coverage differs.

The Bottom Line

The insurance business works on the principle of utmost good faith. While purchasing a health insurance policy, do not hide any critical information. Now, that you know the meaning of health care insurance words, we hope that buying a suitable plan will be easy for you. A little knowledge beforehand helps to go a long way. Make sure to go through the policy wording carefully.   *Standard T&C apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.