Health Insurance Terms You Need To Know

Health Insurance Explained - What is Health Insurance?

Understanding health insurance can be like decoding a complex language filled with terms and jargon.  Gain the knowledge needed to maximise healthcare benefits with confidence.

Claim: The payment request for medical expenses that the insured party submits to the insurance company.

Co-Payment: In health insurance, co-payment is a required cost-sharing amount where the policyholder agrees to pay a portion of the hospital bill, resulting in a lower premium without changing the insured amount, a feature commonly found in senior health insurance plans.

Cumulative Bonus: A cumulative bonus in health insurance is a reward for every claim-free year, adding a percentage increase to the sum insured. This bonus encourages policyholders to maintain a healthy lifestyle and avoid claims, enhancing their coverage over time. *

Deductible: Opting for a higher deductible in health insurance leads to a lower premium. The deductible, either a set amount or a percentage of the claim, is a cost-sharing requirement, exempting the insurance provider from covering that portion. The policyholder pays the agreed-upon deductible directly to the hospital. ##

Grace Period: The 15-day window after the premium deadline allows for policy renewals without affecting benefits like waiting periods and pre-existing disease coverage. However, coverage is only available after the due date, emphasising the importance of timely health insurance renewals.

Critical Illness Policy: A critical illness policy in health insurance provides a lump-sum payout upon diagnosis of specified severe medical conditions. It offers financial support for medical expenses and related needs, helping policyholders cope with the impact of critical illnesses such as cancer, heart attack, stroke, and organ transplants.

Insurer: The insurance provider

Premium: The set monthly amount that an insured must pay to receive their insurance coverage benefits. Health insurance calculators are used to calculate the cost of premiums.

Pre-Existing Disease: A pre-existing disease in health insurance is any illness, injury, or related condition for which the insured experienced symptoms, received a diagnosis, or sought medical advice or treatment within 48 months of the insurer’s first policy issuance. While some policies cover pre-existing conditions after a specific timeframe, it is crucial to disclose such information to the insurer, including ongoing medications, to avoid claim rejection. Many health plans now cover pre-existing conditions if continuously renewed with the same insurer and remaining claim-free for a continuous four-year period.

Sum Insured: The amount that the insurance company is required to pay the insured in the event of an eventuality is known as the sum insured. It operates on the indemnity principle. For example, if the hospitalisation expenses total Rs. 2 lakh and the health insurance sum insured is Rs. 3 lakh, the company must pay Rs. 2 lakh towards the claim.

Waiting Period: The time after obtaining a new health insurance policy during which the insured is not eligible for certain policy benefits. Usually, a set amount of time from the policy’s start date passes before some of its specific benefits become operative. For instance, there is typically a 4-year waiting period for pre-existing conditions.

Read more about – Types of Health Insurance

* Standard T&C Apply

## All savings are provided by the insurer as per the IRDAI-approved insurance plan. 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.