• Family Health Insurance

• Individual Health Insurance

• Personal Accident Insurance

Top 10 Health Insurance Terms Explained

1. Premium

The premium is the amount you pay to your insurer for availing yourself of the benefits of your health insurance policy. The premium amount differs because of the following factors:

• Age of the insured

• Coverage amount (sum insured)

• Pre-existing health condition

• Health insurance add-ons

• Occupation

• Lifestyle habits

For example, a young, healthy individual will typically pay a lower premium than an older person with pre-existing health conditions.

 

2. Deductible

A deductible is the amount that you choose to pay out of pocket before your insurance provider steps in to cover any medical expenses. Usually, a higher deductible will result in a lower premium, but you might have to bear the initial medical expenses during the claim.

Example: If your deductible is ₹20,000 and your hospital bill is ₹50,000, you’ll pay the first ₹20,000, and the insurer will cover the remaining ₹30,000, provided no other conditions apply.

 

3. Co-pay

Co-pay, or co-payment, is an optional cost-sharing method where a fixed percentage of the total medical bill will be borne by you, and the insurer covers the remaining amount.

Example: If your policy includes a 10% co-pay clause and your hospital bill is ₹100,000, you will pay ₹10,000, and the insurer will pay ₹90,000.

 

4. Sum Insured

The sum insured is the maximum amount of coverage that you will get if any medical claim arises. It is essential to choose an adequate sum insured to avoid hefty out-of-pocket payments at the time of claim.

 

5. Network Hospitals

There are a number of hospitals that are registered on a panel with every health insurance provider. These hospitals are known as ‘network hospitals’ where you can avail yourself of cashless treatment facilities that eliminate the need for upfront payments.

 

6. Waiting Period

It is the stipulated time period that you must wait before you can avail yourself of certain benefits of your health insurance policy. A waiting period kicks in when you have any pre-existing health problem. Common waiting periods include:

• 30 days for general illnesses

• Upto 4 years for pre-existing conditions

 

7. Pre-existing Conditions

Pre-existing conditions are certain health problems that you may have had before the inception of your health insurance policy. Some of the common pre-existing conditions include

• Hypertension

• Thyroid

• Asthma

• Diabetes

• Kidney problems

 

8. Riders or Add-ons

Add-ons, also known as riders, are additional benefits that can be purchased to enhance your basic health insurance policy. These are the optional coverage boosters that you choose depending on the preferred scope of medical coverage required. Add-ons that are most preferred are

• Consumables cover

• Critical Illness cover

• Room rent waiver

• Wellness Benefit

 

9. No Claim Bonus (NCB)

If in a given policy period, you make zero claims, you get a reward in the form of a No Claim Bonus. It usually comes in the form of a discount on premiums or an increase in the sum insured.

 

10. Grace Period

The grace period is the timeframe allotted for you to pay your health insurance premium without facing policy cancellation. If you miss the deadline, the grace period provides a few days or weeks to make the payment. However, failure to pay within this grace period will result in policy lapse and the suspension of your coverage.

 

Conclusion:

Health insurance is the need of the hour nowadays, and with complete understanding, you can protect yourself and your loved ones from the exorbitant medical bills. It is advised to have a thorough discussion with your health insurance provider to understand policy features, coverages, exclusions, terms, and conditions so that your health insurance policy meets your needs and also fits within your budget.

Investing time in learning about health insurance today can save you significant stress and money in the future. Choose wisely, stay insured, and enjoy peace of mind knowing that your health is protected.

 

Disclaimer:

The above-mentioned terms and definitions can have different meanings and conditions associated by the insurance providers. Hence, it is advised to go through the policy documents carefully and consult your health insurance provider before making any financial decisions.