Common Health Insurance Jargons!

Have you ever seen two people trying to converse in two different languages that neither one of them understands? What if life is at stake and the only way out is to make each other understand what they are saying? No hope, right?

This is what happens when we try to buy a health insurance policy with so many technical words involved that we don’t even know whether we are buying the right plan or not! Or whether the benefits we choose are even going to work for us!

Don’t worry though! Help is at hand as we bring to you some of the common jargons and their meanings to make things simple for you:

1. Co-payment

An insurance company charges you a premium amount in return for a sum assured. Now, if you agree to pay a certain percentage of your medical expenses from your own pocket it’ll be considered co-payment. This would enable the insurer to offer you lower premiums while keeping the sum assured intact.

2. Deductibles

This is very much like co-payment with a slight difference. While in co-payment you agree to pay a percentage of medical expenses, deductible is where you commit to pay a particular amount towards expenses from your own pocket. Therefore, whatever be your final claim amount from the insurer, the deductibles will be deducted before the insurer clears your claim.

3. Portability

This is the facility offered to an insured to switch insurance provider if he is not satisfied with the current insurer due to any reason. This would also allow the insured to carry forward any credits earned in regards to waiting period for certain diseases as well as any exclusions involved so that he can enjoy the policy benefits uninterrupted. The only condition is that the insured should be with his existing insurer without any break.

4. Pre-Existing Diseases

This includes any medical condition or injury for which either you were diagnosed or are getting treatment for within 48 months to prior to first policy issued by the insurance provider. Most insurance companies cover pre-existing diseases, but after a specific period of time from the date of initiation of the policy. It is important to disclose all pre-existing diseases at the time of buying the policy or the claims can be rejected for hiding such vital information.

5. Waiting Period

This is the period one has to wait to get coverage for pre-existing diseases. This usually lasts between 6 months to 48 months from the commencement of the policy and varies from insurer to insurer based on various ailments.

6. Critical Illness

Critical illness is a health related medical condition of a serious nature. Critical Illness insurance plan guards you against the financial expenses that occur in the diagnosis of critical diseases such as cancer, heart attack, kidney failure, etc. The range of critical illnesses covered and the payout may vary from one plan to another.

7. Top Up

A top-up health policy provides additional coverage to those who have a running health plan. This plan covers the medical expenses that may arise due to an illness/injury over and above the limit of the actual cover. A top-up health plan works by ‘single incidence hospitalization’, however, a super top-up plan looks at the aggregate claim.

8. Super Top-up

A super top-up health plan puts together several incidence of hospitalization cover the medical bills. It covers a total/aggregate of the medical bills in a year, not just the single instance of hospitalization.

9. Hospital Cash Cover

Hospital cash rider provides for the daily cash that you may need for compensating the medical expenses during the stay in the hospital. Typically, you can claim benefits an amount depending on the nature of your stay. You can also claim a higher payout in case you are admitted to ICU. You will be eligible for the rider payout in case you are hospitalised for a minimum of 24 hours.

10. Lifetime Renewability

Some insurers may deny the renewal of your health plan considering your deteriorating health condition. It is, thus, recommended to go for health plans that offer Lifetime Renewability. With lifetime renewability, you can always cover the health risks irrespective of the age and health condition.

11. Sub Limits

Sub-limit is a budgetary limit which your health insurer puts on your health insurance claim. Sub-limits are generally specified as a fixed amount  regarding a specific  disease or treatment or a  percentage of the total Sum Insured. A health plan with higher sub limits has lower premiums and health plan with no sub limits has a higher premiums.

Example: Mr X has a medical expenses of Rs 85,000  for the kidney stone treatment but his sublimits regarding such treatment is Rs 40,000. The insurer will pay only 40,000 and remaining has to be borne by the insured.

12. Restoration of Sum Assured

Rebuilding of the sum assured of your health policy once the policy sum assured is exhausted because of unanticipated medical requirements. The policy regains the health cover without additional paperwork and other formalities. It is not available with all health plans rather such option is associated with limited health plans.

13. Domiciliary Hospitalization

It is the medical treatment of the insured patient taken at his or her house which requires hospitalization otherwise due to the reasons like non-availability of hospital space to treat the patient or the medical condition of the insured is such that the ferrying of the patient for the treatment to the hospital arena is not possible. Such treatments require the medical practitioner recommendation basis the merit of the case.

14. No Claim Bonus

No claim bonus is a benefit given to the insured for a claim free year in his health plan. The benefits are usually redeemed as enhancement of the sum assured or discount in the renewal premium amount for every claim free year .

Next time when you go through the terms and conditions of the health plan, hope this information will help you to understand the nuances in a better way. Make an informed decision to buy a health plan!

Harjot Singh Narula

Harjot Narula is founder and CEO of ComparePolicy.com, an IRDAI approved insurance web aggregator focussed on selling online insurance for companies. Harjot has more than a decade of experience in software development and has also spent 5 years in US working for the mortgage and risk management industry.

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