It is important to know about certain terms before purchasing health insurance. These terms help to know more about the policy coverage and its criteria. Always go through all the terms to avoid major mistakes. However, some terms can be difficult to understand.
Some of the general and common terms that will help you choose the correct health insurance plans are given below.
1. Sum-Insured
Sum-insured is the policy coverage amount.
2. Premium
Premium is the amount you must pay the insurer or the health insurance company against the policy purchased. The premium will depend on the type of policy you choose, the policyholder, age and other factors.
3. Cashless Claims
Cashless claims are health insurance claims that can be availed in the insurer’s network hospitals.
4. Add-On Covers
Add-on covers are additional features that offer additional financial coverage in health insurance against unknown medical emergencies that involve high medical costs.
Other names for add-on covers are riders and optional covers. Critical illness, room rent waiver, maternity cover and hospital cash benefit are some of the common add-ons that can enhance your base health insurance.
5. Critical Illness
Critical illnesses are life-threatening medical conditions like kidney failure, cancer and cardiovascular diseases. For such critical illnesses, there are special plans that cover these illnesses. Additionally, you can get an add-on or a rider cover.
6. Network Hospitals
All health insurance companies have a tie-up with a certain number of hospitals in the country. These tie-ups with hospitals are called network hospitals.
7. Automatic Restoration
Most health insurance companies are offering automatic restoration benefits. You will benefit from insurance backup when you have exhausted the sum insured. In automatic restoration, the sum insured gets reloaded for the next hospitalisation during the policy term.
8. Pre-Existing Disease/Co-Morbidities
Co-morbidities like hypertension, COPD, kidney diseases, diabetes and other major health issues are considered risk factors for health insurance. So people with any of the co-morbidities mentioned above are charged a higher premium.
9. Exclusions
Exclusions or limitations are circumstances and conditions that health insurance companies will mention in their policy wordings clearly. In such cases, your health insurance claims can get rejected or will not be processed further.
10. Inclusions
Inclusions or coverage benefits are one section that you should check properly. These benefits refer to the benefits and other policy features that the insurer will compensate you for. Some common inclusions include hospitalisation, anaesthesia, surgery, ambulance charges and treatment-related expenses.
11. Waiting Period
In medical insurance, there will be a waiting period for health conditions. During the waiting period, you cannot avail yourself of the health insurance claims. The waiting period will differ for various health conditions and insurance policies.
12. Top-Up Plans
Top-up plans are policies that can be bought along with the base policy. When the sum insured by the base policy gets exhausted, the top plans will cover you.
13. Co-Payment
A copay clause or co-payment is a fixed percentage of the amount the policyholder should pay to the hospital for the expenses of the treatment received. Copay percentage differs from policy to policy and depends on the entry age.