Common Health Insurance Terminologies in India: Explained

Health insurance. Doctor's stethoscope, magnifier and health insurance contract.

You must be looking into a number of viable options if youíre planning to buy a health insurance policy. And, there is a high chance that on each of those quotations you are going through, there is one word or the other that you have never heard before. However, you canít just shrug and move on just because you donít understand a term or two on the documents. Buying medical insurance is a crucial decision and you need to have a clear idea of each word on that document to be sure that youíve chosen the right policy. With that being said, given below is a brief discussion on the common medical insurance terminologies.

  1. Riders/Add-Ons/Optional Coverage

Add-on covers in medical insurance are like additional features that are also called riders or optional covers. It is like an added feature in the medical insurance policies that offer added financial covers against unforeseen medical emergencies that involve higher medical expenses.

Certain optional/add-on covers that one might select for enhancing the base health plan are hospital cash benefit, room rent waivers, maternity cover, and critical illness insurance cover.

  • Automatic Restoration

At present, restoration benefits are the part of most medical insurance policies. You get the financial backup for recovering the exhausted insured sum. In case the sum insured gets completely exhausted, the sum is automatically reloaded for the upcoming hospitalization within the term of the policy.

  • Pre-Existing Ailments/Co-Morbidities

Co-morbidities like cardiovascular issues, kidney problems, diabetes, hypertension, COPD, and other such underlying ailments are held as risk factors for buying a medical insurance policy. Insurers charge a higher than usual premium to patients with comorbidities.

  • Cashless Claims

Cashless claims facility provided by an insurer means that if hospitalized in certain specific hospitals, you will not have to pay anything for the expenses that are covered. The insurance company will pay the hospital directly on your behalf. Such a facility is only available at certain network hospitals, so check that list beforehand.

  • Deductibles

Deductibles are the amount that you will need to pay as a part of your insurance claim when it arises. The insurer will pay the rest of the claim. For instance, if the deductible amount for your plan is INR 10,000 and the healthcare claim is of INR 30,000, your insurer will pay INR 20,000. Deductibles reduce the policy premium, but you have to be ready to pay the fixed sum when making the claim.

  • Waiting Period

In medical insurance policies, there is always a fixed time period before which the insured isnít allowed to avail the coverage. This time is called the waiting period, and medical insurance claims arenít entertained during this time. The waiting period varies for various health conditions, and so does the coverage.

Signing off

Though these are the six terms that you will find in each medical insurance policy, this isnít an exhaustive list. There might be many more terms on that policy document that youíve no clue about. In such cases, talk to your insurance agent and clarify your doubts.