Health Insurance Glossary

Insurance is an intricate product and so is its glossary. Getting to know and understand the terms can go a long way to help you understand the plan and thus choosing the best one. Here we have listed and defined a few common terms used in health insurance. These health insurance terminologies will give you a better understanding of health insurance.

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      Agent: He is a person appointed by the insurer to work on behalf of the insurer.

      Assignee: It is that person who gets the benefits of a policy.

      Claim: A request filed by an insured to the insurance company to pay for services obtained from a health care professional.

      Certificate of Insurance: The description of the benefits and coverage provisions forming the contract between the carrier and the customer. Discloses what is covered, what is not and the cash limits.

      Co-payment: When the insured files a claim, there is a certain out-of-pocket fraction of the claim amount he has to bear himself before the insurer steps in. This fraction is known as co-payment. Co-payment is shown as a percentage of the total claim amount.

      Cumulative Bonus: Cumulative bonus is similar to no claim discounts. For every claim free year, the sum insured will progressively increase by 5%. However, the cumulative bonus is subject to an amount that can never exceed 50 per cent of the Capital Sum Insured and that the policy was renewed continuously.

      Deductible: The amount of loss borne by the insured. This loss can be a certain money amount or a percentage of the claim amount. Bigger the deductible, lower is the premium.

      Dependents: Spouse and/or unmarried children (whether natural, adopted or step) of an insured.

      Exclusions: These are those conditions or circumstances for which an insured will not be given any benefit.

      Insurer: The insurance company that assumes responsibility for the risk issues insurance policies and receives premiums.

      Long-Term Care Policy: Insurance policies that cover specified services for a specified period of time. Long-term care policies (and their prices) vary significantly. Covered services often include nursing care, home health care services, and custodial care.

      Long-term Disability Insurance: Pays an insured a percentage of their monthly earnings if they become disabled.

      Premium: The monthly amount that you or your employer pays in exchange for insurance coverage.

      Policy: It is a legal document, which acts as a contract between the insurer and insured. It contains conditions of the insurance.

      Pre-existing condition: A medical condition of an individual is excluded from coverage if the condition is believed to have existed prior to obtaining the policy from a particular insurance company.

      Network: A group of doctors, hospitals and other health care providers contracted to provide services to customers of the insurance companies for less than their usual fees. Provider networks can cover a large geographic market or a wide range of health care services. Insured individuals typically pay less for using a network provider.

      Sum Insured: Sum insured is the payout amount that the insurer is liable to pay to the insured in case of an eventuality. It works on the principle of indemnity. For e.g. the sum insured is Rs 3 Lakh under health insurance and if the insured gets hospitalized and his expenses turn out to be Rs 2 Lakh, his insurer is liable to pay him Rs 2 Lakh.

      Waiting period: When an individual signs up for a new health insurance policy, there is a fixed period of time after which certain benefits of the policy come in effect. For e.g. the usual waiting period for pre-existing conditions is 4 years.

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      *We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30- minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881.

      *Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. Policybazaar does not provide any medical or surgical advice or diagnosis and is not responsible for your interactions / treatment by a medical practitioner/hospital. Please consult a registered medical practitioner for any medical or surgical advice. The Information that you obtain or receive from Policybazaar, and its employees, or otherwise on the Website is for informational purposes only. As per the Insurance guidelines, you are allowed to cancel the policy with-in 30 days from the date of Issuance of policy.This option is available incase of policies with a term of one year or more.

      *All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

      **All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

      *₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

      *₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

      *₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

      *₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

      *No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

      *The values taken for effective cost calculation are indicative values and may change as per the selected plan.

      *Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

      *Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

      *The scope of coverage may vary from plan to plan.

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      Tax Benefits are subject to changes in tax laws. GST Exemption depends on fulfilment of qualification criteria and submission of relevant documents as required by the insurers. For more details on risk factors, terms and conditions, please read the sales brochure and applicable rules and regulation carefully before concluding a sale.

      STANDARD TERMS AND CONDITIONS APPLY. For more details on risk factors, terms and conditions, please read the sales brochure carefully before concluding a sale.

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