15 Must Know Health Insurance Terminologies in India

The prospect of hospitalization due to the Coronavirus pandemic and expensive treatments in private hospitals have driven more Indians to sign up for health insurance cover. We see a shuffle, albeit temporary, in the pecking order of portfolios of health insurance companies.

Read More

Policybazaar exclusive benefits
  • 30 minutes claim support*(In 120+ cities)
  • Relationship manager For every customer
  • 24*7 claims assistance In 30 mins. guaranteed*
  • Instant policy issuance No medical tests*

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply

*Tax benefit is subject to changes in tax laws. Standard T&C Apply

Find affordable plans with up to 25% Discount**
  • 1
  • 2
  • 3
  • 4

Who would you like to insure?

  • Previous step
    By clicking on “Continue”, you agree to our Privacy Policy and Terms of use
    Previous step

      Popular Cities

      Previous step
      Previous step

      Do you have an existing illness or medical history?

      This helps us find plans that cover your condition and avoid claim rejection

      Get updates on WhatsApp

      What is your existing illness?

      Select all that apply

      Previous step

      When did you recover from Covid-19?

      Some plans are available only after a certain time

      Previous step
      Advantages of
      entering a valid number
      You save time, money and effort,
      Our experts will help you choose the right plan in less than 20 minutes & save you upto 80% on your premium

      If you are buying a health insurance plan, you will come across plans in India with several quotations. These documents hold vital information in terms of the policy coverage, and criteria. And you would need to go through these documents and understand every term to assess the financial protection and coverage offered.

      Still, some of the terminologies in health insurance plans can be difficult to understand. With proper comprehension of health insurance details, you can save yourself from serious mistakes. Failure to do so could mean compromising with your sum insured during hospitalization.  

      But before you decide the right health cover for you and your family there are a few important health insurance terms that you should be familiar with. Prior knowledge of the ABCs of health insurance like Aggregate deductibles, premiums, claims, and co-payments are becoming more and more important for insurance buyers.  

      Here are 15 important terms in health insurance plans in India that could motivate you to go ahead and buy the right insurance policy. Read on to know more:

      1.Add-on Covers/Riders/Optional Covers Add-ons covers in health insurance are additional features also termed as optional covers or riders. This is an additional feature in health insurance that offers additional financial cover against unknown medical emergencies involving higher medical costs.  

      Some of the add-on/optional covers that you can choose to enhance your base health insurance plan are critical illness cover, maternity cover; room rent waiver, hospital cash benefit, etc.

      2. Automatic Restoration: Nowadays most health insurance plans offer 'restoration benefit'. You get a 'financial backup' to recover your exhausted sum insured. In the event the entire sum insured is exhausted, it gets reloaded automatically for the next hospitalization during the policy term.

      3. Co-morbidities/Pre-existing Diseases: Health comorbidities like COPD, hypertension, diabetes, kidney problems, cardiovascular issues, and other underlying diseases are considered to be significant risk factors in terms of health insurance. Patients with pre-existing medical conditions as mentioned above are considered to be at a higher risk and are therefore charged a higher premium.

      4. Co-payment: some of the health insurance plans have a copayment or copay clause. It is a fixed percentage of amounts that the insured/policyholder has to pay to the insurance company before receiving the healthcare service. It is mentioned in the policy wordings, e.g. people above the age of 60 years have to pay 20% co-pay at the time of claim, for each time a medical service is availed.

      5. Critical Illness: Critical illnesses or life-threatening medical conditions refer to life-threatening medical conditions like cancer, kidney failure, and cardiovascular diseases. There are special medical insurance plans that cover these illnesses. Or you can get a rider or add-on cover for the same.

      6. Cashless Claims: It refers to health insurance claims filed for a medical treatment availed in the network hospitals. 

      7. Deductibles: It is very important to understand the deductibles in health insurance. Deductibles can reduce your policy premium, but at the same time, it can mean that you have to pay a fixed sum at the time of insurance claim. So, do check the policy documents for the deductible clause and choose the one that does not include it, until you are ready to bear the treatment cost.

      8. Exclusions: Exclusions are also termed as the limitations. The health insurance companies usually mention them on their site and in policy wordings clearly. These are the conditions and circumstances under which your health insurance claims can get rejected and will not be processed further.

      9. Inclusions: It is something that you really need to check. Coverage benefits or inclusions refer to the policy features and benefits that the insurer will compensate you for. It includes hospitalization expenses, ambulance charges, surgery, hospital room bills, anesthesia, medicines, and treatment-related expenses. 

      10 No-claim-bonus: Health insurers offer a unique proposition termed as No-Claim Bonus (NCB), whereby the policyholder is rewarded for not filing a claim in the preceding years. No-claim-discount around 20-100 percent can be earned by the policyholders for not making a health claim.

      11. Network Hospitals: Every health insurance company in our country has a tie-up with a certain number of hospitals called as the network hospitals. These are the hospitals where you can avail treatment without the need to pay the bills; the insurer settles the bill directly up to the coverage limit. Your insurer will be directly be bearing the cost. It is called as the cashless claim services.

      12. Premium: Health insurance premium refers to the amount that you need to pay the health insurance company against the policy purchased.  The premium depends on the policy type, the sum insured, age of the policyholder, and various other factors. Average, the premium for a policy of Rs 10 lakh will cost around a premium of Rs 8,000.

      13. Sum Insured: The policy coverage amount is termed as the sum insured. The insurer compensates an amount equal to the sum insured that can be from Rs 5 lakh to Rs 100 Crores.

      14. Top-up plans: These are the policies that you can buy along with your base policy. Once the sum insured of the base policy gets exhausted, your top-up plan will cover the cost of the treatment.

      15. Waiting Period: In a medical insurance policy, there is a fixed time-period before which you cannot avail the coverage benefits. During the waiting period, health insurance claims are not admitted. The waiting period for different health conditions and coverage varies.

      Bottom Line

      These were some of the healthcare buzzwords that will help you in shopping for the right health insurance policy. We think now you will agree that some knowledge beforehand will go a long way in and everything will start making sense. This will allow you to make smart decisions for yourself and your family, especially in terms of medical insurance.

      Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

      Health insurance articles

      Recent Articles
      Popular Articles
      Surgeries Covered by Manipal Cigna Health Insurance Plans

      01 Mar 2024

      Amidst the ongoing surge in healthcare expenses, securing
      Read more
      Star Preventive Health Check-ups: All You Need to Know

      29 Feb 2024

      Preventive health check-ups are essential to monitor critical
      Read more
      Reasons to Purchase High-Value Health Insurance Cover

      21 Feb 2024

      When you decide to purchase a health insurance plan for you and
      Read more
      Surgeries Covered by New India Assurance Health Insurance Plans

      22 Feb 2024

      In an era where healthcare expenses are skyrocketing in India, the
      Read more
      Is a 10 Lakh Health Insurance Adequate in Your City?

      10 Jan 2024

      An ongoing medical inflation of 14 percent in India (the highest
      Read more
      How to Apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)?
      Ayushman Bharat Yojana is a flagship health insurance scheme launched by the Government of India to offer universal
      Read more
      Best Health Insurance Plans for Senior Citizens
      Senior citizens are the most prone to diseases. Considering the medical inflation in India, buying health insurance
      Read more
      Does Health Insurance Provide Coverage for LASIK Eye Surgery?
      A vast majority of the Indian population is suffering from vision problems. For some of them, LASIK eye surgery is
      Read more
      10 Major Benefits of Ayushman Bharat Yojana
      Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the second component under Ayushman Bharat Scheme. PM Narendra Modi
      Read more
      How Senior Citizens can save Tax with Medical Bills u/s 80 D?
      Senior citizens can save on income tax by availing tax benefits on medical expenses under Section 80D of the Income
      Read more

      Download the Policybazaar app
      to manage all your insurance needs.