The Vocabulary You need to Understand for Health Insurance Plans in India

Health insurance plans are an integral component of a well-versed risk management profile of an individual. Just the way we purchase life insurance policies, and investment plans it is vital to invest in the best Mediclaim policies. With the right health insurance plan that offers adequate coverage, you ensure that your loved ones and family members get the right treatment and medical attention in times of turmoil without worrying about the financial quotient.

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    The Indian insurance market is quite diverse and highly competitive. Within the past few decades, the industry has witnessed an exponential rise in the number of service providers thereby increasing the competition. If you’ve made your mind to buy medical insurance plans it is important to be aware of the common terminology and vocabulary used in the insurance world. This might appear to be a daunting task but you don’t need to worry. 

    In order to make sure you are familiar with the insurance vocabulary so that you choose the best Mediclaim policy, we’ve come up with a new blog. In this thread, we will decode the medical insurance jargons to give you a better understanding of what you’re buying. This will help you can protect your loved ones from the uncertainties on the trail of life without any hassle.

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    Health Insurance / Mediclaim Policy

    First things first, before we dive deep into the nuances let us understand what actually is a health insurance plan? As the name suggests, it is a bilateral agreement between the insurance provider and the buyer that ensures financial coverage against medical expenses incurred in the diagnosis and treatment of an ailment or medical condition. 

    In order to avail the facilities, the policyholder is supposed to pay a fee known as the premium. The premium of different plans varies on the basis of numerous factors such as the coverage criteria, age of the applicant, medical history, and occupational hazards.

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    The process of applying for reimbursement of medical expenses incurred in the treatment of the covered members is known as a claim. The process of filing a claim is a simple process, claimants can choose online or offline modes based on their convenience. The claimant needs to fill the claim form and attach the required documents to verify the expenses incurred such as invoices, reports, and other relevant documents.

    The provider receives the claim and assesses it verifying the authenticity of the documents presented to make sure that the claim is genuine. Once the provider approves the claim the amount is credited into the claimant’s bank account.

    Cashless Hospitalization / Claim

    A typical feature of a health insurance plan is cashless hospitalization. In this case, the insurance provider has a network of partnered medical institutions and hospitals, and if the policyholder chooses to get medical treatment at any of the network hospitals, the treatment can be cashless.

    However, an important point to be kept in consideration is that the cashless claim is subject to limits and therefore it is crucial to read the fine print of the policy for detailed information regarding this feature. The primary benefit of opting for cashless hospitalization is that it allows the patient to get immediate medical attention just by presenting the policy card at the hospital without making the payment in cash. This feature not only saves time for the policyholder but also allows one to seek the right treatment without worrying about the expenses at first.

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    The term coverage refers to the maximum payable amount by the provider in the event of hospitalization or treatment of any of the covered members. The payable premium of the best Mediclaim policy is directly proportional to the amount of coverage offered by the plan. This basically means that with a rise in the coverage amount of health plans there is an increase in the payable premium. 

    Add-on Riders

    Another very common term used in the insurance industry and especially in the case of health insurance plans in ‘add-on riders. These are auxiliary components available with the best Mediclaim policy that enhances the coverage offered over the basic plan. The add-on riders can be purchased with the basic cover by paying small amounts. There are different types of add-on riders that offer coverage in case of different events.

    For instance, critical illness and terminal illness riders offered dedicated coverage in case of the policyholder or any of the covered members is diagnosed with critical or terminal illness respectively. Similarly, personal accidental coverage offers coverage in case of an accident.

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    Floater Plans

    A floater plan is a type of health insurance plan that offers consolidated coverage to the members of a family under the payment of a single premium. In other words, all the members of a family can be covered under a single plan that offers coverage against medical ailments and conditions. 


    Typically, health insurance plans in India provider coverage for a period of one year, and after that, the policy needs to be renewed. The process of reactivating your health insurance policy to provide coverage is known as a renewal. 

    Final Words

    With these common terms used in the insurance industry, we hope that you’ve got an understanding of the basics that will help you to choose the right medical insurance plan to protect yourself and loved ones on the rollercoaster of life.

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

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