Learn & Protect: Health Insurance Terms Simplified

Looking at buying a health insurance cover and having trouble understanding the terms? Fret not, we are here to help. There are some terms which are commonly used in the insurance literature, and knowing these terms can surely help you in understanding a health insurance plan better. Thus, helping you choose the best plan to secure your health and that of your loved ones. 

CO-PAYMENT
It is an arrangement in which a policyholder has to pay a portion of medical treatment on their own while the remaining amount is borne by the insurer. The percentage of the amount to be paid by the policyholder varies depending on their age and medical condition. Co-payment usually ranges between 10-30% in health insurance plans.

PRE-HOSPITALIZATION
Pre-hospitalization charges are medical expenses incurred before getting admitted in the hospital. There are various medical tests a policyholder may have to go through before getting hospitalized. These are done to diagnose the medical condition of the individual. Most insurance policies cover these charges incurred by a policyholder up to 30 days prior to the admission in a hospital.

POST-HOSPITALIZATION
This includes all the expenses and charges incurred by a policyholder after getting discharged from a hospital. These include expenses on medical tests, medicines, doctor’s consultation fees, etc. In most insurance policies, post-hospitalization expenses are covered by the insurer up to 60 days from the date of discharge from the hospital.

DOMICILLARY HOSPITALIZATION
It is a situation when the policyholder is considered hospitalized when they have to undergo treatment at home. This can happen because of unavailability of accommodation at the hospital or the patient's health condition doesn't allow him to be admitted in a hospital. The insurer considers it as hospitalization when the treatment lasts for at least three days. 

REIMBURSEMENTS
Reimbursement claims can be made if one wants to opt for a non-empanelled hospital. For reimbursements, the policyholder has to spend treatment bill from their own pocket and then file a reimbursement claim from the insurer after getting discharged from the hospital. This is done by submitting original bills, claim form, medical certificate etc. 

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ROOM-RENT CAPPING
The limit imposed on the coverage of boarding expenses or room rent of the hospital is called room rent limit. This limit is usually expressed as a percentage of the sum insured, and at times as an absolute amount. This monetary limit is usually given in per day and is irrespective of the sum insured. Any charges paid towards the room rent over and above the limit has to be borne by the insured person. 

NO CLAIM BONUS
No claim bonus is the extra money added in the sum assured for every claim-free year. It can be considered as a reward that a policyholder receives for not claiming his health insurance in a given year. The rate at which sum insured increases varies between 5-60% depending upon the insurer.

DAY-CARE TREATMENTS
With the advancements in medical science and technology, certain surgeries and treatments can now be completed within less than 24 hours, which earlier required lengthy hospitalizations. All such treatment procedures that require less than 24 hours of hospitalization come under day-care treatments. These include procedures such as chemotherapy, radiation, dialysis, cataract, lithotripsy, tonsillectomy, etc. In most cases, day care treatments covered are maximum upto the sum assured. 

TOP-UP PLAN
It provides additional coverage to a health insurance plan over and above the current limit at a lower premium amount. Under a normal health insurance plan, there could be cases when the medical expenses exceed the amount of the sum assured in your health insurance plan, a top-up helps in such cases. 

SUPER TOP-UP
A top-up policy pays only when the threshold limit on a regular insurance plan is exceeded on a single hospitalization. Whereas, a super top-up policy covers multiple claims over the threshold limit in multiple cases. A super-top up policy covers multiple claims by the insured persons.

RESTORATION BENEFIT
It is a benefit where an insurer restores the sum assured in case it is fully exhausted before the treatment of an illness. So, even if a policyholder exhausts the entire sum assured, the insurer can restore the entire amount and they can use it in the future.