Common Health Insurance Jargons!

Have you ever seen two people trying to converse in two different languages that neither one of them understands? What if life is at stake and the only way out is to make each other understand what they are saying? No hope, right? Knowing about a particular thing is starting off that track and some of the ‘Health Insurance Jargons’ really work like that.

This is what happens when we try to buy a health insurance policy with so many technical words involved that we don’t even know whether we are buying the right plan or not! Or whether the benefits we choose are even going to work for us!

Don’t worry though! Help is at hand as we bring to you some of the common ‘Health Insurance Jargons’ and its meanings to make things simple for you.

List of Health Insurance Jargons

1. Co-payment

An insurance company charges you a premium amount in return for a sum assured. Now, if you agree to pay a certain percentage of your medical expenses from your own pocket it’ll be considered a co-payment. This would enable the insurer to offer you lower premiums while keeping the sum assured intact.

2. Deductibles

This is very much like a co-payment with a slight difference. While in co-payment you agree to pay a percentage of medical expenses, the deductible is where you commit to paying a particular amount towards expenses from your own pocket. Therefore, whatever be your final claim amount from the insurer, the deductibles will be deducted before the insurer clears your claim.

3. Portability

This is the facility offered to an insured to switch insurance providers if he is not satisfied with the current insurer due to any reason. This would also allow the insured to carry forward any credits earned in regard to the waiting period for certain diseases as well as any exclusions involved so that he can enjoy the policy benefits uninterrupted. The only condition is that the insured should be with his existing insurer without any break.

4. Pre-Existing Diseases

Pre-existing diseases are medical conditions or injuries that have been diagnosed or treated within 48 months prior to the first policy issued by the insurance provider. It is important to disclose all pre-existing diseases at the time of buying the policy or claims can be rejected.

5. Waiting Period

This is the period one has to wait to get coverage for pre-existing diseases. This usually lasts between 6 months to 48 months from the commencement of the policy and varies from insurer to insurer based on various ailments.

Insurance companies began covering pre-existing diseases, making a waiting period necessary for common people. Today, there is a cure for almost every disease, and after the waiting period is over, people can get the treatment they want.

6. Critical Illness

Critical illness is a health-related medical condition of a serious nature. A critical Illness insurance plan guards you against the financial expenses that occur in the diagnosis of critical diseases such as cancer, heart attack, kidney failure, etc. The range of critical illnesses covered and the payout may vary from one plan to another.

Covid-19 has been a major issue for the elderly, as their bodies become weaker and they fear different diseases. This has caused them to be more vulnerable to the virus.

7. Top Up

A top-up health policy provides additional coverage to those with a running health plan, covering medical expenses that may arise due to an illness/injury over and above the limit of the actual cover.

In recent times, the word ‘top-up’ comes with enormously and top-up just worked like a top-up does in mobile recharge. It increases the liability of your insurance as well as increases your coverage amount. Suppose, you are admitted to a hospital and you are undergoing treatment, but you have run out of sum insured and the insurance company is refusing to cover you. At such times, the top-up option is the only option that can help you and with this option, you get extra coverage.

8. Super Top-up

A super top-up health plan puts together several incidences of hospitalization to cover the medical bills. It covers the total/aggregate of the medical bills in a year, not just the single instance of hospitalization.

9. Hospital Cash Cover

A hospital cash rider provides the daily cash that you may need for compensating the medical expenses during your stay in the hospital. that is Typical, you can claim benefits for an amount depending on the nature of your stay. You can also claim a higher payout in case you are in ICU. You will be eligible for the rider payout in case you are in hospital for a minimum of 24 hours.

10. Lifetime Renewability

Some insurers may deny the renewal of your health plan considering your deteriorating health condition. It is, thus, recommended to go for health plans that offer Lifetime Renewability. With lifetime renewability, you can always cover the health risks irrespective of age and health condition.

11. Sub Limits

Sub-limit is a budgetary limit that your health insurer puts on your health insurance claim. Sub-limits are generally specified as a fixed amount regarding a specific disease or treatment or a  percentage of the total Sum Insured. A health plan with higher sub-limits has lower premiums and a health plan with no sub-limits has a higher premium.

Example: Mr. X has medical expenses of Rs 85,000  for the kidney stone treatment but his sub-limits regarding such treatment is Rs 40,000. The insurer will pay only 40,000 and the remaining has to be borne by the insured.

12. Restoration of Sum Assured

Rebuilding the sum assured of your health policy once the policy sum assured is over because of Unlear medical requirements. The policy regains the health coverage without additional paperwork and other formalities. It is not available with all health plans rather such an option comes with limited health plans.

13. Domiciliary Hospitalization

It is the medical treatment of the insured patient taken at his or her house which requires hospitalization otherwise due to the reasons like non-availability of hospital space to treat the patient or the medical condition of the insured is such that the ferrying of the patient for the treatment to the hospital arena is not possible. Such treatments require the medical practitioner’s recommendation basis the merit of the case.

14. No Claim Bonus

The no-claims discount is a benefit that provides the insured with a claim-free year in his or her health insurance plan. and The benefit is usually claim in the form of an increase in the sum insured or a discount on the renewal premium for each claim-free year. Next time you go through the terms and conditions of the health plan,

hope this information about ‘Health Insurance Jargons’ will help you to understand the nuances in a better way. Make an informed decision to buy a health plan!