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Health Insurance Terms: An Introduction
When purchasing health insurance, it is common to feel lost with all the terms thrown around. It can be quite intimidating, and often people need a better understanding to explore health insurance options.
It is time to change the narrative and confidently navigate health insurance terminology. We have compiled a comprehensive glossary of all important health insurance terms you need to know. This will help you make the best purchase decision and provide you with a clearer understanding of a health insurance policy.
Health Insurance Glossary: A to Z
Your guide to health insurance terminology without the technical gibberish.
| Health Insurance Terminology | What Does It Mean? |
|---|---|
A |
|
| Automatic Restoration | In case the policy sum insured is exhausted, it is restored automatically to cover you for the next hospitalisation. |
| Add-on Covers | Additional coverage features that you can add to your base policy with slightly higher premiums. Common add-ons are personal accident cover, critical illness cover, etc. |
| Age Limit | The age limits specified by health insurers for customers to apply for purchasing or renewing a health insurance plan. |
| AYUSH Treatment | Alternative treatments like Ayurveda, Unani, Siddha, and Homeopathy are covered by some health insurance plans. |
| Ambulance | Your health plan covers the charges for a road ambulance used to transport you to the hospital. |
| Air Ambulance | Your health plan covers the charges for an air ambulance used to transport you to the hospital. |
| Annual Health Check-Up | Yearly health check-ups are covered by your health insurance plan. |
B |
|
| Beneficiary | The policyholder or the nominee who receives the health insurance benefits is called a beneficiary. |
| Benefits | Coverage features mentioned in the health insurance policy are also called benefits. |
| Bariatric Surgery | A weight loss surgery done by making changes in your digestive system to help you lose weight. |
C |
|
| Cashless Hospitalization | When the health insurance company settles the bill directly with the hospital you have been admitted to, it is called cashless hospitalization. |
| Claim Settlement | The process of settling bills for hospitalisation which have been claimed by the customer. Claim settlement can either be on a cashless or reimbursement basis. |
| Co-payment | A clause that requires you to share the hospitalisation expenses with the health insurance company. It is pre-decided by the health insurance provider. |
| Critical Illness | Illnesses that are life-threatening such as cancer, kidney failure, heart ailments, etc. |
| Cumulative Bonus | The bonus received by a policyholder on successfully completing the policy tenure without raising a claim. A cumulative bonus is received at the time of policy renewal. |
| Coverage | The medical treatments or facilities paid for by the health insurer are known as features that are covered by the insurer. |
| Convalescence Benefit | A fixed amount of cash benefit given to the policyholder during their prolonged hospitalisation. |
D |
|
| Deductibles | The amount of money a policyholder pays out of pocket before the health insurance can cover their medical expenses. It is pre-decided by the policyholder and helps reduce the overall premium price. |
| Dependents | Family members of the policyholder who can avail of medical care benefits under a health plan. Dependents can include spouses, children, parents, etc. |
| Daily Hospital Cash Allowance | A feature of many health policies where the customer receives a specific amount of cash benefit for each day of hospitalisation. |
| Domiciliary Hospitalization | Treatments received by a policyholder at home under a doctor’s recommendation fall under domiciliary hospitalisation. |
E |
|
| Eligibility | The terms and conditions set by IRDAI, like age, etc., that make an individual eligible to purchase a health insurance policy. |
| Entry Age | The minimum and maximum age criteria of the policyholder required to purchase a health insurance policy. |
| Exclusions | Medical treatments, procedures, or illnesses which are not covered by a health insurance policy. Check your policy documents to understand your policy’s exclusions. |
F |
|
| Family Floater | Health insurance plans which cover all the members under one comprehensive policy. |
| Free-look Period | The period during which a policyholder can terminate their policy without paying any cancellation fee or penalty. |
G |
|
| Grace Period | The time offered by an insurance company to the policyholder after the date of renewal is missed, during which they can renew their health plan, avoiding a policy lapse. |
| Group Health Insurance | Health insurance plans designed for large groups like corporate organisations, housing corporations, NGOs, etc. |
| Grievance Redressal | If customers are unhappy with the health insurance company, they can voice their issues and complaints with the grievance office of the company. |
H |
|
| Hospitalization | When a policyholder is admitted to the hospital for a minimum of 24 hours, it is considered a hospitalisation. |
| Hospital Daily Cash | A fixed amount of cash offered to policyholders by the insurance policy for a specific number of days of their hospitalisation. |
| Home Nursing | The facility of being looked after in the comfort of your own home by a professional nurse on the recommendation of a doctor or medical practitioner. |
I |
|
| Illness | Any medical condition leading to the hospitalisation of an individual is called an illness. |
| Insurer | The company providing a health insurance policy is called the insurer. |
| Insured | The individual or group of individuals who avail the benefits of a health insurance plan are known as the insured. |
| In-patient Treatment | Any treatment that requires policyholders to be hospitalised for at least 24 hours is known as in-patient treatment. |
| ICU Charges | The charges a hospital sets for the admission of a patient to their intensive care unit are ICU charges. |
| Individual Health Insurance | A health insurance plan with benefits for a single policyholder is an individual health insurance plan. |
| IRDAI | Insurance Regulatory and Development Authority of India, the governing body and regulator for the insurance industry in India. |
L |
|
| Lapse | When a health insurance policy ceases to exist due to untimely premium payments or fraudulent reasons, it is called a policy lapse. |
M |
|
| Maternity Cover | Hospitalisation, medical treatments, and other facilities received by women policyholders during their pregnancy are covered under maternity cover. |
N |
|
| Network Hospitals | Hospitals listed by the health insurance company where you can avail of cashless hospitalisations and treatments are network hospitals. |
| Non-network Hospitals | Hospitals that are not listed with your health insurance provider are non-network hospitals. On availing treatments in a non-network hospital, your health insurance provider will reimburse your claim amount as specified in your policy. |
| No-claim Bonus | The benefit received by the policyholder in the form of a higher sum insured at the time of policy renewal is a no-claim bonus. It is given to you if you do not raise a claim during your policy tenure. |
| Nominee | A nominee is an individual appointed by you as a policyholder who will receive the benefits of a health plan in case of your absence. |
O |
|
| Out-patient Treatment/Department (OPD) | Medical treatments that require less than 24 hours are included in the out-patient department. |
P |
|
| Premiums | The amount of money paid by you as a policyholder to the health insurance company to avail the health insurance policy benefits is called a premium. |
| Policy Term | The duration of your health insurance policy is called policy tenure. Health insurance policy tenure can be for 1, 2, or 3 years. |
| Pre-hospitalization | Medical care expenses which occur before the actual hospitalisation, such as diagnostic tests, doctor consultations, etc. |
| Post-hospitalization | Medical care expenses which occur after hospitalisation, such as follow-up doctor consultations, pharmacy bills, etc. |
| Portability | The process of transferring your health insurance plan from one health insurance company to another is called portability. |
| Personal Accident Cover | The amount paid by the health insurance company to the policyholder in case of their death or disability. |
| Pre-existing Condition | The medical conditions that an individual is suffering from while purchasing a health insurance policy are called pre-existing diseases, such as hypertension, diabetes, etc. |
| Preventive Health Check-up | Insurance holders can avail of health check-ups which will be covered by their health insurance plan up to a specified amount or number of times in a year. |
R |
|
| Renewal | The facility to extend your health insurance policy for the next 1, 2, or 3 years by paying a specific premium amount is known as renewal. |
| Reimbursement Claim | On availing a medical treatment in a non-network hospital, you can file a claim request for the amount spent during your hospitalisation, which will be reimbursed by your health insurance provider. |
| Room Rent | The amount of money you pay for being admitted to a hospital room is called room rent. |
S |
|
| Survival Period | A feature of critical illness health plans, wherein you are required to outlive a specific number of days before the health policy covers your treatments on being diagnosed with a critical illness like cancer, heart attack, etc. |
| Sum Insured | The maximum amount of money offered by your health insurance plan in case of your hospitalisations, medical treatments, diagnostics, etc. |
| Sub-limit | An upper limit set by health insurance providers for specific features in your health policy. Sub-limits are usually set on room rents, ambulance charges, operations, etc. |
| Super Top-up Plan | Super top-up plans work similar to a top-up plan, enhancing the base sum insured limit. However, a super top-up plan does not require you to cross the threshold limit for every claim. It considers all the claims put together in a policy tenure. |
T |
|
| Third-party Administrator | The officials that are authorised by your health insurance company to provide you with insurance services such as claim settlement services, policy queries, and more. |
| Terminal Illness | Ailments that are not curable and will lead to the eventual demise of the patient, such as a diagnosis of cancer in later stages. |
| Top-up Plan | Top-up health plans enhance your base health plan sum insured up to a certain limit. It comes with a deductible clause; once the deductible limit has been crossed, a top-up plan will be activated. |
U |
|
| Underwriting | The process through which a health insurance company takes the risk of covering a policyholder. |
W |
|
| Waiting Period | The period specified by the health insurance provider before the health policy activates and starts covering you for medical treatments and procedures. |
Wrapping It Up
We agree that health insurance terminology can often be scary and confusing, leading to a lack of understanding of your health policy and the benefits it has to offer. Trust PolicyX to decode health insurance terminologies for you, helping you make the most of your health insurance policy.
