If you are buying a health insurance plan or renewing your existing policy, you may come across many jargons, which may sound overwhelming and confusing. However, as a policyholder, it is paramount that you understand the meaning and implications of these terminologies.
This health insurance glossary will help you understand the meaning of some critical terminologies so that you choose a suitable policy to meet your specific requirements.
As the name suggests, pre-existing conditions or diseases are ailments that you are diagnosed with at the time of buying a health insurance policy. Certain conditions like diabetes, hypertension (high blood pressure), cardiovascular diseases, kidney problems, etc., are considered to be significant risk factors in health insurance.
If you are nursing any such conditions, the insurer will categorise you as a high-risk insurance buyer and, therefore, will charge you a higher premium than others who are healthy.
All health insurance plans have a waiting period clause. It is a fixed period before which you cannot avail of the coverage benefits, i.e., you cannot file a claim, and the insurer is not liable to pay for the medical expenses you incur. Generally, all health insurance policies have an initial waiting period of 30 days. In addition, your policy may have a disease-specific waiting period, which may vary from one condition to another and from insurer to insurer.
Inclusions and exclusions
When you buy any health insurance plan, you must compulsorily check the inclusions and exclusions. Inclusions refer to the policy features or benefits and the things that the insurer will compensate you for. It generally includes ambulance charges, diagnostic tests, bed charges, surgery, etc.
Exclusions are health insurance policy’s limitations. Typically, insurance companies explicitly mention them on their website and policy documents. These are conditions, diseases, and treatments that will not be compensated for.
NCB, or no-claim bonus, is one of the critical health insurance terminologies you will inevitably come across while comparing different plans. It is basically a reward offered by the insurer for not filing a single claim during the policy period. The reward is generally in the form of a discount on the premium upon policy renewal.
You can continue to get NCB benefits for each successive year of not filing a single claim for up to five years. The maximum no-claim bonus you can get from a health insurance policy is 50%.
It is essential to be aware of the deductibles in your health insurance policy. It basically means that you agree to pay a fixed sum out of your pocket at the time of a claim. Most policies have a voluntary or mandatory deductibles clause. If you opt for a large deductible, your premium will reduce proportionately. But, at the same time, when you file a claim, the insurer will consider the deductible and pay the claim amount accordingly.
All insurance companies offering health insurance policies in India have tie-ups with certain hospitals across the country, which are known as network hospitals. You can avail of cashless payment benefits at these network hospitals, i.e., after you seek treatment, you need not pay the bill from your pocket.
Instead, after you get discharged, you must only submit the bills to the TPA (third-party administrator) or the insurer. They will directly settle the bill with the hospital as per the policy’s terms and conditions.
Now that you know of the important health insurance terminologies and their meaning, do your due diligence and make an informed buying decision.