Health Insurance Terminology You Should Be Acquainted With

Health Insurance Terminology

Suppose you have recently purchased your first health insurance policy or plan to do so shortly. In that case, you may feel overwhelmed by all the confusing terms and jargon you encounter online and to understand which is the best medical insurance as per the information received.

Consequently, let’s investigate some key health insurance plan terms more deeply:

  1. Waiting Period

Before submitting a claim for some or all of your health insurance policy’s benefits, a waiting period is required.

This waiting period varies by company, as do its conditions. After a 30-day waiting period, you can begin actively using your health insurance, except for hospitalisations resulting from accidents. In addition, there are unique waiting periods for pre-existing conditions, maternity benefits, and other illnesses.*

  1. Co-payment

A medical coverage claim amount is the policyholder’s responsibility to pay. In essence, it signifies that you and your insurer will divide the medical expenses; therefore, while your insurer will pay most of the bill, you will be responsible for a lesser amount. 

  1. Cashless Medical Benefits

In a cashless health insurance plan, your health insurer will pay your hospital expenses directly after hospitalisation at a Network Hospital. There are no out-of-pocket expenses on your part. Obtain authorisation from your insurer or a third-party administrator; your insurer and hospital will cover the expenses.*

  1. Before and after hospital admission

Frequently, medical expenses are less than the quantity necessary to support an inpatient stay. Diagnostic procedures, investigational procedures, medication, and other costs are incurred before hospital admission.*

Post-hospitalisation expenditures refer to the medical expenses incurred 45 to 90 days after hospital discharge. It may include follow-up examinations, ongoing therapies, specific medications, etc.*

  1. Rent Limitations

During your hospitalisation, the institution will charge you for room and board. There are various hospital accommodations, including a general ward, a double room, a deluxe room, and a luxury room, each with varying room rates.

Several medical coverages impose a maximal room rent cap as part of their health insurance, including ICU room rent restrictions. Therefore, you are liable for the additional cost if you choose a room with a higher rate. *

  1. Pre-existing Illnesses

A pre-existing disease or condition is any disease or health condition for which you experienced symptoms or were treated within 48 months before purchasing health insurance. Depending on your age and the disease or condition, there is a two- to a four-year waiting period before coverage begins.*

  1. Exclusions

Your health insurance plan generally has restrictions and exclusions, such as diseases, conditions, and situations for which medical expenses are not covered.

There are two major classes of exclusion:

Permanent Exclusions: These include hospitalisation without a doctor’s referral and prenatal and postnatal medical expenses, which are never covered by your policy.*

Exclusions in the First Year: These are conditions or treatments covered in your policy’s second year, such as cataracts, hernia, endometriosis, or neurodegenerative disorders with extended waiting periods.*

Before purchasing a policy, it is crucial to comprehend what is not covered to avoid complications when submitting a claim.

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*Standard T&C Apply

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.