Have you ever stared at your insurance policy and got baffled by unfamiliar terms and abbreviations? If so, you are not alone. Healthcare insurance can feel like a maze, filled with jargon that can leave even the most informed individual feeling lost. Thus, staying on top of the latest terminology is essential.
This raises many questions: What are these essential terms that you must know about? This article will guide you through the essential terms related to health insurance in India. So, let us start!
What is Healthcare Insurance?
A health insurance policy is a financial safety net that helps you pay for medical bills. It’s a contract between you and an insurance company. You pay a regular premium, and the company agrees to cover some or all of your medical expenses if you get sick or injured. These can include hospital stays, doctor visits, surgery, and prescription drugs.
7 Healthcare Insurance Terms That you Should be Aware off
Understanding healthcare insurance terms is crucial for making informed decisions about your coverage. Below are the 7 essential terms you should be aware of:
1. Add-on Covers/Riders/Optional Covers
Add-on covers, also known as riders or optional covers, are supplementary features that you can include in your insurance policy for added protection. These covers typically come at an additional cost over the base premium.
Add-ons are tailored to cover specific risks or situations not covered by the standard policy. For example, a critical illness rider may provide a lump-sum payment upon diagnosis of certain severe illnesses like cancer or heart attack. By opting for add-on covers, you can customise your insurance policies to suit your needs and preferences better.
2. Automatic Restoration
Automatic restoration is a feature offered by some insurance providers that automatically reinstates the sum insured to its original amount if it gets exhausted during the policy period. This restoration typically occurs once during the policy term and ensures continuous coverage for unexpected medical expenses without additional cost to the policyholder.
It provides peace of mind, especially when multiple claims are made during the policy year, ensuring that the insured individual or family members are adequately covered for the policy term.
3. Co-Morbidities/Pre-Existing Diseases
These are medical conditions that were present before the start of health insurance in India. Most insurance companies have a waiting period (usually 2–4 years) before they cover these diseases.
This means that if you have a pre-existing condition like diabetes or hypertension, the costs related to its treatment would not be covered until the waiting period is over. The waiting period for pre-existing diseases varies from one insurer to another.
4. Deductibles
The costs that you have to pay out-of-pocket prior to receiving insurance coverage are known as deductibles. It’s a predetermined amount specified in the insurance policy, and you are responsible for paying this amount for covered services before the best health insurance company begins to pay its share.
Deductibles can be fixed amounts or a percentage of the claim amount, depending on the policy terms. Typically, policies with higher deductibles have lower premiums, while those with lower deductibles have higher premiums. Deductibles help insurance companies mitigate risk and discourage unnecessary claims.
6. Network Hospitals
Network hospitals are healthcare facilities with a contractual agreement with an insurance provider to provide cashless treatment to policyholders. When you seek medical treatment at a network hospital, you can avail of cashless services, where the insurance company settles the medical bills directly with the hospital.
This eliminates the need for you to pay upfront for medical expenses and then seek reimbursement from the best health policy company. Network hospitals offer various medical services and specialities, making them a convenient option for those seeking quality healthcare.
7. Premium
The premium is the amount that policyholders pay to the insurance company to maintain their insurance coverage. It’s typically paid periodically, such as annually, semi-annually, or monthly, depending on the policy terms.
The premium amount is determined based on various factors, including your age, health status, coverage amount, deductible, add-on covers, and other relevant risk factors. Paying the premium on time is essential to keep the insurance policy active and ensure continuous coverage for medical expenses and other covered benefits.
Conclusion
Understanding the essential terms of health insurance in India is crucial for making informed decisions about your healthcare coverage in 2024 and beyond. Decoding the details can help you understand your insurance policies more effectively.
For those who are looking for comprehensive healthcare insurance, then consider Niva Bupa Health Insurance. What makes them the best health insurance company is their commitment to providing reliable coverage and excellent customer satisfaction. They offer a range of healthcare insurance plans tailored to meet your needs. Visit their website today!
