10 Words Every Health Insurance Policyholder Must Know

Policyholder

The most elementary yet important term. It means a person who either owns a health insurance policy or shows interest in purchasing a health insurance policy.

Claim

This includes the entire process of applying for reimbursement of the expenses incurred during the treatment at a medical facility. The process of applying is called filing a claim. This is usually taken care of by a third-party admin.

Cashless Claim

This means that a policyholder does not need to pay any cash upfront to the medical facility. That’s because the insurer has a tie-up or a network with certain hospitals or medical institutions around the country. These are called network hospitals. They pay for all the medical expenses. However, certain upper limits may apply for room rents. Plus, the insured has to make sure the medical facility is a network hospital otherwise the cashless claim does not apply.

Free-look Period

It is a period where the insured can opt out of the purchased policy. This usually happens if you are not comfortable with certain terms and conditions or hidden costs. Usually, the insurer refunds within 15 to 30 days after deducting expenses incurred on certain medical tests, stamp duty fee and other miscellaneous charges.

Sum Insured

It is the amount that the insurer has agreed to pay the insured as per the policy and premium paid in case of any medical emergency or eventuality. For example, if you have a sum insured of Rs 10 lakhs and your hospitalization expenses come to 5 lakhs, the insurer will be liable to pay the sum insured to you.

Waiting Period

This is the time frame for which the insured has to wait before he can enjoy or avail benefits on certain illnesses or pre-existing conditions. These usually come into effect in 36 months. Therefore, it is very important to read about the waiting period.

Pre-Existing Conditions

If the insured has some pre-existing illnesses or health conditions at the time of purchasing the policy, they cannot enjoy health benefits for these conditions.

Cumulative Bonus

Didn’t claim health insurance for a year? Guess what? Health insurance companies these days reward you by hiking the sum insured by 5% to 10%. This bonus is known to be a cumulative bonus. A word of caution, this amount can never be more than 50% of the sum insured and the renewal of the policy has to continuous.

Deductible

This usually refers to the amount paid by the insured either through a percentage of the claim amount or certain exclusions in the health insurance plan. This usually happens when the premium is low. That’s why health insurance experts recommend paying extra premiums so that you have fewer deductibles after claiming your health insurance.

Premium

The amount you pay to a health insurance provider for offering you health insurance coverage for any medical emergencies.

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