GLOSSARY

This is an additional benefit offered by most health insurance policies. It compensates you for the charges that you incur when availing an ambulance service in case of an emergency to take the patient from home to hospital or from one hospital to another. The amount of cover provided differs from policy to policy.

Co-payment or co-pay, as it is generally referred to, is a % that you have to pay for overall mediclaim expenses, while the remaining amount will be paid by us. Let’s take an example, if your medical insurance plan has a 10% co-pay clause and your claim amount is Rs 1 lakh, you have to pay Rs 10,000, while we will pay Rs 90,000.

This is an additional benefit offered by most health insurance policies. It compensates you for the charges that you incur when availing an ambulance service in case of an emergency to take the patient from home to hospital or from one hospital to another. The amount of cover provided differs from policy to policy.

Co-payment or co-pay, as it is generally referred to, is a % that you have to pay for overall mediclaim expenses, while the remaining amount will be paid by us. Let’s take an example, if your medical insurance plan has a 10% co-pay clause and your claim amount is Rs 1 lakh, you have to pay Rs 10,000, while we will pay Rs 90,000.

Due to growing medical advancement, certain surgical procedures do not require 24 hours of hospitalisation (the basic requirement when one needs to avail a health insurance claim for treatment). As the term implies, daycare procedures are often covered in polices these days which is an added benefit.

This is a fixed amount that you need to first bear for each claim. The insurance company’s liability starts over and above this amount.

The insurance company’s own claim settlement team is called an in-house claims team, while TPA refers to the third-party/outsourced claims team. An in-house claims team enables the insurance company to directly deal with health insurance claims and provide the customer with faster and better service.

Most health insurance providers empanel, or tie-up with hospitals across the country to provide better medical services to their customers. These hospitals are referred to as network hospitals. The advantage of getting treatment in these hospitals is that one can avail the cashless facility. It is necessary that the insurance company is informed of the hospitalisation so that they can authorise the hospital to not charge the customer.

The compensation for expenses incurred prior to hospitalisation for a treatment as well as for the recovery treatment after discharge.

These are for consultations, medicines, investigations or any other factors related to the illness for which hospitalisation has occurred. The duration of this cover should be checked when you buy a medical insurance policy.

The amount you pay to an insurance company when you purchase a medical insurance policy. This amount depends on the sum insured you have chosen, and other factors like your age, medical condition and physical fitness at the time of taking the policy.

Suppose you take a cover for Rs 5 lakh as the sum insured. At the time of making a claim, if you use only Rs 2 lakh of that cover, then the remaining Rs 3 lakh can still be used by you during the remaining policy period. The amount of cover on your policy is sum insured and assured. It is the maximum amount up to which you can get insured and avail benefits in the event of a medical claim during a single policy year.

As per medical insurance standards, every policyholder must define a waiting period for a pre-existing illness. Usually, it is a 30-day period from the date of issue of your health insurance policy. During this period, if the insured files a claim; the insurance company has the right to reject this claim unless it is an emergency. For example, if a policyholder meets with an accident during the waiting period then his claim settlement is accepted by the insurer. However, his waiting period ends after this claim settlement.

As per medical insurance standards, every policyholder must define a waiting period for a pre-existing illness. Usually, it is a 30-day period from the date of issue of your health insurance policy. During this period, if the insured files a claim; the insurance company has the right to reject this claim unless it is an emergency. For example, if a policyholder meets with an accident during the waiting period then his claim settlement is accepted by the insurer. However, his waiting period ends after this claim settlement.