Health Insurance Terms You Must Know

After COVID-19 Pandemic, people have become more aware of the importance of their health and well-being. Individuals have taken a more serious approach to securing the best mediclaim policy for their families.

However, understanding health insurance can sometimes feel like trying to decipher a foreign language. With numerous terms and acronyms thrown around, it’s easy to get confused. Hence, having a clear understanding of health insurance terminology is essential for making informed decisions.

The purpose of this blog is to provide you with knowledge of crucial health insurance terms to assist you in navigating the world of healthcare coverage.

Premium

The premium is the amount you pay to the health insurance company. It is typically paid annually, and its cost can vary depending on factors such as your age, location, and the type of plan you choose.

Deductible

The deductible is one of the most important insurance terms on this list. It reduces the policy premium, but you must pay some amount before you can claim your insurance. Hence, it is advisable to carefully look into the deductible clause while opting for the right policy. Until you can bear the cost of the treatment, opt for a policy that does not include it.

Copayment

A copayment, or copay, is a fixed amount you pay for a covered healthcare service at the time of receiving the service before the deductible has been met. It is mostly applicable to network hospitals. The amount may vary according to the visit or procedure. 

Network

A network refers to a group of healthcare providers, hospitals, and facilities that have contracted with an insurance company to provide cashless services.

Out-of-network 

Out-of-network refers to providers and facilities that do not have a contract with your insurance company, making them ineligible for cashless claims. However, a reimbursement claim can be filed with your provider.

Top-Up Plan

A top-up plan is an additional health insurance policy that provides coverage beyond the sum insured by the primary health insurance plan. It supplements the existing coverage and comes into play when medical expenses exceed the limit of the primary plan. Top-up plans help to enhance the existing coverage without purchasing a new comprehensive policy.

Inclusion

Inclusion refers to the medical services, treatments, and conditions covered by a health insurance policy. It specifies the extent of coverage and what benefits a policyholder can avail of under the insurance plan. Inclusions can vary from one policy to another, so it’s important to review the policy documents to understand the coverage details.

Exclusion

Exclusion refers to medical services, treatments, or conditions not covered by a health insurance policy. These exclusions can vary depending on the policy and may include certain pre-existing conditions, cosmetic procedures, experimental treatments, and non-medical expenses. Understanding the exclusions is crucial to avoiding any surprises when filing a claim.

While this list is not exhaustive, familiarizing yourself with these health insurance terms will give you a solid foundation for understanding the basics of health insurance coverage. If you have any questions or need further clarification, feel free to call/WhatsApp +91-96433-96433. By being knowledgeable about health insurance terms, you can make informed decisions about your healthcare coverage and better navigate the complex world of health insurance.