Decoding The Health Insurance Jargon 

Looking at purchasing a medical insurance policy and having a problem understanding the terms and conditions? Worry not, read on to find an answer. There are some terms that are very commonly used in the insurance domain and knowing such terms can help you better understand your health insurance policy. 

Co-payment 

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This is an arrangement wherein you as a policyholder must pay a part of the healthcare treatment on your own while the rest of the amount is borne by the insurance company. The percentage of the amount that must be paid by you i.e., the policyholder might differ based on your medical conditions and age. Co-payment generally ranges anywhere between 10 and 30 percent in health insurance policy plans. 

Pre Hospitalization  

Pre-hospitalization charges are healthcare expenditures incurred before being admitted to a hospital or nursing home. There are distinct healthcare tests you as a policyholder might require to undergo before being hospitalized. These are performed to diagnose your medical condition. Most policies even may cover such charges incurred by you for up to thirty days before admission to a hospital. 

Post hospitalization 

This involves all the charges and expenditures incurred by the policyholder post being discharged from the hospital. Such expenditures include medical tests, doctor’s consultations, medicines, fees, and others. In most health insurances, post-hospitalization expenditures are covered by insurance companies for up to sixty days from the discharge date from the hospital. 

Reimbursements 

Reimbursement claims are done if you want to go for any non-impanelled hospital. For such reimbursements, you as a policyholder must spend your money on the treatment and then file for a claim to get reimbursement from the insurance company after being discharged from the nursing home or hospital. Such claims can be performed by providing original bills, medical certificates, claim forms, etc. 

Domicillary hospitalisation

It is a scenario when a policyholder is considered hospitalized for undergoing treatment at home. It may happen owing to the unavailability of beds in a hospital or the medical condition of the patient may be so poor that he/she cannot be admitted to a hospital. The insurance company may consider such hospitalization when the treatment tends to last for at least 2-3 days. 

Room rent capping 

Room rent capping is the imposed limit on insurance coverage onboarding or room renting expenses of a hospital. This limit is generally expressed in the form of a percentage of the insured amount and at times even as an absolute amount. Such monetary limit is generally given on a per-day basis and is regardless of the amount insured. Any charge levied on room rent over the capped amount must be borne by you i.e., the insured individual. 

NCB (no claim bonus)

No claim bonus refers to the additional fund added to your sum assured on every claim-free year. This may be looked upon as a reward that you as a policyholder get for not claiming your Mediclaim policy in the specific year. The rate by which the insured amount enhances differs anywhere from 5 to 60 percent depending on you i.e., the insured. 

Day care treatment 

With the rise in technology and medical science, specific treatments and surgeries now can be done within a day, which previously required a lengthy hospitalization. All the treatment processes that are done within a day of hospitalization are considered daycare treatment. Such procedures involve chemotherapy, dialysis, radiation, lithotripsy, cataract, tonsillectomy, etc. In most scenarios, daycare treatment is allowed for up to the amount assured as coverage. 

Top-up plan 

This offers additional coverage to your bought health insurance policy, which is over the current limit available at a lower premium. Under normal health policy, there can be scenarios when healthcare expenditures surpass the sum assured in your medical insurance policy, here’s where a top-up medical plan comes to your rescue.  

Super top-up

A top-up tends to come to your rescue when a specific threshold limit on your regular insurance policy is surpassed on a single hospitalisation. Super top-up insurance allows multiple claims over a threshold limit. 

Restoration benefits

This is an advantage where the insurer can restore the assured sum in case it is completely exhausted before the illness treatment. So, even if you as a policyholder exhaust the whole assured amount, you can restore the whole fund and you can use the same in the future. 

Assignee 

This is the individual who gets medical insurance policy-associated benefits. 

Claim 

This is the request for payment filed by the insured to the insurer for making payment of the medical treatments and expenditures. 

Co-payment

This is the cost-sharing requirement available under health insurance. In specific scenarios, you as a policyholder must agree on bearing a specific per cent of the hospital bill’s amount, according to the policy’s condition, which is addressed as co-payment. In doing this, the insurer levies a lesser premium. It is crucial to note that the amount insured in such scenarios stays the same and isn’t reduced. Such a feature most likely is available in senior citizens’ medical insurance policies. 

Cumulative bonus 

This bonus is the same as NCB or no claim bonus. For each claim-free year, a sum insured is enhanced by a specific percent as per the policy’s terms and conditions. However, such increments cannot surpass over 50 percent of the sum insured and are just admissible if the insurance policy is constantly renewed. 

Deductible 

The higher the deductible amount, the lesser would be the premium. Deductible refers to the cost-sharing need under a policy, which may be a fixed percentage. As per this provision, the insurer is not liable to make payment of the percentage or fixed amount of the expenses covered. It basically is the liability of the policyholder to make payment of the deductible to the hospital or nursing home. 

Dependents 

Unmarried children, parents, and a spouse of the insured are addressed as dependents. So, dependents are basically the family members who depend on the earning member of the family.