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Health Insurance Glossary: Learn Terms and Terminologies

Team AckoOct 30, 2025

Buying or updating a health insurance policy can feel confusing, especially with all the complex terms and jargon involved. That’s where this Health Insurance Glossary comes in, it breaks down key terms in simple language so you can understand your policy better and choose one that truly suits your needs. As healthcare costs continue to rise, having health insurance is more important than ever. But to make the most of your cover, it helps to know what terms like sum insured, deductible, and co-payment really mean. Once you’re familiar with these basics, you’ll find it much easier to compare plans and make confident decisions about your health cover.

Glossary

Contents

Glossary of Health Insurance in India: Terminologies Explained (A to Z Definitions)
- List of Basic Glossary Terms and Terminologies Used in Health Insurance:
A
- Age Limit
- Agent
- Accident
- Any One Illness
- AYUSH Treatment
- Ambulance Cover
- Accumulation Period
- Automatic Restoration
- Add-on Policy
- Advanced Technology Methods
- Air Ambulance Cover
- Annual Aggregate Limit
- Annual Renewal Date
- Artery Embolization Coverage
- Assistance Service Provider
- AYUSH Day Care Centre
B
- Benefit
- Bodily Injury
- Broker
- Balloon Sinuplasty Coverage
- Bariatric Surgery
- Basic Sum Insured
- Beneficiary
- Break in Policy
- Bronchial Thermoplasty Coverage
C
- Cashless Facility/Hospitalization
- Claim
- Claim Settlement Ratio
- Co-Pay or Co-Payment
- Comorbidities/Pre-Existing Diseases
- Critical Illness
- Cashless Claims/Treatment
- Cumulative Bonus
- Convalescence Benefit
- Certificate of insurance
- Chronic Condition
- Claim ID
- Claim Adjudication
- Claim Buffer
- Claim intimation
- Claim Scrutiny
- Claim settlement
- Congenital Anomaly
- Copay Waiver
- Coverage
D
- Deductible
- Dependents
- Daily Hospital Cash
- Domiciliary Hospitalization
- Deductible Waiver
- Deep Brain Stimulation Coverage
- Discharge Summary
- Disclosure of Information
- Disease-specific waiting period
- Disease-wise capping
E
- Eligibility
- Emergency Care
- Emergency Hospitalization
- Endorsement
- Ex-Gratia Payment
- Exclusions
F
- First Diagnosis
- Family Floater Policies
- Free Look Period
- Final Bill
- Fraud
G
- Grace Period
H
- Hospitalisation
- Home Nursing
- Health Assistance Services
- Hospital Daily Cash Allowance
I
- Illness
- Insurer
- Insured/Insured Person
- ICU Charge or Room Rent
- Individual Health Insurance
- IRDAI
- In-Patient Treatment
- Initial Waiting Period
- Inpatient Care
- Inpatient Hospitalisation
- Installment Premium
- Internal Claim Audit
- International Second Opinion
L
- Long-Term Care Policy
- Lapsed Policy
- Limit of Coverage
M
- Maternity Cover
- Medical Concierge Services
- Medically Necessary Treatment
- Migration
- Moral Hazard
- Moratorium Period
N
- Network Provider/Hospital
- Non-Network Provider/Hospital
- Nominee
- No Claim Bonus (NCB)
O
- Out-Patient Department (OPD)/Treatment
- Out of pocket expenses
P
- Primary Insured
- Policy Period
- Premium
- Pre and Post-Hospitalization Expenses
- Portability
- Private Room
- Personal Accident Cover
- Policy Schedule
- Policyholder
- Pre Authorisation
- Premium Freeze
- Premium Payback
- Primary Insured
- Proposal Form
- Proposer
R
- Renewal
- Reimbursement
- Restoration Benefit
- Room Rent
- Risk pooling
S
- Sum Insured
- Survival Period
- Sub-Limit
- Shared Accommodation Cash Benefit
- Shortfall Letter
- Stem Cell Therapy Coverage
T
- Third-Party Administrator (TPA)
- Terminal Illness
- Top-up Plans
U
- Utilisation Ratio in Health Insurance
W
- Waiting Period
- War and nuclear attacks
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Glossary of Health Insurance in India: Terminologies Explained (A to Z Definitions)

Mentioned below are common health insurance terms used in India along with their explanation.

List of Basic Glossary Terms and Terminologies Used in Health Insurance:

A

Age Limit

The age at which a person is allowed to apply for a health insurance plan or renew a policy.

Agent

Persons who act as a link between the insurance company and the customers. They help customers to understand the features and benefits of a plan as well as renew the policy or raise a claim against the policy.

Accident

An unforeseen, sudden and involuntary event that causes financial loss to the policyholder.

Any One Illness

A continuous period of a specific illness that relapses within 45 days from the last date of consultation with the respective hospital or nursing home.

AYUSH Treatment

The full form of AYUSH is Ayurveda, Yoga, Unani, Siddha and Homeopathy (referred to as alternative medicine treatment). Some health insurance policies provide coverage for such treatments.

Ambulance Cover

Coverage of ambulance charges for transportation to the hospital.

Accumulation Period

A period during which any medical expenses incurred by the policyholder will be adjusted towards applicable health insurance deductible. Only after the deductible is satisfied, the insurer will begin covering the medical costs of the policyholder and the beneficiaries.

Automatic Restoration

Some policies provide the benefit of the restoration of the sum insured in case it is exhausted. It gets automatically restored for the next hospitalization.

Add-on Policy

An Add-on Policy helps you increase the existing health insurance with extra benefits like room rent upgrade or coverage for non-medical expenses. You can customise your plan based on your needs with an add-on policy.

Advanced Technology Methods

Advanced Technology Methods include modern medical treatments such as robotic surgery or laser therapy. These help in faster recovery with less side effects. Many health insurance plans cover these advanced medical procedures to give you access to the best healthcare in India.

Air Ambulance Cover

Air Ambulance Cover pays for emergency air transportation when you need medical evacuation. It’s useful if you live in remote areas or face a life-threatening emergency. With this cover, you can reach the right hospital in time without worrying about travel costs.

Annual Aggregate Limit

The Annual Aggregate Limit is the total amount your insurer will pay for all claims in one policy year. After you cross this limit, you need to bear additional expenses.

Annual Renewal Date

Your Annual Renewal Date is the date on which your health insurance policy expires. Renewing on or before this date keeps your coverage active. It’s also the time to review and update your policy as per your changing healthcare needs.

Artery Embolization Coverage

Artery Embolization Coverage refers to health insurance coverage that pays for a procedure that helps remove blockages from arteries. It comes under advanced treatment coverage of comprehensive health plans.

Assistance Service Provider

An Assistance Service Provider act as a bridge between you and the insurance company during emergencies. Having them ensures a smoother claim and support experience.

AYUSH Day Care Centre

An AYUSH Day Care Centre offers treatments under Ayurveda, Yoga, Unani, Siddha, or Homeopathy. These centres provide alternative care without the need for 24-hour hospitalisation. Many modern insurers now include AYUSH treatments to promote holistic health.

B

Benefit

Any benefit declared in the Policy Schedule or Certificate of Insurance is referred to as ‘Benefit’.

Bodily Injury

Refers to the physical injury caused to the beneficiary’s body such as cuts, bruises, abrasions, etc.

Broker

It refers to the person or company who forms the link between the insurer and the policyholder. Unlike an agent, a broker is not employed by the insurer.

Balloon Sinuplasty Coverage

Balloon Sinuplasty Coverage refers to the costs for minimally invasive sinus treatments using balloon catheters. It helps relieve chronic sinus issues without major surgery. This procedure comes under modern treatment coverage.

Bariatric Surgery

Bariatric Surgery in health insurance refers to weight-loss surgery for people with severe obesity. It’s often covered if recommended by a doctor and after completing a waiting period. This benefit helps manage obesity-related health risks effectively.

Basic Sum Insured

Your Basic Sum Insured is the main amount that your insurer will pay towards medical expenses during the policy tenure. Choosing the right sum insured ensures that you are sufficiently covered against hospital bills.

Beneficiary

A Beneficiary is the person who receives the policy benefits in case of the insured’s death or claim approval. They are nominated by the policyholder. Naming a beneficiary makes sure that the loved ones get the intended financial protection.

Break in Policy

A Break in Policy occurs if the policy is not renewed in time. During this period, you lose benefits like continuity of waiting periods. Always renew on time to keep your coverage seamless.

Bronchial Thermoplasty Coverage

Bronchial Thermoplasty Coverage pays for advanced asthma treatment where controlled heat reduces the thickness of the airway muscle. It helps patients with severe asthma breathe easier. This procedure is covered under advanced procedure benefits.

C

Cashless Facility/Hospitalization

A facility provided by the insurer to the insured where the payment of the medical bills is directly paid by the insurer to the network provider or hospital.

Claim

A formal request by the insured to the insurance company asking for the payment or compensation of the medical costs based on the benefits of the insurance policy.

Claim Settlement Ratio

A metric for gauging an insurance company’s ability to settle health insurance claims against the number of health insurance claims it receives during an entire financial year. It also includes any pending claims from the previous year.

Co-Pay or Co-Payment

A cost-sharing agreement between the insurance company and the policyholder. It states that the policyholder will bear a part of the claim amount.

Also, read: Copay in Health Insurance

Comorbidities/Pre-Existing Diseases

When two or more illnesses or diseases coexist in a patient or additional conditions or diseases often co-occurring with a primary condition are known as comorbidities.

Critical Illness

Refers to an illness, disease or sickness that is critical. Examples of critical illnesses are kidney failure, cancer, heart attack, bypass surgery, etc. Some insurers offer add-ons on critical illnesses along with the standard health insurance plans.

Cashless Claims/Treatment

A hassle-free and paperless method of payment of medical bills to the network hospital. The insurer will settle the claim or medical bills directly with the hospital or third-party administrator. This process of claim is referred to as cashless claims since the policyholder does not have to pay the bill except mentioned in the terms and conditions.

Cumulative Bonus

Refers to the bonus provided by the insurer to the policyholder for not raising a claim during the policy period. The bonus can be between 5% to 10% and can go up to 50% of the sum insured.

Also, read; Cumulative Bonus in health insurance

Convalescence Benefit

A cash benefit to the policyholder during the recovery period in the hospital. This is provided in case the patient needs to stay in the hospital for a prolonged period of time. It is offered in the form of a lump-sum payment that is pre-defined in the policy schedule.

Certificate of insurance

A Certificate of Insurance is proof that you’re covered under a specific policy. It includes details like your policy number, coverage amount, and validity. It’s often shared digitally or as a document after purchase.

Chronic Condition

A Chronic Condition is a long-term illness like diabetes, hypertension, or arthritis that requires regular care. Such conditions are usually covered after a waiting period. Managing chronic conditions early can reduce long-term healthcare costs.

Claim ID

A Claim ID is a unique number assigned to each claim you raise with your insurer. It helps track the status of your claim easily online or through customer care. Keep it handy until your claim is fully settled.

Claim Adjudication

Claim Adjudication is the process where your insurer reviews your claim documents and decides whether to approve or reject the claim. It ensures fairness and accuracy in every settlement. The process usually includes medical and policy verification steps.

Claim Buffer

A Claim Buffer in Group Health Insurance is an extra fund set aside by the employer to pay claims that go beyond an employee’s sum insured. It acts as a safety net for large or unexpected medical expenses. This ensures employees get support even in high-cost treatments.

Claim intimation

Claim Intimation is the first step of letting your insurer know that you’ll be making a claim. It’s usually done before a planned hospitalisation or immediately after an emergency one. Quick intimation helps your insurer process the claim faster.

Claim Scrutiny

Claim Scrutiny is when your insurer reviews all the claim documents, bills, and reports to verify their accuracy. It ensures only valid and genuine claims are approved. This step protects both the insurer and policyholders from errors or fraud.

Claim settlement

Claim Settlement is the process where your insurer pays or reimburses hospital bills after verifying your claim. It can be cashless or reimbursement-based, depending on where you get treated. A smooth settlement process shows how reliable your insurer is.

Congenital Anomaly

A Congenital Anomaly is a physical or functional defect present from birth. Some health insurance policies cover these conditions after a waiting period. It’s always good to check if your plan includes congenital conditions.

Copay Waiver

A Copay Waiver means you don’t need to pay any part of the hospital bill from your pocket during a claim. The insurer covers the entire amount. It’s a great add-on if you want zero cost-sharing on medical expenses.

Coverage

Your Coverage defines what medical treatments, conditions, and expenses your health insurance plan will pay for. The wider the coverage, the more financial protection you get. Always review the coverage section to know what’s included and excluded.

D

Deductible

A fixed amount that the policyholder has to pay every year to raise a claim against the policy. For example, if the deductible is Rs. 20,000, the insurer will cover your medical expenses after you bear the cost of the medical bill of up to Rs. 20,000.

Dependents

Dependents can be any family members for whom the policyholder is willing to assume medical coverage. Dependents include spouse, children and parents/parents-in-law.

Daily Hospital Cash

A benefit offered in some of the insurance policies that provide a fixed cash payment to the policyholder for each day of hospitalization. It is a cash benefit for meeting additional expenses otherwise not covered by the health insurance or for compensating the loss of income during the hospitalization period. You can purchase it as an add-on or bundle it with the standard plan.

Domiciliary Hospitalization

Medical treatment received by the policyholder at their home is referred to as domiciliary hospitalization.

Deductible Waiver

A Deductible Waiver removes the amount you’d otherwise have to pay before your insurance cover starts. It means your insurer begins paying from the first rupee of your claim. It’s useful for people who don’t want any out-of-pocket expenses.

Deep Brain Stimulation Coverage

Deep Brain Stimulation Coverage includes costs for neurological treatments that use electrodes implanted in the brain. It’s mainly used to manage disorders like Parkinson’s disease. Some comprehensive health plans cover this advanced procedure.

Discharge Summary

A Discharge Summary is a hospital-issued document that details your diagnosis, treatment, and medications given during your stay. It’s required for filing reimbursement claims. Keep it safe, it’s proof of your hospitalisation.

Disclosure of Information

Disclosure of Information means sharing all your medical history and lifestyle details honestly when buying health insurance. Hiding facts can lead to claim rejection later. Always be transparent to ensure smooth claim approvals.

Disease-specific waiting period

A Disease-specific Waiting Period is the time you must wait before certain listed conditions are covered under your policy. For example, hernia or cataract might have a 2-year waiting period. Knowing these helps you plan medical expenses better.

Disease-wise capping

Disease-wise Capping limits how much you can claim for specific illnesses or procedures. For instance, a ₹50,000 cap on cataract surgery means the insurer won’t pay beyond that. Always check this before finalising your policy.

E

Eligibility

It means the required conditions or criteria that the person should qualify to apply for a health insurance policy.

Emergency Care

Emergency Care covers treatment for sudden, life-threatening conditions like heart attacks or accidents. It ensures you get medical attention immediately without worrying about costs. Most plans cover this benefit from day one.

Emergency Hospitalization

Emergency Hospitalisation happens when you need to be admitted urgently due to a medical emergency. You or your family should inform the insurer as soon as possible for quick claim processing. Cashless admission is usually available at network hospitals.

Endorsement

An Endorsement is an official change made to your policy details after purchase, like adding a new member or updating your address. It ensures your policy stays accurate and up to date. Always confirm endorsements in writing from your insurer.

Ex-Gratia Payment

An Ex-Gratia Payment is a goodwill gesture from the insurer, where they approve a claim even though it doesn’t strictly meet policy terms. It’s done at the company’s discretion and not guaranteed. Such payments reflect a customer-first approach.

Exclusions

Exclusions are medical conditions, treatments, or expenses that your policy doesn’t cover. Common exclusions include cosmetic surgery or injuries from war. Reading this section helps avoid surprises at claim time.

F

First Diagnosis

The first recorded medical diagnosis of an illness or disease or condition is referred to as “First Diagnosis”.

Family Floater Policies

A single health insurance policy that covers more than one beneficiary is referred to as a Family Floater Policies. It typically includes the policyholder and their dependents such as spouse, children and parents/parents-in-law.

Free Look Period

A free look period is a period of time in which a policyholder can terminate the policy without penalties. Insurers provide this feature without any penalties and the period can range up to 30 days.

Final Bill

The Final Bill is the complete hospital bill you receive at discharge, listing all treatment, room, and medicine costs. It’s an important document for reimbursement claims. Always review it carefully to ensure all charges are accurate.

Fraud

Fraud in health insurance means intentionally giving false information or using fake documents to get a claim approved. It’s a serious offence and can lead to policy cancellation. Being honest ensures a smooth and hassle-free claim process.

G

Grace Period

A special or extended period after the expiry of the due date to pay the renewal premium of the plan. During this period, until the policy is renewed, there is no health insurance coverage; however, the existing policy benefits remain active. Typically, the grace period can vary between 15 and 30 days.

H

Hospitalisation

Hospitalisation means being admitted to a hospital for more than 24 hours to get medical treatment. It covers doctor visits, room charges, and treatment costs. Most health insurance claims are based on hospitalisation events.

Home Nursing

A nursing speciality in which nurses provide home care to patients who have undergone treatment in a hospital. The services are provided after the recommendation of the medical practitioner and specialist.

Health Assistance Services

Health Assistance Services include support like doctor consultations, hospital arrangements, or emergency medical help. These services make your healthcare journey smoother and stress-free. Many insurers offer them 24×7 for your convenience.

Hospital Daily Cash Allowance

Hospital Daily Cash Allowance gives you a fixed amount for every day you’re hospitalised. It helps cover non-medical costs like food or travel for attendants. This benefit offers extra financial comfort during recovery.

I

Illness

It means sickness or a pathological condition or disease leading to the disruption of the normal physiological functions and requires medical treatment.

Acute Condition: An illness or injury that responds quickly to treatment which leads to full recovery.

Chronic Condition: A disease or illness or injury that needs long-term or ongoing treatment, relief from symptoms or requires rehabilitation or is recurring is referred to as a chronic condition.

Insurer

The insurance provider that takes care of financial assistance for the medical treatment of the policyholder and its beneficiaries.

Insured/Insured Person

The beneficiary of the insurance policy and/or the dependent family members named in the policy schedule is known as the insured or the insured person.

ICU Charge or Room Rent

The charge for the use of the Intensive Care Unit room by the policyholder or the beneficiary of the policy.

Individual Health Insurance

A health insurance policy that covers a single individual for planned and unplanned hospitalization.

IRDAI

The full form of IRDAI is the Insurance Regulatory and Development Authority of India, which is the apex body or the regulator of the insurance sector or industry in India.

In-Patient Treatment

In-Patient Treatment refers to medical care received while admitted to a hospital. It includes surgery, nursing, and medication during your stay. This is one of the core coverages in most health insurance plans.

Initial Waiting Period

The Initial Waiting Period is the short duration right after buying a policy when you can’t raise non-emergency claims. It usually lasts 30 days from the start date. Only accident-related hospitalisations are covered during this period.

Inpatient Care

Inpatient Care covers treatments that require at least one night of hospital stay. It includes room rent, medicines, and diagnostic tests. Most comprehensive policies provide full coverage for inpatient care.

Inpatient Hospitalisation

Inpatient Hospitalisation is when a patient stays in a hospital for continuous medical treatment. It usually involves surgeries or critical care that can’t be done on an outpatient basis. Health insurance covers the costs associated with such stays.

Installment Premium

An Installment Premium allows you to pay your health insurance premium in parts, monthly, quarterly, or half-yearly. It makes premium payments easier to manage. This flexibility ensures continuous coverage without financial strain.

Internal Claim Audit

An Internal Claim Audit is a quality check done by insurers to ensure claims are processed fairly and accurately. It helps detect errors or fraudulent claims. Regular audits build trust and maintain transparency.

International Second Opinion

International Second Opinion lets you consult global medical experts about a diagnosis or treatment plan. It helps you make informed healthcare decisions. Some premium health plans include this service for major illnesses.

L

Long-Term Care Policy

A policy that covers specified treatment for a specified duration such as nursing care, home nursing and custodial care is referred to as a long-term policy.

Lapsed Policy

A Lapsed Policy means your health insurance has expired because the renewal wasn’t done on time. During this period, you lose your coverage and benefits. Renewing promptly avoids the hassle of fresh waiting periods.

Limit of Coverage

Your Limit of Coverage is the maximum financial protection your health plan offers during a policy term. Once you hit this limit, you’ll need to pay further costs out of pocket. It’s wise to choose a limit that matches your healthcare needs.

M

Maternity Cover

The insured can avail of financial assistance for the medical expenses incurred on child delivery. It includes coverage for medical expenses related to child delivery (normal and cesarean), pre and post-natal costs, etc.

Medical Concierge Services

Medical Concierge Services provide personalised help for your medical needs, such as doctor appointments, hospital transfers, or pharmacy deliveries. They’re like a one-stop support system during health emergencies. This service adds convenience and care to your insurance experience.

Medically Necessary Treatment

A Medically Necessary Treatment is a procedure or care recommended by a doctor to treat an illness or injury. Insurers cover only such necessary treatments, not optional or cosmetic ones. It ensures that claims are made for genuine health needs.

Migration

Migration means moving from one health insurance plan to another within the same insurer. It helps you switch to better benefits while keeping your existing policy continuity. You don’t lose waiting period credits when you migrate properly.

Moral Hazard

Moral Hazard refers to risky behaviour by a policyholder because they know their insurer will pay for damages. For example, skipping precautions because you have full coverage. Insurers manage this risk through co-pays and deductibles.

Moratorium Period

The moratorium period is a fixed time (usually 8 years) after which your insurer cannot reject claims on non-fraudulent grounds. It’s a safeguard for policyholders who have maintained their policy continuously. In short, your policy becomes stronger over time.

N

Network Provider/Hospital

A hospital or nursing home or healthcare provider listed by the insurance company to provide medical treatment to the insured through the cashless facility or hospitalisation is called a network hospital.

Non-Network Provider/Hospital

A hospital or nursing home or healthcare provider not listed by the insurance company or is not part of the insurer’s network of hospitals is called a non-network hospital.

Nominee

A person nominated by the primary policyholder to receive the benefits of the policy based on the terms and conditions of the policy.

No Claim Bonus (NCB)

The NCB is a benefit or discount provided by the insurance company to the policyholder for not raising any claims during the period. This bonus is offered in the form of a higher sum insured for the same premium amount.

O

Out-Patient Department (OPD)/Treatment

A treatment that requires less than 24 hours and does not require hospitalization is referred to as out-patient treatment. The person receiving the treatment is known as out-patient, and the department providing this service is known as the out-patient department or OPD.

Out of pocket expenses

Out-of-pocket expenses are the costs you pay yourself, like co-pays, deductibles, or uncovered treatments. These aren’t reimbursed by your insurer. Choosing a plan with fewer out-of-pocket costs keeps your budget safe during emergencies.

P

Primary Insured

The person applying for the insurance policy and pays the premium for the coverage is known as the primary insured.

Policy Period

The time frame between the commencement date and the expiration date of the insurance policy is known as the policy period.

Premium

An amount the policyholder pays to the insurance company to avail of health insurance coverage. Typically, the premium is paid on an annual basis.

Pre and Post-Hospitalization Expenses

Medical expenses arising before and after the hospitalization of the insured person are known as pre and post-hospital expenses.

Portability

The process of transferring the health insurance policy from one health insurance company to another or from one plan to another is known as portability.

Private Room

It means a single occupancy room in a private hospital.

Personal Accident Cover

A fixed benefit plan that offers a one-time payment of the amount specified in case of accidental death or disability is called a Personal Accident Cover. It does not cover medical costs incurred by the insured but pays a lump sum amount to the policyholder.

Policy Schedule

The policy schedule is your policy’s summary, it lists your coverage, exclusions, and premium details. You’ll find it attached to your policy document. Keep it handy for quick reference while filing claims.

Policyholder

A policyholder is the person who buys and owns the health insurance policy. They’re responsible for paying premiums and managing the plan. The policyholder can insure themselves and their family members.

Pre Authorisation

Pre-authorisation is the insurer’s approval process for planned hospitalisation under cashless claims. It helps you confirm what’s covered before treatment begins. This makes the hospital billing process faster and stress-free.

Premium Freeze

A premium freeze feature allows you to lock your premium amount for future renewals. It helps protect you from rising insurance costs each year. Not all plans offer it, so check before you buy.

Premium Payback

Premium payback means you get a portion or all of your paid premiums back if no claims are made. It’s like a reward for staying healthy. Some plans offer it as a bonus or no-claim benefit.

Primary Insured

The primary insured is the main person covered under a health insurance plan, especially in family floater policies. Other members are covered as dependents. Claims are usually filed under the primary insured’s name.

Proposal Form

A proposal form is the application you fill when buying health insurance. It includes personal, medical, and nominee details. Providing accurate info here ensures smooth claim approvals later.

Proposer

The proposer is the person who pays for and owns the policy, even if they’re not the one insured. For example, a parent can be the proposer for their child’s policy.

R

Renewal

An act of extending the period of validity of the health insurance policy for another period by paying the required premium on or before the renewal date.

Reimbursement

When the policyholder avails medical treatment at a non-network hospital, they can recover the medical expenses by requesting the insurance company to reimburse the costs. This process of settling claims by the insurer is known as reimbursement claims.

Restoration Benefit

In case the sum insured is exhausted, through the benefit, the insurer will recharge or re-fill the sum insured.

Room Rent

A charge towards the use of the room in the hospital or nursing home. Usually, there is a cap on the room rent specified in the policy schedule.

Risk pooling

Risk pooling is how insurers manage risk, by collecting premiums from many people to pay for the few who need treatment. It keeps health insurance affordable for everyone.

S

Sum Insured

The maximum payable amount specified in the insurance policy. The policyholder cannot raise a claim over and above the sum insured. The premium of the policy is calculated based on the sum insured.

Survival Period

A period during which the policyholder or beneficiary of the insurance policy should survive after they are diagnosed with a covered sickness, condition or illness is called survival period.

Sub-Limit

An additional limit set by the insurance company for specific medical care. The treatment of such illnesses cannot exceed the specified sub-limit. Sub-limits are typically placed on room rent, doctor’s consultation fee, ambulance charges and pre-planned medical treatments such as cataract operation, plastic surgery, etc.

Shared Accommodation Cash Benefit

The shared accommodation cash benefit rewards you for choosing a shared hospital room instead of a private one. You get a small daily cash payout for each day of hospitalisation.

Shortfall Letter

A shortfall letter is a note from your insurer asking for more documents or details to process your claim. Don’t panic, it just means they need extra proof. Send what’s needed quickly to avoid delays.

Stem Cell Therapy Coverage

Stem cell therapy coverage includes treatments using stem cells to repair or replace damaged tissues. It’s often available under advanced or experimental coverage options. Always check if your plan includes it

T

Third-Party Administrator (TPA)

Those authorized by the insurance provider to offer administrative services to customers or policyholders are referred to as Third-Party Administrator or TPA. Their primary role is to process claims, settle claims, collect premiums, etc.

Terminal Illness

Those illnesses or conditions or diseases which cannot be treated or cured are known as terminal illness. Some of the examples include heart ailments, last-stage cancer, etc.

Top-up Plans

These are plans that can be bought along with the standard health insurance plan. After the sum insured of the standard plan is exhausted, the top-up plan will cover the medical costs.

U

Utilisation Ratio in Health Insurance

The utilisation ratio shows how much of your health insurance coverage you’ve used in a policy year. A lower ratio means fewer claims, which could help maintain lower premiums in the future.

W

Waiting Period

The period during which some of the benefits of the policy will not be available to the insured. Typically, this fixed period commences from the start date of the policy. Upon expiration, the insured can claim the benefits of the policy. Pre-existing diseases or conditions or illnesses have a waiting period of approximately up to 3 years depending upon the type of insurance policy.

War and nuclear attacks

Most health insurance plans exclude coverage for injuries caused by war and nuclear attacks. These are considered extreme situations beyond normal medical risk. Always read your policy exclusions carefully.

Explore More:

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