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10 Health Insurance Jargons Explained


While evaluating health insurance policies, one would certainly come across various jargons which could cause confusion. Rather than purchasing an insurance policy by being unsure about certain jargons, it is better to clarify one’s doubts. Here are 10 must know health insurance terms:

  1. Insurer and insured:

    Insurer is the company which sells life or non-life insurance policies. The insurer bears the risk of fulfilling claims in exchange to receiving a premium from the insured. Insured is an entity, which can be either a person or an organization who pays a premium to secure financial protection against loss or damage to life, health or assets due to predefined perils. For example: if Mr Ram is purchasing a comprehensive health insurance policy from Bharti AXA Life Insurance, then Ram is insured and Bharti AXA Life Insurance is the insurer.

  2. Waiting Period:

    Waiting period is a period which you need to let go to unlock or activate certain/any benefits of your health insurance policy.

  3. Co-Payment:

    Co-payment is a provision where a person who opted for health insurance shares the cost of medical expenses with the insurer. The ratio of sharing usually varies from 70:30 to 90:10, with the larger portion being paid by the insurer and the smaller one by the insured. For example: If the co-pay ratio is 70:30 and cost of medical expenses is Rs 50,000, then the insurer would pay Rs 35,000 and remaining Rs 15,000 would be borne by the insured.

  4. Coverage:

    Coverage is the amount of risk covered for an individual or entity by the insurer. For example, if your health insurance policy offers coverage of Rs 5 lakhs, then you can claim up to that amount when the need arises.

  5. Rider:

    Rider is nothing but an additional benefit which you can buy by paying an additional premium. Riders are optional and not compulsory, it's up to you to choose it or not.

  6. Group Insurance:

    Health Insurance offered to the group of people without any medical examination is group insurance. This is typically issued to the companies, where employers insure his employees. And issues membership cards to them which are valid till their continued employment.

  7. Out-of-Pocket Medical Expenses:

    Expenses which you need to pay from your own pocket for any medical care agreed in the co-payment ratio. When you hear the term “annual out-of-pocket maximum” in a health insurance plan, then it’s nothing but the highest amount you have to pay (excluding policy premiums) for the calendar year.

  8. Exclusions:

    Exclusions are those specific conditions for which coverage is not provided to you under the health insurance policy.

  9. Beneficiary:

    When an insured person passes away, the beneficiary received the death benefit. The beneficiary is nominated by the insured. For example, consider that you have purchased a term insurance policy that offers a death benefit of Rs 50 lakhs to the beneficiary in the case of your unfortunate demise. If you have nominated your wife as the beneficiary she would receive this payout.

  10. Pre-existing Conditions & Maturity Date:

    Pre-existing condition is nothing but the existing medical condition of the insured before taking the health insurance policy. Depending upon the nature of the condition the insurer decides to exclude or include from the coverage. Exclusion can be for the period of 1 to 2 years. Pre-existing conditions usually affect the amount of premium and ends up increasing it.

The above list does not cover all the terms of health insurance policies. But these are the most common terms you will come across while looking for the health insurance policies.

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