Terms commonly used in Health Insurance Policy [Infographics]

Health Insurance is must to have cover for everyone but the complexities of the product are good enough to give headache to even Einstein of our time. Most of you will be having group health insurance from your employer but let me tell you there are n number of limitations in such polices. To avoid any rude shock read terms & conditions of your policy.

This infographics may help you to understand the common terms that you will find in the health insurance policy document (some time in small font) or the product presentation circulated by your employer. If you would like to ask something specific, feel free to add your question in comment section.  

Terms commonly used in Health Insurance Policy

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{ 13 comments… add one }
  • anil koul October 8, 2012, 6:48 PM

    Dear hemantjee-kudoos to ur hard-work for general-good,one thing “TOP-UP” term has been missed out-which means client will get claim above basic amount (say 3 or 5 lakhs) whatever opted for-but in single hospitalization or disease. Duductible gives cover in policy calender year-whereas top-up provides for per hospitalization.
    wishing you & TFL all the Best..

  • Mamta October 10, 2012, 1:08 PM

    Hi Hemant

    The Definition you posted for Co-Payment is actually Co-Insurance.

    Co-Payment is :- A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

    Co-Insurance – Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

    Thanks,
    Mamta

  • Rohan October 11, 2012, 9:00 PM

    Hi Hemant,
    I have a medical insurance from my employer. I read your optima restore medical insurance post. Last month, i bought it. Now i have 2 medical insurance policy. But i didn’t declare my employer medical policy deatil in optima restore praposal form. Agent told me that no need to declare your employer medical policy, we don’t consider it. Now, I think that it’s important factor. Can they reject my claim in future? what should i do now?

    • vinod joshi October 20, 2012, 11:44 AM

      It always beneficial to policy holder to declare the facts. Now you still inform your earlier insurance co. about new mediclaim policy.

    • Vikas December 25, 2012, 8:53 PM

      Hi Rohan,

      To avoid any dissatisfaction during claim you should inform the company about your other policies. Companies do consider it when claim is given.

  • B.S.Khatri October 25, 2012, 11:24 AM

    Hi hemant!
    Thanking you very much for spreading awareness among we people who do not know much about some ticklish financial matters. I am having two sons aged 18 and 14 years, I intend to take a health insurance plan for both of them. Is there any composite policy covering both the sons by paying single premium or I have to take 2 independent policies. Please suggest any good policy for them to provide them life time health cover with reasonable premium.
    With regards
    B.S.khatri

    • Vikas December 25, 2012, 8:49 PM

      Dear Mr.B.K.Khatri,

      You can consider a floater policy if individual premium prove to be costly.But since they will get married in future and will have their own families, its wise to have individual policies.

      You can consider Apollo Munich.

  • mebin October 26, 2012, 7:45 PM

    Respected sir, i have some doubts that,
    1.whether we can trust the private insurance companies,
    2.Is there any chances for those private companies to stop functioning and loss money of the investors?
    3. if such losses occurs whether IRDA is responsible for that?
    4.Is there any chances for private companies to reject claims purposefully?
    kindly please answer for my doubts, as i being a person who is planning to take a Term Policy with low premium..Thankyou

    • Ashwin November 16, 2012, 12:29 PM

      Mobin,
      All insurance companies are governed by IRDA. To answer your questions,
      1. Check the claim ratios of all the companies (which you have shortlisted) and then move forward. When you say “Trust” what you mean?
      2. There are chances, in that case, you have “Portability” where in you can transfer to another insurer.
      3. No. IRDA is a regulator, not Insurer.
      4. They cannot do it “purposefully”. You can dispute if you think its not against the rules. Unless you have not disclosed existing conditions and not claiming something that is not included, the claim process should be straight forward. Note that the Insurance companies have their own network of doctors who verify your claims.

    • Vikas December 25, 2012, 9:02 PM

      Hi Mebin,

      Private companies are well governed by IRDA regulation which even stipulates what risk premium to be kept aside for every policy issued. Also, no ocmpany can reject a claim purposefully and since life insurance falls under Indian Contract Act, insurance companies are bound to pay the claims much like a policyholder is bound to pay the premium for receiving policy benefits.The rejections happens if any company founds some information is supressed or other reasons.
      So you should go ahead and buy th epolicy.

  • Kailash Dhyani February 4, 2013, 3:25 PM

    Dear Sir,
    I want to buy a health insuranc policy but i am very confused to choose because there are a lot companies in the market which is better today. This is very difficult fot a common person. Sir I want family plan 2 or 3 lac aprox for me and spouse with maternity facility. Please suggest me which plan should i buy from in the following-
    Apollo Munich
    Religare Health Care
    Star Health Insurance
    LIC Health Protection
    Reliance General Insurance

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