Know the Essential Terms in Health Insurance

Health is wealth. To protect this wealth, you require financial support. This support gets offered by health insurance, and to be straightforward; it can get complicated.

Health insurance gets complicated thanks to some terms or jargons that a person may not know. In this article, we have explained the meaning of some terms that you may have read but did not understand when you came across the plan. Have a look:

Nominee

A nominee is a person who will get the proceeds of the policy in case the policyholder has a demise. With regards to medical insurance, a nominee is not eligible for the proceeds in case of a cashless claim, though, all the proceedings will be sent to the nominee if it is a reimbursement plan. Do not mix up a nominee with a beneficiary. A beneficiary is the legal successor of the deceased. In contrast, a nominee will be liable for managing the proceeds of the policy to the beneficiary if they are not the same person.

Deductible

A deductible is a small part of the claim amount that is to be taken care of by the policyholder. One needs to pay the deductible amount if a cashless claim whereas this amount gets deducted from the final claim amount in case of a settlement claim. The notion of applying a deductible amount is to encourage preventing claims for smaller incidents.

Sum insured

Sum insured applies to an amount of money to be paid by the insurance provider in case of an adverse event. It is the maximum amount your insurer is responsible for paying when you file a claim. Any expenses that go beyond the amount of sum insured are to be taken care of by the policyholder. The premium of your medical insurance policy may approximately depend upon the amount of sum insured you wish to receive.

Waiting period

This is the time during which a policyholder cannot raise a claim. A waiting period gets applied to pre-existing diseases, maternity benefit, etc. It can range from a few months to a few years. Hence, it is recommended to buy a health insurance policy as early as possible.

Maternity benefit

Expenses related to pregnancy are termed as maternity benefits. It could include pre-natal, post-natal costs and medical insurance coverage for the infant. Most insurance companies apply a waiting period to avail maternity benefits that can be from 9 to 48 months. Thus, it is ideal to buy health insurance policy in India for a newly married couple as soon as possible.

Pre-existing disease

As the name implies, a pre-existing illness is a condition suffered by the policyholder before purchasing medical health insurance. Common pre-existing diseases are asthma, cataract, high blood pressure, diabetes, etc. One must declare all the pre-existing conditions truthfully to the insurance company. Consequently, if the insurer agrees, one can get coverage for a pre-existing illness too.

TPA

TPA or Third-Party Administrator, they are professional agencies that are responsible for managing health insurance claims and other related services. A policyholder must get in touch with the TPA to start with the claim process. TPA acts as a connection between the insured and the insurer.

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