In-house Claim Settlement | Quick Turnaround | Cashless Facility at 6000+ Hospitals
In recent times, insurance companies have simplified how you can buy health insurance policies. In fact, many insurance providers offer health insurance online, and the process requires minimal documentation. However, despite the simplified methods, people find it challenging to understand the common jargons used in a mediclaim policy. And we are here to help you with just that.
Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.
The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918
Let this glossary page be your go-to article for understanding the commonly used insurance terms.
The person who is skilled in the field of mathematics and statistics is known as an actuary. They are well-versed in analyzing the risks involved with an insurance cover. With their in-depth understanding of the financial system, they can calculate insurance premiums (much like a health insurance calculator tool online).
Add-on benefits are also known as rider covers and are additional insurance coverages that can be purchased with the underlying health insurance plan. Some of the common add-on benefits include personal accident cover, critical illness cover, restoration of the sum insured, air ambulance cover, and more.
An agent is a professional that acts as a bridge between the health insurance policyholder and the insurance company. They sell the plan on behalf of the insurance company and charge a commission for the intended sale.
Any non-allopathic treatment is considered as alternative medicine. Some conventional treatments involve acupressure treatment, magnetic therapy, aromatherapy, and naturopathy. Many insurance companies do not extend coverage to alternative treatment. Thus, it is wise to confirm with your insurance provider before purchasing the policy.
All insurance companies state an amount that they can reimburse in case of medical expenses incurred by the individual. However, the amount charged by the hospital can be either less or more than the amount allowed. Most network hospitals will consider the allowed amount when charging the patient.
It is a measure used by insurance companies for indicating the number of inpatient hospitalizations per 1000 persons covered under a specific health insurance plan.
Your insurance policy will include the list of extended health insurance benefits under your primary insurance plan.
The balance billing is nothing but the process of billing the insurance provider up to the specified limit under your plan and invoice the remaining amount under your name.
Cashless health insurance is provided at the network hospitals by certain insurance providers. So, if you are admitted to any of the network hospitals, the treatment is conducted without spending money out of your pocket. The bill is covered by the insurance provider directly.
It is the total medical expense incurred by the patient. Based on your policy, the claim amount can include daycare treatment expenses, pre and post hospitalization bills, domiciliary expenses, etc.
Health insurance co-payment, as the name suggests, is the portion of the claim that you require to pay. For instance, your policy may require seniors to copay 10% of the claim amount. In this case, 90% of the amount will be reimbursed by your insurance provider.
It is the bonus amount provided by the insurer for not making any claim during the policy term. Many insurance companies offer a cumulative bonus of 5-10% every claim-free year.
Deductibles are the amount that you have to pay during every claim year. Some health insurance plans have voluntary as well as involuntary deductibles. Let's say for instance that the deductible limit mentioned in your health plan is Rs. 3 Lakh. You get hospitalized for an illness and the bill amounts to Rs.20 Lakh. In this case, you'll have to pay Rs. 3 Lakh from your own pocket & the remaining amount of Rs. 17 Lakh will be covered by the health plan.
It refers to the family members of the primary insured individual who are not financially independent. Generally, dependents are spouses, children and parents.
It is the set of conditions that an individual must meet before applying for a health insurance policy.
Like we mentioned earlier, health insurance is now available online by different insurance providers. In case you are confused about which policy to purchase, then it’s recommended that you compare different health policies online and choose one that best suits your needs.
Then, get in touch with us at Finserv MARKETS. With health insurance plans available on our platform, you can benefit from features like quick claim settlements, plenty of insurance solutions, extensive coverage facilities, and much Why choose anyone else? Apply for Health Insurance on Finserv MARKETS, today!