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Common Health Insurance Terms and Definitions

Health insurance is a great tool to protect yourself and your family against unexpected medical emergencies. The COVID-19 pandemic has only served to highlight the importance of having a health insurance plan. Before buying a health insurance policy, it’s important to know and understand the different terminologies used in your plan’s terms and conditions document. In this article, we have explained some of the most important health insurance terms to help you make an informed decision.  

Important Health Insurance Terms You Must Know

Here is a list of health insurance key terms that can help you decide which insurance policy to buy:

  • Premiums: When you buy a health insurance policy, you have to pay a specific sum of money at regular intervals to keep your insurance policy active. You can choose different intervals to pay your premiums such as monthly or yearly payments. Health insurance premiums can go up and down depending on various factors.

  • Deductible: Deductible refers to the percentage of the money that you will have to spend on medical expenses. For example, if you have an insurance policy with a 10% deductible, you will have to pay 10% of all your medical expenses and the rest will be covered by your insurance provider.

  • Claim: A health insurance claim is a financial benefit you receive from your insurance policy regarding medical treatment and expenses.

  • Floater Plan: A family floater plan is an insurance policy where all family members are covered under one single insurance policy. Under a family floater policy, a specific sum is insured which can be used any number of times by any family member, until the maximum insured value has reached its limit.

  • Pre-existing Conditions: Pre-existing conditions refers to any disease, injury or illness you may be suffering from, before getting your insurance policy. Pre-existing conditions such as heart disease, diabetes, etc, increase your insurance premiums

  • Waiting Period: The waiting period in health insurance refers to an initial period after buying health insurance when the insurance company is not liable to pay for any medical expenses arising out of pre-existing conditions.

  • Claim Settlement Ratio: Claim settlement ratio refers to the percentage of claims that an insurance company settles within a period term compared to the total number of claims that the company receives. A higher claim settlement ratio means your claims have a higher chance of being approved.

  • Cashless Claim Facility: A cashless claim is a health insurance benefit wherein, the insurance company pays the amount directly to the hospital in case of medical treatment or emergency. However, you can get treated only in the specified range of network hospitals that are authorised by your insurance company. Finserv MARKETS offers health insurance with cashless facilities across 6000+ network hospitals.

  • Cumulative Bonus: When you do not claim any money from your health insurance during a policy year, you get the cumulative bonus (CB) benefit. The CB amount increases your sum assured for the next policy year. A cumulative bonus could range anywhere between 5% to 10%.

  • Domiciliary Hospitalisation: Domiciliary Hospitalisation refers to the treatment of the insured patient at home instead of a hospital. Most health insurance policies will cover you under domiciliary hospitalisation. However, this can only be processed if recommended by your doctor.

  • Exclusions: Exclusions refer to certain conditions, treatments, diseases and other medical illnesses that are not covered by your health insurance policy. When buying a policy, you should ensure that your policy has as few exclusions as possible.

  • Complimentary Health Check-Ups: Most health insurance companies provide free yearly health check-ups to the policyholders. Make sure you utilise these free health check-ups so that any dormant health condition is revealed.

  • Critical Illness: Critical illness refers to any disease or medical condition which is life-threatening and requires an intensive amount of medical care. You can get coverage for critical care by buying the critical care riders.

  • Free Look Period: A free look period is the span of 15-30 days after buying the health insurance policy when the policyholder can return the policy without any conditions and get a refund. However, not all insurance policies have a free look period.

  • Sum Assured: Sum assured refers to the maximum amount of money that the policyholder is eligible to receive under the insurance policy. For instance, a sum assured of ₹10 lakh means that a policyholder can get a maximum of ₹10 lakh as compensation against their medical expenses.

Rising Need for Health Insurance

The costs of healthcare and good medical treatments have gone up exponentially over the past few years. Extended stays in the hospital or even minor surgeries can result in a medical bill that can significantly deplete your finances. The medical costs can be effectively covered by having a good health insurance policy in such a situation. Here are the main reasons you should get a health insurance plan:

  • Financial Coverage: The most important advantage of having health insurance is its financial coverage against unexpected medical emergencies.

  • Peace of Mind: When you have a health insurance policy, you can rest assured that you will be covered against any unexpected costs that arise out of medical expenses.

  • Tax Benefits: Buying health insurance also provides tax benefits. The premiums that you pay for your health insurance policy are eligible for Tax Deductions under Section 80D of the Income Tax Act.


These health insurance terms will be very helpful when you set out to buy a health insurance policy. Buying health insurance online has become an easy and hassle-free way to choose the perfect health policy as per your requirements. You can take a look at the various health insurance policies available at Finserv MARKETS and choose a plan that fits your needs.

Best Health Insurance Plans Available at Bajaj MARKETS

Frequently Asked Questions

  • ✔️How do I find affordable health insurance?

    You should take a look at all the different health insurance options available online and choose a plan that fits your budget.

  • ✔️How many claims are allowed in health insurance?

    You can make as many claims under your health insurance policy as long as your sum assured is not depleted. Once your sum assured is fully used up, you cannot make any more claims.

  • ✔️Can health insurance be claimed twice?

    You can have two health insurance policies, but cannot claim the same medical expenses on both policies.

  • ✔️Can I claim health insurance every year?

    You can claim health insurance every year, but it might increase your premiums.

  • ✔️Does health insurance take effect immediately?

    There is usually a small period after buying health insurance when you will not be eligible for any coverage for a few days. You should read your policy document to determine this period for your particular insurance plan.  

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