Health Insurance

Co-Pay: Co-pay is the share in the claim that you would be required to pay each time there is a claim. For eg: If your policy has a 20% co-pay. You will have to bear 20% of the bill every time there is a claim

Room rent limit: Across many policies, insurers apply a “room rent limit” which not only restricts the type of room you may have but also the associated medical expenses like surgeon fees

Sub-limits: It is the cap or maximum amount that insurer can reimburse under health insurance cover. For eg: Room Rent limit: In certain polices insurer caps the room rent limit to Rs. 4000.

Pre-existing Disease: If a person suffers from any PED, the insurer will not cover any illness related to that disease for a specified no of years which is called a waiting period. In the waiting period, any claims arising out of that disease will NOT be paid by the insurer.

No claim Bonus: Suppose in a year you don’t make any claim, then the insurer rewards you with a No claim bonus by increasing your insured value. The quantum of increase is pre-defined and can be from 10-50%. Similarly, the insurer downgrades the bonus in case of a claim.

Restoration of the sum insured: A policy can offer multiple reinstatements of the sum insured in case of claims for multiple diseases. For eg: The 10L policy is there, if you claim for 5L for disease A, the Insured sum available is reset to 10L in case the claim is for disease B.

Critical Illness: This policy covers critical diseases such as Cancer, Heart attack.

Free Look up Period: The Insured will be allowed a period of at least 15 days from the date of receipt of the policy to review the terms and conditions of the policy and to return the same if not acceptable.

Top Up: A top-up plan is an add on which offers additional coverage when the basic health insurance plan is exhausted.

Cashless Facility: Under an insurance policy offering cashless facility, a policyholder can take treatment in any of the network hospitals without having to pay the hospital bills as the payment is made to the hospital directly by the TPA, on behalf of the insurance company.