The coverage features, benefits and terms and conditions of insurance plans contain technical concepts which, if not understood properly, can lead to disputes and hassles at the time of claims. Health insurance plans are no different. They also contain technical jargons which confuses most of you. You should know the important terms of health plans to know the exact coverage offered and the conditions applicable in the plan.
To simplify your health insurance policy, here are ten of the most important terms which you should know about.
- Specific treatments and diseases
Medical insurance plans list some specific illnesses and treatments for which coverage is available after a specified duration. For instance, in many plans, coverage for piles, fistula, hernia, etc. is available only after the first 2 policy years. These ailments are called specific diseases.
- Pre-existing waiting period
These ailments are covered by the health insurance policy only after a specific duration. This duration is called pre-existing waiting period and it ranges from one year to six years depending on the health insurance plan.
If the insured member is a senior citizen aged 61 years and above, health plans have a co-payment clause. This clause states that a specific proportion of the claim would be paid by the policyholder. The specific portion which is payable by the policyholder is called the co-payment ratio and it usually ranges from 10% to 25%.
- No claim bonus
Medical insurance plans are usually annual plans. After the completion of the policy period, if there has been no claim, the plan offers a no claim bonus. This bonus is allowed as an increase in the sum insured or a premium discount depending on the plan’s feature.
- Room rent sub-limit
In some health insurance plans, there is a limit on the room rent which is expressed as a percentage of the sum insured. This limit specifies that the maximum room rent coverage allowed under the policy. If the policyholder chooses a hospital room with a higher rent, he would have to pay for the excess claim.
- Day care treatments
Coverage for day care treatments is available in health plans. Day care treatments mean those treatments which do not require a hospital stay for 24 hours. Due to medically advanced technology, such treatments are completed in a few hours after which the insured is discharged.
- Inclusions and Exclusions
Your policy’s coverage is governed by what is included and excluded. You must ave total clarity about the inclusions and exclusions of your policy before purchasing it in order to avoid any shocks during the claim settlement process.
- Alternative treatments
Alternative treatments are non-allopathic treatments like Ayurveda, Unani, Siddha and Homeopathy. Many health plans allow such non-allopathic treatments to be covered up to a specified limit.
- Medical second opinion
In some health plans cover is allowed for medical second opinion. This cover means that in case of a critical illness, you can avail a free second opinion from the insurance company’s empaneled doctors.
- Add-on covers
Add-on covers are optional coverage features which are available in health plans for increasing the scope of coverage. You can choose any add-on which you want. Every add-on cover requires an additional premium which is added to the premium of the base policy if you choose the add-on.
So, these are some of the important terms associated with health insurance plans. You should know these terms before buying health plans so that you don’t face any confusion regarding the policy coverage and claim process.
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