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Key Terms Used In Health Insurance Policy

Published On Feb 01, 2022

Health insurance provides coverage of an insured person's healthcare expenses. The policyholder may pay out-of-pocket and later be reimbursed, or the insurance company might reimburse costs immediately, depending on the terms of the policy. Health insurance is a form of policy that covers an user's medical and surgical costs. It covers the insured person's care provider directly or reimburses expenditures as an outcome of illness or injury.

A comprehensive health insurance plan covers you in the event of injuries, illnesses, or medical emergencies. It pays for your medical bills according to the coverage and the total insured amount you choose. In India, purchasing health insurance policies is not required. However, given the increasing relevance of medical insurance during the pandemic and the rising costs of healthcare, a medical insurance plan has become a necessity in recent years. To know more about the key terms used in health insurance policy, read on.

Key Terms Used In Health Insurance Policy

Key Terms Used In Health Insurance Policy

Following are the key terms used in health insurance policy -

1. ASSIGNEE - The individual who receives the policy's benefits.

2. CLAIM - The payment request for Medical Expenses submitted by the covered individual to the insurance company.

3. CO-PAYMENT - A health insurance policy's co-payment is a cost-sharing obligation. Co-payment is a term used to describe when a policyholder agrees to pay a particular proportion of the hospital bill in accordance with the terms of the policy. As a result, the insurance charges a lower premium. It's vital to remember that in such circumstances, the sum insured stays unchanged and is not lowered. A senior citizen health insurance plan is more likely to provide this benefit.

4. CUMULATIVE BONUS - NCB is comparable to cumulative bonus (No Claim Bonus). The amount insured rises by a predetermined percentage based on the policy, but it cannot exceed 50% of the Main Sum Insured and is only available if the policy has been renewed continually.

5. DEDUCTIBLE - A health insurance policy's deductible is a cost-sharing obligation that might be a set sum or a percentage of the claim amount. The insurance company will not be responsible to pay for that set or percentage amount of the insured expenditures under this clause. The policyholder is responsible for paying the hospital the agreed-upon deductible sum.

6. DEPENDANTS - The insured's spouse and/or unmarried children (whether biological, adopted, or stepchildren).

7. EXCLUSIONS - Conditions or conditions for which the policy will not provide coverage.

8. GRACE PERIOD - The 15-day period that begins immediately after the due date for premium payment has passed. During this time, payments may be paid to renew or prolong a policy without sacrificing continuity advantages like waiting periods and pre-existing condition coverage. However, coverage would not be accessible for the period after the due date has passed. As a result, it's critical to continuously renew your health insurance when the payment is due. Depending on the illness, health insurance policies include waiting periods ranging from 12 to 48 months. When an insurance is not renewed during the grace period, the continuity advantages are lost.

9. INSURER - The respective insurance company

10. LONG TERM CARE POLICY - Insurance plans that cover a certain set of services for a set amount of time. Nursing care, home health care, and custodial care are common examples of such services.

11. LONG TERM DISABILITY INSURANCE - If the insured becomes incapable or disabled, the employer pays a part of his monthly salary.

12. PREMIUM - To receive the insurance coverage benefit, an insured must pay a set sum on a regular basis.

13. POLICY - It's a legally binding agreement between the insurer and the insured. It provides the insurance's terms and conditions.


To protect yourself and your family from financial responsibilities coming from medical bills, you should get the finest health insurance plan in India that includes hospitalisation charges and coronavirus expenses.

Also read - Will Health Insurance Policies Cover Omicron Variant?

How To Make Health Insurance Policies Omicron Ready?

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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