Navigating the world of health insurance can be overwhelming, especially with the plethora of specialised terms used in policies. To help you make informed decisions about your health coverage, it’s crucial to familiarise yourself with some key terms that frequently come up. Understanding these terms not only aids in choosing the right policy but also ensures that you’re well-prepared for any medical expenses that might arise.

Here are 10 must-know health insurance terminologies that every policyholder in India should understand.

1. Premium: The amount you pay for your health insurance policy, typically on a monthly or annual basis.
2. Sum Insured: The maximum amount that your insurance company will pay for covered medical expenses during a policy period.
3. Deductible: The amount you need to pay out-of-pocket before your insurance starts covering expenses.
4. Co-payment: The percentage of the claim amount that you need to pay from your own pocket, while the insurer covers the remaining portion.
5. Cashless Facility: A service provided by the insurance company that allows you to get treatment at network hospitals without paying at the time of discharge. The insurer settles the bill directly with the hospital.
6. Network Hospitals: Hospitals that have a tie-up with the insurance company to provide cashless treatment.
7. Pre-existing Conditions: Medical conditions that you have before purchasing the insurance policy. Some policies have waiting periods for coverage of these conditions.
8. Waiting Period: The period during which certain benefits or coverage are not available, often applicable for pre-existing conditions or specific treatments.
9. No Claim Bonus (NCB): A reward given by the insurance company for not making any claims during a policy year. It can be in the form of a discount on the premium or an increase in the sum insured.
10. Exclusions: Specific conditions or treatments that are not covered by the policy. It’s crucial to read the policy document to understand these exclusions.

By familiarising yourself with these essential health insurance terms, you’re better equipped to navigate the complexities of insurance policies and make choices that best suit your needs. Whether you’re selecting a new policy or reviewing an existing one, understanding these terms helps you avoid surprises and ensures that you get the most out of your coverage. Always remember to read the fine print and consult with insurance experts if needed to clarify any doubts.