As the cost of healthcare services continues to rise owing to inflation, it is reasonable to expect an increase in the number of individuals obtaining health insurance online and offline in the coming days. To ensure you stay healthy, health insurance can help in making sure you get the medical treatment at the right time without the financial worry looming over your head.
However, if you are buying health insurance in Kerala for the first time, it may become confusing for first-timers looking at the different health insurance plans due to the terminology they use. It is preferable to be aware of such terms in advance so that you are not deceived when purchasing the coverage. In this post, we have explained some of the most-used health insurance terms.
#1 Sum Insured: The term “sum insured” refers to the amount of money that the insurance company will pay in case of an unfortunate event for which you have taken the health insurance plans. This is the maximum amount that your insurance company is required to pay when you file a claim. Any expenses that exceed the coverage amount must be met by the policyholder. The premium you will pay for your health insurance in Kerala policy will be generally determined by the level of coverage you have chosen.
#2 Nominee: In the event that the policyholder dies, the nominee is the one who will file the claim for reimbursement if the claim isn’t cashless. If the claim is for reimbursement, all proceedings will be delivered to the nominee. A beneficiary is the deceased’s legal heir, whereas a nominee is responsible for administering or transferring the insurance funds to the beneficiary.
#3 Deductible: A deductible is just a small percentage of the claim amount that the policyholder is responsible for paying. In the event of a cashless claim, the deductible amount must be paid beforehand; in the case of a reimbursement claim, the deductible amount is deducted from the ultimate claim amount. The objective behind a deductible amount is to encourage people to avoid filing claims for minor incidents.
#4 Pre-existing Disease: A pre-existing disease is a condition that the policyholder had prior to purchasing health insurance plans. Diabetes, cataracts, high blood pressure, and asthma are examples of common pre-existing disorders. All pre-existing illnesses must be declared to the insurance company. Thus, if the insurer permits it, one can also obtain coverage for a pre-existing sickness.
#5 Waiting Period: This is the time when a policyholder cannot file a claim. A waiting time is typically applied to pre-existing conditions, maternity benefits, and so on. A waiting period might last from a few months to several years. As a result, it is recommended that you purchase health insurance plans as early as possible in life.
#6 Maternity Benefit: Pregnancy-related expenses are known as maternity benefits. This might include prenatal and postnatal fees, as well as infant medical insurance coverage. Most health insurance plans require a waiting time for maternity benefits, which can range from 9 to 48 months. Thus, new husband and wife should purchase maternity health insurance in Kerala as soon as feasible.
#7 TPA: TPA stands for Third Party Administrator; they are specialized organizations that coordinate and manage health insurance in Kerala claims and other associated services. To start the claim procedure, a policyholder must contact the TPA (who is normally present on the hospital premises). TPAs serve as a link between the insured and the insurers.
#8 Inclusions: Inclusions/coverage refers to the circumstances under which a policyholder may make a claim. One should choose insurance, taking into account the availability of coverage. Common health insurance coverage includes bed costs, doctor visits, nurse expenses, and so on.
#9 Exclusion: There are instances for which your health insurance policy does not provide coverage. These scenarios are specifically stated in health insurance policies. When a claim is filed against exclusions, the insurance company is within their right to reject the claim.
#10: Family Floater, Group Health Insurance, Individual Plan: There are several sorts of health insurance coverage accessible in India. Let’s see what each of these words means.
Family floater plan: As the name implies, this plan may be purchased by members of a family linked by blood or law. The money insured is divided by all family members. These proposals are not very comprehensive in scope.
Employee medical insurance: It is an excellent example of a group health insurance plan. The money insured is not always split among the participants. Each member of a group health insurance plan may be assigned a certain sum insured.
Individual Plans: These plans are comprehensive and may be customized to meet the needs of a single policyholder. The money insured is intended solely for the policyholder.
#11: Automatic Restoration: Nowadays, most health insurance plans provide a restoration benefit’. You receive a ‘financial backup’ to reclaim your sum insured amount. If the whole sum covered is consumed, it is immediately reloaded for the following hospitalization within the insurance period.
#12: Copayment: Some health insurance plans in Kerala policies include a copayment or co-pay provision. It is a set amount of the fees that the insured/policyholder must pay to the insurance company prior to obtaining healthcare services. It is stated in the terms of the policy that those over the age of 60 must pay a 20% co-pay at the time of claim for each medical treatment received.
#13: No-claim-bonus: Health insurers provide a unique concept known as the No-Claim Bonus (NCB), in which the policyholder is compensated for not submitting a claim in previous years. Policyholders can get a no-claim discount ranging from 20 to 100 percent by not filing a health claim.
#14: Critical Illness: Life-threatening medical problems include cancer, renal failure, and cardiovascular disease. There are certain medical insurance policies that cover these conditions. Alternatively, you may purchase a rider or add-on cover.
So, we are saying,
While there are other jargon in health insurance, the aforementioned are the ones that you should be aware of since they can impact your decision to buy a health insurance policy. It would be beneficial to learn more about them rather than purchasing insurance without a thorough understanding of the phrases. You can contact an insurance agent to learn more about them.
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