Simplifying Health Insurance Jargons

Confused about terms such as copayment, deductible, sum insured in your health insurance policy? Don’t worry we are here to clear your doubts

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While shopping may be considered therapeutic and relaxing, a lot of us might not associate the same emotions with health insurance purchases. This is because many of us don’t understand terms that are used in our health insurance policies. We are here to help in order to make your health insurance buying journey more simple and fun. Here are some common health insurance terms simplified for you.

Copayment

This is an out of pocket expense which you pay every time you avail yourself of a healthcare service. The co-pay is a fixed percentage. For instance, if the co-pay in your health insurance policy is 15 per cent, on every claim made, you will pay a minimum of 15% of the total amount claimed, even as your health insurance provider pays its share.

Deductible

Deductible can be easily mistaken for co-payment, however there are differences between the two terms. While co-payment is a fixed percentage that you are required to pay every time you make a claim, deductible is a fixed amount that you need to pay each time you make a claim. The health insurance provider will pay you only after you have paid the deductible amount. Let us understand this better with the help of an example. If your deductible is INR 15000, and you make a claim for 30000, your insurance provider will pay you 15000—after subtracting the deductible amount. On the other hand, if your make a claim less than your deductible, say INR10000 in this case, your health insurance provider will not pay you any claims.

Sum Insured

Sum insured is the maximum amount your health insurance provider will pay you in the event of any hospitalization. For example, if the sum insured on your health insurance policy is INR15 lakh, and your hospital bill runs into INR23 lakh, your health insurance provider will only pay INR15 lakh and the balance amount of INR8 lakh will have to be borne by you.

Portability

If you are not satisfied with your current health insurance provider, you can choose to port your health insurance policy from your current health insurance provider to another while retaining all the benefits collected on your policy. This is known as portability. For instance, you can use the credit gained for any pre-existing illnesses. Portability can also be used to switch from one health policy to another while staying with the same health insurance provider.

Free Look Period

Have you ever bought something and then decided soon after that you don’t like it? No matter how careful we are while spending our money we have all made at least one buying decision that we have regretted later. This could also apply to health insurance policies. After buying a health insurance policy have you ever decided that you are not satisfied with the terms and conditions of your policy, but unfortunately there’s nothing you can do about it? Actually, you can. The free look period allows you to return your policy within 15 days of purchase.

Pre-existing Conditions

pre-existing condition is any ailment/disease that you were diagnosed with or sought treatment for 48 months before the first policy provided by your health insurance company. Your health insurance policy also covers pre-existing illnesses, however you might have to wait a certain period before your health insurance provider starts paying you claims for any pre-existing conditions.

Waiting Period

Waiting period is the duration that you are required to wait before your health insurance provider starts paying you claims for certain conditions. The standard waiting period for pre-existing illnesses is usually four years. After the waiting period has lapsed, the health insurance provider cannot reject claims related to the condition which is related to waiting period.


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Trade Logo displayed above belongs to Dewan Housing Finance Corporation Limited and used by DHFL General Insurance Limited with modification under license.
Coco (By DHFL General Insurance) is the Trademark used by DHFL General Insurance for its digital platform.