' Five important Health Insurance terms you should know

Decoding Insurance Jargon: Five Important Health Insurance Terms you should knowData shows that only 21.62 crore people or 17% of the Indian population have health insurance. This is a low figure considering the sharp rise in medical costs over the recent years. People avoid buying health insurance for many reasons. One of them is the lack of information. This can be a problem if the relevant terms are shrouded in jargon. Here, we unravel the mystery surrounding a few such terms.


A co-payment clause means that you agree to pay a part of the medical expenses. The insurance company pays the rest. This helps reduce the cost of the policy. You may pay a lower premium. But before you buy, know the details. Know when and how you need to pay. Work out your real-time costs. You do not want a lesson when it is time to pay the bills.

Waiting period

A waiting period is the time before which you cannot claim coverage. Your health insurance will not reimburse you for certain ailments within this time. For instance, it is common for pre-existing ailments to have a waiting period of four years. Such pre-existing conditions may include diabetes, high blood pressure and so on. But once the waiting period is over, the insurance company must process all your claims.

Pre-existing condition

You may have an ailment even before you buy health insurance. Such ailments are pre-existing conditions in insurance parlance. It is defined as “any condition, ailment or Injury or related condition(s) for which the Insured Person had signs or symptoms, and / or were diagnosed, and / or received medical advice / treatment within 48 months prior to the first Policy issued by the Company under which he was covered,” according to Reliance Insurance.

People believe that pre-existing diseases prevent you from buying health insurance. This has been partly true for a long time. People who suffer from pre-existing ailments are more likely to seek treatment. This is a higher risk for the insurance company. Yet, health insurance plans have started to cover pre-existing ailments now. Check the waiting period for different policies if you have any pre-existing ailment. Understand how the policy responds to these issues before you choose a plan.

Reasonable charges

A reasonable charge is the rough cost of the same treatment in your geographical area. The cost of treatment for an ailment can differ from one hospital to another though. For instance, a super-specialty hospital may charge higher than a local, general hospital. So, a reasonable charge is not a specific mathematical number. It can vary based on different factors like location, type of treatment and so on. Your medical bill may exceed the insurance company’s estimate of a reasonable charge. In such a case, you may have to pay the difference out of your own pocket.

Grace period

Make timely payments to enjoy the benefits of your health insurance policy. But you may miss your payment deadline by chance. Does that mean your policy is no longer valid? No. Most policies have a 15-day window. This is the grace period. You have these 15 days to make the payment and renew your policy. You will not lose out on continuity benefits like coverage for pre-existing conditions. But your health insurance will not cover for the period between the due date and actual payment date.

Digital policy

These days everyone is connected to the internet. You connect with your friends through chatting apps; you shop online and even book tickets online. So how about buying insurance online? Many companies have started allowing people to buy health insurance policies online because it is much faster and easier. You can compare the policies offered by different companies and check for yourself which suits you the best. When you buy a policy online, it is known as an online or digital policy.

There is no difference in the benefits, rules and regulations for online and offline policies offered by a company. Only the mode of payment is different. Companies have also started offering discounts for people who buy policies online. This is consistent with the cashless journey undertaken by our country.

To sum up

Any topic can seem quite complicated when all you hear is jargon. The topic of health insurance is no exception. Understand the relevant terms. You will find it easier to choose the right health insurance policy.

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Decoding Insurance Jargon: Five Important Health Insurance Terms you should know

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