Terms to Know Before Buying a Health Insurance Policy
22 June, 2023
16 Shares
539 Reads
Share
When investing in any insurance plan, it is essential to get familiar with some of the terms most commonly associated with it. This way, you can stay on top of the benefits you are set to receive and will not end up being overwhelmed by all the paperwork. Even when buying health insurance for children, who are dependants; the responsibility is left with you to cater to all their needs.
While it may sound like a mammoth task right now, the trick is to learn some of the most common terms used in the industry. Don't know where to start? Here is our compiled list of terms that every health insurance novice/ buyer must know.
Sum Insured
One of the first things you need to decide when you buy health insurance is the "sum insured". Sum insured is the maximum coverage amount for the health cover under your medical plan. The sum insured comes into play when you are hospitalised, i.e. it is the maximum amount which your insurer will pay to the hospital. If the medical expenses/ hospital bill ismore than this amount, the remaining cost will have to be borne by you. Hence, the higher the amount, or the "cover", the higher is your premium. However, keep in mind the rising costs of healthcare when deciding on the sum insured.
Family Floater
If you are single/living alone, you will only have to buy health insurance for yourself. However, if you are married and have a family; an all-encompassing family floater health insurance plan can take care of all your family members. Typically, such a plan will cover yourself, your spouse, and children. Niva Bupa's Heartbeat plan covers up to 4 children, with the cover ranging from ₹ five lakh to ₹ One crore.
Co-Pay & Sub-Limits
When you go to buy health insurance, you will inevitably come across terms like co-pay (co-payment) and sub-limits. Policies with co-pay clauses require you to pay a part of the expenses mentioned in the hospital bill, irrespective of what the sum insured is. So, for a hospital bill of Rs 50,000, a 10% co-pay policy means you shell out Rs 5,000, and the insurer pays the remaining Rs.45,000.
Sub-limits, on the other hand, are caps on particular types of diseases/ expenses (For example: Rs.20,000 per eye sub-limit on cataract surgeries will mean the insurance company will only pay up to Rs.20,000 for cataract surgery in one eye). Most commonly used sub-limit is the room rent capping.. These are usually mentioned in your policy wordings/ Certificate of Insurance.
Top-Up Plans
With rising costs in the healthcare industry, the need for larger health insurance covers is also increasing. However, this often means higher premiums which everyone cannot afford. This is where a top-up health insurance plan comes to save the day.
These plans essentially provide higher cover age at a nominal fee as opposed to buying a separate plan.. Basically,, if costs cross the deductible limit, then that extra expense will be covered by your top-up health insurance plan. Insurance providers such as Niva Bupa offer top-up plans such as Health Recharge can take care of your higher coverage needs. Under this plan, you can avail more coverage on hospitalization expenses, hospital accommodation, day-care treatments etc.
Restoration/ Re-fill Benefit
Another term to know when you buy health insurance is the restore/re-fill/restoration benefit, which restores your coverage amount if it has been exhausted during the policy year. This feature ends up being very handy in family floater plans, where it is possible for one member to exhaust the entire sum insured due to a medical emergency.
No-Claim Bonus
One of the perks you need to know about when you buy health insurance is the no-claims bonus clause. This benefit is offered to the policyholder if they have made no claims in the previous year and lets them avail a discount on their premium or increases their sum insured for the following year. This is generally upward of 5% of the basic sum insured (the upper limit varies with different insurers).
Pre-existing Diseases
When getting a new health insurance plan, any "pre-existing disease ", i.e. a disease you are suffering from before buying the policy, usually needs to be disclosed. This occurs as the insurer would usually have a waiting period ) for such illnesses and will not be able to cover you for those illnesses immediately. They may also come under "exclusions" of the policy which are provided to you at the time of buying the policy.
Portability
If you are unhappy with your current health insurance provider, you would probably want a different one. However, if you buy a new health insurance plan from another insurer, you may stand to lose benefits such as the waiting period served and no claim bonus attained, and have to start all over again. To avoid this, you can "port" or transfer your health insurance to the new insurance provider wherein all your waiting period credits and no claim bonus are considered if the new insurer accepts your proposal for insurance.
Health insurance can end up being tricky work for many if they aren't vigilant consumers. So take an active interest in this investment and make sure you know what is up for grabs so that you are never left in the lurch again.
Secure your Health with comprehensive insurance plans from Niva Bupa
Popular Searches - Health Insurance | Medical Insurance | Best Health Insurance Plans | Health Insurance Plans | Health Insurance Policy | Best Health Insurance Plans | Best Family Health Insurance | Best Mediclaim Policy | Best Health Insurance In India | Best Medical Insurance In India | Best Health Insurance Plans In India | Best Health Insurance Policy In India | Mediclaim | Best Health Insurance For Senior Citizens In India | Best Health Insurance | Health Insurance With Opd Cover | Mediclaim Insurance | Medical Insurance Plans | Best Health Insurance Company in India | Critical Illness Insurance | Personal Accident Insurance | Mediclaim Policy | Individual Health Insurance | Pregnancy Insurance | Maternity Insurance | | Best Family Health Insurance plans in India | Best Health Insurance company | Family Health Insurance | Best Health Insurance plans for Senior Citizens | Mediclaim Policy for Family
Health Insurance Schemes - Chief Ministers Comprehensive Health Insurance Scheme | Employee State Insurance Scheme | Swasthya Sathi Scheme | Pradhan Mantri Matru Vandana Yojna | Government Health Insurance Scheme | Dr. YSR Aarogyasri Scheme | Pradhan Mantri Suraksha Bima Yojna | Health Insurance Deductible | West Bengal Health Scheme | Third Party Administrator | Rashtriya Swasthya Bima Yojana | In Patient Vs Out Patient Hospitalization | Mukhyamantri Chiranjeevi Yojna | Arogya Sanjeevani Health Insurance | Copay Health Insurance | Cashless Health Insurance Scheme | Mukhyamantri Amrutum Yojna
Travel Insurance Plans - Travel Insurance | International Travel Insurance | Student Travel Insurance | Travel Insurance USA | Travel Insurance Canada | Travel Insurance Thailand | Travel Insurance UK | Travel Insurance Germany | Travel Insurance Bali | Travel Insurance Vietnam | Travel Insurance Dubai | Travel Insurance Singapore | Schengen Travel Insurance
Top Hospitals - Best Hospitals in Chennai | Top Hospitals in Delhi | Best Hospitals in Gurgaon | Best Hospitals in India | Top 10 Hospitals in India | Best Hospitals in Hyderabad | Best Hospitals in Kolkata | Best cancer hospitals in Bangalore | Best cancer hospitals in Hyderabad | Best cancer hospitals in Mumbai | Best cancer hospitals in India | Top 10 cancer hospitals in India | Top 10 cancer hospital in Delhi | Multi Speciality Hospitals in Mumbai | Multi Speciality Hospitals in Chennai | Multi Speciality Hospitals in Hyderabad | Super Speciality Hospitals in Delhi | Best Liver Hospitals in Delhi | Best Liver Hospitals in India | Best Kidney Hospitals in India | Best Heart hospitals in Bangalore | Best Heart hospitals in India | Best Heart hospitals in Kolkata | Best Heart hospitals in Delhi
Others - Top Up Health Insurance Policy | Corporate Health Insurance | Health Card | Section 80d of Income Tax Act | Ayushman Bharat | Health Insurance Portability | GoActive Family Floater Plan | Health Companion Family Floater Plan | Health Premia Family Floater Plan | Health Pulse Family Floater Plan | Health Recharge Family Floater Plan | Heartbeat Family Floater Plan | Money Saver Family Floater Plan | Saral Suraksha Bima Family Floater Plan | Senior Citizen Family Floater Plan | Super Saver Family Floater Plan | Corona Kavach Family Floater Plan | Hospital Cash Insurance | Cashless Health Insurance | Health Companion Price revision | Heartbeat Price revision | ReAssure Price revision
COVID - Omicron | Coronavirus Health Insurance | Covid XE Variant | Norovirus
www.nivabupa.com
+91 11 41743397
1860-500-8888
14th Floor, Capital Cyberscape, Sector 59, Gurgaon
- Insurance is a subject matter of solicitation. Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited) (IRDAI Registration Number 145, Category:Health), 'Bupa' and 'HEARTBEAT' logo are registered trademarks of their respective owners and are being used by Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited) under license. CIN: U66000DL2008PLC182918
- 1 Niva Bupa processes pre-authorisation requests within 30 minutes for all active policies, subject to receiving all documents and information(s) up to Niva Bupa’s satisfaction. The above commitment does not include pre-authorisation settlement at the time of discharge or system outage.
- 2 Since Inception refers to claim data from 2010 till December 2023.
- 3 ReAssure 2.0 Premium: The premium is including taxes and for Bronze Variant, for a 25-year-old individual living in Delhi.
- 4 Aspire Premium: The premium is including taxes and for Gold+ Variant, for a 25-year-old individual living in Delhi.
- 5 Senior First Premium: The premium is including taxes and for Gold Variant, for a 65-year-old individual living in Delhi.
- 6 Health Premia Premium: The premium is including taxes and for Silver Variant, for a 25-year-old individual living in Delhi.
- 7 SmartHealth + Disease Management Premium: The premium is including taxes and for Disease Management Gold Variant rider when bought with ReAssure 2.0 Bronze variant with Base Sum Insured of 5 lacs, for a 25-year-old individual living in Delhi.
- Beware of spurious / fraud phone calls! Do not share your confidential information like Debit / credit card number, Internet Banking User ID/Password, Pin, CVV, OTP, etc. with anyone. Avoid clicking on attachments / payment link received in mails / message from unknown sources. IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment or premium. Public receiving such phone calls are requested to lodge a police complaint. Do not respond to unsolicited and attractive offers received through unidentified calls, emails, SMSs, and other social media platforms. Beware of misleading telephone calls from people posing as Niva Bupa officials, agents, IRDAI Officials, Officials from ECI (Office of the Executive Council of Insurers) etc. and offering alluring benefits or sharing false information on your policy or on Niva Bupa. Niva Bupa shall not be responsible for any loss or damages whatsoever for any acts or omissions arising out of such spurious calls, and all customers are advised to contact our customer care at 1860-500-8888 and verify any representations or promises made by any such spurious callers before acting upon the same.