Understanding Health Insurance Terms and Conditions

Terms and Conditions of Health Insurance

Living a healthy life requires knowing the lingo of health insurance terms and conditions.

health insurance terms, conditions

Key terms in health insurance:

Assignee: The person who is entitled to benefits under the policy.

Claim: The request for reimbursement of medical costs made to the insurance company by the covered person.

Co-payment: A co-payment is an obligatory cost-sharing sum under health insurance coverage. The policyholder agrees to pay a co-payment, or a percentage of the hospital bill, as stipulated by the insurance terms. After that, the insurer sets a reduced rate. It’s important to keep in mind that the insured amount remains unchanged and is not reduced in these circumstances. This kind of coverage is more likely to be included in a senior health insurance plan.

Cumulative Bonus: There is a similarity between the NCB (No Claim Bonus) and cumulative bonus. The coverage increases by a specific percentage for each year that passes without a claim; this increase is only permitted if the policy is continuously renewed and is subject to the maximum.

Deductible: A reduced premium is obtained with a larger deductible amount. A deductible is a part of a health insurance coverage that has to be paid out of pocket. It can be a fixed amount of money or a percentage of the claim amount. The insurance provider is released from paying that fixed or proportionate amount of the insured costs by virtue of this clause. The agreed-upon deductible amount must be paid by the insured to the hospital.

Dependents: Spouse and/or unmarried children (natural, adopted, or stepchildren) of the insured person.

Exclusions: Circumstances or states in which the policy provides no coverage.

The grace period is the allotted fifteen days that begin to run immediately following the premium payment deadline. During this period, payments for insurance renewals or continuations may be made without compromising continuity advantages such as waiting periods and coverage for pre-existing illnesses. However, coverage will not be available after the due date. Therefore, it’s imperative to keep up with health insurance renewals whenever the premium is due. Health insurance coverage have waiting periods that range from 12 to 48 months, depending on the ailment. The continuity benefits are lost if the insurance is not renewed, not even during the grace period.

The insurer, or insurance provider.

Long-term care insurance refers to policies that offer particular services for a predetermined period of time. These services frequently include nursing care, home health care, and household care.

health insurance terms, conditions

Long-term Disability Insurance: The company will return a portion of the insured’s monthly wage if the insured becomes unable or disabled.

Premium: The predetermined monthly sum that an insured person has to pay in order to get insurance benefits.

Policy: There is a legally enforceable agreement between the insured and the insurer. It contains the terms of the insurance.

Pre-existing disease: A pre-existing disease is any illness, injury, or related condition(s) for which the insured received medical advice or treatment within 48 months of the insurer’s first policy issue, experienced symptoms, or received a diagnosis. It is advised to inform the insurer of any pre-existing diseases and any current drugs, if any, even though the insurance will cover them after a certain period of time. If the information is kept secret, the insurance provider can deny the claim. Pre-existing conditions are now often covered by many health plans, provided that the policy is continuously renewed with the same insurer and remains claim-free for the whole four-year period.

A network is a group of physicians, hospitals, and other healthcare facilities that are mandated by the insurance to treat covered patients at a discounted rate.

The sum insured is the amount that, in the case of an occurrence, the insurance company must pay the insured. It uses the indemnity principle to function. The company will have to pay Rs. 2 lakh towards the claim, for instance, if the hospitalization costs are Rs. 2 lakh and the health insurance amount covered is Rs. 3 lakh.

Waiting period: The length of time following the acquisition of a new health insurance policy during which the policyholder is not entitled to some policy benefits. Typically, some of the policy’s special benefits don’t kick in until after a predetermined period of time from the start date. For example, pre-existing conditions may have a 4-year waiting period.

Disclaimer: Liberty General Insurance provides you with health insurance coverage based on your needs. But before you apply, please make sure you read the policy language thoroughly. Click this link for additional details.

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