A Beginner’s Guide to Understanding Health Insurance Terms and Coverage

Breaking Down Health Insurance Jargon: A Beginner’s Overview

If you buy a health insurance policy, you will come face-to-face with several offered documents. These documents include vital information regarding your coverage, including special terms and conditions. You need to read and understand each of these points to assess the quality and extent of financial protection offered.

However, some of the health insurance terminologies can be challenging to understand. Without proper comprehension of your policy details, you can make serious mistakes. You may end up with compromised financial aid during medical emergencies.

Only when you know what these standard healthcare terms signify can hope you to make a comprehensive decision regarding choosing a healthcare provider and coverage.

Key Health Insurance Terms

You’re likely to run into a lot of complex health insurance industry jargons when you’re looking for coverage. Let’s define a few of these key terms.

Policy period

The policy period is defined as the time between the exact hour and date of policy inception and the exact hour and date of policy expiry.

Sum insured

The amount that the insurance company will pay to the policyholder in the event of an unexpected event, like an illness, accident and diseases, up to the limit opted by the insured is known as the sum insured.

Premium

To use your health insurance benefits, you must pay your insurance company a certain amount. These annual insurance-related payments are typically referred to as the premium.

Co-payment

A co-payment is a fraction of the claim amount the policyholder must pay out of pocket while the insurance company pays the remaining amount. As a result, the policyholder and the appropriate insurance company split the cost of the treatment. Make sure you understand the financial obligations a co-payment coverage places you under in the event of a medical emergency before choosing it.

Network

In-network insurance denotes the existence of contracts between an insurance provider and a group of medical professionals (e.g., doctors, hospitals, diagnostic centers, pharmacies, etc.).

Non-network

There was no agreement between the provider and the insurer. Insured has to remit the bill and submit the Original documents for reimbursement.

Pre-existing conditions

A pre-existing condition is any illness or disease the policyholder already has when purchasing health insurance.

How to Choose the Right Health Insurance Plan?

Look for adequate coverage

Choose a health plan that offers advantages like pre-hospitalization and post-hospitalization, coverage for diseases you may be more susceptible to based on your family’s medical history, etc. and protects you from unexpected medical expenses. Make sure the plan fulfils the needs of each family member if you are purchasing health insurance for your family. Select a health plan that meets your requirements consider your requirements, and evaluate plans based on benefits and pricing.

Keep it affordable

While it’s essential to get a health plan that fulfils your demands, it’s also important that it fits within your budget. When buying health insurance, a person’s budget is an essential factor. However, it would help if you considered the plan’s advantages before considering its cost. It might be safe to start with a reasonably priced health insurance policy. You can review your plan over time and enhance coverage as your income, family size, and needs change.

Choose a plan with lifetime renewability

When purchasing a health insurance policy, be cautious to verify whether it offers limited renewability or how long it will cover you. Your need for a health plan will increase as you age. Therefore, pick health insurance that offers lifetime renewability.

Compare plans online

You can compare various health insurance policies online to make sure you purchase a health plan that meets your needs. You can even request a quotation online and get an estimate of your policy’s premium. Collect the quotes and then compare them to make a decision.

Different types of health insurance plans

You could compare different health plans and choose the one that best suits your needs.

Features	Comprehensive Health Insurance	Young Star	FamilyHealth Optima	Star Women Care	Senior Citizen Red Carpet
Policy Type	Individual & Floater	Individual & Floater	Floater	Individual & Floater	Individual & Floater
Entry age	Min - 18 yrs; Max - 65 yrs	Min - 18 yrs; Max - 40 yrs	Min - 18 yrs; Max - 65 yrs	Min - 18 yrs; Max - 75 yrs	Min - 60 yrs; Max - 75 yrs
Entry age	Min - 91 days; Max - 25 yrs	Min - 91 days; Max - 25 yrs (Floater only)	Min - 16 days; Max - 25 yrs	Min - 91 days; Max - 25 yrs	Not applicable
SI options	5 Lakhs	3 Lakhs	3 Lakhs	5 lakhs	Individual - 1 Lakh; Floater - 10 Lakhs
SI options	1 crore	1 crore	25 Lakhs	1 crore	Individual - 7.5 Lakhs; Floater - 25 Lakhs
Maximum family size	2A+3C	-	6A+3C	2A+3C	2A
Day Care Procedures	All Day Care Procedures	All Day Care Procedures	All Day Care Procedures	All Day Care Procedures	All Day Care Procedures

Conclusion

Understanding the coverage, exclusions, terms, and conditions outlined in your insurance is essential before deciding on and buying any plan. If you need help understanding any terms, approach your insurance provider for further assistance.
Consider buying a health insurance plan online once you’ve got all your queries answered and clarified.