Terms Related To Health Insurance

Health insurance is a type of insurance which helps the policyholder in case of any unfortunate condition where the policyholder or the other covered member has to get hospitalized. In this case, the insurance company will provide financial assistance to the policyholders so that they can survive in that unfortunate condition. The financial assistance will be provided in terms of paying the hospitalization bills and other charges depending upon the policy the policyholder is carrying. Hence, before going ahead with the health insurance policy one has to know about some basic Health Insurance Terms related to it. These Health Insurance Terms are very important and have to check them properly before purchasing any Health Insurance by the policyholder.

Now, we are going to discuss basic terms related to the health insurance policy below.

Health Insurance Terms


This is the person who is going to tell about all the formalities and will look after all the things while purchasing the policy. The agent will be decided by the insurer which is going to guide the policyholder during the whole process.


The person or the policyholder who is going to get all the benefits of the health insurance and who can claim for the benefits at any time whenever needed is known as the assigning. It is not like that the person who is purchasing the policy is going to be the assignee as one can purchase it for someone else and can pay the premiums. For example, the parents can pay the premiums for the health insurance of their children. In that case, the purchase of the policy will be done by someone else and the assignee will be the other person.

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In case of need whenever the assignee or the policyholder wants to get the benefits of their insurance then they can claim for it. Then claim could be done at the time of hospitalization and most of the time, the claim would get passed after a little time.

All the benefits will be provided to the assignee at that time and all the charges would be paid by the policy.

Certificate of Insurance

These are the documents which are stating that what all is being covered under the policy and is signed by the customer and the provider both. This is given and signed in the starting when the policy is being purchased by the policyholder who is going to pay the premiums.


These are the payments which are going to be paid by the person in the starting once the claim gets approved at the time of hospitalization. This amount is calculated as the percentage of the claimed amount.

No Claim Bonus

It is the bonus provided by the policy in the case when the assignee of the policyholder doesn’t claim for the policy in one policy year. This benefit could never exceed 50% of the total sum assured of the policy. But it can be added in the policy in terms of extra benefits or the large coverage.

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In this, the insurance will also be provided to the dependable of the assignee of the policyholder. For example, if your wife or children are dependent on you then they will also get covered in the type of policy opting for.


Every policy may carry some terms and conditions which have to be checked by the policyholder properly in the starting when he or she is purchasing a policy. In this, all the conditions like when you will not be able to get the full benefits or about other importing things are mentioned properly.


An insurer is a company who is going to provide their services or the health insurance plans to any individual. The company is taking the risk of issuing the policy to the individual and hence their concern is must while making any change in the policy.

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Long-Term Care Policy

These are the policies which are going to be covered in large extent. The coverage of this policy is a little large for example nursing care or home health services will be provided and covered under this type of Health Insurance. Therefore, we can say these are the types of an add-on which can be purchased in a differently.

Long-Term Disability Insurance

This is an amount which is going to be paid to the insurer every month in case of any long term disability. This gives life assistance to the Concern person and will allow them to live on their property. The claiming for this policy could only be done by the disabled person and no one can on behalf of them claim. The amount will be transferred to the bank of the concerned person every month.


The amount which is going to be paid by the policyholder every year or every month depending upon the type of policy is known as the premium of the policy. The amount of the premiums could be more or less depending upon the type of policy one is opting for. Hence, after going through all the policies and the premium decide the one which is suitable for you.

Pre-existing Condition

In any case, if the assignee is carrying any pre-existing disease then it could be covered in the health insurance policy after a specified period but not from the starting. Most of the health insurance policies come with the 4-year pre-existing plan in which after the 4 years the pre-existing diseases would be covered.

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Network Hospitals

This is the number of Hospitals, the doctors or the specialist which are being covered under a specific plan. One has to go to the network list of a specific policy to know how many or how much hospitals and doctors are being covered under the policy. Checking this list is very important as you will get to know that how many hospitals you can go and claim for getting the benefits at any unfortunate condition.

Sum Insured

It is the amount which is going to be paid by the policy to the policyholder at the time of claiming. The total sum insured will depend upon the total premiums and unclaimed years and the coverage under a specific plan. Hence, it is needed to be checked by the policyholder in the starting only you know about the total sum insured they are going to claim for.

Waiting Period

It is the period after which one can claim for the policy after purchasing it. As most of the companies don’t allow claiming for the benefits just after purchasing the policy and hence one has to wait for a specific period depending upon the policy to claim. Hence, this period is specifically known as the waiting period. One can check the waiting period in the starting when he or she is going to purchase the policy. This period is always mentioned in the documents when you are purchasing a specific policy, and in most of the policy, it is one month before any pre-existing condition.


Sub-limits are the limits which Insurance Company applies on a specific procedure or treatment. Under this, the insured person would not be able to claim for above the amount above than that. These sub-limits are applied on like daily room rent charges limit (generally, 1% of the total sum assured), ambulance charges, maternity charges. These charges may vary from policy to policy.

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Restoration Benefits

These are restorable benefits which one can avail after the exhaustion of the sum assured for a specific policy. Many companies are providing this facility in their policies to provide an extra benefit to the insured person.

Cashless Treatment

Once you pay the premiums for your health insurance after that you will be able to get the cashless treatment at the time of emergency. It means that the insurance company will be paying all the bills for the whole treatment.

Inpatient Treatment

It is a type of treatment in which the insured person is hospitalized for a minimum of 24 hours or more and the bills have to be paid to the hospital from the side of the insurance company.

Outpatient Treatment

In this, the insured person is to be physically admitted in the hospital for less than 24 hours and is taking the claim for routine checkups and to meet the specialist.

Portability Policy

This is the best part of any health insurance policy. As portability means a person can transfer all the benefits of a specific plan to the other plan while changing the policy. In this, all the credits secured by the insured person for a pre-existing condition and all the exclusions can be transferred easily.

Room Rent

The room rent limit is the most important part of the health insurance as the whole policies premiums will depend upon the type of room for a day you are choosing in a hospital. There is a limit for paying the room bed from the side of the insurance company as per the policy which maybe 1% of the sum assured or there will be no limit.

Daycare Procedure

Not every policy is covering all daycare procedures some of them are having specific days for giving the claim. The take care includes all the therapies, dialysis, and angiography and so on. Hence, it depends on your policy that is you going to attain the claim for the whole treatment or you have to pay yourself when you are having a daycare limit in your policy.

Hence, the above mentioned are the basic terms related to the health insurance which can be used at any stage after purchasing till claiming and after that. These are the small terms which could seem very big once at the time of need. Therefore, at any point in time, you think that any of the condition is not being followed while claiming then you can ask for the same.

We will get in touch with you and will reply to you with the specified answer within a short time if you have any query.

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