Demystifying Health Insurance Jargon: Terms You Need to Know

Demystifying Health Insurance Jargon Terms You Need to Know

Health insurance can be a complex and confusing topic, especially when confronted with a sea of unfamiliar terms. In this blog, we’re going back to basics and breaking down some of the most common health insurance terms which you need to understand thoroughly to make informed decisions about your coverage. But before that we at Chola MS health insurance answer the question: what is health insurance?

What is Health Insurance?

The official definition is that ‘Health insurance is a legal contract between a person or a group of people and an insurance company, where the company agrees to pay for some or all of the individual’s medical expenses in exchange for a payment’. 

This coverage helps protect you from the financial burden of unexpected medical costs, ensuring access to essential healthcare services.

Now that we’ve understood what is health insurance, we at Chola MS Health insurance help you familiarise yourselves with the common terminology used :- 

Premium: The premium is the amount you pay for your health insurance policy and is paid either monthly or annually, depending on the insurer. The premium amount varies based on factors such as age, health condition and coverage selected. In most cases, a higher premium often corresponds to more extensive coverage.

Deductible: A deductible is the money you must pay out of pocket first before your insurer starts to contribute. Let’s take an example to understand this better; if your policy has a deductible of Rs.10,000, you’d first need to pay this amount of Rs.10,000 of the total expenses before your insurer starts sharing the costs.

Copayment (Copay): A copayment is a fixed amount one has to pay for a covered medical service. This usually needs to be paid at the time when expense arises and is a set amount. Let’s understand this better with an example;  copay can be Rs.200 for a doctor’s appointment or Rs.150 for general prescriptions where the insurer will cover the remaining costs.

Coinsurance:  Co-insurance is the cost of a covered medical insurance that you must pay after you have met your deductible. This is expressed in percentage. Let’s take for example, if your coinsurance is fixed at 20%, you will have to pay 20% of the cost of the service and your insurance company will cover the rest of the expenses.

Network: Health insurance plans often have a network of healthcare providers with whom they have tie-ups and negotiated reduced rates. Understanding your plan’s network is crucial, as seeking care from out-of-network providers may result in higher costs.

Pre-existing Condition: A pre-existing condition is a health problem you had before purchasing a health insurance policy. Some insurance plans don’t cover pre-existing medical conditions in their policy. Ensure to read the policy document thoroughly before purchasing.

Exclusion: Exclusions are specific services or conditions that a health insurance policy does not cover. It is crucial to review the exclusions in your policy to avoid surprises when seeking particular types of care.

Waiting Period: Some health insurance policies may have a waiting period before certain benefits become effective. This period can vary and may apply to specific treatments or pre-existing conditions.

Navigating health insurance jargon becomes more manageable with a clear understanding of these terms. As you evaluate health insurance plans, we at CHOLA MS health insurance urge you to consider your specific healthcare needs, budget and preferences to choose a coverage that aligns with your requirements and that falls within your budget. In order to make comprehensive health insurance solutions available to our customers, we at Chola MS health insurance operate with a commitment and dedication to providing reliable coverage and a range of plans to suit different lifestyles. At Chola MS Health Insurance, we believe that the back up of a reliable health insurance plan can help safeguard your health and financial well-being for a secure future.

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