Merriam-Webster dictionary defines medical insurance as – “the system for the advance financing of medical expenses through contributions or taxes paid into a common fund to pay for all or part of health services specified in an insurance policy or law.”
Definitions play an important role in understating the meaning of terms and to avoid being confused about what your policy document states! Medical insurance in India uses a certain set of typical terms, which you would find in brochures and on websites when you attempt to choose a plan.
Medical Insurance in India: 10 Important Definitions
1. Congenital Anomaly: It can indicate to two things –
• External condition: One which is visible and present since birth in the external parts of the body and depicts abnormality of shape or structure.
• Internal condition: One that is present since birth, but is not visible to the naked eye.
2. Co-pay: Co-pay is the cost shared by the insured for which the insurer compensates a certain percentage. Co-pay doesn’t affect the sum insured.
3. Day Care Procedure: It refers to medical treatment and surgical procedure that may –
• Be carried under local anaesthesia in a hospital for less than 24 hrs, and
• Have required hospitalization for more than 24 hours.
Out-patient treatment is not included in this.
4. Dependents: Your family members:
• Your legally married spouse.
• Financially dependent unmarried children, less than 21 years old.
5. Domiciliary Treatment: It refers to treatment that may have required hospitalisation but is carried out at home because –
• The condition of the patient is critical and it is difficult to move him/her to a hospital
• Unavailability of hospital rooms/beds
The treatment must exceed at least three days of care to fit the definition.
6. Family Floater Policy: A policy that covers the insured and his/her family members. There are different floater plans for nuclear and joint families.
7. Hospitalisation: Admission as an inpatient in a hospital for a minimum of 24 hours continuously for an illness or injury due to an accident
8. In-patient Treatment: Treatment for the patient inside the network hospital (hospitals with which the insurer has an association)
9. Network: An insurance provider has a tie-up with a number of big and small hospitals. They -mutually agree to provide cashless schemes to the insured. Treatment in out-of-network hospitals would mean that the insurer pays the medical bills and later files for a claim from the insurer.
10. Policy Period: It refers to the time of validity of the insurance policy - from the date of commencement to its expiry date.
Satisfy yourself with the terms and conditions of a health insurance policy before purchasing it. Medical insurance in India can be purchased online, but do read the fine print before making a decision.
Definitions play an important role in understating the meaning of terms and to avoid being confused about what your policy document states! Medical insurance in India uses a certain set of typical terms, which you would find in brochures and on websites when you attempt to choose a plan.
Medical Insurance in India: 10 Important Definitions
1. Congenital Anomaly: It can indicate to two things –
• External condition: One which is visible and present since birth in the external parts of the body and depicts abnormality of shape or structure.
• Internal condition: One that is present since birth, but is not visible to the naked eye.
2. Co-pay: Co-pay is the cost shared by the insured for which the insurer compensates a certain percentage. Co-pay doesn’t affect the sum insured.
3. Day Care Procedure: It refers to medical treatment and surgical procedure that may –
• Be carried under local anaesthesia in a hospital for less than 24 hrs, and
• Have required hospitalization for more than 24 hours.
Out-patient treatment is not included in this.
4. Dependents: Your family members:
• Your legally married spouse.
• Financially dependent unmarried children, less than 21 years old.
5. Domiciliary Treatment: It refers to treatment that may have required hospitalisation but is carried out at home because –
• The condition of the patient is critical and it is difficult to move him/her to a hospital
• Unavailability of hospital rooms/beds
The treatment must exceed at least three days of care to fit the definition.
6. Family Floater Policy: A policy that covers the insured and his/her family members. There are different floater plans for nuclear and joint families.
7. Hospitalisation: Admission as an inpatient in a hospital for a minimum of 24 hours continuously for an illness or injury due to an accident
8. In-patient Treatment: Treatment for the patient inside the network hospital (hospitals with which the insurer has an association)
9. Network: An insurance provider has a tie-up with a number of big and small hospitals. They -mutually agree to provide cashless schemes to the insured. Treatment in out-of-network hospitals would mean that the insurer pays the medical bills and later files for a claim from the insurer.
10. Policy Period: It refers to the time of validity of the insurance policy - from the date of commencement to its expiry date.
Satisfy yourself with the terms and conditions of a health insurance policy before purchasing it. Medical insurance in India can be purchased online, but do read the fine print before making a decision.
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