Important terms to know in your Health Insurance

Floater Policy: Its a policy where one single limit stands for the entire family. For eg you have floater policy with limit of 3 lakhs, the maximum your entire family is covered is Rs 3 lakhs not for each individual.

The floater policy is generally not given to individuals but is taken by corporates for their employees and their families.

Non floater policy or the standard policy: Also known as Standard policy, its limit is policy taken per Individual.You can take 1 lakh limit for yourself, 2 lakhs for your wife and 25000 for your Child.

Waiting period

It’s the period of time specified in a health insurance policy, which must pass before your health insurance coverage pertaining to certain ailments can begin. For example: If one has a waiting period of one year for covering cataract, and one has been operated for cataract around 9 months after the policy commenced, the claim will not be payable.

Prexisting diseases: A pre-existing medical condition is one in which the ailment has been diagnosed (or medically treated by a doctor) before the policy starting date

The claim is repudiated when the prior existing medical condition has a direct bearing upon the ailment for which the hospitalisation has now taken place.

This exclusion applies normally to all individual policies, whereas groups can negotiate for waiver.

TPA (Third Party Administrator): A TPA is an authorised agency, appointed by the insurance company, to take care of claim settlements in health insurance.

Cashless Claim Settlement: When you opt for a cashless facility, you can avail medical treatment as an inpatient (only at an empanelled hospital — known as ‘network’) without paying the treatment costs upfront to the hospital. The insurer will directly settle the bill with the hospital.

Reimbursement Claim Settlement: When you opt for a reimbursement facility, all the bills related to the hospitalisation will have to be paid by you directly to the hospital.After discharge, all the reports, bills and receipts must be submitted by you, along with the claim form to the insurer or TPA. After scrutiny of the same, the insurer/TPA will settle the claim and reimburse you the claimed amount.

One of the most important things you can do as a policy-holder to avoid hassles during a claim is to review and understand the terms and conditions of the insurance policy before you take a policy.