A-Z Insurance Glossary
We translate confusing insurance jargon into simple, plain English so you can make confident coverage decisions.
Cashless Claim
A facility provided by insurers where the medical bills are settled directly between the hospital (if it is a network hospital) and the insurance company, allowing the policyholder to undergo treatment without paying cash upfront.
Co-pay (Co-payment)
A specific percentage of an eligible claim amount that you (the policyholder) must pay out-of-pocket, while the insurer pays the remaining balance. For instance, a 10% co-pay on a ₹1,00,000 bill means you pay ₹10,000.
Deductible
A fixed initial amount you must pay out-of-pocket for medical expenses in a policy year before the insurance company's coverage kicks in. Commonly found in Super Top-Up plans.
Exclusions
Specific conditions, medical treatments, or situations that are explicitly NOT covered under an insurance policy under any circumstance.
Free-Look Period
A window (typically 15 to 30 days) given to the policyholder after receiving the policy document to review the terms and conditions. If unsatisfied, they can cancel the policy and get a refund (subject to minor deductions).
Grace Period
The 15 or 30-day period granted after the policy renewal due date to pay the premium. Coverage normally continues consecutively without losing waiting-period benefits, though claims filed strictly during the grace period may not be honored if the premium isn't paid.
Network Hospital
Hospitals that have a tie-up with your insurance company or Third Party Administrator (TPA) to provide cashless treatment services to policyholders.
No Claim Bonus (NCB)
A reward provided by the insurer for every claim-free year. This is usually given as an increment in the base sum insured (e.g., +20% extra cover) without any increase in the premium.
Portability
The right accorded to individual health insurance policyholders to switch their policy from one insurance company to another while protecting all continuity benefits (like completed waiting periods).
Pre-Existing Disease (PED)
Any condition, ailment, or injury that was diagnosed or for which medical advice/treatment was recommended by a doctor within 48 months prior to the first health insurance policy issued by the insurer.
Reimbursement Claim
If you undergo treatment at a non-network hospital, you must pay the hospital bills yourself and later submit the required documents to the insurer for reimbursement of the expenses incurred.
Rider / Add-on
An optional, supplementary cover that can be attached to a base insurance policy for an additional premium to enhance protection (e.g., Critical Illness Rider, Consumables Cover).
Sub-limits
A monetary cap pre-defined by the insurer on specific medical expenses (e.g., room rent, cataract surgery, maternity benefits). Even if your total sum insured is high, the insurer will only pay up to the sub-limit for that particular expense.
Sum Insured
The maximum amount an insurance company promises to pay for medical expenses in a policy year. This is the base cover limit you choose when buying a health insurance policy.
Waiting Period
A block of time specified in a policy (usually ranging from 30 days to 4 years) during which certain diseases or pre-existing conditions are excluded from coverage. Claims related to those conditions can only be raised after the waiting period expires.
