Top 10 Terms You Must Know Before Buying Medical Insurance

Health​‍​‌‍​‍‌ emergencies are often unexpected. As medical care gets more expensive, a medical insurance plan has gone from being a more option to a must-have. But, in their quest for health insurance, people frequently come across so many different terms that they get completely confused. These terms like “copayment,” “deductible,” and “waiting period” considerably affect the working of your insurance.

It might even mean the difference between having an insurance policy that is there for you and one where you have surprise costs that you hadn't thought of. To help you pick here’s an all-in-one guide explaining the top 10 health insurance terms you should know before selecting a policy.

1. Premium

Your premium is the amount you pay to keep your medical insurance plan active, whether yearly or in instalments. It varies based on age, health, policy type, and coverage. Lower premiums may reduce benefits or increase out-of-pocket costs. Choose a plan with a premium that matches your budget and healthcare needs.

2. Sum Insured

The sum insured is the maximum amount your insurer will cover in a policy year; any expenses beyond it must be paid by you. For example, with ₹10 lakh coverage on a ₹12 lakh bill, you pay ₹2 lakh. Choose a sum insured suited to your family’s needs and city costs.

3. Deductible

A deductible is what you pay before insurance contributes. For a ₹50,000 bill with a ₹5,000 deductible, you pay ₹5,000 and insurance covers the rest. Higher deductibles reduce premiums but ensure you can afford them during emergencies.

4. Copayment (Co-pay)

Copayment is when you pay a certain portion of medical costs while undergoing treatment at a hospital. Let us assume that a 10% co-pay clause exists in your plan and the overall bill amounts to ₹1 lakh, you would pay ₹10,000, and the insurance company would cover ₹90,000.

Also, plans with copay options are less in price upfront, however, if you are in need of frequent medical care, they might turn out to be quite ​costly.

5. Waiting Period

A waiting period is the time before your policy covers certain conditions. Pre-existing health issues like diabetes often have 2–4 year waits. Claims aren’t allowed then, so choose plans offering shorter periods for such benefits.

6. Pre-Existing Disease (PED)

A pre-existing disease is any condition you had before buying insurance, like asthma or thyroid issues. Insurers need health disclosures, and hiding them risks claim rejection. IRDAI mandates coverage of such conditions after a waiting period

7. Cashless Hospitalisation

Cashless hospitalisation lets you receive treatment at network hospitals without upfront payment; the insurer settles bills as per policy. Choose a provider with a wide network for access to care at home or while travelling.

8. Exclusions

Exclusions are treatments your health insurance won’t cover, such as cosmetic procedures, fertility treatments, dental work unless accidental, or risky-activity injuries. Review exclusions before buying; they’re important as coverage also.

9. No Claim Bonus (NCB)

A No Claim Bonus rewards years without claims by reducing your premium or increasing coverage. For example, a 10% NCB raises ₹5 lakh coverage to ₹5.5 lakh, enhancing protection over time.

10. Free Look Period

Health insurance policies offer a 15–30 day free-look period, allowing you to review terms, clarify doubts, or cancel the policy without penalties, except minor administrative charges. Understanding essential insurance terms ensures informed choices, smoother claims, financial protection, and greater peace of mind.

Closing Thoughts

Before buying a health insurance policy, spend some time understanding the terms like premiums and exclusions. Knowing these will help you make informed decisions.

Chola MS Health Insurance provides a variety of medical insurance plans. These plans come with clear coverage details, simple online processes, and cashless treatments at more than 10,000 hospitals in their network. Whether it's for you or your family, Chola MS makes sure to offer full protection with transparency at every stage.

FAQs

Q1: How much sum insured should a family medical insurance plan have?

The sum insured depends on how many family members you have, your city, and your way of living. Urban families are advised to go for ₹10 to 15 lakh.

Q2: Is it possible to have multiple health insurance policies?

Yes, owning more than one health insurance policy is allowed. You might even be able to file claims under both, based on the coverage and the amount of the claim.

Q3: Can I increase my insured amount later?

You can increase your coverage during policy renewal as long as you follow policy terms, complete health checks, and the insurer allows it. Insurers like Chola MS offer this option.

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