The Terminology You Need to Know for Indian Medical Insurance

Over the last decade, there has been an exponential increase in the costs of medical treatment and care. Today, if an individual needs to avail of a surgery or treatment that requires hospitalisation, then the total costs can burn a hole in the pocket. Hence, many people have started opting for medical insurance policies.

As the demand for medical insurance grew, insurance providers started offering a range of plans to cater to the varying needs of people. For example, you can buy a critical illness insurance policy that offers a lump sum payment of the sum assured if the insured person is diagnosed with a critical illness (as defined by the insurer).

To find the best health insurance policy for your needs, it is important to compare providers and plans and choose the one that best suits your requirements. We also recommend people go through all available literature to assess the features and terms of the policy before buying. However, most of these documents are jargon-rich, making it difficult for non-finance professionals to understand them completely. In this article, we will help you in understanding health insurance jargon to find the best health insurance plan.

●        Mediclaim Policy and Health Insurance Policy

These terms are often used interchangeably since they mean the same thing. These policies offer coverage to the insured person for medical expenses subject to the terms of the policy. The policyholder pays a fixed fee to the insurer to get this protection. Hence, despite the various definitions available online highlighting the differences between the two, make sure that you understand the inclusions and exclusions of the policy before signing the dotted line.

●        Claim

When you buy a health insurance policy, the insurer reimburses the costs incurred due to the treatment of a certain disease or ailment. You can file a claim online or offline based on your comfort. You need to submit a claim form along with medical bills and documents requested by the insurer. Once the documents are verified, the insurance provider credits the claim amount to your bank account.

●        Cashless Hospitalisation

Every insurance company offering health insurance coverage has a list of network hospitals that it has tied up with. Many such insurers allow the insured person to get treated at any of these network hospitals without having to pay for the treatment first and file a claim later. The policyholder can get admitted to a network hospital once the insurer approves the case and can get treated without having to pay from his pocket. However, it is important to remember that most insurers have predefined limits for cashless hospitalisation along with other terms and conditions. Therefore, go through the policy documents carefully and read everything that you can find about cashless hospitalisation.

●        Coverage

The medical coverage offered by a health insurance policy is not limitless. The insurer determines the maximum amount it can reimburse for medical treatments after analysing the health and lifestyle of the insured person(s). This amount forms the coverage of the policy.

●        Riders or Add-On Covers

A health insurance policy offers comprehensive protection to everyone insured under it. However, you can boost the scope and extent of the coverage by buying add-on covers or riders. These are additional services that can be added to your medical policy after paying a small amount. There are various add-on riders available like personal accident cover, critical illness cover, Covid 19 insurance, etc.

●        Floater Plans

This is one of the most commonly used health insurance jargon. These plans offer coverage for multiple members of a family under a single plan.


We have mentioned the primary terms that one needs to know and understand to learn more about health insurance plans. However, for an in-depth knowledge about the insurance jargons, we suggest you read the policy wording of your insurance document.