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    Health Insurance Terms Made Easy To Understand.

Emergency Care

Any health condition, illness or injury that occurs unexpectedly and suddenly and needs immediate attention of a medical practitioner, including but not limited to hospitalisation, is referred to as Emergency Care. Health insurance policies cover Emergency Care to prevent complications such as severe long-term disability, impairment, or worse, the insured person's death.


Eligibility, also referred to as eligibility criteria, are conditions a potential health insurance buyer must satisfy to qualify for health insurance. Eligibility also refers to specific requirements policy buyers must fulfil to avail of insurance coverage for certain treatments. Typical eligibility criteria set by insurers include the policyholder's age, existing medical conditions, family history of severe health conditions, etc.


Exclusions in a health insurance policy are illnesses, ailments or treatments that the insurance provider does not cover. The policyholder must bear all the medical expenses associated with treatments or medical conditions excluded from coverage. Common examples of exclusions include cosmetic surgeries, pregnancy termination (non-emergency), self-harm leading to injuries, etc.

Eligibility Period

Eligibility Period is a term used in reference to group health insurance policies, wherein it represents the duration after which a policyholder can enjoy health insurance benefits. For instance, an employer may require employees to complete three months in their organisation before adding the latter to their group insurance plan. The eligibility period in group insurance allows employers to ascertain that the individuals in their employment are in it for the job and not just the perks.

Eligible Employees

Under a group health insurance plan, eligible employees are individuals who have fulfilled the employer's condition to avail of health insurance. For instance, a company may offer insurance benefits to its new employees after 45 days of service. In such a case, the new employees become eligible for group insurance after riding out the probationary term or waiting period.

Enhanced Cumulative Bonus

An enhanced cumulative bonus is a monetary benefit that increases the percentage of the existing cumulative bonus, and by extension, the sum insured under a medical insurance plan. In India, health insurance providers typically enhance the cumulative bonus by 10% for every consecutive claim-free year. With the enhancement benefit, policyholders can enhance their cumulative bonus by 50% of the sum insured for five consecutive claim-free years.

Emergency Medical Evacuation

The emergency medical evacuation clause comes into effect when an adequate healthcare facility is unavailable near the insured person's location. In such cases, the health insurance policy covers the cost associated with transporting the patient to the nearest available medical facility by ambulance, even if the insured party does not have an ambulance coverage add-on rider in their insurance plan.


An E-Opinion is an online second opinion a policyholder can seek from the insurance provider's panel of medical practitioners. The insured can book an appointment with a medical specialist via the insurer's website or by contacting customer support. The E-Opinion benefit is limited only to illnesses covered under the insurance plan. The policyholder can decide whether or not to act on the E-Opinion but should not hold the insurance company liable.