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  • Glossary

    Health Insurance Terms Made Easy To Understand.

Medical Treatment

Medical Treatment refers to the management and care a patient receives in order to combat a sickness, an illness or a disorder. Medical treatments may include hospitalisation and surgical procedures, day-care treatments completed within a few hours of admission or prescribing medication, physical therapy, and other healthcare services, to improve and restore bodily functions.

Medical Advice

Medical Advice is the action plan a doctor or healthcare practitioner formulates after analysing a patient's medical condition. Based on the patient's condition, a medical practitioner may prescribe medications. The practitioner may also issue a follow-up prescription and recommend further tests, screenings, X-rays, and treatment plans if the issue at hand remains unresolved.

Medical Expenses

Medical Expenses entail the costs incurred by a health insurance policyholder towards their medical treatment based on the recommendation or prescription of a medical practitioner. Insurance providers typically cover or reimburse policyholders for various medical expenses in the event that the latter needs hospitalisation against an illness covered under health insurance. Common medical expenses covered by insurance providers include diagnostic tests, doctor's fees, hospital room rent, etc.

Maternity Expenses

Costs related to pregnancy and childbirth are known as Maternity Expenses. In health insurance plans, maternity expenses are typically covered under an additional maternity cover rider that policyholders can purchase with their standalone health insurance plan. This cover allows policyholders to get coverage for normal and caesarean-section deliveries, pre-and post-natal expenses, delivery-related complications, lawful termination of pregnancy, etc.

Medical Practitioner

A Medical Practitioner is a physician, doctor, or clinical specialist who holds a valid registration to practice medicine. The Medical Council of India or any Indian state should permit such an individual to practice medicine in its jurisdiction. Medical practitioners are obligated to provide patients with the necessary healthcare facilities and to act within the jurisdiction and scope of their medical license.

Medically Necessary Treatment

Medically Necessary Treatments are the healthcare services prescribed by a medical practitioner, which are necessary to diagnose and treat symptoms, illnesses, and injuries suffered by an insured party. Such treatments must conform to the professional standards accepted in the Indian medical community to pass medical insurance claims. Medically necessary treatments must also not exceed the scope, duration, and intensity of care required for treating health conditions.

Medical History

Medical History indicates a potential policyholder's personal and family health records based on factors like age, profession, lifestyle choices, past surgical treatments, allergies, etc. Insurers use this information to understand the health risks and decide the health insurance premium. Individuals historically diagnosed with severe medical conditions or with a family history of medical conditions are usually charged higher premiums to mitigate the insurer's risk.

Mental Illness

Mental Illness is defined as a disorder that affects an individual's thinking, perception, mood, and behaviour. Such a condition impairs judgement and compromises the ability to meet life's ordinary demands. Depression, anxiety disorders, schizophrenia, and dementia, are common examples of mental illnesses. Health insurance policyholders can get coverage for mental health treatment under their standalone health insurance policies, per IRDAI guidelines.

Major Illness Benefit

Insurance Providers typically categorise and list illnesses as minor and major/critical in the policy document. If diagnosed with a major illness, a health insurance policyholder becomes eligible for a Major Illness Benefit. Under this benefit, the insurer pays 100% or the maximum sum insured amount, whichever is lower. Policyholders must ride out the waiting period to be eligible for this benefit that helps pay for the treatment of illnesses like cancer, heart ailments, head trauma, etc.


Health insurance providers allow their existing policyholders to shift or migrate their current insurance plan to another product offered by them. Policyholders looking to migrate their policies must apply for Migration at least 30 days prior to their policy renewal date. Policyholders who utilise this option, who may have accrued benefits like no-claims bonus, ridden out the waiting period, and obtained continuous coverage without any lapse, can also migrate their amassed benefits to their new policy.

Mediclaim Insurance calculator

A Mediclaim Insurance Calculator is an automated online tool that enables potential and existing health insurance policyholders to estimate the cost of their insurance premiums. Insurance buyers must input details like their age, gender, type of coverage needed, etc., in the various tabs of the calculator. The calculator factors in these details to compute the estimated premium cost.

Material Facts

Material Facts represent the relevant, necessary facts an insurance company seeks in its proposal form and other associated documents. These facts enable insurance providers to determine whether or not to offer coverage to a potential insurance buyer. Material facts also help insurers ascertain the underlying risks of providing insurance coverage and making an informed decision in the process.

Medical History

Health insurance providers ascertain several material facts about potential policyholders before offering them medical insurance coverage. One such fact is Medical History which indicates a potential policyholder's family medical history, past surgical history, long-term medication prescribed by doctors, social history, allergies, etc. Medical history enables insurers to understand a potential policyholder's health risks and decide the health insurance premium.