• Glossary-banner
  • Glossary

    Health Insurance Terms Made Easy To Understand.

Sum Insured

The Sum Insured in health insurance is the insurance provider's maximum liability towards the policyholder's medical expenses for a policy year. If the medical expenses exceed the sum insured limit, the policyholder is liable to pay the excess costs from their pocket. Factors like age, lifestyle habits, and pre-existing health conditions influence the sum insured amount.

Surgery/Surgical Procedures

Surgery or Surgical Procedures are treatments conducted by licensed medical practitioners after assessing a patient's medical condition. Medical practitioners may recommend surgeries if/when prescription medicine does not relieve a patient of an illness. Surgeries help correct defects and deformities, treat injuries, relieve suffering and help prolong the insured's life. The medical practitioner may perform surgery at a hospital or a day-care centre.

Specific Exclusions

Specific Exclusions are a set of notable exclusions in a health insurance policy wherein the insurance provider is not liable to honour claims. Specific exclusions comprise medical expenses due to war, rebellion, detainment, nuclear attacks, etc. Treatment undertaken outside India, pregnancy termination unless medically necessary, suicide attempts, and injuries sustained by policyholders due to their involvement in criminal activities are a few other specific exclusions.

Standard Exclusions

Standard Exclusions are medical costs associated with treating diseases and ailments or post-surgery expenses for which the insurance provider is not liable to reimburse the costs. Typically, standard exclusions comprise diagnostic fees, home nursing, hospice care, cosmetic surgery, etc. Standard exclusions can differ across policies and insurance providers.

Sum Insured Refill

A Sum Insured Refill, also known as Sum Insured Restoration, is an additional rider that policyholders can purchase. Policyholders who opt for the sum insured refill rider can get their entire sum insured restored after utilising it. Policyholders can choose from partial and complete sum insured refills and enjoy this benefit once per policy year after filing an insurance claim within that policy year.

Sub limit

Sub Limit in health insurance is a fixed amount or percentage of the sum insured designated for specific medical expenses. For instance, a policy may state that the insurance provider is liable to pay 10% of the basic sum insured or Rs 50,000, whichever is lower, for treating mental health conditions. Similarly, the sub-limit for hospital room rent may be Rs 2,000 per day of hospitalisation.

Single Private Air-conditioned Room

When receiving treatment at a hospital, policyholders can choose to stay in general wards or private rooms. Patients intending to file an insurance claim and considering lodging in a Single Private Air-Conditioned Room must ensure that they seek admission in the most economical of all the single accommodations available in the hospital. Also, the room rent expense should be within the sub-limit determined under the insurance policy. This does not include suites or deluxe rooms.

Survival Period

In critical health insurance, the Survival Period is the duration a policyholder must survive after receiving a medical diagnosis for a critical illness. The survival period comes into effect after the policyholder rides out the waiting period and after 15 to 30 days of receiving the critical illness diagnosis. Policyholders who survive this period become eligible for the lumpsum amount of the sum insured, per policy terms.