Insurance glossary

A

Adventure / Hazardous Sports

Sport or activity involving physical exertion and skill — rock climbing, rafting, motor racing, scuba diving, sky diving and similar. It applies whether you do it for entertainment or professionally.

Ambulance

A vehicle run by a licensed provider and equipped to transport and treat someone needing medical attention.

Annual Health Check-up

A package of tests for a general assessment of your health, provided as a benefit. It specifically excludes tests done to investigate an illness.

Associated Medical Expenses

The charges that ride alongside the room bill — consultation fees, operation theatre, surgical appliances, nursing, anaesthesia, blood and oxygen.

AYUSH Day Care Centre

A registered centre providing Ayurveda, Yoga, Unani, Siddha or Homeopathy treatment — from a community health centre or dispensary up to a polyclinic.

B

Base Sum Insured

The core annual limit on your policy, before any bonus, restoration or top-up is added on.

Break in Policy

A gap between one policy period ending and the next beginning, because the premium was not paid in time.

C

Co-Payment

A share of every approved claim that you pay yourself, as a fixed percentage. If your policy has a 20% co-pay and the hospital bill is ₹1 lakh, the insurer pays ₹80,000 and you pay ₹20,000.

D

Day Care Centre

A registered medical facility set up for day-care treatment, with qualified staff and a supervising medical practitioner, but without in-patient beds.

Day Care Treatment

A procedure needing hospital or day-care facilities but taking less than 24 hours. Cataract surgery and dialysis are typical — medical advances made them fast enough not to need an overnight stay.

Deductible

An amount you cover yourself before the policy starts paying at all. Below it, the insurer pays nothing; above it, they pay the rest.

Dental Treatment

Treatment of the teeth and the structures supporting them — examinations, fillings, crowns, extractions and surgery.

Disclosure of information norm

The clause stating that the policy is void, and premiums forfeited, if information was misrepresented, mis-described or withheld.

Domiciliary Hospitalization

Treatment taken at home that would normally have required a hospital bed, either because the patient could not be moved or because no bed was available.

E

Emergency Care

Treatment for something that came on suddenly and needs immediate attention to prevent death or lasting harm.

G

Grace Period

A short window after your renewal date in which you can still pay the premium and keep the policy continuous — typically 30 days.

H

Hospital

An institution registered with the local authorities as a hospital. Where it is not registered, it must meet minimum standards on beds, round-the-clock qualified nursing, an operation theatre and daily patient records.

Hospitalization

Being admitted to a hospital as an in-patient for at least 24 consecutive hours — except for procedures on the day-care list, which are covered in less.

I

ICU (Intensive Care Unit) Charges

What a hospital charges for an intensive-care bed, including the general medical support services provided there.

Illness

A sickness, disease or condition that impairs normal function and needs treatment. It is split into acute conditions that resolve with treatment and chronic ones that persist.

In-Patient Care

Treatment where you occupy a hospital bed for more than 24 hours for a covered condition.

Injury

Accidental bodily harm caused by external, violent and visible means, certified by a doctor. Illness and disease are specifically excluded from it.

Intensive Care Unit (ICU)

A dedicated hospital section with the equipment and specially trained staff for continuous monitoring of critically ill patients.

M

Material Facts

Anything an insurer would want to know when deciding whether to cover you and on what terms — your medical history, habits, occupation and existing policies.

Medical Advice

Any consultation or advice from a registered practitioner, including a prescription or a repeat prescription.

Medical Expenses

Costs you actually and necessarily incurred for treatment on a doctor advice. They are capped twice over: at what you would have paid uninsured, and at what other hospitals nearby charge for the same treatment.

Medical Practitioner

Someone holding a valid registration with a State or national Medical Council, whether allopathic, Indian medicine or homeopathy. They must be acting within the scope of that registration.

Medically Necessary Treatment

Treatment that is appropriate for your condition, matches accepted medical standards, and is no more extensive or expensive than it needs to be. It must also genuinely have required admission.

Migration

Moving to a different policy with the same insurer while keeping the waiting-period credit you have already built up. A group plan to an individual one, or an old product to a current one.

N

Network Provider

A hospital the insurer has a cashless agreement with. The insurer settles the bill directly, so you do not have to fund it yourself and claim it back afterwards.

Non-Network Provider

Any hospital or day-care centre the insurer has no cashless agreement with.

Notification of Claim

Telling the insurer or their TPA that a claim is coming, through any of the channels the policy recognises.

O

OPD Treatment

Treatment where you visit a clinic or hospital for consultation and treatment without being admitted.

P

Policy Schedule

The document attached to your policy naming the insured persons, the sum insured, the policy period and the sub-limits your cover is actually subject to.

Policy Year

The twelve months running from your commencement date — not the calendar year, and not the financial year.

Portability

Moving your health policy to a different insurer without losing the waiting periods you have already served.

Post-Hospitalization Medical Expenses

Follow-up costs after discharge — review consultations, medicines, physiotherapy — for the same condition you were admitted for.

Pre-existing disease (PED)

Any condition you were diagnosed with, or got medical advice or treatment for, in the years before the policy started. Insurers usually look back 36 months, and will not cover it until a waiting period has passed.

Pre-Hospitalization Medical Expenses

The consultations, tests and medicines you paid for in the days before being admitted. They are covered if they were for the same condition and the hospitalisation claim itself is accepted.

R

Renewal

Continuing the same policy for another term by paying the premium, keeping everything you have already accrued.

Room Rent

What the hospital charges per day for your room and board. Many policies cap it, either as a rupee amount or as a percentage of your sum insured.

S

Second Medical Opinion for Major Illness

An independent practitioner reviewing your treating doctor recommendation, at your request. It is an opinion, not a replacement for your doctor care.

Specific Waiting Period

A separate waiting period attached to a named list of conditions and procedures. Cataract, hernia and joint replacement are the usual entries, and it applies whether or not you had the condition before.

Sum Insured

The maximum the insurer will pay in a policy year. Once it is used up, further claims that year come out of your pocket unless the policy restores it.

Surgery or Surgical Procedure

A manual or operative procedure to treat illness or injury, correct a defect, diagnose disease or relieve suffering. It has to be performed in a hospital or day-care centre by a registered practitioner.

U

Unproven / Experimental Treatment

Treatment or drug therapy that is not established medical practice in India.

W

Waiting Period

A stretch of time at the start of a policy when certain conditions are not covered yet. It runs from the day the policy begins, not from the day you fall ill.

Frequently asked questions