Welcome to our comprehensive group health insurance glossary! In this blog, we have compiled an extensive list of terms and definitions to help you navigate the complex world of group health insurance. Whether you’re an employer seeking to provide health coverage for your employees or an individual looking to better understand the terminology related to group health insurance, this glossary is designed to provide you with clarity and insight.
Also read about Group Health Insurance provided by Healthysure.
So, let’s dive in and demystify the language of group health insurance!
Table of Contents
Insurance for Specific Diseases
A condition-specific insurance plan is one that is designed to offer coverage for a certain sickness or illness. One example is ‘cancer insurance,’ which is intended exclusively for cancer treatments and covers all associated costs.
Sub-limit
Sub limit is a provision in the policy that places a cap on the amount of coverage that is available for a specific type of expense or service.
For example, let’s say that a group health insurance policy has an overall annual limit of Rs.10 lakhs and a sub limit of Rs.50,000 for mental health services. This means that the policy will cover up to Rs.50,000 in mental health expenses each year, but any expenses beyond that amount will not be covered by the policy.
Sub limits are often used in group health insurance policies to help manage the overall cost of coverage by limiting the amount of coverage for certain types of services or expenses. They are usually outlined in the policy’s coverage details, and it’s important for policyholders to be aware of them when seeking healthcare services.
It’s worth noting that sub limits can vary widely between insurance policies, and some policies may not have sub limits at all. Therefore, it’s important for policyholders to carefully review their policy’s terms and conditions to understand what is covered and what limitations may apply.
Insured Amount
The insured amount is the maximum amount of money that an insurance policy will pay out to the policyholder in the event of a covered loss. This amount is agreed upon between the policyholder and the insurance company when the policy is purchased.
For example, let’s say that John purchases a life insurance policy with an insured amount of Rs.500,000. This means that if John were to pass away while the policy is active, his designated beneficiaries would receive a payout of up to Rs.500,000 from the insurance company.
Similarly, if Mary purchases a home insurance policy with an insured amount of Rs.300,000, this means that if her home is damaged or destroyed by a covered event such as a fire, the insurance company would pay out up to Rs.300,000 to cover the cost of repairs or rebuilding.
It’s important for policyholders to carefully consider the insured amount, as selecting an amount that is too low could leave them vulnerable to financial loss in the event of a claim, while selecting an amount that is too high could result in unnecessarily high premiums.
Waiting Time
You have diabetes, but you’ve found a health insurance policy that covers your pre-existing condition, yay! There is, however, a catch. According to your policy restrictions, you must wait two years before filing a claim for any therapy related to your high blood pressure.
The waiting period is the period during which the insured cannot claim health insurance benefits. For example, in many policies, the waiting period for pre-existing conditions is typically 2-3 years.
This means that if you have a stroke or a sickness that is remotely related to your existing condition before the waiting period is over, your insurance company is not obligated to pay for the expenses. Unfortunately, waiting periods are a standard provision in most insurance. The best option here is to look for one with no or a short waiting period for your condition.
Floater for Business
Corporate Floater Cover allows employers to build a common pool of employees for usage in emergency situations. Consider this a common sum that any of your employees can utilise if they exhaust the amount insured under their individual policy limit due to a major medical expense.
Cumulative Bonus
A cumulative bonus is a bonus or incentive given to an insured by an insurance company for not filing a claim in a given year. The insurance provider rewards you for each claim-free year by raising the sum insured in the next renewal year.
The DB Scheme
A DB Scheme, also known as a Defined Benefits Scheme, pays you a defined amount in the event of an insured event. The insurance company pays a fixed amount/benefit regardless of hospitalisation costs. Policies such as ‘specific sickness’ policies are examples of defined benefit plans.
Deductibles
A deductible is the amount you must pay before an insurance company will pay anything towards a claim. The majority of insurance policies have a yearly deductible.
If your policy includes a deductible, you will most likely pay a lower premium. However, it also implies that you must pay a fee each time you file a claim.
Dependents
Dependents are members of the insured policyholder’s family. In such circumstances, the policy’s benefits are extended to the dependents as well. Your parents, husband, and children will be deemed dependents if you purchase an insurance for yourself.
Expenses for Residency
Domiciliary expenditure refers to any therapy you receive at home on the advice of a doctor. Even though you are not in the hospital in this case, it is considered and treated as home hospitalisation.
The treatment must last three days in order for the domiciliary expense clause to apply. It is important to note that not all insurance policies cover domiciliary charges. However, it is an useful clause to have in your insurance policy for times when you cannot transfer to a hospital or locate accommodation but need to be treated as soon as possible.
Expenses incurred by donors
Donor expenses cover the costs associated with an organ transplant. If you are the recipient, the donor expenditure clause will help you cover the costs spent by the organ donor.
This category includes donor fees such as compatibility checks, harvesting, transplanting, and so on.
Coverage
The whole amount that an insurance company covers for a risk is referred to as coverage. The coverage amount assists you in recovering from financial risk following illness, injury, or treatment. This is also known as the Sum insured.
Assume you’re in the process of purchasing a new policy. You’re considering getting a policy worth 20 lakhs. Does this imply you’ll have to pay 20 lakh rupees? No. The policy amount is sometimes referred to as the coverage or sum insured.
This means that your insurance provider will assist you in recovering from financial risk following illness, injury, or treatment up to the coverage level. You may be wondering if this sum is for the rest of your life. Your coverage period is one year. So, if your insurance coverage covers 20 lakhs, your insurance company will assist you in covering costs up to 20 lakhs every year.
Exclusions
Treatments and ailments that are not covered by the insurance coverage are referred to as exclusions. Pre-existing diseases and cosmetic treatments are common examples of exclusions. The exclusions are explicitly stated in every policy document.
One of the most prevalent exclusions in insurance policies is for ‘pre-existing conditions.’ For example, if you have diabetes and your insurance policy excludes pre-existing diseases, any ailment or treatment that results from it will not be covered, and you will have to pay out of pocket. Keep in mind that these exclusions are distinct from ‘permanent exclusions’ such as war injuries, HIV, intentional injuries, and congenital disorders, which would never be covered by insurance. For exclusions such as PED, you can actually acquire coverage after a pre-determined waiting time, which is usually 2-4 years. (For GHI—waiting periods can be eliminated for a nominal fee)
It might be difficult to cut through the language of an insurance policy document. Consider being at a hospital with the expectation that your insurance will cover the medical costs, only to discover that it will not. You buy a policy with the expectation that it will cover your medical bills when you need them, but more often than not, some procedures are not covered, which are known as ‘exclusions.’
Similarly, particular exclusions apply to group health insurance coverage, such as bariatric surgery, Lasik surgery, robotic surgery, cochlear implants, rejuvenation therapy, and so on. These limitations typically apply to non-life threatening operations or aesthetic surgeries and vary by insurer.
Cover for a floater
Floater coverage is a type of health insurance that covers the entire family rather than just one person. A floater policy gives insurance coverage to a group and allows them to share the policy’s benefits.
If you buy an insurance just for yourself, it is considered individual coverage; but, if you include your family in it, it is considered ‘floater coverage.’
Coverage that is adaptable
The capacity of the insured to tailor the insurance to their specific needs is referred to as flexible coverage. It may let you to select between treatments, the total insured, the premium, the premium tenure, and so forth.
Flexible coverage allows you to customise numerous aspects of your insurance to meet your specific needs.
Your needs, unlike terms and conditions, are constantly changing. Assume you have a health insurance policy that includes maternity coverage, family coverage, and alternative treatment coverage for a yearly premium of Rs.20,000. However, if you are single and do not want to start a family very soon, two of the three benefits will be useless to you.
Flexible coverage allows you to select treatments, benefits, and premiums at the time of purchase. And personalise it so that it makes the most sense to you when you buy the coverage.
Freelook Period
The freelook period is a trial period for insurance. You have the option to cancel a policy and receive a full refund for a certain number of days after purchasing it (usually 15 days).
The Grace Period
A grace period is a set number of days following your premium renewal due date during which you can pay your health insurance premium.
If your insurance policy provides a 7-day grace period, you can make your renewal payment within 7 days of the original due date and continue to use your policy’s benefits.
Assume you purchased an insurance policy that ends on December 10. If your insurance has a grace period of 7 days, you can renew it at any time up to 7 days after December 10.
Group Protection
A group policy is a sort of health insurance that covers a whole group of people rather than an individual. Employee insurance provided by employers is an example of group coverage.
Healthcare at Home
Home healthcare refers to treatments that necessitate hospitalisation but are delivered at the patient’s home. A nice example would be to use physiotherapy. If you are getting physiotherapy and want to claim the costs, you can do so under home healthcare if your insurance coverage allows you to do so.
You’ve recently recovered from a severe hand fracture. Your doctor has prescribed ten physiotherapy sessions to assist you in getting back on your arm. The physiotherapist you contacted charged roughly Rs.2,000 per session, for a total of around Rs.20,000.
You may be wondering if you need a physiotherapy session, but you check your insurance coverage, which includes a provision for treatments that require hospitalisation but are delivered at home. In this instance, your physiotherapy costs would fall under home healthcare, and your insurance company would cover them up to the limit. Domiciliary expenses are the fancy name for all of the expenses you incur while receiving home nursing.
ICU limit
The ICU (Intensive Care Unit) refers to the maximum amount of coverage that a policy will provide for ICU-related medical expenses. ICU-related medical expenses can include room and board, medical procedures, and specialized equipment needed for critical care.
For example, let’s say that a health insurance policy has an ICU limit of Rs.50,000. If a policyholder requires ICU care for a medical emergency, and the total cost of their ICU-related medical expenses comes to Rs.60,000, the policy will only cover up to the limit of Rs.50,000. The policyholder would be responsible for paying the remaining Rs.10,000 out of pocket.
It is important for policyholders to be aware of the ICU limit of their health insurance policy and to ensure that it adequately covers their medical needs. In some cases, individuals may choose to purchase additional coverage to supplement their existing health insurance policy and provide additional protection against high ICU-related medical expenses.
Inclusions
While reading your policy, you’ll find various therapies and illnesses listed under ‘inclusions.’ These are treatments, diseases, and healthcare that the insurer will pay for under the insurance.
Imagine you’ve just purchased a policy that covers cancer, heart disease, and other severe ailments. You know this for certain because they are specified as ‘inclusions’ in the insurance policy.
Even though most policy phrases are tough to grasp, this one is very simple. Treatments and illnesses that your insurance provider is ready to pay for on your behalf are considered inclusions.
Policy of Indemnity/Indemnification
Your policy’s indemnification clause gives you the authority to make a variety of medical decisions. So, during treatment, you have complete control over the doctor, hospital, and so on, and your insurer cannot force you to select otherwise.
In-patient Treatment
In-patient care refers to a patient who is hospitalised or formally admitted to an institution such as a hospital for at least one night to get a specific therapy. Anyone hospitalised to a hospital for treatment that requires more than one night is said to be in ‘in-patient care.’
Insurer
During a health crisis, an insurer is a company that offers financial coverage based on the terms of your insurance policy. If you buy your insurance coverage from a specific firm, that company is referred to as the ‘insurer.’
The Master Policy
A master policy is a group insurance policy that is offered to a group of policyholders. The master policy eliminates the need to provide individual policies to each member of a certain group. For example, if you are covered by your employer’s group health insurance, the policy that will be supplied is known as the’master policy.’
Maternity Supplement
A maternity add-on is an add-on benefit that can be added to a health insurance policy. Maternity add-on covers expenses linked to childbirth, newborn coverage, pre- and post-natal care, and so on.
Imagine being admitted to a hospital to birth a kid or admitting your wife to deliver a child only to discover that your insurance does not cover maternity care charges.
Maternity care is typically an add-on that covers expenses linked to childbirth, newborn coverage, pre- and post-natal care, and so on. If you are planning to establish a family in the near future, it is critical that you seek for maternity coverage before getting a policy.
Network Service Provider
A network provider is a doctor, healthcare professional, hospital, or institution that has a contract with an insurance carrier to provide you with medical care under a certain plan. If you receive care from a network provider, you are more likely to receive a cashless facility and a more simplified claims process.
You are considering obtaining a new health insurance policy for yourself and are reviewing the policy document. There, you’ll find a list of hospitals and medical facilities around you. You also recognise hospitals that are only a kilometre distant from your house.
These hospitals are known as ‘Network Hospitals,’ and your insurance company has a deal with them to provide you with the medical care you require. If you contact these network providers for treatment, you will very certainly be able to take advantage of a cashless treatment.
Cover for a Newborn
Your newborn’s health insurance coverage is supplied via the newborn cover. A family floater cover includes newborn coverage. You can get baby insurance, but the benefits normally start after 3-4 months and cover things like immunizations and follow-ups.
You return home after labour to celebrate the arrival of your newborn with your family. After a while, you’re back at the doctor’s office for check-ups, and before you know it, your baby needs to be vaccinated. Unless you have infant coverage, all of these expenditures can soon mount up.
A newborn cover is an insurance add-on that helps you stay financially secure against any medical bills that most insurance policies cover after three months of your baby’s birth.
Bonus for No-Claim
A no-claim bonus is a type of incentive provided by the insurance company. Every claim-free year, the NCB is added to the total sum covered. Assume you did not file any claims this year. When you renew your insurance policy, the insurance company will boost the sum insured by a set percentage as a “no-claim bonus.”
Non-floater
The individual policy is another name for the non-floater insurance. Individual benefits are provided under a non-floater policy. This word will only appear if you want to get insurance for yourself and your sibling without include your parents. Because dependents can only be spouses, parents, or children, your brother and sister will need to purchase their own individual policies, which is what non-floater insurance entails. A non-floater policy, unlike a floater policy, provides benefits to only one person.
Non-Network
Non-network refers to a doctor, healthcare provider, or hospital that does not have a contract with the policyholder’s insurance carrier. If you receive treatment from a non-network provider, you will most likely be able to file a reimbursement claim.
PED
PED, or ‘Pre-Existing Disease,’ refers to a health condition or sickness that existed in the policyholder prior to the start of their health insurance policy. Cancer, heart disease, diabetes, and other chronic diseases are common examples of PED.
You’ve finally decided to buy health insurance, but you want to put it off for a few months because your finances are tight. You are diagnosed with diabetes 15 days later, much to your dismay.
You have now accelerated the process of acquiring your insurance coverage, and while filling out the form, you see that they want you to disclose any existing ailments. Diabetes falls under PED, or Pre-Existing Disease, for you because it existed before you began your health insurance policy.
Pre-Hospitalization Protection
Pre-hospitalization coverage covers any expenses incurred by the policyholder prior to hospitalisation. Common charges such as consultations, diagnostics, and so on that occurred before to the hospitalisation can be paid.
You’ve been feeling ill for a while and decide to see a doctor. They order some tests and find no definite evidence of an illness, so they prescribe some medications and tell you to relax. Unfortunately, your illness worsens during the next week, and you return to your doctor, who orders additional tests such as X-Rays and MRI Scans, which cost around Rs.10,000-20,000.
Following the results, they will diagnose your ailment and advise you to get treatment as soon as possible. Following your treatment, you discover that your insurance company covered the treatment expenditures but not the tests and medications that preceded it.
It’s because your insurance policy does not include ‘pre-admission’ coverage, which covers expenses such as consultations, diagnoses, and so on that occur before to hospitalisation.
Post-Hospitalization Protection
Post-hospitalization coverage pays for expenditures incurred after the policyholder is discharged from the hospital. Common situations, such as follow-ups, testing, and medications, fall under post-hospitalization coverage.
You were just released from the hospital after receiving therapy. Fortunately, your insurance covered the high medical bills that came with it. You return home thinking how fortunate you are to have such a dependable insurance policy.
And then it starts. Follow-up appointments, diagnostic testing, and medications will be required for the next two months. You begin to see that the costs are stacking up and that paying these bills is becoming a hardship. Fortunately, your insurance policy includes post-hospitalization coverage, which compensates for such expenses that arise after your treatment.
When selecting an insurance policy, keep post-hospitalization coverage in mind as it can be quite beneficial in the long term.
Cash Advance Advantage
You can acquire an advance cash benefit as an add-on to your insurance. This means that if you are hospitalised, your insurance may pay a portion of the expected treatment costs in advance. It’s a useful benefit because it alleviates some of your concerns by ensuring that a portion of your medical bills have already been covered and you don’t have to wait until the treatment is completed. In most circumstances, the advance cash benefit covers 50% of the expected costs, with the remainder reimbursed after treatment.
Ambulance Cover
Some insurance policies may include ‘Ambulance Cover,’ as the name implies. In that case, the insurance company would pay for your (the policyholder’s) transportation to the hospital. Check the scope of this insurance when purchasing the policy; some may have an upper limit, and some may even cover air ambulance costs—it all depends on the policy you purchase.
You get a health insurance coverage and exhale a sigh of relief, thinking, ‘Now I won’t have to spend a single rupee.’ Then comes the day of the hospitalisation, and the extra costs begin to pile up.
That ambulance ride you had to take to get to the hospital? Unless you have an Ambulance Cover add-on, that will be an extra Rs.5,000 (or more).
If your insurance policy offers ambulance coverage, the expense of transporting you to the hospital will be covered. However, you should also look into the scope of ambulance coverage. They may even reimburse air ambulance fees in some situations.
An annual premium
The annualised premium is the total amount you must pay in a year to purchase the coverage.
A Single Illness
A continuous duration of any ailment is referred to as Any One Insurance. For example, if you’ve been admitted and recovered from a specific sickness but fall ill again or relapse within 45 days, you’re covered by ‘everyone insurance’ or ‘anyone illness.’
Beneficary
A beneficiary is a person designated in an insurance policy who receives all of the benefits listed in the policy’s plan. It’s just another term for ‘policyholder,’ which is used occasionally. For example, if the policy is issued in your name, you are deemed the beneficiary. Similarly, if you purchase Group Health Insurance, the beneficiary will be an employee of your organisation.
Claim
Assume you are hospitalised and your medical expenses total roughly 1 lakh rupees. When you request that your insurer cover your medical expenses, you are ‘claiming’ the benefits of your insurance coverage.
There are two kinds of claims: cashless claims and reimbursement claims. The type of claim you file will depend on your agreement and the hospital where the treatment is provided.
If you have a cashless claim agreement, you will not have to pay any money up front, and your insurance company will pay for the treatment straight at the hospital.
If you have a reimbursement claim, you must pay the medical expenses that the insurance company will repay you for once your claim is granted.
You will have the choice of filing a cashless claim or a reimbursement claim, depending on your agreement with the insurance company. The insurance company will reimburse the expenses once your treatment is completed and you have claimed your benefits.
When it comes to cashless claims, you must notify the insurance carrier prior to treatment or within the 24-hour window following hospitalisation in case of an emergency.
Reimbursement
The payback of medical expenses by the insurance to the insured after they have incurred out-of-pocket expenses for their medical treatments is referred to as reimbursement. Under this plan, you will pay for any expenses such as hospitalisation, treatment charges, and so on, and the insurance company will repay you once the treatment is completed and the claim is satisfied.
Cashless
Cashless hospitalisation means that you do not have to pay for your hospitalisation out of pocket. You won’t have to worry about anything because the insurance company will pay the hospital immediately. Only in-network hospitals, that is, hospitals that have a contract with the insurance company, accept cashless claims.
Co-pay
Copay or coinsurance is a percentage of the total claim amount that you, the policyholder, must pay. The insurance company will cover the remaining balance. For example, you may be required to pay 15% of the expenses, with the remainder reimbursed by your insurance provider. This is known as a 15% copay. Ideally, you should look for a policy with no copays, which means that the insurer will pay the entire price in the event of hospitalisation.
Premium
The amount you pay to the insurer each year as part of the insurance contract to cover your health risk is referred to as the premium. If you pay an amount of 10,000 each year to obtain health insurance worth 5 lakhs, the yearly payment of Rs.10,000 is your premium.
You’re thinking about getting a new policy but can’t decide between two options: 2 lakhs, 5 lakhs, and 10 lakhs.
You believe that the coverage of 2 lakhs is insufficient, and that the premium of Rs.15,000 for 10 lakh coverage is excessive. As a result, you select the policy with a cover of 5 lakhs and a premium of Rs.10,000.
If you pay an amount of Rs.10,000 each year to obtain health insurance worth 5 lakhs, the yearly payment of Rs.10,000 is your premium.
Charge for Premium Allocation
The Premium Allocation Charge (PAC) is the portion of your premium that is deducted to cover the initial costs of issuing the policy, such as the distributor charge and the cost of underwriting. Any costs incurred by the insurer in providing the coverage in excess of the actual cost of the policy would be accounted for as PAC. This would be added to the total amount you pay to the insurance provider or deducted from the sum covered to you.
Percentage of Premium Allocation
The Insurance and Regulatory and Development Authority, or IRDA, has set norms that ensure a maximum on these charges to ensure that insurers do not deduct a very high Premium Allocation Charge (PAC). This is a fixed percentage of the premium received, and it is typically levied at a greater rate during the first few years of a policy. For example, if the PAC is 12%, on a Rs 1 lakh premium, Rs.12,000 is deducted and the remaining Rs.88,000 is available for financing your healthcare bills.
Prenatal and Postnatal Costs
Prenatal and postnatal expenses are the costs incurred during pregnancy and after the kid is born. Pre and post-natal expenses include treatments such as ultrasound, delivery procedures, medications, consultations, and so on.
Having a child is an amazing experience. You are at the start of a new chapter in your life. You must also be cautious during the nine months of pregnancy, as well as when caring for the infant and ensuring that they receive proper healthcare.
Thankfully, insurance companies now cover pre- and post-natal expenses to help you meet your financial obligations. These include treatments such as ultrasounds, delivery procedures, consultations, postnatal care, and so on.
Deduction in proportion
Deduction in Proportion is applied when the sum insured is less than the actual cost of medical treatment. If a policyholder with an under-insured policy makes a claim, the insurance company will proportionately reduce the claim amount based on the ratio of the sum insured to the actual cost of treatment.
For example, if a policyholder has a GHI policy with a sum insured of Rs. 2 lakhs and incurs a medical expense of Rs. 3 lakhs, the insurance company may apply a “Deduction in Proportion” formula to calculate the claim amount payable. If the company applies a proportionate deduction of 25%, the actual claim amount payable would be Rs. 2.25 lakhs (i.e., Rs. 3 lakhs minus 25% of Rs. 3 lakhs).
It’s important for policyholders to ensure that they have adequate coverage to avoid under-insurance and the potential for a reduced claim amount through Deduction in Proportion.
Refund Pro-rata
Refund pro-rata is a feature that allows policyholders to receive a partial refund of their premium if they cancel their policy before the end of the policy term. The amount of the refund is calculated based on the number of days remaining in the policy term, and the insurance company will typically charge a pro-rated premium for the duration that the policy was active.
For example, if a policyholder pays an annual premium of Rs. 30,000 for their group health insurance policy and decides to cancel their policy after six months, they may be eligible for a refund of the premium paid for the remaining six months. If the insurance company charges a pro-rated premium of Rs. 15,000 for six months, the policyholder may receive a refund of Rs. 15,000.
It’s important to note that there may be fees or penalties associated with canceling a group health insurance policy before the end of the policy term, and the exact refund amount may vary depending on the specific terms and conditions of the policy. Policyholders should carefully review their policy documents and consult with their insurance provider to understand the refund pro-rata feature and any applicable fees or penalties.
Charges that are reasonable and customary
R&C Charges, or Reasonable and Customary Charges, are the average rates imposed in the healthcare sector based on location, service, and community. R&C charges can help you obtain an idea of what medical prices are in your area and give you a better understanding of overall treatment costs. Always double-check these before deciding on the sum insured for your policy.
R&C charges in cities like Mumbai and Delhi will be substantially more than in cities like Nashik and Kochi. It is critical to consider this before determining your Sum Insured, as you do not want to be underinsured and experience financial hardship during a health risk.
Medical costs vary depending on where you reside. They are likely to be higher in a Tier-1 city than in a Tier-2 or Tier-3 city. R&C Charges, or Reasonable and Customary Charges, are the average rates imposed in the healthcare sector based on location, service, and community.
Room Rent Cap
Room rent cap is a feature that limits the amount of money the insurance company will pay for the cost of hospital room rent. Under this feature, the policyholder may be required to pay the difference if the cost of their hospital room exceeds the capped amount.
For example, if a policyholder has a room rent cap of Rs. 5,000 per day and is admitted to a hospital where the cost of the room is Rs. 7,000 per day, the insurance company will only cover Rs. 5,000 per day, and the policyholder will be responsible for paying the remaining Rs. 2,000 per day out of pocket.
This feature is designed to help keep healthcare costs under control and ensure that policyholders are not taking advantage of more expensive hospital rooms unnecessarily. It’s important for policyholders to carefully review the terms and conditions of their group health insurance policy to understand the room rent cap and any other limitations or exclusions that may apply.
Preventive Medicine
Preventive treatment is provided with the goal of early diagnosis and health monitoring. In contrast to diagnostic care, preventative care focuses on an individual’s general health and can include fitness consultations, food monitoring, and so on.
Checkups for prevention
Preventive check-ups comprise screenings, tests, and diagnostics designed to delay the start of sickness and raise the likelihood of early disease identification. If a corporation provides semi-annual or annual checkups to its employees, these checkups are classified as ‘preventive checkups.’
You subscribe to the adage that ‘prevention is better than cure,’ so you schedule a full-body checkup once a year, for which you pay a consultation fee and have numerous blood tests performed at a cost of roughly 2,000. What appears to be a little annual sum quickly adds up to tens of thousands of rupees invested over many years.
If your insurance company covers preventative checkups, they will cover the costs of screening, tests, and diagnostics used to delay the development of an illness and raise the chances of early identification of any disease.
Surrender
Surrender refers to the decision to cancel an insurance policy before its maturity date. An insurance policy typically has a one-year term. If you want to cancel your policy before that, you will be surrendering it.
Tele-consultation
Tele-consultation, also known as telemedicine or virtual consultation, is a remote medical consultation that allows patients to speak with healthcare providers through video or phone calls. Here’s an example of how a tele-consultation might work:
Mr. Patel is a 55-year-old man who is experiencing chest pain. He schedules a tele-consultation with a cardiologist, Dr. Shinde, who is able to diagnose a minor heart condition and prescribe medication to manage it. Mr. Patel is grateful for the quick and convenient consultation that helped him address his health concerns.
Underwriting
Underwriting is the process of comprehending and analysing the risks connected with insuring a person or entity. This work is completed by an underwriter, who uses their analysis to determine whether or not to give insurance to you.
Through the underwriting process, underwriters study and analyse the risks connected with insuring a person or entity. In this case, they would determine if you are covered or not. If so, they will also suggest the best coverage quantity and rate.
Conclusion
We hope this group health insurance summary has provided you with a valuable resource for understanding the intricacies of health coverage in a group setting. We understand that navigating the world of group health insurance can be overwhelming, especially with the numerous terms and acronyms involved. By breaking down these concepts into easily digestible definitions, we aimed to empower you with knowledge and enable you to make informed decisions regarding your health insurance options.
Remember, staying informed about group health insurance is essential for both employers and employees. With this detailed summary, we aimed to bridge the gap between confusing jargon and practical understanding, allowing you to navigate the complexities of group health insurance with confidence. Whether you’re exploring different plan options, understanding your rights under federal laws, or simply seeking to comprehend the terms commonly used in the industry, we hope this glossary has been a valuable tool for you.
As the world of group health insurance continues to evolve, it’s important to stay up to date with the latest changes and advancements. We encourage you to consult with professionals or additional resources to deepen your understanding further. Remember, knowledge is power when it comes to making informed decisions about your health and well-being.
