7 Health insurance jargons you must know


06 Jul 2023

Master These 7 Essential Health Insurance Jargons for Better Understanding

You should always have a financial backup to protect you from all financial adversities. But, there are certain words you might not be aware of, which makes it complicated for you to understand. We have covered a few health insurance jargons to ensure you understand everything easily.

Health insurance jargons

Below are some health insurance terms you should be aware of -

  • Waiting period

You cannot file a claim during a waiting period. Usually, there is a waiting period for benefits related to pre-existing conditions, maternity care, etc. A waiting time might be anywhere between a few months and many years. As a result, it is advised to purchase health insurance as early as feasible.

  • Deductibles

The portion of the insurance claim costs you are liable for is the deductible. The deductible will be subtracted by the insurance company from the total claim amount in a reimbursement claim. A deductible is intended to persuade consumers to forego making claims for relatively small mishaps.

  • Sum insured

The sum insured is an amount that the insurer will pay in the event of any mishap or health emergency. When you file a claim, your insurer must only pay up to this amount, which is pre-specified. The policyholder must cover any costs that are more than the sum insured. Your choice of the sum insured will likely have some bearing on how much your health insurance policy's premium will be.

  • Nominee

The proceeds of the insurance will be given to the nominee in the case of the death of the insured or policyholder. Sometimes, in the case of health insurance, if the claim is cashless, the nominee might not get the proceeds. However, the nominee will always get all the proceeds if you opt for a reimbursement claim.

  • Pre-existing illness cover

As the term implies, a pre-existing ailment is one you had before purchasing health insurance. Hyperglycemia, cataracts, hypertension, asthma, and other pre-existing conditions are typical. You should be honest with your insurance provider when disclosing all pre-existing conditions. Hence, you can also acquire health insurance coverage for a pre-existing condition if they permit.

  • TPA

Third Party Administrators, or TPAs, are specialized organizations in charge of organizing and handling insurance claims and other associated services. To start the claim procedure, a policyholder must contact the TPA, frequently located on hospital grounds.

  • Inclusions

The circumstances under which a policyholder may make a claim are described in the inclusions/coverage. Insurance should be purchased with the accessibility of ranges in mind. Regarding health insurance, popular coverages include bed costs, doctor visits, nurse fees, etc.


With the health insurance jargons mentioned above, you can understand a policy better and buy the best one that suits your needs. Also, read the health insurance policy document along with the terms and conditions.

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Team Kotak GIC

The content of this blog has been created and carefully reviewed by the esteemed team at Kotak General Insurance, with the sole purpose of providing valuable guidance and sharing insights on the importance of general insurance. Our objective is to assist users in making informed decisions when purchasing or renewing insurance policies for their cars, bikes, and health. Our expertly curated information aims to empower our readers with the knowledge they need to protect their valuable assets and financial interests.