Network and Non-Network Hospitals

Any hospital that has an agreement with an insurance company for providing cashless treatment is referred to as a network hospital. On the other hand, hospitals that are not a part of the network of an insurance company are called non-network hospitals.

Network and Non-Network Hospitals

Members Covered

This refers to the extent (number of members) to which your insurance provides coverage. Family members might include - a spouse, dependent children, and dependent parents.

Members Covered

AYUSH Hospital

An AYUSH Hospital is a healthcare facility wherein treatment procedures, and interventions are carried out by AYUSH medical practitioners.

AYUSH Hospital

AYUSH Treatment

This refers to hospitalisation treatments given under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems.

AYUSH Treatment

Cashless Claims

In the case of cashless claims, insurance companies pay directly to the hospital. There is no waiting period for reimbursement. This means the policyholders can get medical treatment at a network hospital without paying from their pocket at the time of hospitalisation.

Cashless Claims

Covid Hospitalisation Cover

The insurer shall compensate medical expenses incurred for hospitalisation of the policyholder during the policy period for the treatment of Covid on a positive diagnosis of the virus in a government-authorised diagnostic centre. This includes expenses incurred on treatment for Covid up to the sum insured specified in the policy.

Covid Hospitalisation Cover

Day-Care Treatment

Day-care treatments are procedures that require hospitalisation for less than 24 hours. Insurance policies may or may not provide coverage for such treatments depending on the policy type.

Day-Care Treatment

Disclosure To Information Norm

A policy shall be void in the event of non-disclosure of any medical information by the policyholder.

Disclosure To Information Norm

Emergency Care

Emergency care is for an illness with symptoms which occur suddenly and unexpectedly. Such ailments require immediate care by a medical practitioner to prevent death or serious long-term health issues for the insured person.

Emergency Care

TPA

A Third Party Administrator (TPA) is an intermediary between the insurance provider and the policyholder. Its key function is to ensure the settlement/processing of insurance claims.

TPA

Health Care Worker

Health care worker refers to doctors, nurses, midwives, dental practitioners and other health professionals, including laboratory assistants, pharmacists, physiotherapists, technicians and people working in hospitals.

Health Care Worker

Insured

The individual, group, or organisation who has obtained some sort of coverage through an insurance policy.

Insured

In-Patient Care

This means treatment for which the policyholder has to stay in a hospital for more than 24 hours to avail insurance coverage.

In-Patient Care

Unproven Treatments

Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their requirement. However, treatment authorised by the government for the treatment of COVID is always covered.

Unproven Treatments

Exclusions

Exclusions refer to treatments for which the insurance company does not provide coverage. So, claims against such treatments will be rejected by the insurance company.

Intentional injuries, congenital diseases and HIV are a few examples of exclusions in health coverage. The list of exclusions can be different for different insurers and even for different policies provided by the same insurer. This is why it is important to have all the information regarding your policy to avoid sudden surprises in an emergency.

Exclusions

Room Rent Limit

The limit imposed on the coverage of boarding expenses at the hospital or room rent of the hospital is called the room rent limit. The limit is either expressed as an absolute amount or as a percentage of the sum insured. Often times a company offers a high sum-insured of say ₹7-10L but the room rent limits would be capped at ₹3,000. This defeats the whole purpose of taking a higher sum-insured. When your room-rent limit is capped at ₹3,000 any expenses in hospital rooms with a higher per-day rent will also be capped at 3,000 no matter what your sum-insured is.

Room Rent Limit

ICU Charge

This refers to covering the charges of being admitted to the Intensive Care Unit. Many insurance policies also have a limit on the extent to which they cover ICU charges.

ICU Charge

Pre- Hospitalisation Medical Expenses

Relevant medical expenses incurred up to a certain period of time (depending upon the policy type) before hospitalisation will be covered by the health insurance. This includes expenses such as doctor follow-ups, medical tests, and medications.

Pre- Hospitalisation Medical Expenses

Post-Hospitalisation Medical Expenses

Relevant medical expenses incurred up to a certain period of time (depending on the policy type) after hospitalisation will be covered by the health insurance. This includes expenses such as doctor follow-ups, medical tests, and medications.

Post-Hospitalisation Medical Expenses