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Illuminating the language: A glossary of health coverage and medical terms

A glossary of health coverage and medical terms

Understanding the language of health coverage and medical terms is important for making decisions about your healthcare with a plethora of acronyms, jargon and technical terms. Navigating the complex world of health insurance can often feel like trying to solve a foreign language. Kotak General Insurance will illuminate the language by providing a comprehensive glossary of health coverage and medical terms commonly encountered in the domain of medical insurance.

Glossary of health coverage and medical terms

Below are some key points of health coverage and medical terms:

  • Deductible: For instance, if your deductible is Rs. 1,000, you will need to pay this amount before your insurance coverage kicks in. The deductible refers to the amount of money you must pay out of pocket for covered medical services before Kotak General Insurance starts to contribute.
  • Premium: A premium is the amount of money you pay for coverage which is usually paid annually, regardless of whether you use any healthcare services. Premiums can differ based on factors such as age, location and the type of plan you choose.
  • Copayment: A copayment or copay, is a fixed amount you pay for a covered service at the time of receiving care. For example, you may have a copayment of Rs.2000 for a doctor’s visit or Rs.1000 for prescription medications. Copayments differ depending on the type of service and your health insurance plan.
  • Coinsurance: Coinsurance refers to the percentage of costs you are responsible for paying after meeting your deductible. For instance, if your insurance plan has a coinsurance rate of 20%, you will pay 20% of the cost of covered services, while your mediclaim will cover the remaining 80%.
  • Out-of-pocket maximum: The out-of-pocket maximum is the maximum amount of money you will have to pay for covered services during a specific period, usually a year. Once you reach this limit, your insurance will cover 100% of covered services. It includes deductibles, copayments and coinsurance.
  • Pre-authorisation: Pre-authorisation is a process where you obtain approval before receiving certain medical services or procedures. It is usually required for expensive or non-emergency procedures to ensure that they are medically necessary and covered under your plan.
  • Network hospitals: A network hospital refers to a group of healthcare providers, including doctors, cashless hospitals and clinics, that have agreed to provide services to members of a specific insurance plan.
  • Out-of-network: Out-of-network providers are healthcare professionals or facilities that do not have a contract with your insurance plan. Seeking care from out-of-network providers may result in higher out-of-pocket costs or limited coverage.
  • Explanation of benefits (EOB): An explanation of benefits is a document you receive after you have received medical services. It explains what services were provided, the amount billed, the amount covered by insurance and any remaining balance that you may owe.
  • Pre-existing condition: A pre-existing condition is a health condition or illness that you have before obtaining medical insurance for your parents.

Conclusion

Understanding the language of health coverage and medical terms is essential for effectively managing your health insurance. This glossary provides an overview of some key terms commonly encountered in the realm of health insurance. Remember, if you ever come across unfamiliar terms, don’t hesitate to reach out to Kotak General Insurance for clarification.

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Health

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