The Insurance Regulatory and Development Authority of India (IRDAI) has come out with guidelines on standardization in health insurance.
Co-payment: Co-payment means a cost sharing requirement in which the insured will bear a specified percentage of the admissible claims amount. Co-payment does not reduce the sum insured.
Cumulative bonus: Cumulative bonus means any increase or addition in the sum insured granted by the insurer without an associated increase in premium.
Deductible: Deductible means a cost sharing requirement in a health insurance policy where the insurer will not be liable for a specified amount in case of indemnity policies and for a specified number of days/hours in case of hospital cash policies which will apply before benefits are paid by the insurer. A deductible does not reduce the sum insured.
Grace period: Grace period is the specified period of time following the premium due date during which a payment can be made to renew or continue a policy without loss of continuity benefits.
Inpatient care: Inpatient care means treatment for which the insured person has to stay in a hospital for more than 24 hours.
Network provider: Network provider means hospitals or health care providers enlisted by an insurer, Third Party administrator (TPA) or by an insurer and TPA jointly to provide cashless medical services to an insured.
Newborn: Newborn means baby born during the policy period and aged up to 90 days.
Pre-existing disease: Pre-existing disease means any condition, ailment or injury for which there were symptoms or diagnosed, for which treatment was received within 48 months prior to the first policy issued by insurer and renewed continuously.
Pre-hospitalization medical expenses: Pre-hospitalization medical expenses cover expenses incurred during pre-defined number of days preceding hospitalization of the insured person.
