Insurance terms, in plain language
The jargon you'll meet when buying health cover — explained simply.
| Term | What it means |
|---|---|
| Sum insured | The maximum the insurer will pay in a policy year. |
| Premium | What you pay the insurer (usually yearly) to keep the cover active. |
| Pre-existing disease (PED) | A condition you already have when you buy (e.g. diabetes, BP). Usually covered after a waiting period. |
| Waiting period | Time after buying during which certain conditions or treatments aren't covered yet. |
| Initial waiting period | A short wait (often 30 days) at the start, before most non-accident claims are payable. |
| Co-pay | The share of each bill you pay yourself; the insurer pays the rest. E.g. 10% co-pay on ₹1,00,000 = ₹10,000 from you. |
| Sub-limit | A cap on a specific item (e.g. a limit on room rent or on cataract surgery), even within your sum insured. |
| Room-rent limit | A cap on the daily hospital room charge the insurer will cover. A higher room can also scale up other charges you must pay. |
| No-claim bonus (NCB) | Extra cover added free for each claim-free year. |
| Restoration / refill | Tops your sum insured back up if you use it up during the year. |
| Cashless | The insurer settles the bill directly with a network hospital, so you don't pay upfront for covered costs. |
| Network hospital | A hospital tied up with your insurer where cashless treatment is available. |
| TPA | Third-Party Administrator — the agency that processes cashless approvals and claims for the insurer. |
| Day-care procedure | Treatment needing less than 24 hours in hospital (e.g. cataract, dialysis) that's still covered. |
| AYUSH | Cover for Ayurveda, Yoga, Unani, Siddha, and Homeopathy treatments. |
| Floater | One shared sum insured covering the whole family, instead of a separate amount each. |
| Deductible | An amount you pay first each year before the insurer starts paying. |
| Free-look period | A window (usually 30 days) after buying to cancel for a refund if the policy isn't right. |
| Grace period | Extra days after the due date to pay your renewal without losing continuity benefits. |
| Portability | Switching insurer while carrying over the waiting periods you've already served. |
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