{"id":7748,"date":"2025-02-18T09:45:00","date_gmt":"2025-02-18T04:15:00","guid":{"rendered":"https:\/\/www.carepalsecure.com\/blog\/?p=7748"},"modified":"2025-05-28T16:06:16","modified_gmt":"2025-05-28T10:36:16","slug":"understanding-the-fine-print-of-health-insurance-policy-2","status":"publish","type":"post","link":"https:\/\/www.carepalsecure.com\/blog\/health-insurance-2\/understanding-the-fine-print-of-health-insurance-policy-2","title":{"rendered":"Understanding the fine print of Health insurance policy"},"content":{"rendered":"Reading Time: <\/span> 12<\/span> minutes<\/span><\/span>\t\t
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Understanding the fine print of
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Most experts emphasize reading the fine print of all investment documentation, nobody iterates the importance of understanding the terms and conditions. Given the number of times terms and conditions are required to be read even while you are browsing the net or downloading software, we have become immune to it and don\u2019t even bother reading it. However, for your investment documents, despite being digitised, you must spend time and energy to understand what you are committing your money to.<\/p>

Health insurance documents are quite complex since the risk assumed by the insurer is quite huge, they have a very comprehensively drafted policy document that covers their bases and indicates what the policy would cover.<\/p>

Health insurance gaining momentum:<\/span><\/h2>

The current pandemic has increased the need for availing of health insurance. There has been an increased probability of hospitalisation due to coronavirus over the past 2 years. The treatments for complicated cases in private hospitals have been expensive. This has made many individuals sign up for health insurance to cover their medical expenses in the event of hospitalisation or incurrence due to contracting coronavirus. There are many options for health insurance in India, the choice of the right one is itself challenging. After choosing the right one, it is important to read and understand the terminologies in health insurance plans.<\/p>


Health insurance is a complex instrument with many clauses which may be beyond the comprehension of individuals. By understanding the terms and conditions pertaining to health insurance, you will be able to make an informed decision.<\/p>


Ignoring or signing up for health insurance without reading the fine print could lead to rejections during claims. To de-jargonise the health insurance policy, we have the below terminologies which you would come across in most health insurance plans in India.<\/p>

  1. Sum insured:<\/span><\/li><\/ol>
    1. Also termed as sum assured is the policy coverage, the sum insured can range between Rs. 5 Lakh to Rs. 100 cores. The sum insured should align with the existing ecosystem and requirements. If one is availing of health insurance for multiple people (family members), then one has to evaluate the cumulative requirement and avail a family floater health insurance.

      <\/li><\/ol>
      1. Premium:<\/span><\/li><\/ol>
        1. A certain amount, called the premium, is paid to the health insurance company against the policy purchased. The insurance company assures to pay the sum insured on the occurrence of a certain event.

          In the case of health insurance, the insurance company honours any claim against medical expenses. The premium is a function of the type of policy, the sum assured, age and health of the policyholder, family history, lifestyle etc.

          <\/li><\/ol>
          1. Critical illness:<\/span><\/li><\/ol>
            1. Health insurance companies cover expenses related to medical treatments. Critical illness refers to those illnesses which are life-threatening such as cancer, heart attack, kidney failure, organ transplant etc. Critical illness may be offered as a cover under the basic plan or can be offered as a rider.

              <\/li><\/ol>
              1. Network hospital:<\/span><\/li><\/ol>
                1. Insurance companies have a set of network hospitals from where the insured can undergo the required medical treatment. Any hospital which has an agreement with the insurer to provide cashless medical treatment to policyholders is termed as a network hospital. On signing up with a health insurance company, the insured will be given a copy of the network hospitals, the same can be downloaded from the health insurers website as well. This is a very convenient arrangement extended to individuals, as the insured will have to directly take admission in the hospital and not worry about arranging for funds etc., The hospital based on the policy number will directly interact with the insurance company and carry out the settlement seamlessly. This is a stress-free mechanism for the insured.

                  <\/li><\/ol>
                  1. Cashless claims:<\/span><\/li><\/ol>
                    1. Cashless settlement is one of the two types of settlement offered by health insurance companies, under this settlement method, the hospital bill is directly settled by the insurer. The settlement is done upfront and there is no waiting period to reimburse the payment.

                      Cashless claims are convenient, reduce the time in logistics and documentation as well. Many people prefer this mode of settlement and consider it as one of the vital factors for choosing a health insurance policy. The alternate type of settlement involves the insured making the upfront payment, collecting the required bills and submitting to the insurer alongside required documentation. The insurer will then make the required investigation and due diligence honour the claims to the extent that it adheres to the nuances of the policy.

                      The important aspect that you need to keep in mind whilst availing of cashless settlement: