Health insurance glossary
Plain-English definitions of the health-insurance terms that decide what you actually get paid — co-payment, room-rent limits, waiting periods and the rest — each with a worked ₹ example and no sales pitch.
Cost-sharing
- Co-paymentOn every hospital bill the insurer approves, you chip in a set share (say 10 or 20 percent) and they pay the rest. Your total cover stays untouched.
- Zone-based PricingWhere you live sets your premium, because hospitals are pricier in big cities. Buy cheap on a small-town zone, then get treated in a metro, and you may have to chip in a co-pay.
- Non-Payable ItemsThe small stuff on your hospital bill — gloves, syringes, admin fees, slippers — that insurance never covers. You pay for these yourself, even with cashless.
Waiting periods & eligibility
- Waiting PeriodIt is the 'not yet' clock on your cover. You are insured, but some treatments only start getting paid after you have held the plan for a set time.
- Pre-existing Disease (PED)It is a health problem you already had before the policy started. You can still get covered, but claims for that condition only begin after you have held the plan for the waiting period.
Coverage & benefits
- Room Rent LimitIt's the cap on how much your policy pays per day for your hospital room. Go above it and you pay the difference — and often a chunk of the rest of the bill too.
- Sub-limitIt's a smaller ceiling inside your big cover that applies to one particular treatment. Your ₹10 lakh plan might still pay only ₹25,000 for cataract.
- No Claim Bonus (NCB)Stay claim-free for a year and your cover grows for free, or your renewal gets cheaper. It is the insurer's way of rewarding healthy, low-claim years.
- Restoration BenefitIf your cover runs out mid-year after a big hospital bill, this benefit tops it back up so you are not left with zero protection for the next admission.
- Top-Up vs Super Top-UpBoth are cheap extra cover that starts after a set amount. A top-up counts that amount per hospital visit; a super top-up counts it once for the whole year — so the super top-up triggers more easily.
Claims & process
- Proportionate DeductionIf you pick a pricier room than your policy allows, the insurer doesn't just cut the extra room cost — it shaves a matching percentage off many other charges on your bill too.
- Moratorium PeriodAfter you have held your policy for five continuous years, the insurer loses the right to dig into old paperwork to deny a claim, unless it can prove you committed fraud.
- Cashless vs ReimbursementCashless means the insurer pays the hospital directly (at network hospitals only). Reimbursement means you pay first, then send in the bills to get your money back.
Policy admin
- Free-Look PeriodA 30-day no-questions trial on a new policy. Don't like the fine print? Cancel and get your money back, minus small charges.
- Grace PeriodA short buffer to pay a late renewal — 15 days (monthly) or 30 days (yearly) — so you keep all the benefits you've built up. Miss it and the policy lapses.
Reviewed by
Atul SharmaAVP, Founder’s Office at CoverSure · 7+ years in insurance (ex-Tata, Ditto, Cholamandalam)
