Simply having the basic understanding of terms used in insurance can make the difference between having a plan that will cover you against potential risks and having a plan that will not meet your insurance needs.
This article will help you understand some of the common terms used in health insurance.
Annual Limit
This is the maximum amount of money your insurance company will pay for the benefits in which you are covered within a year.
Bed Limit
This refers to the cost of accommodation including the standard meals served by the hospital.
Chronic disease
This refers to a medical condition that has one of the following characteristics:
- Has no treatment/cure
- Needs prolonged treatment or management
- Can change your body in a way that cannot be reversed
Dependents
Spouse and/or unmarried children of an insured who are eligible to be covered.
Exclusions
These refer to a set of conditions and/or services that are not covered in a health insurance plan. These conditions are stated in the medical insurance contract between the insured and the insurer also known as a policy document, and the insurance company will not cover any claim submitted for such conditions.
Inpatient
Inpatient care generally refers to any medical service that requires admission into a hospital or medical facility. Health insurance companies usually require you to be formally admitted into a hospital for a stay for a service to be considered inpatient. The cost shall be recovered from the members hospitalization benefit.
Lapse
This refers to the end of a policy once the period of cover has ended.
Outpatient
This refers to medical treatment or consultation that does not require a day admission or an overnight stay at a medical facility.
Provider network
This refers to a group of medical providers that have contracted with the insurance company to provide health care services. CIC Group has an extensive list of medical providers that can be found here >> https://cic.co.ke/wp-content/uploads/2021/09/CIC-Approved-Panel_of-Medical-Service-Providers.pdf
Sublimit
This is where certain and specified types of illnesses and conditions are not covered up to the full inpatient or outpatient limit the client has taken. For instance, if you have an inpatient cover limit of KES 1 Million, there are illnesses or conditions that are not covered up to KES 1 Million rather, they are covered up to KES 200,000.
While there are more health insurance terms than the ones outlined in this article, these are some of the most common definitions that will be of help when purchasing a health insurance policy. For any inquiries on health insurance, feel free to call us on 0703099120 or visit https://cic.co.ke/. At CIC, we keep our word.
