Health Insurance FAQ

What are the main types of health insurance?

 

The main types are employer-based plans, group, club or association plans, and individual insurance.

How do I get the best value-for-money policy?

 

By getting comparative online quotes from this site, you give yourself the widest choice between different insurance companies. Then it's up to you to pick the best value.

What exactly does the premium pay for?

 

In a health plan, there is far more administration involved because the health care providers in the scheme will invoice for work done or contact the company for permission to give particular treatment. This is in addition to the usual costs of advertising and selling the policies less the investment income from the premiums received, plus a profit margin.

What's the difference between primary and secondary coverage?

 

It's possible you are covered by two or more policies, i.e. through work and as a member of the family plan. The rules prevent you from claiming twice for the same event so you must claim only from the primary and not the secondary plan.

What's likely to be covered?

 

You should study the exact terms and any limitations or exclusions of any policy before you buy. Most cover the expense of treatment following an accident, injury, illness and disease. This usually includes visits by a physician, hospitalization, surgery and any follow-up treatment.

What are the main hospital plans?

 

The so-called "major medical" pays for visits by your physician, surgery, hospitalization and treatment for chronic illnesses, but you can opt for "hospital and surgery" which only pays for hospital stays, surgery, lab tests and the physicians' charges, or "hospital confinement indemnity" which contributes a set amount toward the cost of every day you spend as a hospital in-patient.

What's an HMO?

 

A Health Maintenance Organization offers complete service coverage with a selection of participating psysicians in general practice able to refer on to specialists. Depending on the terms of the plan, visits by a physician, preventative care, hospitalization, surgery and reduced-rate prescription drugs may be available.

Can you target an individual health risk?

 

Yes, it's called "specified disease" and it provides cover against the costs should you contract the specified disease, e.g. cardiovascular disoease, AIDS, cancer, etc.

If my health is good should I take out any cover?

 

As a young person in excellent health, you might decide to take the risk of falling sick and only insure against the costs directly resulting from an accident. Alternatively, take out a short-term policy which provides major medical cover for a limited period of time.

What's long-term insurance?

 

This is sometimes allied with home-health care and provides cover for people who suffer serious injury or chronic disease who will need long-term care either at home or in a residential facility.

What are the main exclusions?

 

Subject to separate rules that apply when you transfer cover between different insurance companies, the most usual exclusion is for a pre-existing condition. Most companies insist on a waiting period to see what happens to the condition before the company decides whether to accept you or not. Other common exclusions include alcohol and drug abuse, attempted suicide, cosmetic surgery, and dental and vision work which is usually insured separately.

What's copayment?

 

These are most usually found in HMO plans and require you to pay a fixed dollar sum every time you use one of the medical services, e.g. for each visit by a physician, prescription filled, etc.

What are the problems with cancellation clauses?

 

Make sure you have a guaranteed right to renew your policy no matter what your state of health. Similarly, make sure your company cannot cancel the policy because you make a claim for a condition likely to be expensive. You don't want the company to be a fair-weather friend who takes your premiums during the good health days and runs away when you fall sick. However, note that the premium will be higher to give you this right. Also note that a company should only be allowed to increase the premiums in line with inflation or some other defined formula. A company could effectively cancel a policy by only offering to renew for a massively increased premiuum.