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Health Insurance Cover

Health Insurance protects everyone in your family against financial loss

Medical emergencies can hit anyone

Medical emergencies can hit anyone, anytime regardless of age, gender or lifestyle. Due to this it is always advisable to be prepared for it.

Health Insurance protects everyone in your family against financial loss from the unexpected. After paying and agreed annual premium, the insurer pays for your hospitalization and other medical expenses as per your policy.

Common Types Health Insurance Plans

a) Inpatient cover:

Inpatient covers come into effect when the policyholder is admitted to hospital. This cover the direct costs of treatment and also covers policyholders from the liabilities associated with accommodation costs in the medical facility.

b) Outpatient cover:

The outpatient cover protects policyholders from liabilities associated with access to outpatient facilities. A policyholder accesses health services in a hospital or clinic accredited by the insurance. Outpatient covers do not usually exist on their own. They are normally taken together with the inpatient cover.

c) Maternity cover:

Maternity cover usually meets the costs of hospitalization, including delivery and any eventualities such as congenital illnesses that may result from the pregnancy. This cover is usually included as an enhancement of a basic health insurance policy.

Factors to consider when choosing a Health Insurance cover

a) Benefits :- Assess the benefits associated with each policy. Compare the limits of each policy to see just how much would be available to you.

b) Budget: –  Consider how much are you willing and able to spend on health insurance. Make a decision on how much you can spend on health insurance based on your needs and based on your capacity.

c) Needs: –  Consider what you are looking for. The needs should be your individual needs and those of your dependents. The needs will be determined by your current state of health, which will have an influence on how frequently you need medical attention and the type of care.

d) Preferred Insurance Company: – Decide on your preferred insurer. Finding a company that fits within your needs is very important. Once you have understood what your needs are, compare the policies available, assessed the benefits of these policies, and finally you have settled on a provider, then and only then, are you ready to buy health insurance.

Health Insurance Claims Process

Here is how the claims process works: -

a) Claim as you go:

Health insurance claims are made when one visits a hospital to access medical services. Once you visit a hospital to access treatment, the insurance company will pay for your treatment based on the cover limits of your policy. One can make claims as many times as possible provided one does not exceed the limit as per the policy

b) Co-payment: -

Most insurance companies will have a co-payment policy on their cover. This means that each time you visit a health facility you will have to pay a fixed amount to the hospital. The specific amount varies from hospital to hospital and also varies according to specific policy.

c) Exclusions: -

Health insurance usually comes with certain exclusions. These exclusions may include some medicines and procedures that do not meet the threshold for services that can be insured against.

Conditions excluded from Health Insurance Policies

a) Congenital defects: Refer to defects that affect unborn children, and are usually detected before, during or after birth, and in some cases later in life.

b) Pre-existing & chronic conditions: Insurance companies are not obliged to cover a policyholder who joins their scheme after the onset of a medical condition. For instance, a policyholder who has an organ defect (say failing kidneys) does not have the right to demand an insurer to cover the costs associated with his treatment of the disease had been detected earlier than the effective date of their policy.

c) Cosmetic surgery unless caused by an accident: insurance companies do not pay for elective cosmetic surgery and procedures. Elective cosmetic surgery does not qualify for a risk, and is a deliberate choice by an individual. A health policy will cover a cosmetic procedure if it is required to restore normalcy to the looks of a policy holder. This may be the result of burns, wasting infections, or any other ailment causing physical deformity.

d) War and kindred risks: – Health problems associated with war and kindred risks are not insurable

e) Dental and Optical Conditions: Some covers still do not cover dental and optical conditions unless specifically included in premium calculations.

f) Intentional self-injury: This exclusion stems from the understanding that insurance is meant to cover risks, and not premeditated events.

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