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 Health insurance guide

Health insurance is designed to cover the cost of private medical treatment for illnesses and injuries that are curable and short term.To help you decide if it's right for you, our health insurance guide explains how it works in more detail.

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Health insurance explained

To help you decide if health insurance is right for you, we've compiled a short guide that explains what it is and how it works.

What is health insurance?

Health insurance is designed to cover the cost of private medical treatment for illnesses or injuries that are curable and short term (also known as ‘acute conditions’). Although a health insurance policy won't make such events any less stressful or upsetting, it can provide valuable peace of mind that specialist treatment will be available promptly, often at a hospital of your choice.

Remember! Health insurance is not designed to replace all NHS services as some services are outside the scope of private hospitals e.g. Accident and Emergency and GP services.

What’s the difference between ‘health insurance’ and ‘private medical insurance’?

There’s no difference other than in the name. Private medical insurance is also commonly referred to by its abbreviated form – PMI.

What does health insurance cover?

There are a wide variety of health insurance policies available, ranging from budget policies offering a limited range of benefits to higher priced policies offering much more extensive cover. Depending on the individual policy cover may be available for:

Out-patient treatments

Diagnosis, investigations, consultations or treatments that do not require the patient to be hospitalised overnight. Out-patient treatment usually includes consultation with specialist, diagnostic tests, radiotherapy / chemotherapy, physiotherapy and psychiatry.

Day-patient treatments

Day-patient treatments often require the patient to attend a hospital or clinic on a regular basis or for a period that lasts at least half a day without requiring them to be hospitalised.

In-patient treatments

In-patient treatment requires the patient to be hospitalised for one or more nights. In-patient treatment usually includes hospital charges, specialist / consultant fees, diagnostic tests, psychiatry and physiotherapy.

As a private patient you will usually have the privacy of an en-suite room along with other comforts, such as a television and telephone.

Remember! Some insurers do not make a distinction between out-patient and day-patient treatment, instead preferring to split the type of treatment into in-patient and out-patient treatments only. Cover can vary significantly between providers, so it's important to check exactly what level of cover you are getting from a policy before you buy.

What isn’t covered by a health insurance policy?

Health insurance usually does not provide cover for:

Chronic conditions i.e. those that cannot be cured

GP services

Accident and emergency admissions.

Pre-existing conditions i.e. a health condition or medical problem that was diagnosed or treated before the insurance policy was taken out.

What are exclusions?

An exclusion is a circumstance of event – such as a particular condition or treatment – that can prevent or invalidate a claim e.g. drug abuse, self-inflicted injuries, infertility, cosmetic surgery, preventative treatment, mobility aids, etc.

Remember! Always check the policy documents for a full list of policy exclusions.

What is an excess?

An excess is the contribution you agree to pay towards any claim. The excess is split into two different types, compulsory excess and voluntary excess.

Compulsory excess

This is the amount your insurance company requires that you pay towards any claim made on your policy. Normally it is deducted from the settlement made to you.

Voluntary excess

This is the amount you agree to pay towards the claim in addition to the compulsory excess. You agree this at the start of the policy; the higher the excess the lower your premium will be.

Depending on the insurance company, you may be able to opt for a no-excess policy. This means that you will not be required to contribute towards a claim, although the cost of the policy will increase as a result.

In the next part of our guide we look at arranging health insurance in more detail.

Arranging health insurance

Arranging health insurance can provide peace of mind in the event that you fall ill or are injured, so knowing what to look for when you compare policies is the key to getting the right cover for your needs.

What should I look for when I buy a policy?

When comparing policies you’ll need to consider:

Whether you want the policy to include access to a specialist as an out-patient – budget policies normally only provide cover for in-patient treatments.

Whether you’d like a choice of hospitals rather than access to a limited selection chosen by your insurance company.

Who you’d like to cover i.e. yourself only; yourself and your spouse or partner; or yourself and your family.

Whether you want cover for alternative therapies, for example acupuncture.

Whether you’d like access to additional benefits, such as nursing at home, a private ambulance, etc.

Whether you’d be willing to receive NHS treatment where it is available within 6-12 weeks.

What grade of hospital accommodation you’d prefer.

The cost of the policy will depend on the choices you make.

What other factors affect the cost of a health insurance policy?

Insurers will ask you whether you are a smoker – if you are then you will normally pay more for the policy than a non-smoker as tobacco use has proven links to conditions such as lung and throat cancer.

Insurers will also look at your age when calculating the cost of your policy. This is because people are more likely to need medical treatment as they get older.

Some insurers will allow you to choose from a range of excess amounts when you take out the policy (the excess is your contribution towards the claim); the higher you set the excess, the cheaper your premiums are likely to be. However, remember to always set the excess at an amount you can comfortably afford should you need to make a claim.

Will my premiums stay the same for the duration of the policy?

Whichever policy you choose, it is likely that your premiums will increase on an annual basis. This is because more people are claiming on their health insurance policies each year with some treatments now becoming routine e.g. hip replacements in older people (Source: Association of British Insurers). Similarly, as you get older your insurer will normally increase your premiums to reflect the fact that you are more likely to require medical treatment.

In addition, the advances in medicine mean that the complexity of tests and treatments is increasing, with more hospitals having access to sophisticated equipment and specialist staff – both of which come at a cost. To support these developments, insurers need to review the cost of the policies they offer.

Remember! If you stop paying your premiums your cover will stop.

Will I need to provide details of my medical history?

When you make a health insurance application the insurance company may accept it based on either a medical history declaration or ‘moratorium’.

Medical history declaration

If the insurer requests that you complete a medical history declaration then you will need to fill in a form giving full details of your medical history; this may result in the insurer requesting a medical report or Doctor’s letter.

Moratorium

Instead of asking you to provide details of your medical history the insurer will simply exclude cover for any pre-existing conditions, usually those that occurred within the past five years. Depending on the insurer, these conditions may become eligible for cover in the future providing that you have not had any symptoms or received treatment or advice for a continuous period. Some conditions will be classed as ‘chronic conditions’ and as a result they will never be covered.

What if I am disabled?

If you are disabled then you will still be eligible for cover, however in line with their stance on pre- existing medical conditions the insurer is within its rights to exclude cover for treatments that directly result from your disability.

Remember! Always declare all relevant information about your disability, that way the insurer can make an informed decision when underwriting the policy. Failure to do so could invalidate your right to make a claim.

For more information on insurance for disabled people, call the Association of British Insurers on 020 7600 3333 and ask for their information sheet ‘Insurance for disabled people’.

Where can I buy a health insurance policy?

You can buy a health insurance policy through a financial advisor, bank, building society or insurance company.

By using an online comparison site you can compare quotes from a number of different insurance companies with one search. This enables you to compare prices and see what is included in each policy before you buy, enabling you to find the right level of cover at a price that’s right for you.

Remember! The cheapest policy may not provide the right level of cover for your needs. By paying a little extra for your insurance it is usually possible to secure better cover and therefore get better value for money.

What if I change my mind?

If you do not receive full details of the policy terms when you buy the policy you will be entitled to a ‘cooling-off period’, which normally lasts 14-28 days. If you decide not to go ahead you will usually be entitled to a full refund of any premiums you’ve paid – providing you’ve not made a claim.

If you want to cancel your policy after the cooling off period then your insurance company does not have to refund the payments you’ve made.

Can I change insurance companies?

Although you can change insurance companies it’s important to remember that the new company may not cover any previous or existing medical conditions that your current company may cover.

Before changing insurance companies always check how the change may affect the cover you receive.

If your insurance company plans on making changes to your policy you will be provided with the details of the changes before you renew.

3:00 AM

Health Insurance

Health insurance is the insurance that pays for unexpected or high medical expenses. There are many countries that have health care funded by government. This means that majority of citizens have access to medical facilities and treatment. It can be also purchased from private insurance company. It can work on group basis (e.g. when company covers its employees) or on an individual basis. In each case the group or the individual pays premiums or taxes to in order protect themselves from high or unexpected health-care costs. Many people get health insurance through their employers, meaning that the employer helps to pay for insurance. This type of insurance is usually with a managed care plan that is a contract with medical facilities to provide health care for members with lower costs.

You can also buy health insurance on your own, it costs a little more than employer-based insurance. In summary, if you don't have health insurance, you need to pay your medical bills directly.

Your health insurance is actually an agreement between you and your insurance company. It gives you certain medical services such as medication, tests and treatments. The cost of these benefits are covered by insurance, and are called "covered services ". Please notice that a medical necessity and a medical benefit are not the same. A medical benefit is what covered by your insurance. A medical necessity is something decided by your doctor as necessary. It might be that your doctor can recommend medical care, which is not covered by your insurance policy. Insurance company has to decide, what types of drugs, tests and services will be covered by your health insurance plan. What you can do is to understand better your health insurance coverage so that you can help your doctor prescribe you the medical care that is covered by your insurance. Just remember that your insurance company decides what you pay, not your doctor.

It's very important to know your health insurance options. When you have enough information, you can always make a better decision about health care. Your aim should be high quality medical services and this is not necessarily the cheapest offer. The insurance should also cover vision and dental, baby and preventive care. You can use various ways to measure and compare the quality of your health care choices so you can make the best decision. You can do things like Quality Reports and Accreditation Reports, read consumer ratings - how satisfied customers are with the doctors in their health insurance plan, or clinical services, and how well health care organization provides treatment.

To select the right health insurance plan is not easy. Actually, there is no such thing as "best" plan for all. Some health insurance plan can best suits you and your family, however, it may not necessarily be the best for another family. There are some things to consider when you selecting a plan. Let say you thinking about choosing long-term health insurance coverage or something for the short term. There are some notices about that. If you know that you need a plan for a specific period of time, e.g. you are between jobs for a while, so short term plan works fine. Short term health insurance plans can be helpful in case of sudden illness or injury, so they don't have a number of benefits of long-term insurance plans like dental and eye care.

There are many health insurance policies, but the basic principle is to give you access and opportunity to health care service, and to ensure that health care is affordable. The point is, make sure that you understand what you are purchasing and that the health insurance plan you selected can cover your health needs.

5:45 AM

Finding a Good Cancer Life Insurance Agent

An important step of purchasing cancer life insurance online is getting a certified agent who will do many things for you. The agents are certified pros who: Will do necessary steps to get you an insurance company that may understand your situation and offer the best pricing.

• They are experts in cancer life insurance that will wipe away your frustration and disappointing rejections that result from employing agents who aren't well educated in cancer risk.
• They will direct you from during whole proceeding from QUOTE right into ISSUE, furnishing you with periodical updates and allowing you to be aware on all things may do to get the best possible pricing.
• Have dependable connection to insurance company, so they do not need to speculate at the way you'll be ranked, and may negotiate with insurance company to ensure you to get you the lowest price.
• Have knowledge in choosing what hospital that can handle each cancer case in the most pleasing manner.
• Value your privacy rights and honor while getting all the required details in giving you the best cancer insurance policy.
• Continuously giving you SERVICE on the policy when it is established.

7:26 PM

Tips for Choosing Health Insurance Appropriately

Tips for Choosing Health Insurance Appropriately - "Do not wait until you are impoverishing disease", I think the phrase as it is much good to be obeyed. Why not, of course, because the cost of qualified medical expenses is expensive. However, if the expression says "Healthy is Expensive", I think this is less precise because it is not healthy to be expensive. For example, often eat more vegetables guarantee we will be healthy, this is much better than we always mengkonumsi fast food every day is expensive diresto. Healthy Is not it cheaper?

In spite of it all, we also need health insurance . For anyone who knows the future life later. We are now healthy, did not know about next week suddenly diagnosed with pain that would cost a lot of care. Or we are already diagnosed? But not to me. So, do not wait diseases impoverish us to forget to follow because of health insurance.

Health insurance can be a safety net when we are sick so that the hard work has not gone to pay for medical care. For that enrich yourself with the types of insurance in accordance with the expected protection.

Health insurance continues to grow, there is the cost of replacing critical illness insurance critical for the early stages of the disease, or the only guarantee of hospitalization alone.

According Tejasari, a financial planner from Tatadana Consulting, ideally everyone has health insurance, not to mention the children because of their tendency to get a bigger hospital.

"In addition to more easily hurt, the mother usually easy to worry about the health of their children. Fever usually 3 days immediately taken to the hospital," he said.

Tips on choosing the right health insurance for Us

Select the type of health insurance that is pure

Currently, many insurance options are combined simultaneously with investment, or popularly called unit-linked. However, should we choose who is pure as health insurance. Because pure health insurance premiums are cheaper and also more precise benefits.

Choose Insurance that covers the entire cost of treatment

Health insurance in Indonesia is currently replacing many claims of health costs to the number specified or agreed. Replacement level could include the cost of room, doctors, drugs, and other medical measures, the limits for each type of health service.

There is also a health insurance that only covers hospital room just so that customers still have to pay for various medical procedures and medicines. Should select to cover the entire cost because it is usually expensive and drugs act.

Room Rate Survey

Before determining the amount of the premium, we should do a survey of the price of a hospital room where we are headed when the possibility of pain later. If we wants when ill treated in the class room 1, yes only adjusted premiums. If it wanted in the VIP room, so grab a higher premium.

Critical illness insurance

    In addition to hospitalization insurance at the hospital, is now also available insurance for critical illnesses, such as heart attack, diabetes, cancer, and many more.

    Critical illness insurance is usually not to replace the cost of hospital care. This is a type of insurance policy pays for the insurance money so customers critical illness. Paid in full but after that is not covered anymore.

    Critical illness insurance is important for those who have a family history of certain diseases. For example, if a parent, grandparent, or a brother who has cancer, then we should buy this insurance just in case. Especially now tend lifestyle is not healthy.

Reimbursement or card

    Reimbursement of health care costs generally consist of two types, namely through the reimbursement system or we pay first and then changed the insurance company, or put on the card.

    Reimbursement systems are usually cheaper premiums. But we have to pay the consequences first, while the card system all been taken care of so we do not bother.

    To prevent the occurrence of unpaid claims, especially those wearing reimbursement system, we should ask the insurance agent with details, ie what are the conditions that are not covered by insurance.

Do not forget to be honest, for example if it's smoking do not say no because once we entered the hospital on the grounds that we could not pay the claim.

3:00 AM

Maryland Health Insurance

I was surprised to get this card because the Maryland Health Insurance Exchange recently issued a report that said they would have among the lowest health insurance rates in the country once "Obamacare" goes live on October 1:

    For the scenarios evaluated, Maryland’s approved rates are among the lowest of the 12 states that have proposed or approved rates available for comparison. For example, for a 50-year-old resident, New York has approved a Silver plan at a rate of $319 per month. For a 50-year-old resident, Maryland has approved a Silver plan that costs as much as 18% less (from $260 to $269 a month, depending on the region).

    Among Bronze plans compared for young adults, Maryland rates were lower than those proposed or approved in all other eight states for which a comparison was possible. For example, the lowest price for a Bronze plan for a 25-year-old in Maryland was $114, compared to $134 in Virginia, $146 in Colorado, $163 in Ohio, $167 in Washington State, and $174 in California.

Among Silver plans for middle-aged adults, Maryland rates were lower than those proposed or approved in all other states except New Mexico. For example, the lowest price for a Silver plan for a 50-year-old in Maryland is $260, compared to $319 in New York, $329 in Virginia, $343 in Colorado, $374 in Ohio, $376 in California, $392 in Washington State, and $400 in Rhode Island.

I keep seeing one study or comparison after another from state to state comparing the lowest, or second lowest cost Silver plans (the federal subsidies are tied to the second lowest cost Silver plan), to existing health insurance rates and bragging about how low they are.

But what is often happening here is that these lowest cost and second lowest cost plans are likely the most limited access plans available.

For example, Wellpoint is the only insurer offering a plan on the New Hampshire exchange. That plan offers only 14 of the 26 state hospitals and only 65% of the docs in their wider networks.

A McKinsey analysis of 13 state exchange plans found 47% were HMO plans––last year only 5% of the individual market sales on eHealthinsurance.com were HMO products.

In California, Blue Shield is offering only one exchange plan, a narrow network plan that includes only 36% of their contracted docs and is notable for not including the most highly regarded hospitals in the state.

The lowest cost California plan comes from insurer Health Net. The LA Times is reporting that Health Net is offering, "less than half [the number of providers] some other companies are offering in Southern California." The Times reports that Health Net is limiting its network to one-third its usual employer network. In San Diego, the company will only have 204 primary care physicians in its provider network.

"We are nervous about these narrow networks," Donald Crane, CEO of the California Association of Physician Groups was quoted by the Times. "It was all about price. But at what cost in terms of quality and access? Is this contrary to the purpose of the Affordable Care Act?"

Dr. Crane, this is certainly contrary to the claims health insurance exchanges like California are making declaring victory over rate shock.

What many health plans have done is to put their lowest cost plans on the exchanges and have often built new very narrow network plans just for the exchange. Some of these lower cost plans are being offered by Medicaid contractors moving into the commercial market for the first time. The thought is that many of the people coming onto the exchange will be low income people coming from the ranks of the uninsured where even the narrowest network plan will be a huge improvement.

Offering narrow network plans is a legitimate strategy.

What is also happening is that health plans are expecting that higher income people will not be eligible for a subsidy and will come directly to the health plan for the better coverage when it isn't available on the state exchange.

My sense is that is what this post card is alluding to. Yes, there are very cheap rates on the Maryland exchange. But if you want the better plans, you had better come to us directly and buy now and avoid the "significant" rate increases the wider network plans will be subject to as they begin to comply with the new law.

The exchanges bragging that they have reduced the cost of insurance, and citing these low cost plans as examples, is tantamount to opening a new car dealership and just cherry picking the cheapest compact cars available and then claiming you've found a magic way of cutting the cost of car ownership!

I will suggest that a Buyer Beware warning is in order here.

In the past, health insurance companies could develop lower rates by underwriting and wide variations in plan design. But with the new health law they can no longer underwrite and they are very limited on what they can do for plan design––all plans must fit into the actuarially tight Bronze, Silver, Gold, and Platinum benefit boxes.

What rate reduction tools are left to them? Restricting which health care providers consumers can use and the terms under which they can access them––setting up a tight referral system before being able to see a specialist, for example.

These are fair and appropriate ways to differentiate health insurance products and control costs. And, creating safety-net style health plans for lower-income consumers to put on the exchange is a good idea.

But buyers need to be very careful in looking past the lower rates by being sure they understand just what they are buying.

And, they should also understand that the federal subsidies are tied to the second lowest cost Silver plan. By creating these new narrow network plans, insurers have capped the federal subsidy people will be eligible for in each market. If you want a wide access plan, if it is available on the exchange, the consumer is going to have to pay that difference out of their pocket.

Some will argue that even with the narrower networks we all need to concede that the new state health insurance exchanges are providing attractive and affordable health insurance products for lower income people.

8:02 PM