Health Insurance Program: Is It Really All Inclusive?
June 01, 2016
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The issue of obligatory health insurance has been an arguable point for quite some time now. Unfortunately, no progress has been reached so far in this matter while voluntary health insurance is becoming more and more popular. If you are a lucky owner of health insurance policy and would like to make the most of it the tips below would be of use to you.
The first question is - what does such policy cover? Every insurer has its unique approach to drafting program overview. Nevertheless it is practically always broken down into four sections such as – ambulatory care, in-patient care, emergency health care and bonus coverage. Detailed description is given in the addendum to insurance policy. Services covered by the insurance are usually marked “+”. The level of medical institutions usually differs from section to section. Insurance companies normally divide them all into three classes – A, B, C or I, II, III, A(I) being the most expensive private clinics, and C(III) – the most affordable public hospitals. The brief overview of each section is given below.
Ambulatory care. This section is devoted to medical services and procedures which can be provided by ambulatory facility. Please read carefully which class of clinic you can request under your policy and don’t hesitate to ask for the most expensive one if this is stipulated by your health insurance policy.
In-patient care. This section defines the list of services you are entitled to with regard to in-patient clinics. The class of the clinic is defined accordingly.
Emergency care. Since the time is of the essence in emergency cases majority of insurers cover the expenses for the ambulance which can arrive the fastest. Normally all classes of clinics are included in the coverage for cases of emergency.
Bonus coverage. Meaning dental care or phylactic massage therapy, in the first place. Before calling assistance make sure to consider two aspects: 1) whether these procedures are covered at all; 2) which limit of coverage your insurance policy provides. Besides, you can include vitamins, vaccination, routine check-ups or discount for business travel insurance upon your discretion.
A few tips
1. “Leading specialists” option is often included into the coverage meaning that you can get consult from doctors with academic degree. However frequently enough the deductible amount for their services is set at 50 % or even more. In some cases they are not covered at all. Sometimes the insurance policy covers the A class clinics while offering no coverage for consults by leading specialists.
2. Massage is the second most popular option among the insured. It is usually included into Ambulatory care section or Bonuses section. However please keep in mind that there are two kinds of massages – prophylactic and medical massage. Medical massage can only be prescribed by a doctor in the course of treatment for your illness.
3. The list of medical institutions along with the deductible amounts for each of them usually is provided in the addendum to your health insurance policy. The best case scenario is to have insurance company cover full cost of medical services for each clinic.
4. “Pharmaceuticals” section can sometimes stipulate that only pharmaceuticals of national origin are covered or they should be the meds of the first choice.
Sometimes you are being sent to the public hospital although A class clinics are covered by your policy as well5. Sometimes you are being sent to the public hospital although A class clinics are covered by your policy as well. There are two possible reasons for such a situation. First, insurance company is trying to save money at your expense. Second, private hospitals are not capable of providing you the proper services. This is often the case if we are talking about serious illnesses or traumas. If you require simple medical procedures, don’t hesitate to insist on getting doctor’s appointment at the private clinic. If not, you will most probably be taken to the public hospital to get the emergency treatment with further transfer to the private hospital, if necessary.
Finally, it’s sensible to read the insurance policy and the program overview very closely to know your rights and the extent of insurance coverage.
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