Understand Your Health Insurance Policy Requirements

HEALTH INSURANCE 17121703798_9d11380ded_b

Published on May 27th, 2015 | by Joan Makai


Medical bills are mounting high these days. A minor surgery can cost you up to $350 and if are diagnosed with a critical ailment that needs immediate medical attention the bill may rise as high as $9000. There is no dispute over the fact that a health insurance policy suiting your requirements can help you cut down the cost at such a crucial time. The life insurance companies offer a wide range of policy options to its customers. As a customer, you must understand that when it comes to selecting a health plan, there is no one plan that suits everyone. The needs of people differ based on their age and medical condition. So before selecting a health insurance plan, consider the below listed key components and check which plan best caters to your needs.

  1. Look at the plan cover

There are certain health benefits that must be covered by a health plan you choose which includes hospitalization, maternity and newborn care, laboratory tests, prescription drugs, immunization, management of chronic diseases and emergency services. The health insurance companies have a tie up with specific doctors, hospitals, pharmacies, and laboratories which render their services to the plan members at some specific rates. Before selecting the plan, closely check with these health benefits and the service providers to help you make your choice wisely. Many health insurance companies provide directories with listed hospitals and doctors; you must check the directory before signing the health plan to ensure your doctor and your choice of hospital are listed with the insurance company you plan to choose.

  1. Calculate the plan cost

The health insurance companies offer health plans in “metal tiers” (with various combinations) of bronze, silver, gold and platinum. The bronze plan has the lowest premium, but the highest out-of-pocket cost. Also, it covers only 60% of the total health care cost. Whereas platinum plan has the highest premium, but the lowest out-of-pocket cost and covers up to 90% of the health care cost. If you have a chronic disease and require expensive medical treatment, you must opt for the plan with a higher premium which ensures maximum cover. If you generally keep healthy, you may choose a plan with a lower premium. In this case, you must be prepared for any unexpected emergency. You must always choose the health plan depending on your health and financial situation and not entirely on the premium cost. Besides premium cost, deductibles, copays, coinsurance and out-of-pocket limit are some important cost- sharing terms which must be highly considered.

  1. Look out for the claim options

There are two ways you can claim the policy either through cashless basis or through a reimbursement procedure. Under the cashless procedure, the entire hospital bill, if covered by your policy, is paid be the health insurance company without you needing to pay a single penny. Under the reimbursement procedure, you have to pay the entire bill, which can be later reimbursed from the health insurance company.

The bottom line is that a health plan should be chosen as per your health requirements, assessing your financial condition and not just because it is available at a lower price.

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Joan Makai



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