Health Insurance Solutions


There are many pitfalls that may await you in health insurance coverage- unless you look carefully at what is offered.

Let's get one thing straight...there's no way this makes exciting reading! But, one day what you learn here and what you do about it could save your life or the life of a loved one!!!

So, let's get started......the topics we'll cover are:

• Reasons you should be thinking about private health insurance
• The Basic Features of Private Health Insurance
• Applying for a Policy
• Your Age
• Policy Exclusions to be aware of
• Getting Claims Paid
• Paying Premiums
• Renewing Coverage
• Advantages available to Groups
• Emergency Medical Evacuation
• Claims

You should be thinking about private health insurance if...

• You are not eligible for group health insurance
• you are covered by a National Health System
• you would like to have the option of private coverage where you live
• you would like to be able to obtain problem-specific treatment in another country

What are the Basic Features of private health insurance ?

There are generally one or two major levels of coverage...

• Comprehensive coverage: in-hospital care and services, services of doctors,  lab tests, x-rays and other scans, etc. in a non-hospital setting
• Basic coverage: limited to all care and services relating to an inpatient hospital stay only.

The common variables are the aggregate, annual, and other scheduled limits within the policy, deductibles and any differences based on location where care is provided. But beyond that, there are traps waiting for you unless you look carefully at what is offered. How do you decide what makes a policy better for your specific needs?

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Let’s look at some of the things you should be aware of:

Applying for a Policy...

• Guaranteed-Issue Policies
  It’s easy to get coverage with one of these policies - just answer a few easy questions and pay your premium. However, when you submit a claim, that’s when the problems can start! You may be asked for proof that the problem you just had treated wasn’t a preexisting condition at the time you applied for the policy.
  
  What’s a Pre-existing condition? Generally it means a medical condition which is being (or was) treated and any condition associated with it.
  
  For clarification:

  Treated generally means: Doctor’s visits, tests, or even taking medication for the condition within the past one year, two years, five years, or anytime in the past; (the time frame varies  depending on the policy), or Any condition which a ‘prudent person' would have had treated - even if you didn’t know about it!

  Any condition associated with it...this could mean, for example, a broken leg being deemed to be the result of brittle bones caused by cancer treatments!

  If the insurer decides it is a preexisting condition, they may deny the claim. Always remember, the larger the claim the more they’re going to examine it very carefully! Not what you want to go through when you have just incurred a claim for $10,000!

• Fully-Underwritten Policies
  These policies ask very detailed health questions on the application form and may even ask for doctors’ reports. Based on all the information you supplied, they may:
     1. Accept your application with no exclusions or conditions;
     2. Accept your application with an increase in premium;
     3. Accept your application with an exclusion for a specific
         medical condition; or
     4. Reject your application.

It always makes good sense to disclose pre-existing conditions on your application form even if the application doesn't ask about them; then the insurance company will be hard-pressed to deny a claim for a pre-existing condition if they didn’t exclude it when they approved your application.

• Your Age
  Some insurers automatically reduce benefits, charge extra premiums, or even discontinue your coverage when you reach a specific age, for example - 60, 65, or 70.

• Travel:
  Some policies exclude travel if it’s specifically to get medical care. Others exclude care if you travel "against the advice of a physician" or "while you are on a waiting list for treatment".  In this case, treatment for that specific condition may not be covered while you’re travelling.
   
• Pregnancy and Childbirth:
  Some policies exclude one or both completely while others exclude them only for the first 12 months of the policy. Even if the pregnancy is covered, some policies automatically exclude the first 15 days of a newborn’s life - while others cover only the first 14 days of life. In these cases, the baby must apply as a "separate person".
  Because many policies exclude birth defects, and congenital and hereditary illnesses, the baby may not be accepted for coverage. Therefore such policies may not be appropriate for you if you’re in the childbearing years - take a long, hard look and ask questions before you sign up for such a policy.
   
• Chronic illnesses:
  Some policies specifically exclude or limit the coverage of conditions which are or become chronic (even after you purchase the policy). An asthma attack (acute) may be covered but not ongoing asthma problems (chronic).
   
• Limited Coverage:
  Some policies limit coverage for any single accident or illness to, for example, the first 12 months of treatment following the onset of that accident or illness.
   
• Organ transplants:
  Some policies exclude such procedures; others offer it as an additional benefit, and some include it as a part of the regular coverage.
   
• Where you are:
  Some policies place no limitations on where you can get care while others limit the region of the world where they will cover you (and may charge different premiums based on the region(s) you select).
   
• Home Country:
  Some policies limit the time you can spend in your "Home Country" or even exclude it completely.  For example, travel to/in the U.S. may be limited from  60 days  to 12 months for U.S. citizens or anyone born there, regardless of their current citizenship. This could apply even if you go for a short visit and then, because of an illness or accident, need to stay longer. The policy may be cancelled or suspended when you reach the time limit, regardless of your health condition at the time.

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Getting Claims Paid...

• Pre-certification:
  Many policies now require you to get prior approval for a planned hospitalization, with a penalty of reduced benefits if you don’t. They may be more lenient with emergencies but still require notification as soon as possible after the emergency. Some may also limit the choice of hospitals or doctors you can use. Even if you don’t need pre-approval, informing an insurer before a hospitalization is a good idea since they can usually pay the hospital directly for your stay.
   
• Non-hospital bills:
  In most cases, you must pay physicians, labs, etc. yourself and then submit those bills with proof of payment.
   
• Submitting Claims:
  Some policies require a completed claim form - others, just the original bill. In almost all cases, you should get the bill in English or supply an English translation - it tends to smooth the path to reimbursement.
   
• Emergency Help:
  Almost all policies offer the services of an International Help Centre, 24 hours a day, seven days a week. The Centre can direct you to an English-speaking doctor and/or hospital and assist in the event of an emergency requiring medical evacuation. This is useful when you’re in a non English-speaking area, but you can use it wherever you are in the world.
   
• Medical Evacuation:
  This is a useful feature if you’re in a country/region with a healthcare system which is below par. However, be aware that no policy offers evacuation just because you would prefer it. If the emergency couldn’t be treated locally, you would be evacuated to the nearest major facility capable of providing a decent standard of care, and the definition of ‘nearest’ and ‘decent’ are decided by the Emergency Help Center and the insurance company.

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Paying premiums...

• Premiums are normally payable for each person in a family, although some policies offer a family premium, and others offer "free" coverage to pre-teen dependent children if one parent is covered.
   
• Premiums may vary with age and where you live. Payment is usually by cheque or credit card and may offer a choice of currencies.

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Renewing Coverage...

Guaranteed renewability of an insurance policy is fundamental to the selection of a policy. If there is no guarantee to renew coverage regardless of your health condition at the renewal date, beware!
Cancellation of coverage is not what you want to happen in the middle of a serious sickness or when you have a preexisting condition.

Group Coverage...

There are many advantages available to employer groups, partnerships, and associations in which there are several primary members applying together for the same plan. These are described in:
The advantages of international group health insurance

This quick look at private health insurance is to remind you, once again, that there are no bargains out there. You should always use the services of an experienced international insurance consultant to assist you in selecting a policy.

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Emergency Medical Evacuation - What it does and what it doesn't!

Claims - How to file, what to file, and what to do when claims are denied


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