Learn what to know when looking for a good health insurance policy. Why take chances when proper planning can help you avoid costly mistakes in the future!
Everybody knows what a big risk it is to become ill when you don’t have any insurance coverage. Today, even a few days in a hospital can add up to thousands of dollars in medical costs. We also know that many hospitals will even refuse treatment to a patient who lacks adequate coverage by a reputable insurance company. That puts health insurance in the ‘must have’ category.
A health insurance policy is in fact a legal document with pages of terms and conditions in small type and technical language. It is a binding contract crafted by the insurer’s capable legal staff between the company and the policy holder in which the company promises to provide treatment for illness and injury in return for the payment of regular premiums by the policyholder. If it is an individual policy, only the policy holder is covered, In the case of some policies, the holder’s family members are also covered at the cost of additional premium payments.
Individual policies tend to be quite costly unless a percentage paid by the insured’s employer by adding him to the firm’s group policy. Twenty years ago, it was common for bigger employers to pay 100% of the health premiums for key employees as an incentive to join the company. Today, thanks to spiraling costs, the company’s share is usually limited to 30-50% of total premium cost.
No matter what the source, a complicated insurance policy is difficult for the layman to understand. If you don’t truly comprehend all those terms and conditions, you may very well get a big, unpleasant surprise when you submit a claim. This arises from language like ‘pre-existing conditions’, ‘medically necessary’, ‘recission period’ ‘covered services’ ‘out of pocket’, ‘deductible’, ‘lifetime maximum’ and ‘exclusions’. It is strongly suggested that you have your policy’s terms and conditions carefully reviewed by a knowledgeable person or attorney prior to signing it to ensure that the coverage meets your needs.
Remember that the insurance company is in business to make money and they do so by collecting far more in premiums than they will pay out in claims. This is partly determined by actuaries who calculate that a significant number of insured people probably won’t file claims that exceed the total of their premium payments. Another of their little secrets is in all that fine print and fancy technical language. For example, most policies exclude coverage for pre-existing conditions or medical problems that the insured had prior to buying the policy. A heart attack and cancer are good examples. If these exist, the company merely lists them under exclusions for things they won’t cover under the policy. Then there is ‘medically necessary’ defined as something your doctor feels is necessary for you. The insurance company lists ‘medical benefits’ or things they will cover, but keep in mind that they might not always agree with your doctor and deny the medical coverage.
Certain health care falls under what the company calls a ‘waiting period’ meaning it will not be covered until a stated amount of time elapses.
The bottom line is that you need to really understand what you’re paying for even if you must hire an attorney to review it. If you don’t, you may find that there are many, many little loopholes that can cost you big money if you’re ill.
source:- Medicalneeds
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