**Article was originally published on LinkedIn in May 2020***
Health Insurance is cover for individuals to seek medical treatment when they are ill. This type of insurance can be provided in 3 ways: 1) through a policy you pay for yourself, 2) as a benefit from the company you work for, or 3) from your government at a subsidised rate. Lack of Health Insurance is a fiscal burden on people and their families and can cause worse health outcomes. (Urban Institute, 2007) While no one plan’s to get sick, at some point in time you will need to visit a doctor. What happens, if something problematic is discovered? Who will bear the costs for your medical treatment? Unfortunately most of us tend to only think about questions like this when the need arises, and by then it’s too late.
Following the global outbreak of Covid-19, it is clear that countries who took early preventative action saved lives. An age-old saying goes “ A stitch in time saves nine.” The time to think about and understand medical insurance cover for yourself and family is now.
This is my take on 7 things to consider before purchasing a health insurance policy.
1. Assess what your main medical concerns are
Do you have any pre-existing conditions or a family history of cancer, diabetes or cardiac problems that will need routine monitoring? Are you planning a pregnancy to expand your family in the near future? This is important; because when you take out a health insurance policy you will be medically underwritten. What this potentially means is your insurer might exclude you from receiving certain kinds of treatment after purchase for a period (possibly 12–24 months) or indefinitely. Taking time to assess your medical concerns prior to purchase will ensure you don’t fall into the common trap of not being able to use your policy due to exclusions.
2. Make a list of Healthcare facilities you frequently visit
Do they accept insurance as a method of payment? What insurance companies do they currently have relationships with? This is important, because as a cost savings measure, insurers build relationships with healthcare providers to negotiate discounts for their customers. There is no point in buying a policy to only discover you can not use it at your preferred health care provider or worse, get slammed with a heavy bill because your insurance provider does not cover treatment at the location you received care. If you have just moved to a new country/city and have no preferred health care network, ask potential insurers for a list of hospitals covered in their network. Make a shortlist based on what is most important to you (proximity to your work or home, reputation of consultants, online reviews etc.).
3. Consider what level of cover and benefits would suit your current lifestyle
Are you a frequent traveller who needs cover in various countries? Are you comfortable receiving treatment in a general ward or would prefer a private room? Do you want a policy that covers your outpatient consultations and prescriptions or just in-patient hospital admissions? Would you want an annual health check covered by your policy? These are important details to consider before purchase.
4. Which value-added services are important to you?
In today’s competitive business environment, insurance companies stand out to customers by offering value added services. Value added services on your insurance policies could be things like, a complimentary retail shopping voucher once you purchase a plan, a 24/7 customer care line, access to a virtual doctor/ telemedicine service or a promise to process your claims and payments in a certain number of business days.
5. Consider options to reduce total costs
Purchasing health insurance is a risk transfer mechanism. To reduce your potential for loss from medical bills you will have to pay a monetary premium as consideration to enforce the insurance contract. The cost of insurance policies varies across global regions. Consider what changes you can make on your policy to reduce costs. This could be by adding excess on your policy (in certain countries this is also referred to as a co-pay or deductible). A policy excess is an amount deducted from each claim that you will be responsible for paying. If you have a policy with a $200 excess, and receive a hospital bill of $500, you will be responsible for paying $200 of the bill and your insurance company will pay $300
6. Research your potential insurance company
The Internet provides us a wealth of information at our fingertips. Find out if you can, what is the claims payment ratio/turnaround time? Have members of their senior management team been sanctioned for malpractice in the past? Is there any public information on the company’s financial stability (this will determine if they can pay your claims when the time comes)? Finally research online reviews from other customers and how they respond to them-it is unlikely you will find only positive reviews but how they handle negative feedback is telling.
7. Review your policy documents
This is not an exciting task, but it is imperative you read the fine print of your policy documents/handbook/offer and ask questions. Not every risk is insurable and the devil is in the details. Reviewing this information helps you understand how your potential insurers define certain words and situations. What is their definition of a medical condition or uninsurable risk? What actions by you could invalidate your policy? In light of Covid-19 many will discover insurance policy wording usually does not cover the outbreak of a pandemics, as losses of this nature are hard to calculate.
Dooshima Dapo-Oyewole is a Nigerian/Ugandan risk management professional, interested in technology as a tool for transformation and financial literacy. She is certified in Insurance and Financial Services by the Chartered Insurance Institute UK.
This article is for information purposes only. Please seek out a licensed insurance professional or broker in your country that is registered by the insurance regulator or institute to discuss your particular circumstances