Selecting a private health insurance plan can be a lengthy process. This guide will help you navigate the options and find the best private health insurance to suit your needs.
Health insurance can be a financial lifesaver during a severe health crisis. Even in the healthiest countries, it's essential for expats to insure themselves to mitigate risks. Finding suitable medical insurance, especially in the private sector, can be a daunting task.
The private health insurance market is highly competitive, with numerous providers offering a variety of plans and supplementary insurances. These plans come with different coverage conditions and restrictions, so it's crucial to read the fine print to understand the benefits and potential drawbacks.
Additionally, private health insurance companies provide several ways to lower costs, such as co-payment schemes, higher deductibles, or bundling insurance plans.
So, what exactly is private health insurance? This guide will help you understand the policies and pitfalls of private and supplementary health insurances, aiding you in selecting the right plan and the best insurance company for your needs.
Applying for insurance
Obtaining coverage from guaranteed-issue private health insurance plans is straightforward; simply answer a few basic questions and pay your premium. However, it's important to be cautious: when you file a claim, you might be required to provide evidence that the condition you're treating wasn't pre-existing at the time you applied for the policy.
Features
Private health insurance policies typically provide one or two primary levels of coverage:
Comprehensive coverage, which includes in-hospital care as well as services from doctors, lab tests, x-rays, and other scans conducted outside of a hospital setting.
Basic coverage, which covers all care and services related to an in-patient hospital stay but excludes outpatient services.
Common variables within these policies include reimbursement limits, deductible options (i.e., the amount you contribute towards treatment), and the location of care provision. Additionally, factors such as coverage for specialized treatments, prescription medications, and access to certain healthcare providers may vary between plans.
However, beyond these aspects, there may be hidden pitfalls unless you scrutinize the offerings carefully. It's also crucial to grasp how pre-existing conditions are categorized, as this can significantly impact coverage and premiums. Understanding the fine print and any exclusions related to pre-existing conditions is essential for making informed decisions about your health insurance.
Pre-existing conditions
A pre-existing condition typically refers to a medical condition that is currently being treated or was treated in the past, along with any associated conditions.
The term 'treated' is defined in various ways:
Visits to doctors, undergoing tests, taking prescribed medication, or following a specific diet for that condition within a specified timeframe.
A condition that a reasonable person would have sought treatment for, even if you didn't, or, in some policies, even if you were unaware of it but should have been.
'Any condition associated with it' encompasses medical issues that are considered to be a consequence or outcome of the original pre-existing condition.
Private health insurance companies have the discretion to classify conditions as pre-existing, which may lead to claim denials. It's important to note that the higher the claim amount, the more thorough the examination of your private health insurance claim, which can be undesirable when faced with a significant claim.
Not all private health insurance policies cover pre-existing conditions. Fully-underwritten plans involve detailed health inquiries on the application form and may even request doctors' reports. Based on this information, the insurance company may accept the application outright, increase the premium, or impose exclusions for specific medical conditions, or reject it altogether.
It's advisable to disclose pre-existing conditions on your application form, even if not explicitly asked. This way, the insurance company will find it challenging to deny a claim for a pre-existing condition if it wasn't excluded during the approval of your private health insurance application.
Private health insurance claims
Several private health insurance plans now mandate prior approval for planned hospitalizations, imposing reduced benefits as a penalty for non-compliance. While they may exercise more flexibility in emergencies, notification is typically required as soon as possible following the emergency.
Additionally, certain policies restrict the selection of hospitals or doctors available for use. Even if pre-approval isn't required, it's advisable to inform the insurer before hospitalization to ensure that your medical provider is approved. In such instances, the insurer typically directly settles the hospital expenses for your stay.
For non-hospital bills, you typically need to pay physicians or laboratories upfront and then submit those bills, along with proof of payment, to your private health insurance company for reimbursement.
When submitting claims, some private health insurance companies may require a completed claim form, while others may only request the original bill. In most cases, it's beneficial to obtain the bill in English or provide an English translation (or the language your insurer operates in), as this facilitates the reimbursement process.
These considerations are also important when selecting your private health insurance plan, especially regarding the ease of making claims, whether it can be done online, and if your insurer provides support in your preferred language.
Emergencies
Nearly all private health insurance plans provide access to an international help center, which can connect you with English-speaking doctors or hospitals and facilitate medical evacuations. While particularly beneficial in non-English-speaking regions, this service is available worldwide, offering support wherever you may be.
Possible policy exclusions
Organ transplants
While some policies may exclude organ transplant procedures altogether, others may offer them as an add-on or part of regular coverage. It's important to clarify the policy's stance on this matter if it's crucial to you.
Travel
Some policies exclude travel if it’s specifically to get medical care. Others may not cover care if you travel against the advice of a physician or while you are on a waiting list for treatment. In such instances, treatment for that particular condition may not be covered while you’re traveling; it's crucial to review your policy carefully.
Pregnancy and childbirth
While some policies exclude pregnancy and childbirth entirely, others may only exclude them for a set period (e.g., the first nine or 12 months of the policy). Private health insurance plans concerning pregnancy and childbirth can vary significantly. Even if pregnancy and birth are covered, some policies may exclude coverage for the first 15 days of a newborn’s life, while others may cover only the first 14 days. In these cases, the baby may need to be added as a separate insured individual. Policies often exclude birth defects and congenital or hereditary illnesses, which may not be suitable for individuals in their childbearing years. It's essential to carefully review and inquire about such policies before making a decision.
Chronic illnesses
Certain policies may specifically exclude or limit coverage for conditions that are, or become chronic, after you purchase the policy. For example, an acute asthma attack may be covered, but ongoing asthma problems may not be. Individuals with pre-existing conditions should conduct additional research to ensure their insurance covers them adequately.
Limited coverage
Some policies may limit coverage for any single accident or illness, often within the first 12 months of treatment following the onset of the accident or illness.
Location
Certain private health insurance plans may have no restrictions on where you can seek healthcare, while others may limit coverage to specific regions of the world. Insurance companies typically adjust premiums based on the selected regions. Notably, including the United States in your private health insurance plan may increase premiums due to the high costs of healthcare in the country.
Some policies may limit the time you can spend in your home country or even exclude it entirely. For example, some plans may restrict travel to the United States to 30 or 60 days for citizens. It's essential to be aware of these limitations, as the policy may be canceled or suspended once you reach the maximum time limit, irrespective of your health condition at the time.
Cost
Private health insurance is usually payable for each individual within a family. However, certain policies may offer a family premium at a reduced rate. Additionally, some plans may provide coverage for pre-teen dependent children at no extra cost. This aspect could significantly influence families' decisions when selecting a private health insurance plan.
The cost of your private health insurance is often determined by your place of residence or where you intend to receive treatment. It commonly rises with age and the presence of pre-existing conditions. Many providers also allow customers to select the currency for premiums and reimbursements.
Renewing your healthcare plan
The guaranteed renewability of a private health insurance policy is crucial in choosing the right coverage. Without a guarantee of renewal, irrespective of your health condition at the renewal date, caution is warranted. Facing cancellation of coverage could be detrimental, especially if you've developed a medical condition that would be considered pre-existing when applying for another policy.
Others
When selecting your private health insurance plan, you'll encounter a variety of supplementary insurances that allow you to tailor your coverage to your specific needs. Here are explanations of some common supplementary private health insurances:
Dental insurance
Dental insurance plans often provide coverage for dental cleanings, checkups, and discounted treatment costs. While it's typically a supplement to private health insurance, you can also opt for standalone dental insurance plans.
Vision insurance
Vision insurance may offer discounted payment plans for eye care and eyewear, reducing costs for eye exams, prescription glasses, and contact lenses. However, it may not cover medically necessary eye surgeries or elective procedures like laser eye corrective surgery.
Accident insurance
This type of insurance covers medical expenses resulting from accidental injuries, including emergency services, hospital stays, and transportation, filling in gaps not covered by private health insurance.
Critical illness insurance
Critical illness insurance pays out a lump-sum benefit upon diagnosis of certain illnesses, helping cover medical expenses, lost work time, and other related costs.
Life insurance
Life insurance provides financial security to your family in case of your premature death. It's a crucial component of financial planning for expats and may offer investment features with tax benefits.
Short-term health insurance
This temporary insurance can fill gaps in coverage or serve as quick proof of insurance for short periods, offering lower premiums and easier approval but may come with limited benefits and exclusions.
Travel insurance
Trip cancellation insurance covers costs associated with canceled or changed flights, while travel medical insurance covers emergency medical expenses abroad, including medical evacuation and accidental death. It's essential for covering medical treatment abroad and insuring belongings during travel.
Understanding these supplementary insurances can help you customize your private health insurance plan to meet your unique needs and circumstances.
