Health Insurance - FAQs

In some countries, it is mandatory to have health insurance, at least with minimum essential coverage. When shopping for health insurance, and considering incentives like skipping eternal waiting lists, or being assisted by qualified professionals, we also have to check the criteria we are requested to meet in order to be insured.  That is, those requirements our insurance company may expect from us.

So what if we suffer an illness before we hire the insurance? Will the insurance company reject us? Procedures are usually very simple as no medical tests are normally required; at least, as long as the person applying for cover is under a certain age, for example, 60 years old.

One only would need to complete a Proposal Form, in which they would have to declare their conditions by answering questions like if they ever had surgery or if they ever had any broken bone. Some of the coverages accept by all means those illnesses which are not serious or in danger of death or serious lesions. But it does not mean we are not allowed to have health insurance if we do suffer from a chronical illness or if we need hospitalization regularly. Only, our health insurance will be different, in order to meet our health requests.

Those illnesses we may already suffer or have are called our pre-existing conditions. They are defined as those conditions the insured already had before taking out the policy, and which they should have informed the insurer of. This is also valid for the beneficiaries, and includes any medical condition or symptoms whether they were being treated or not; any previous medical condition which recurs or which the insured and his beneficiaries should have reasonably known about.

Insurance companies must know about all pre-existing conditions when hiring the policy, for they may cancel if they were not told at the right moment. This is not the case, however, if we prove that we have not consulted any doctor for medical treatment or advice (including check-ups). Once they know, insurers will try to adapt their services in order to cover our conditions and offer the best service.

Health insurances have their own protocol of action and it is very recommendable for us to know a bit about it, so that we can avoid further incidents and annoyances in the future. One of the most important steps when we are enjoying our health insurance is what to do when we need to see a specialist. Even if you are covered for their services and you have the right to see and visit a specific doctor whenever you need them, you may be required a prior approval by your insurance.

Those are known as referrals, and they are authorizations patients need in order to get a specific medical service. When in need of a particular medical revision, our doctor may refer us to a liaison department, working along with our insurance company. We usually need referrals when we are asked to have any particular analytic test, medical treatments, or interventions. Some companies usually require referrals for physical therapy, rehabilitation, surgeries, genetic tests, speech therapy and special treatments such as those of cardiology and oncology.

As bothersome as it may sound, our insurance companies usually make referral forms as easy as possible, so we do not have to worry anymore. Referrals may be done through our general practitioner, by phone at the customer service, personally at any of the insurer offices, online, and by email or fax. Once formalities are over, we are given a document that we must show to the specialist doctor whenever our visit / test / treatment / intervention / therapy / etc. take place.

Nonetheless, much of the everyday medical tests we may need are included in our health insurance directly; that is, we do not need any approval for most of the consultations, clinical and blood analysis, simple radiographies, diagnostic sonographies or ultrasonographies, and cytologies, among others.

Referrals are approvals useful for insurers to control every medical management, and supervise everything is going fine, besides checking we are covered by their service and up-to-date with payments, premiums and membership. In exchange, we are able to enjoy their services with no lines or waiting lists.

We cannot foresee what medical treatment we may require in the future. But we always want to think ahead and protect ourselves, and our beloved ones, in the best conditions. Therefore, health insurances offer financial assistance for medical treatment, in order to protect our welfare. Yet, sometimes the variety of competitors in the marketplace may complicate our decision making. Some insurances companies may look cheaper, but we do not want to cut back on our comfort and get just any bargain. That is why it is essential to look under a magnifying glass for the best deal to make the right choice.

First of all, there are some things we have to consider beforehand. Some factors are determining and may affect the amount of money we have to pay for the insurance each month. Those factors point to age, lifestyle, family medical conditions and history, body mass index, tobacco and alcohol use, and even our location and zip code. Even our job can be a factor, if, for instance, we work with hazardous chemicals. Considering how healthy our habits are, our insurance company will estimate our policy costs, regardless, nonetheless, of our gender or our specific current situation (it may be illegal to take those characteristics into consideration to estimate the premium).

Accordingly, bearing those conditions in mind, we may get an idea of our insurance policy. Yet, insurances are not only for fit, sporty people with a flawless medical history. Insurance companies understand we all need assistance and protection, and that is why some different types of cover are offered, in order to cover every type of needs. Therefore, insurances are usually classed in basic schemes, hospital schemes and international coverage.

There may be also some cost-reducing options more accessible to a wider section of the public, whereby the applicable premium may be significantly improved when any of the the first two types of cover is selected. These two variations offer insurance protection for hospitalization as an in-patient, excluding out-patient treatments or consultations.

Depending on these factors and on the type of coverage we want to contract, the premium for our insurance may be estimated. Considering what is best for everyone, we may hire those options suiting best our needs and therefore, offering peace of mind for us and for those we love.

Healthier means happier. Caring for ourselves and for those we love is vital. Health insurances are aware of these human needs, and that is why they offer financial assistance for medical treatment, in order to protect our wellbeing and the wellbeing of those we love. So far, so good. But there are some things we have to consider in advance when shopping for a Health Insurance, regarding that financial assistance just mentioned.

There is an essential term in health insurances, we all must know: it is copayment. Copayment is the variable amount of money we have to pay out of pocket for a covered and received service. It is a type of cost-sharing between us and our insurer. This amount varies according to the type of service we may receive; if we visit the doctor’s office, we might have to copay 20€, if we get a prescription filled we may have to pay a little bit more; and if we go to the emergency services, we might have to pay considerably more.

All things said, it seems really important to bear this copayment in mind when we are shopping for our health insurance, in order to get the best policy suiting our needs. Relevant aspects to consider are:

• How much we expect to use our insurance.
• How much coverage we want against unpredictable expenses.

For instance, if we visit the doctor’s office very often, we may consider advisable those insurances with a low copay for visits and prescriptions. Otherwise, and if we rarely go to the doctor’s and we do not have any chronical illness, we may prefer to get a lower premium and then, copay every medical visit. Nonetheless, we will have access and right to benefit from all the same services as any other modality of insurance.

Therefore, it is essential to be informed about the conditions and costs of every medical service we may require, for they can be very different from one company to another. Copayment usually involves lower premium costs, but it should be convenient to study all possibilities to get the best from our health insurance. As the insured part, we must analyze what type of coverage suits best our needs, always considering that copayment is a special condition that must be meditated before making any important decision.

Health is one of the pillars of our happiness. Caring for ourselves and for our beloved ones is essential to our lives. Health insurances are aware of these human needs, and that is why they offer financial assistance for medical treatment, in order to protect our wellbeing. So far, so good. But there are some things we have to consider in advance when shopping for a Health Insurance.

One of those things is the waiting period. Everybody knows health insurance companies, however much courteous their aim is, they do not want to lose money. Therefore, many policies require this kind of condition for the insured. The waiting period means you have to wait for a specific time to enjoy all of the conditions of your health insurance.  It is a gap in coverage that prevents individuals from making a large claim shortly after joining or upgrading their cover and then cancelling their contract. They also want to prevent covering diseases existing in the individual before joining. This procedure depends on every company, and even on the country, for some governments may regulate the maximum time for waiting periods. Naturally, accidents and emergencies are excluded from these gaps.

Nevertheless, waiting periods may vary from one company to another. Some of the companies even lack of those periods. There may be occasions in which the insurer company may eliminate them, in order to face its competitors firmly. Waiting periods usually affect obstetrics (pregnancy), surgery, familiar planification, transplants and prosthesis, assisted reproductive technology, second medical opinions, or specific types of treatment and medical operations.

Now that we are aware of what the waiting period means, the next step will be studying how it can affect our premium when purchasing an insurance policy. As the insured part, we must analyse what kind of coverage suits best our needs, and this is a special condition that must be taken into account before making any important decision regarding our money; particularly, if our insurer options work with gaps in coverage for the mentioned cases.