6 things you need to ask your health insurer

How many of us carefully read the fine print before signing on for health insurance?

Many people buying a health insurance policy believe all of their medical treatment costs will be taken care of, but that may not be the case.

No doubt, health insurance policies come with a host of benefits, but it is equally important to understand the terms and conditions of the policy to avoid last-minute surprises.

Making a little bit of extra effort to ask your health insurer any of your doubts can not only save potential hassles that may arise in the future, but can also enable a policy holder to get the best out of the health insurance, say experts.

Here are the 6 things you must ask your health insurance companies before buying a health cover.

Are pre-existing conditions covered?

A good health insurance policy starts with the clarity on whether it covers pre-existing conditions - a medical condition that exists before you obtain your health insurance and are usually chronic diseases and expensive but they could also be a complication of previous injury- fracture- or disability. Pre-existing conditions coverage varies by insurance companies, according to experts.

“Pre-existing conditions might be covered after a certain period of time- for example the coverage may start after 6 months or 2 years. Some insurers say it’s covered but for a limit or to a certain sublimit–for example until you consume Dh5,000 to Dh25,000 and then we’ll stop. Some companies give 100 per cent coverage of pre-existing conditions upto the policy limit or which is or covered up to the policy limit with no exclusions. So if you’ve any pre-existing conditions, make sure that it’s covered in the insurance,” said Dr. Saif Al Jaibeji, Medical Director, Green Crescent Insurance Company, Dubai.

He said, a person should also declare not only the diseases but all symptoms, including headaches, on the declaration form and let the insurance company choose which one is relevant and which one is not.

“Sometimes, buyers of the insurance cover are afraid of declaring their ailments or diseases because it might reflect on the price of the insurance coverage. Buyers should also keep a copy of their declaration form,” he added.

Chronic conditions, on the other hand, are long-lasting and recurrent, they could be pre-existing, before you obtain your health insurance, or during the policy coverage. “It is very important to know the coverage of these conditions as the treatment is usually expensive and ongoing. Diabetes, hypertension, high lipids and cancer are common examples, he said.”

Does the policy offer co-payment or deductable options?

A customer looking for a health insurance cover should also be sure whether the policy bought provides copayment or deductable payment options, industry experts add.

“Copayment is a percentage of the treatment cost and its variable while deductable is a fixed amount of dirham’s paid by the person when he or she visits a hospital. Both copayment percentage and deductable are mentioned on the insurance card,” Jaibeji said. Moneywise, although it’s better to go for deductable than copayment, however, it is upto the buyer to choose what makes more sensible to him, say experts.

Is there a limit on maternity cover?

Limit on maternity is also important as it might be covered up to a certain amount, say experts.

However, as Jaibeji said, this doesn’t apply in Abu Dhabi as all polices cover maternity up to policy limit and this is mandated by the Health Authority Abu Dhabi. However, in Dubai, maternity cover is optional and so it’s important to ask whether maternity is covered and, if yes, whether it’s covered upto a limit or it’s open.

Does the policy offer health providers option?

Health providers option is very important especially if you plan to change from one insurance provider to another while you have an ongoing treatment at certain hospital, or you are following with a specific doctor as providers network may vary between policies even for the same insurance company, said Jaibeji.

For example, you might have coverage in the whole of the UAE. However selective hospital- usually high cost -are not included. In other words, when a policy says it covers all of the UAE a buyer may assume that it covers all of the hospitals in the UAE. But in actual it may not be true.

A health insurance buyer should, therefore make sure that the particular hospital or the doctor you’re following with is within the network. Otherwise you may not continue your treatment with your doctor or hospital in the new insurance policy, say experts.

Does the policy offer coverage in home country?

The UAE has one of the highest ratios of expat population in the world, and therefore experts say it’s important for expats to make sure whether the health insurance policy they are buying offer coverage in their home countries.

“Coverage in home country is another point to look for when you buy insurance as treatment in Europe or the US might not be included, or in some other cases treatment is covered but not on direct billing basis and the patient should pay first and get reimbursement later on,” said Jaibeji.

Are complimentary services included?

When you buy normal health insurance, it’s not necessary that it would cover alternative medicine or complimentary services like dental or optical treatment. That’s why, experts say, if someone wants these to be covered, he should ask the insurer.

Similarly, as Jaibeji pointed out, congenital disease and birth defect might not be covered by all polices and it is important to include it even for adults as certain congenital condition may require treatment at adulthood.

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