Do your research before taking medical insurance

Customers should read the fine print and analyse benefits before getting insured.

Are you sure your health or medical insurance policy is going to cover all your medical expenses, in case you need them?

Is your health or medical insurance policy primed to pay the medicine bills when you rush to the nearest pharmacy to buy them?

Many people who buy a health insurance policy on their own or who are provided such insurance cover either by their employers or their sponsors believe they are on top of the world and have the eternal peace of mind – until, of course, the proverbial rug is pulled out from under them.

So what's the way out to avoid mistakes and the last-minute surprises?

Read between the lines

It doesn't cost anything to read the fine print of the insurance document carefully. So never forget to lay your hands on the document and read the terms and conditions of the policy.

Many policyholders end up finding that their health insurance policy is out of sync with their needs and thus keep on shuttling between the insurer and the clinic/hospital to sort out the doubts at the eleventh hour.

When it comes to health insurance, don't be in a false sense of security, insurance experts believe. Considering the importance of a health insurance cover, you can ill-afford to ignore the clauses, sub-clauses and the exclusions of the insurance policy.

"The biggest mistake when going for a medical insurance is to buy a policy without going through the document, and without verifying whether the benefits the policyholder will be getting in times of need, is properly interpreted in the policy or not," says Abdul Muttalib Mustafa Al Jaidi, CEO, Oman Insurance Company.

Steve Gregory, Managing Partner, Holborn Assets, Dubai said: "The biggest mistake people make is that they don't read the fine print. They also need to know the claims policy – whether the broker supports the claim or whether they leave it to the company itself."

Identify your needs

Experts believe a good health insurance policy starts with the selection of a right policy suited to one's needs. Then comes choosing the right insurance company, making sure of the benefits as well as exclusions of items, and being clear on the mode of payment – whether direct billing or reimbursement.

"There are so many health or medical insurance providers that the best thing somebody should do is decide what benefits they want and then find that policy that provides those benefits.

"If the policy is providing something that they don't really need, then they end up paying more premium than they should," says Gregory.

On the other hand, if the policy is not providing something that they do need, then the policy is not fully serving the interests of the customer.

Additionally, if it's affordable to the clients they should always take health insurance cover from an international insurer because the difference in the level of protection is enormous.

Whereas some local insurance companies might give, say, Dh100,000 maximum claim in a year, for most of the international insurers this limit is around Dh2 million a year, said Gregory of Holborn Assets.

Industry experts add that a customer looking for an insurance cover should also be sure whether he/she needs a policy that provides an extensive or international coverage or whether he needs coverage for only the Gulf region.

"One must marry the region to one's requirements and should not go overboard and select an extremely wide coverage when it may not be of any use. One needs to be certain what region one wishes to select if in case one falls sick or medical expenses are to be incurred," says Rumi Sanjana, Director (General Insurance) at Nexus Insurance.

"In other words, if one is based in the GCC region, it's better to take a Gulf dominated policy, namely, a policy which will look after you in the Gulf area should you fall ill or should you have to be hospitalised and treated in the hospitals based in the region," said Sanjana.

"It would not make any sense to take a worldwide cover where you will be paying an exceedingly high premium to cover yourself for travel to a country which you hardly visit, added Sanjana. There are a lot of companies providing health insurance cover in the UAE. But how should a customer select which one is best suited to him?

One of the commonest propensities among people looking for a health insurance cover is to rely on word of mouth, get convinced by health insurance cover of others or to get impressed by big billboards flashing an insurance company's advertisements.

Experts say there are often misleading ways to make one's judgement. Rather, it's much better to test the waters and find out the right insurer yourself that matches your needs.

"First of all, a personalised relationship with a customer or potential customer is very important. People choose somebody they feel comfortable with. But if they don't know anybody they should not go to someone who doesn't have the adequate experience and qualifications," says Gregory.

"The image, reputation and credibility of the insurance company are the most important factors when one is going to choose a health insurance policy. However, if the consumer is not aware of all these things, the customer can assess whether a company is good or not on the basis of the way the insurance agent, or the insurance company or the company's management responds to a person's needs or enquiries," says Al Jaidi of Oman Insurance Company.

Pay attention to benefits

While opting for health insurance what are the things a person should consider – benefits or low premium? Experts say it's the benefits provided by the insurer that matters the most than the premium one pays to get those benefits. You get what you pay for and this holds true in case of health insurance as well.

"Benefits are the important factors when deciding to opt for a health cover. When it comes to health insurance, most people calculate the cost that comes with it. But that should not be the case because one can't compromise on one's health. When it comes to health insurance, one has to see the benefits and calculate the budget accordingly," says Al Jaidi.

Expert point out that one needs to be careful in making sure that there are sufficient hospitals or clinics on the approved list of the insurance company one selects.

"It's best to check with the insurance company what are the hospitals/clinics one would be allowed treatment in or the pharmacies one could go to buy medicines. You must know beforehand what is being offered by the insurance policy," says Sanjana.

One should also make sure whether he is covered by direct billing service or he has to pay first and get reimbursement later.

Many people make mistake by not ensuring whether the insurance company has a direct billing procedure or reimbursement procedure. Additionally, one should also see whether the sum assured in the policy is adequate for him or not, he adds.

Another important factor is the price one would be happy to pay to get the insurance cover, experts say.

"One needs to be sure whether he/she is going to look at purely a cost effective health policy or looking for an international plan. It all depends on one's needs. If the person is a frequent traveller, then he needs to take an international plan with direct billing facility abroad," says Sanjana.

The checklist

- Ensure the insurance policy provides coverage you need and excludes that you don't

- Go through the list of exclusions twice to find out what the exclusions would be

- Get a first hand knowledge about an insurance firm and don't go by word of mouth

- Make sure the policy provides a wide coverage as per your needs

- Ensure the names of the hospitals or clinics or pharmacies are clearly mentioned in writing where you can go to in times of need

- Choose the right insurance broker who knows insurance companies well and who can suggest right products that meet your needs

- Know the claims settlement procedure

- Ensure the sum assured is adequate

- Be confirmed whether the insurance policy has a direct billing procedure or you'll get your medical expenses reimbursed


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