health insurance

Common Health Insurance Terms You Need to Know

 

Health insurance, sachet insurance, prepaid health cards, and a lot more terminologies are confusing the majority of our friends out there. HMO or health maintenance organization could be the most popular related term but is only fully understood by employed individuals and their employers.  It is undeniable that there are still a lot of things we need to know especially jargons we should be familiar with before we can have a full grasp of the health insurance world.

At this point, let GoBear help you uncover the terms used in the industry so you can choose the right insurance plan for you and your family.

Claim

A health insurance claim refers to the billing filed by the insured to seek reimbursement of medical costs from the insurance provider. For a claim to be valid, the insured should present receipts, medical certificates and duly-filled out a claim form from the provider.

 

health insurance claims

Coverage

Coverage pertains to the medical supplies, services, and repayments granted to the insured by the health insurance providers. Upon enrollment period, the insured individual is notified of conditions that are covered and reimbursable according to the chosen health insurance plan.

Deductible

Deductible refers to the amount which the insured individual should pay from his pocket and the remaining will be covered by the insurance company.

Dependent

The spouse, children or parent of the primary insured member who is also covered by the health insurance plan.

 

health insurance dependents

Health Maintenance Organization

Health maintenance organization or HMO refers to a healthcare system delivered primarily to employees and their beneficiaries by their employers. HMO benefits include a wide range of medical assistance that goes with your PhilHealth coverage. Medical procedures and interventions depend on the package your employer has chosen for you including but not limited to surgical assistance, hospitalization, inpatient services, outpatient services, laboratory tests, and even medications.

Insurance premium

Insurance premium refers to the cost of the health insurance plan. Premiums are determined during the underwriting writing process which highly depends on the covered treatments. In HMO, premiums are set by the insurance provider depending on the number of insured employees and the coverages selected by the employer.

Insured

Insured refers to individuals or organizations that are protected by a health insurance plan

PhilHealth

PhilHealth is a government corporation under the Department of Health entrusted the responsibilities to provide health insurance benefits for all citizens of the country. Its functions stated in Article IV, Section 16 of RA 7875 include the administration of the National Health Insurance Program which is acceptable, affordable, accessible and available to all.

What can PhilHealth do for you?

Members of PhilHealth and their qualified dependents can get reduced cost for select health services during confinement in both public and private hospitals.

Partner hospital and clinics

Insurance providers have a long list of clinics, hospitals and medical professionals as partners. These partners usually acknowledge your health insurance plan to fully implement and recognize the benefits that come with it. It is important to identify institutions and practitioners that are affiliated with your health insurance provider to get full medical assistance and discount. Some non-affiliated medical institutions will only honor your PhilHealth coverage and may not consider other benefits indicated in your HMO or prepaid health insurance plans.

Pre-existing condition

A medical issue or problem that has been detected, diagnosed or treated before the purchase of a health insurance plan. Most insurers ask for your medical history to make sure that your previous medical condition will be addressed accordingly.

Prepaid Health Insurance

Prepaid health insurance, also referred to as sachet insurance, provides one-time health packages specially customized with medical benefits for clients’ needs and budget. Customers can purchase prepaid health cards which work like vouchers. These vouchers will then be presented to medical institutions to cover for services during emergencies. Some people with either PhilHealth or HMO plans still buy prepaid health cards because of coverages like dental services, urinalysis, accidental death and livelihood assistance.

Rider

Any add-on clause or coverage that are added to the initial set of coverage in the plan is called a rider. Some people opt to pay extra for the rider which fit their current condition.  Most riders include maternity benefits for critical illnesses.

 

health insurance underwriting

Underwriting

Underwriting refers to the process by which the health insurance provider determines the extent and price of the coverage included in the plan.

In a country where medical conditions are usually treated with pito-pito, banaba, oregano, and other medicinal plants, a lot of people are still skeptical about health insurance and its benefits.  The journey to fully understanding and accepting the importance of health care insurance has just begun; and while we still rely on the powers of traditional medical intervention, GoBear finds pleasure in helping every Filipino appreciate health insurance plans. Breaking down health insurance jargon is a huge step to begin this course.

Medical emergencies are unpredictable and costly and getting protected can save you from spending on hospitalization and other treatments.

 

health insurance

 

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