At the recent thanksgiving dinner at my parent’s, a guest enquired how I’m 'managing’ life in my 40s.
I was tempted to speak outside my Laura Ashley dress and spill how amazing it’s been, discovering my life purpose, and creating a life I love, doing what I do. Instead I muttered a polite “Very well, thank you” as I emptied my wine glass.
As I considered excuses for an acceptable escape from the evening, the same guest brought up a subject that caught my attention. I shrugged off the droning effects of the bottle of wine almost immediately.
Her moving real-life story on a disputed health insurance claims was riveting. My heart went out to her. It is indeed no easy task using health insurance once you have it.
Insurance terms and health insurance rules often lead to confusion and many have found themselves inundated with costly disputed insurance claims.
Here are 5 areas that would help you avoid any of such costly mistakes:
1. Timing of benefit coverage
Your health insurance coverage begins on the policy issuance date or risk commencement date.
That said, not all your benefits coverage have the same start date. This is usually featured in the fine print of your policy terms and conditions. Do ensure you clarify this before you buy.
Some benefits start immediately.
Some benefits like maternity and pre-existing conditions feature a waiting period during which you cannot claim.
Some benefits could carry exclusions which are not covered by your health insurance.
2. Pre-existing conditions
A pre-existing condition is a medical condition or health problem or an ongoing problem from a past injury before buying your health insurance. This may be:
- Conditions which you already received medical advice or treatment, or
- Symptoms which are present that you would seek advice or treatment
In your health insurance application, you are obliged to tell your insurer about any serious medical conditions you have suffered from, even if your doctor or you now consider yourself to have fully recovered.
These include serious or critical illnesses, such as cancer or heart disease and any even less severe but chronic conditions, such as hypertension, diabetes or asthma; and any medication you are on or surgery or medical tests you have undergone.
No matter how minor you think the problem is, it is better to be safe than sorry during claims.
Insurers may exclude or have a waiting period for pre-existing conditions.
If you do not disclose a condition and you subsequently make a claim, your insurer has the right to turn down your claim based on non-disclosure clause even if your claim is unrelated to your condition.
3. Waiting period
Some health insurance may impose a waiting period of up to 12 months on benefits for medical conditions for which the signs and symptoms have existed six months prior to the start date of your health insurance and a 3 month waiting period for all other benefits. Maternity usually have a 12 month waiting period.
Your health insurance will not cover medical services and treatments for pre-existing conditions, obstetrics conditions, etc. during the waiting period
Exclusions are specific situations, medical conditions, services and treatment that your health insurance doesn’t pay for. These may include pre-existing conditions, cosmetic surgery, non-illness medical check-ups, immunization, etc. You are expected to pay the full cost of non-covered services.
Before buying your health insurance, be sure to find out about your plan’s exclusions so that you will not be surprised with a big out-of-pocket medical bill.
Exclusions are at the heart of almost all disputed insurance claims
Now you have your health insurance in your hands, you would think that you have continuous coverage.
A closer look at your renewal clause would reveal what your renewal eligibility is:
Most health insurance are annual renewable plans which can be terminated to due excessive claims or non-disclosure.
Guaranteed renewability plans protect your rights by ensuring that you have continuous health insurance as long as you pay the premium on time. Your insurer cannot terminated your health insurance at any time especially when you need it the most.
Other related articles that you may be interested in:
International Health Insurance: 10 most important questions to ask
12 Key Health Insurance terms explained