Important Questions You must ask Before Purchasing Health Insurance Plan

Health insurance is essential to have for every individual. It helps us pay for all the medical expenses that we incur due to unforeseen health conditions or accidents. However, the whole process of choosing the right insurance plan can be overwhelming, as you need to know your options and the different plans available. You will need to do a certain amount of research on the right insurance plans that would work for you, your family, and your budget because these plans may vary in terms of premiums, benefits, and deductibles. Thus in order to help you choose the best coverage, there are a few important questions that you need to ask your certified insurance agent before purchasing any health insurance.

WHAT TYPE OF INSURANCE PLAN IS IT?

The very first thing you must find out or ask directly to your insurer is what type of plan that will suit you best as everyone has different health concerns and conditions. Basically, there are three insurance plans that were commonly offered, such as fixed benefit, medical, and critical illness. Bear in mind that some critical illness health insurance plans will only cover certain types of critical illness which are already written on the policy. Thus it’s important to fully understand your unique health situation and family health history before deciding to purchase any plan.     

DOES THE PLAN INCLUDE MY CURRENT DOCTORS?

Each health insurance company has specific contracts with certain doctors, clinics, and other medical providers, allowing them to have special agreement at a specific cost. If you have a preferred or regular doctor and hospital, ask your insurance agent for a list of doctors and hospitals that will be covered by health insurance you’re considering to ensure that they are included in the plan’s network. If your doctor is not included on the list, the insurance company may not cover the medical bill, and thus leaving you with bigger expenses. 

DOES IT COVER MY ROUTINE HEALTH EXAMINATIONS?

Routine examination or medical check-ups are required when you suffer from certain health conditions or when you start to age. With the help of right insurance coverage, you will be able to save quite a fortune.  

WHOM DO I CALL IF THERE IS AN EMERGENCY HOSPITALIZATION?

Be sure to ask about the claim settlement process and procedures before any emergency hospitalization happens. Ask what documents are needed and whom to call in a case of emergency. There are some plans that require you to contact a primary care physician or specially appointed insurance representative within 24 hours after emergency hospitalization, or your medical bill won’t be covered at the time of claim. While in other urgent cases, hospitals will contact your insurance company for initial authorization until your condition is considered “stable”.   

HOW MUCH WILL I BE CHARGED FOR PREMIUM AND OUT-OF-POCKET MAXIMUM?

One of the most important things to find out when buying a health insurance plan is the amount of premium you are needed to pay, either monthly or annually. 

Besides paying for premiums, some health insurance plans will require you to pay for a small percentage of your own care. These are called out-of-pocket cost, while the upper limit or maximum amount of this cost is known as out-of-pocket maximum. Beyond that, your insurance provider will fully cover your healthcare expenses. The policy of out-of-pocket maximum will vary from one to another but each plan will include copayments, deductibles and coinsurances. Below are further explanations of the four out-of-pocket terms:  

• Deductible: fixed amount (usually below or much lower than the total bill) that you have to pay before your insurance begins contributing for any medical claims.
• Copay: a small flat fee that you have to pay for each medical treatment, for example paying $25 for a doctor consultation or a drug prescription. Please note that the amount may vary depending on the type of insurance plan.
• Coinsurance: a percentage the policyholder is required to pay after the total medical expenses is cut off with deductible.

Due to the variation of premium and out-of-pocket amounts that may occur, you are strongly advised to get a clear and transparent answer from the insurer on a written document of your insurance policy to prevent any wrong expectations in the future.