The Top 8 Health Insurance Terms to Know When Buying a Plan

There are other cases in which co-insurance might be applied. For example, hospitalisations, outpatient surgeries, and rehabilitation treatments must be preauthorised prior to treatment, or else a 20% co-insurance fee applies.

Underwriting

Underwriting is the process of assessing risk to offer insurance and set the premium you pay. Underwriters look at several factors, such as your age, gender, occupation (for example, if you work in construction or have other risky jobs), your medical history, and if you have any pre-existing conditions.

If an applicant does not disclose all relevant information on their application form, this could result in them being declined when trying to make a claim later on.

Pre-existing Condition

Before buying a health insurance plan, a pre-existing condition is a health problem you have been diagnosed or treated for, whether successfully or unsuccessfully.

Health insurance companies usually have different ways of covering pre-existing conditions. Minor pre-existing conditions, like a bone fracture for instance, might be covered as standard, without loading to your premium. For more serious conditions, you may be offered different underwriting decisions:

• Your condition may be covered, but the insurer will add a loading to your premium,

• You may be offered a standard premium, but your condition will be excluded from coverage,

• For very serious conditions, like cancer or chronic heart disease, your application may be declined.

This is why it is key for you to apply for health insurance before actually being sick.

Some health insurance plans only cover certain types of pre-existing conditions, while others will cover them all. You should check with your provider to see what they cover before signing up for coverage.

Exclusion

An exclusion is a condition that is not covered under your health insurance policy. It can be related to two things.

First, it can be a specific medical condition or treatment that is excluded from your policy coverage. Some health insurance plans may exclude certain types of care, such as cosmetic treatment, substance abuse treatment, LASIK surgery, or some experimental procedures, for instance.

Second, an exclusion can be determined during the underwriting phase and is linked to a pre-existing condition you declared. For example, if you have a condition like high cholesterol it is likely to be considered as pre-existing and any treatment related to this condition will be excluded from your policy and therefore not covered.

Deductible

A deductible is a fixed amount of money you must pay before your insurance company starts covering you. It can be an amount per policy year and or/per disability, for instance. Usually, the higher the deductible, the more money you will save on premiums. If you are on a budget, adding a deductible to your plan will allow you to pay a more affordable premium. In case of major illness or hospitalisation, you will have to pay your deductible out of pocket but will then be covered up to your annual limit.

If you already benefit from a basic insurance plan (local plan, company plan…) but would like more comprehensive coverage, you can top up your current policy by adding our MyHEALTH Inpatient Module with a high deductible. In case of treatment, your first insurance plan will cover you up to its limit. Your top-up will then jump in and cover the remaining cost of treatment, ensuring you don’t have anything to pay out of pocket.

For example, let’s say a member has a limit of US$15,000 per disability under his local plan. He is then hospitalised and the bill comes to US$45,000. His existing insurance policy cover him up to its limit of US$15,000, which will apply to his deductible, and APRIL will then cover the remaining US$30,000.