Health Insurance

By Anna Lynn C. Sibal

Health insurance is a measure that a person or a group may enroll in for protection in case an illness or an accident befalls the person or a member of the group.
In exchange for the medical shield granted by the company granting the health insurance, the insured pays a premium depending on the coverage of his or her health plan.

A typical health insurance plan works this way:

A person applies for membership to a health insurance plan that a certain company provides. This company may be a private entity or funded by the government. Oftentimes, an employer provides health insurance as part of a benefit package for his or her employees.

The provider of the health insurance assesses the application of a potential member by asking the member personal information, background information as well as medical history. The applicant is then made to undergo a series of medical examinations. The result of these examinations will greatly influence the kind of policy that the health insurance provider shall offer the applicant.

After the examinations are completed and the results are evaluated, the health insurance provider shall draft a policy for the applicant. The policy details the benefits, the terms and the conditions under which the applicant may use his or her health insurance. The policy also contains a list of exclusions; exclusions are the conditions and situations wherein the applicant cannot avail of his or her medical insurance.

If the applicant finds the policy acceptable, he or she signs it. The policy then becomes the binding agreement between the insured person or group and the health insurance provider. An identification card is also usually presented to the insured person as a proof of the existence of the policy.

In the event of an illness or accident, the insured person or a representative presents the identification card to the attending doctor or hospital staff. The health insurance provider then assumes part of the cost of the insured person’s medical expenses as accorded in the signed policy.

A health insurance is usually valid for only one year and is renewed by the insured person on or before the expiration of the health insurance. The premium the insured person pays the health insurance provider on the initial year is dependent on the coverage provided for in the policy and the general condition of the insured person’s body. People who are healthy and live healthy lifestyles generally pay discounted premiums. For the following years of coverage, the premium to be paid often changes according to how the health insurance plan is used.

Careful evaluation of the choices available to the person or the group applying for health insurance is extremely important. Before signing up for one particular health insurance policy, the applicant must be sure that he or she understands all the stipulations included in the policy in order to avoid confusion in a critical period of illness or in case of an accident.

There are a number of factors that an applicant must consider before signing up for a health insurance plan. Among these factors are the following:

Available benefits. What benefits are included in the coverage of the health insurance plan? Do these benefits include preventive care, baby care, a maternity plan, vision, dental or accidental? Will you be required to pay out-of-pocket expenses when you avail of these benefits? Are these benefits the ones you truly need?

Quality. The quality of a health insurance plan varies from provider to provider, but quality can be measured. Quality should never be sacrificed. You can check for quality by getting feedback from other members of the insurance plan and by checking for accreditation.

Change in family status. How will certain life-changing events such as marriage, divorce, the death of a spouse, or the birth or adoption of a child affect your health insurance? The health insurance you are considering should have provisions to take account these changes that may happen in your life.

Retirement. Will your health insurance continue to provide you coverage once you hit the retirement age? What benefits will be available to you then?

Appealing. The health insurance plan you would choose should have a definite procedure to follow in case your claim is denied. You should understand this procedure so that you can effectively file grievances or make an appeal later on.

Ultimately, the choice of which health insurance provider to take on depends entirely on the person applying for it. But whatever company is chosen, it is important that copies of all information given to and given by the provider during the application process and during the membership – brochures, the policy itself, the correspondences, and other such documentation – must be kept and filed carefully for future references.