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Be Insurance Savvy

Be Insurance Savvy

While the jargon and fine print can be overwhelming, it’s crucial that consumers understand all the details pertaining to their prospective policies. When navigating the insurance minefield, you may want to consider working with a professional insurance broker/intermediary. Like working with a travel agent, an insurance broker can shortlist the most suitable products from various insurance companies according to your needs and budget.

Whether working on your own or with an intermediary, it is paramount that you diligently do the necessary research in order to save you and your loved ones unnecessary emotional and financial stress in future.

Expatmedicare, a licensed insurance broker in China for nearly 10 years, shares some of the key points that expats should be aware of when choosing a medical insurance in Shanghai. It is especially important if you have special requirements - like if you have pre-existing condition or if you’re planning on having a baby.

What is not insured - Exclusions

When searching for a health insurance policy, it’s important to know that most insurers may not cover all conditions and treatments. The most common are:

  • pre-existing condition which is generally understood as a medical condition that existed prior to the purchase of the medical insurance, e.g. asthma, pregnancy, cancer, etc. Get the list of conditions and treatments that are not covered by each insurance company as it differs from one to another.
  • addictive and mental conditions and disorders
  • allergies and allergic disorders
  • artificial life maintenance
  • birth control
  • conflict and disaster
  • cosmetic and plastic surgery for aesthetic reasons
  • obesity
  • congenital conditions (any abnormalities, deformities, diseases, illnesses or injuries present at birth, whether diagnosed or not)

Take note:

Some insurers may cover certain pre-existing conditions which often result in a high premium and certain limitations may be imposed, e.g., the amount of coverage, duration of waiting period, etc.

How long do I have to wait before getting reimbursed? – Waiting Period

Waiting periods are common when you buy new health insurance. Short-term or serious illness or injury, however, are typically covered immediately after the policy begins.

Waiting periods can vary from 6 to 24 months depending on the treatment or procedure, so be sure you are aware of them before purchasing your policy. Generally there are the following waiting periods:

    a)dental - 6 to 9 months,

    b)maternity - 8 to 12 months

    c)pre-existing condition - 24 months

An insurer may waive or shorten the waiting period when the policy is purchased as a group.

Getting paid – Claims

It’s important to understand the insurer’s claim procedure. For most out-patient treatments, it’s common to pay first and claim later. Most insurers will require that the doctor complete the claim form, so be sure it is completed during or after the treatment. With treatment/payment guarantee or direct payment network, insurers will settle your medical bill directly with the medical institution.

If you are hospitalized, be sure to notify your insurer within the time frame established in your policy – usually 48 hours after admission - to make sure that they pay directly. Otherwise you may only get reimbursed for part of your hospital costs.

Most claims should be reimbursed within 2 weeks if everything is in order.

Chronic conditions

Insurance that covers chronic conditions and naturally more expensive compared to those that do not.

Chronic conditions are defined as a disease, illness or injury that has at least one of following characteristics:

  • ongoing and has no known cure,
  • likely to re-occur,
  • permanent
  • requires long-term treatment.

Most insurers will put a cap to the type and cost of treatment, such as setting a lifetime or annual limit to claims pertaining to chronic conditions.

One of the most common misconceptions about chronic conditions is that they only affect the elderly. Research shows that 50 percent of chronic disease deaths occur in people under 70 and 25% to people under 60. Chronic diseases can often be caused by unhealthy diet, inactivity, smoking and excessive drinking.

Those that fall in the low risk category can choose not to be covered for chronic conditions. However, there are also rare cases of healthy people developing chronic illnesses. If and when this happens, insurers will classify this as a pre-existing condition, which may not be covered or will be covered at a high cost.

Maternity

If you are planning on becoming pregnant, it’s particularly important to be aware of what the policy does and does not cover in terms of maternity. While most insurers provide maternity benefits, there is usually a waiting period of 8 to 12 months.

Maternity insurance usually covers:

- pre and post-natal care and treatment - delivery cost - complications - routine newborn care

Take note:

Be aware of how the insurer defines “waiting period”. Some insurers provide maternity coverage after the stipulated waiting period and some insurers provide maternity coverage only if conception happens after the stipulated waiting period.

Medical Evacuation and repatriation

If you are living in a developing country, one crucial part of an expat health insurance policy is medical evacuation. A medical evacuation is only carried out when the required treatment is not available locally and is medically necessary. Insurers cover the cost of transporting you to the nearest medical facility, and the policy may cover the cost of one other person to accompany you.

A medical repatriation is similar to medical evacuation, but it offers the option of receiving treatment in your home country.

Final Word of Advice

Do not sign on the dotted line before reading the Policy Wordings, which contains all the details and usually comes in a separate document. Receiving medical attention in a foreign country can be confusing enough, and being prepared by clearly knowing what is included in your policy, and what is not, is the best way to prevent further confusion.

To educate yourself further and be more insurance savvy, click here to read more.