Innovative Benefits Consultants: Introduction to International Insurance

Health Insurance:
- the pitfalls that may
await you,unless you look
carefully at what is offered

Let's get one thing straight...there's no way this makes
exciting reading! But, one day what you learn here
and what you do about it could save your life or the
life of a loved one!!!

So, let's get started......the topics we'll cover are:

You really ought to be thinking about private health insurance if:

What are the Basic Features of private health insurance?

Applying for a Policy

Your Age

Policy exclusions to be aware of

Getting Claims Paid

Paying premiums

Renewing Coverage

What advantages are available to a group

   You really ought to be thinking about private health insurance if:
   you’re not eligible for group health insurance
   you’re covered by a National Health System
   you’d like to have the option to have private care where you currently live
   you’d like to be able to go for treatment for a specific problem to another country

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   What are the Basic Features of private health insurance ?
There are generally one or two major levels of coverage:

   Comprehensive coverage: in-hospital care and services, services of doctors,
     lab tests, x-rays and other scans, etc. in a non-hospital setting; and
   A basic coverage which is limited to all care and services relating to an
     inpatient hospital stay only.

The common variables are the aggregate, annual, and other scheduled limits within
the policy; deductibles and any differences based on where the care is provided.

But beyond that, there are traps waiting for you unless you look carefully at
what is offered. How do you decide what makes a policy better for your
specific needs? Let’s look at some of the things you should be aware of:

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Applying for a Policy

Guaranteed-Issue Policies
It’s easy to get coverage with one of these policies - just answer a few easy questions
and pay your premium. However, when you submit a claim, that’s when the problems
can start! You may be asked for proof that the problem you just had treated wasn’t a
preexisting condition at the time you applied for the policy.

What’s a Pre-existing condition?
Generally it means a medical condition which is being (or was) treated and any condition
associated with it. For clarification:" Treated" generally means:

   Doctor’s visits, tests, or even taking medication for the condition within the past
      one year, two years, five years, or anytime in the past; (the time frame varies
      depending on the policy), or
   Any condition which a ‘prudent person; would have had treated
      - even if you didn’t know about it!

" Any condition associated with it " could mean, for example, a broken leg being
deemed to be the result of brittle bones caused by cancer treatments!

If the insurer decides it is a preexisting condition, they may deny the claim. Always
remember, the larger the claim the more they’re going to examine it very carefully!
Not what you want to go through when you have just incurred a claim for $10,000!

Fully-Underwritten Policies
These policies ask very detailed health questions on the application form and may
even ask for doctors’ reports. Based on all the information you supplied, they may:

1. Accept your application with no exclusions or conditions;
2. Accept your application with an increase in premium;
3. Accept your application with an exclusion for a specific medical condition; or
4. Reject your application.

It always makes good sense to disclose preexisting conditions on your application
form even if the application doesn't ask about them; then the insurance company
will be hard-pressed to deny a claim for a preexisting condition if they didn’t exclude
it when they approved your application.

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Your Age
Some insurers automatically reduce benefits, charge extra premiums, or even discontinue
your coverage when you reach a specific age, for example - 60, 65, or 70.

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Policy exclusions to be aware of

Travel:
Some policies exclude travel if it’s specifically to get medical care. Others exclude care if
you travel "against the advice of a physician" or "while you are on a waiting list for treatment"
in this case, treatment for that specific condition may not be covered while you’re travelling.
Pregnancy and Childbirth:
Some policies exclude one or both completely while others exclude them only
for the first 12 months of the policy. Even if the pregnancy is covered, some policies
automatically exclude the first 15 days of a newborn’s life - while others cover only the
first 14 days of life. In these cases, the baby must apply as a "separate person".
Because many policies exclude birth defects, and congenital and hereditary illnesses,
the baby may not be accepted for coverage. Therefore such policies may not be
appropriate for you if you’re in the childbearing years - take a long, hard look and
ask questions before you sign up for such a policy.
Chronic illnesses:
Some policies specifically exclude or limit the coverage of conditions which are
or become chronic (even after you purchase the policy). An asthma attack (acute)
may be covered but not ongoing asthma problems (chronic).
Limited Coverage:
Some policies limit coverage for any single accident or illness to, for example,
the first 12 months of treatment following the onset of that accident or illness.
Organ transplants:
Some policies exclude such procedures; others offer it as an additional benefit,
and some include it as a part of the regular coverage.
Where you are:
Some policies place no limitations on where you can get care while others limit
the region of the world where they will cover you (and may charge different
premiums based on the region(s) you select).
Home Country:
Some policies limit the time you can spend in your "Home Country" or even exclude it
completely. For example, travel to/in the U.S. may be limited to 30 or 60 days for U.S.
citizens or anyone born there, regardless of their current citizenship. This could apply
even if you go for a short visit and then, because of an illness or accident, need to stay
longer. The policy may be cancelled or suspended when you reach the time limit,
regardless of your health condition at the time.

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Getting Claims Paid

Pre-certification:
Many policies now require you to get prior approval for a planned hospitalization, with a
penalty of reduced benefits if you don’t. They may be more lenient with emergencies but still
require notification as soon as possible after the emergency. Some may also limit the
choice of hospitals or doctors you can use. Even if you don’t need pre-approval, informing
an insurer before a hospitalization is a good idea since they can usually pay the hospital
directly for your stay.
Non-hospital bills:
In most cases, you must pay physicians, labs, etc. yourself and then submit those bills
with proof of payment.
Submitting Claims:
Some policies require a completed claim form - others, just the original bill. In almost
all cases, you should get the bill in English or supply an English translation
- it tends to smooth the path to reimbursement.
Emergency Help:
Almost all policies offer the services of an International Help Centre, 24 hours a day, seven
days a week. The Centre can direct you to an English-speaking doctor and/or hospital
and assist in the event of an emergency requiring medical evacuation. This is useful when you’re
in a non English-speaking area, but you can use it wherever you are in the world.
Medical Evacuation:
This is a useful feature if you’re in a country/region with a healthcare system which is below par.
However, be aware that no policy offers evacuation just because you would prefer it. If the
emergency couldn’t be treated locally, you would be evacuated to the nearest major facility
capable of providing a decent standard of care, and the definition of ‘nearest’ and ‘decent’
are decided by the Emergency Help Center and the insurance company.

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Paying premiums
Premiums are normally payable for each person in a family, although some policies offer a family
premium, and others offer "free" coverage to pre-teen dependent children if one parent is covered.
Premiums may vary with age and where you live. Payment is usually by cheque or credit card and
may offer a choice of currencies.

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Renewing Coverage
Guaranteed renewability of an insurance policy is fundamental to the selection of a policy. If there is
no guarantee to renew coverage regardless of your health condition at the renewal date, beware!
Cancellation of coverage is not what you want to happen in the middle of a serious sickness or when
you have a preexisting condition.

Group Coverage
There are many advantages available to employer groups, partnerships, and associations in which
there are several primary members applying togther for the same plan. These are described in:
The advantages of international group health insurance

This quick look at private health insurance is to remind you, once again, that there are no
bargains out there. You should always use the services of an experienced international
insurance consultant to assist you in selecting a policy.

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Back to the Introduction

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