It’s so common these days to call scam on insurance policies especially on health insurance. But what does comprise application and benefits for their coverage?
Well first, it’s important to note that, upon application, the applicant will be assessed on their eligibility for the insurance. For good measure, insurance companies will have to consider your state of health including history of medical conditions stemming from your parents and/or grandparents. Of course, it’s considerably ill advisable to allow a person on his deathbed to avail of the same insurance benefits paid for in long term by someone else who has applied a couple of years back with under top physical condition. This serves as fair terms for previous clients as well. Biruin mo, antagal mo nang nagbabayad ng insurance tapos may ibang umani ng benepisyo na kailan lang nag-member kasi pinayagan siya sa kabila nang nagbabadya niyang tuberculosis? It’s not that the insurance company is being heartless—it’s for the mutual protection interest of both the insurer and the insured.
Of course, as per physical health, insurances will always be personalized and the applicant must be legally capable so as to enter into an agreement with the insuring company, ie you have to be of legal age and are not mentally handicapable.
Facts of the Files
Say you have succeeded in your application—make sure that you have all the papers and documents (including premium payment receipts) kept safe and ready for presentation. Some people think that and insurance ID would suffice to be able to receive insurance claims. Documentation is important because, with it, you can track down your payments as well as you have, in hand, all the necessary documents to prove your eligibility to receive the benefits. Mas madali ka makakapag claim at mas madali rin nila maiaayos ang kailangan mo. In other countries, they have insurance advisors but here, most people would want to go it alone with the paper work thus making proper documentation all the more important.
For your benefit, here are some terms you have to look out for in a policy:
It’s the coverage that you have personally paid for. If you’ve completely paid for your deductibles, copays, and consinsurances, you have fulfilled your out-of-pocket maximum but this does not count in the same scope as your premiums which means that if you want coverage for a given month, you still will need to pay for premium on said month.
Remember when we said that you need to first be assessed medically sometimes before you are enrolled for an insurance? Some conditions will be filed under here and those conditions might or might NOT be included in your coverage. Kung may TB ka at pinayagan kang mag enroll para sa insurance, tingnan mo muna kung covered ang TB mo. If you get hospitalized for a pre-existing condition that is stated to be not covered, you will not be able to claim benefit for it as well as for…
This part of the policy must be well defined when you check yours. These are the incidents that the company will not cover at all so look for the “Exclusions” clause and make sure know them well.
This is for the benefit of the client. Should you be unable to pay on the deadline, the company will provide you with a certain grace period before they cancel the coverage for the month or year.
There are more terms to look out for but these are some of the most important ones. Make sure to clarify them with you policy provided as well as ask them for clarifications regarding your policy fine print.