Medical insurance provides you financial protection in the event of specific diseases, illnesses, or ailments, depending on your coverage. However, just because you have medical insurance doesn’t mean your medical costs are totally covered! Here’s what you need to watch out for so that you can take full advantage of your medical insurance:
Not all medical insurance packages are created equal. You should choose a package that suits your occupational hazard, family background, and financial viability. You can also have additional coverage not stated in the main policy by purchasing riders. The very fact that you may purchase riders should clue you in to the fact that medical insurance does not cover any and all trips to the hospital. Read your policy carefully to know what ailments are covered.
Have you ever been admitted to a hospital with your medical card in hand, but you got slapped with a medical bill anyway? Have you noticed that said bill can be either a portion of or the entire cost of your hospital stay? That’s because of an insurance mechanism called a deductible. You’ll have to foot the bill yourself if you haven’t exceeded your deductible value for a given yearly cycle. So if your deductible is RM2,000, you’ll have to continuously foot the bill yourself as many times as necessary until you exceed the RM2,000 mark before you can claim from your insurer.
Even if you’ve exceeded the deductible amount, you may not be entirely scot-free from subsequent payments! Thanks to co-insurance, which is a form of cost-sharing between you and your insurer, you might have to foot a certain percentage of your future medical bills even if your medical costs are already more than your deductible. It is possible to choose a policy that has zero co-insurance – which means you don’t have to pay after exceeding your deductible – so read the fine print carefully!
Repetitive hospital visits for the same reason may raise a red flag for hospitals, who may then request for a guarantee letter from your insurance company to confirm that your insurer will foot the bill. An insurer will issue a guarantee letter for the hospital only if you pass background checks for previous similar reasons, or received treatment for pre-existing illnesses that were present before you signed up for their medical plan. They might not issue that guarantee letter at all if they found out you lied during your application. This will leave you to foot the bill on your own and your policy may even be canceled, so be truthful.
Pay First, Claim Later
Investigations into your background can take time, but bills must still be paid within a certain time limit. The lack of a guarantee letter for the hospital will mean that you must foot the bill yourself. However, you can pay first, keep a copy of your proof of payments, and submit it in a report to your insurer’s claims department to be reimbursed once you get that guarantee letter.
Your policy is only worth so much every year. This is known as the annual limit, or the maximum value of claims you can make in a year. You’ll have to pay your own bills for the rest of the policy year if you exceed this annual limit. In short, you’ll have to beware the deductible at the beginning of your policy year, and the annual limit as your year progresses, as that will indicate how much will have to come out of your own wallet.
Medical insurance is a very helpful financial safety net in the event of illness, ailments, and diseases, but it is not a perfect shield for you. Know its limits and optimise it so that you don’t lose too much due to medical costs!