The Mom’s Guide to Understanding Health Insurance Terms
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The mom’s guide to understanding health insurance and the terms related when searching for the best policy for your family.
That tooth that got chipped when your kiddo so unpolitely head-butted your face in the pool last summer; that emergency visit to the ER when your husband sliced his finger open carving the juicest turkey ever; and even the urgent care visit for what you were certain was the hallmark chills and aches of the flu–all could cost a boat-load of money if you don’t have proper health insurance. Of the most basic financial must-do’s I recommend–health insurance is one of them!
From dental care to vaccinations, medical insurance plans cover the full spectrum of medical care and assistance. However, whether you gain access to all of this depends on the level of coverage you select when choosing your plan. But some of the terms can be confusing.
There is standard coverage, which typically only allows policyholders to benefit from in-patient care, yet there is comprehensive coverage, which has a whole host of great benefits. Also, sometimes your employer may provide options that are referred to as low-ductible versus high-deductible plans (which is typical in the US.) These plans usually offer very similar coverage, but have different premiums and deductible amounts.
General terms you should know when selecting a plan:
1.In-Patient – As mentioned, this is offered in all worldwide health insurance policies, as it is considered the most basic form of care. You are classed as an in-patient when it is essential that you stay in a hospital overnight to receive treatment.
2. Out-Patient – An out-patient is someone that does not need to be admitted to hospital. Treatment is typically provided in the medical practitioner’s surgery or practice. This type of treatment is often covered in intermediate and comprehensive cover policies.
3. Long-Term Care – Some policies provide long-term care coverage. The insurer will pay for treatment and assistance for an individual who is unable to care for him or herself for an extended period of time. This includes those that are disabled, as well as individuals with chronic illnesses.
4. Optical – High coverage policies tend to offer optical care, which can include everything from eye tests to laser eye surgery. In the US, policies sometimes don’t cover certain things like measuring for contact lenses, so be sure to read up on what’s available before visiting the eye doctor.
5. Dental – Dental care is also a regular feature in policies with comprehensive coverage. In these instances the insurer will cover anything from complex dental treatments to yearly check-ups.
6. Maternity – Maternity care is another option that tends to be provided only in comprehensive cover policies. This involves any medical costs related to giving birth and the entire pregnancy, and so can range from the expense of a midwife to prenatal care. For any mom, this is a worthwhile extra. No matter what pressing concerns you have, you will have someone to help you. Will my baby’s eczema disappear? Why am I struggling to breastfeed? What should I be giving my child in terms of nutrition? If you are going to take out a policy, you may as well take advantage of expert maternity and childcare. (US policies generally don’t cover childcare.)
7. Well Being – This concerns medical costs that occur because of pivotal tests that are required to ensure you maintain good health. This does not mean you can go for random check-ups for any illness under the sun! What it does mean however is that if your doctor suspects an illness or wants to test you for various things; your policy will cover the costs. In the US, these may be called ‘preventative’, which are usually covered at 100% or close to it–check your policy.
8. Vaccinations – Last but not least, another option you may have with your health insurance policy is coverage for booster injections and immunizations. In the US, most policies automatically cover these at 100%.
9. In-Network– This refers to doctors that are contracted with the insurance company you’re signing with. They have pricing already agreed upon in advance with your insurer, and therefore your insurer usually covers these doctors at a much better rate. (This may only apply in the US.)
10. Out-of-Network–This refers to doctors or facilities that are not contracted with your insurance company. They have not agreed upon reasonable costs for visits, supplies, or procedures. This means your insurer may charge a higher deductible, and give less coverage for these doctors or facilities. (Again-may only apply in the US.)
If you are thinking about acquiring health insurance, you may be feeling a bit overwhelmed and confused by all of the options at your disposal. You do a search on the Internet and you’re met with an abundance of information. It’s difficult to know where to start. Here are some commonly asked questions…
In which countries can I have treatment?
This depends on your policy. Insurers will provide you with a list of countries whereby your global health insurance will be applicable.
What is excess or deductibles?
This is the amount of money you have to pay for treatment and/or care before your insurer will fund anything. For example, if your excess or deductible is $500, you will have to pay this sum of money for your insurer to cover you. The higher your excess or deductible is the lower your premiums will be.
Are outpatient treatments covered?
This depends on the level of coverage you opt for. Generally speaking you can choose between basic cover, intermediate cover and comprehensive cover. If you opt for a basic policy you will only be covered for inpatient treatments. However, most intermediate cover policies and all comprehensive cover policies will cover outpatient treatments. Many plans will allow for it, but offer coverage at different rates and may also have a completely separate excess or deductible for in-patient vs. outpatient visits.
Is pregnancy and maternity care covered?
You will need to opt for a policy that provides this type of coverage, which typically means selecting a high coverage policy. It is important to be aware of the fact that there could be a waiting period in place for maternity care. You have to seek this policy before falling pregnant, otherwise you could be deemed to have a pre-existing medical condition and consequently you will struggle to find someone to insure you.
How can I keep my premium costs low?
There are various ways you can lower your premiums. One option is to pay for your international medical insurance plan on a yearly basis rather than a monthly basis. You may also want to consider increasing your excess or deductible. Group schemes are also ideal for those looking to pay a lower premium amount. And yet, other plans have wellness clauses that will reimburse you part of your premiums if you fall within guidelines they set for wellness activities and health status.
Hopefully, you now feel like you have a better understanding regarding health insurance and all of the different options available to you as a mom. If you intend to get pregnant, make sure you take out insurance before doing so.
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