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Health Insurance

By: Stephen Leslie France, Editor - aLookingGlass | Last Updated: October 26, 2016

By Brian Jermyn, Director – Caribbean Insurers

Why Do I Need Health Insurance?

Health care costs have become increasingly more expensive over the years. Serious illnesses or injuries can run into the hundreds of thousands of dollars and cause severe financial difficulties.

The purpose of health insurance is to help you pay for care that you or a family member may need. It is best to enrol in a health insurance plan at an early age as generally pre-existing conditions are excluded from coverage. If you wait until you become seriously ill or injured, you will likely not be able to obtain the health insurance coverage you require.

People with health insurance are also more likely to get routine and preventative care on a more regular basis which can reduce the chances of a medical problem escalating into something more serious and more costly.

At the very least, you should consider a medical plan with a higher deductible and establish a savings account, to ensure you will have the funds available to meet your deductible should a medical emergency arise.

What are the Standard Health Insurance Coverages?

Most health insurance policies have coverage for the following medical services:

Hospitalisation, Doctors Office Visits, Prescription Drugs, Diagnostic Tests such as X-Rays and MRI’s, Surgery, Maternity, Organ Transplants, Radiotherapy & Chemotherapy and Annual Check-Ups.

Optional coverages generally include Air Ambulance, Dental, Vision, Life and Accidental Death & Dismemberment coverage.

Most insurance plans are “coinsurance plans” where the insurance company will cover a percentage of the eligible medical expenses after the deductible has been met (say 80% or 90% for example) with the remaining (20% or 10%) to be paid by the insured as their coinsurance share.

What are Preferred/ In-Network Providers?

Preferred Providers are doctors, hospitals and other health-care providers who have contracted with an insurance company or third party administrator to provide health care at reduced rates.

Non-preferred providers can often charge higher amounts for services rendered and will expect upfront payment from the insured as they do not have a relationship with the insurance company. Furthermore, insurance companies will generally reduce the claim amount to the Usual Customary and Reasonable (UCR) amount for the medical service, leaving the insured to pay any excess billing by the medical provider.

As a result, health insurance policies generally try and encourage using preferred providers by offering better benefits either through reduced deductibles or lower coinsurance payments to the insured. Your insurance agent can generally provide you with a list of preferred providers both in the BVI and abroad for the health insurance plan you are enrolled in.

Pre-Certification, Exclusions, Waiting Periods and Pre-Existing Conditions

Most health insurance policies have built-in restrictions to prevent abuse of the policy benefits. You should make yourself familiar with pre-certification requirements, policy exclusions, waiting periods and any pre-existing condition limitations you may have in your health insurance policy.

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