Saturday, August 15, 2009

Three Things to Consider in a Health Insurance Contract

By Terry Yahzik

Very few people find the task of reading through contracts inspiring. After all, most contracts tend to be written by lawyers in a language (called legalese) which only they understand, yet they expect the documents to be assimilated by members of the general public. Matter are not made any easier by the fact that the most important elements of the typical contract, the elements that can have the biggest impact to both parties in the contract tend to be hidden deep in the contract's fine print.

Yet in spite of the difficulty of the task which is carefully going through a health insurance contract, you simply cannot afford to get into any such contract without going through it with a toothcomb. The adverse effects of getting into a health insurance contract without examining it carefully can include anything from going into a healthcare facility, incurring a bill and being told to you have to foot it from your pocket because your health insurance provider 'does not cover that' to actually getting detained the healthcare facility in question for non payment if you happen not to have any alternative way of footing your bill there.

To avoid such inconveniencing and potentially embarrassing situations, it is important to make an effort to understand at least some three crucial things in your health contract, before signing on the dotted line.

At the very least, then, you need to ensure that you know what the limits of your health insurance cover are. No health insurance covers all medical conditions and 'to all extents' - but at least it would help if you understood what the limits are. Make sure then, before you sign onto your health insurance contract, that you know what medical conditions and procedures it covers and what medical conditions and procedures it doesn't cover. Make sure, too, before you sign onto your health insurance contract, that you know what amounts of medical bills it covers and what amounts of medical bills it doesn't cover, and whether it allows for bill splitting, so that in case you incur a bill above what it covers, it can pay up to the level it is supposed to and have you pay for the rest. As you will discover, some health insurance policies don't come with this level of flexibility.

Ensure too, before you sign onto your health insurance contract, that you know at what point in time the coverage in it takes effect. This will save you from a situation where you incur a medical bill a few weeks after taking the up the health insurance, only to be told that you have to pay the bill, as the cover had not yet taken effect when you incurred the bill!

And in the same spirit of knowing the major components of your health insurance contract, ensure too, that you are very clear about what health facilities the insurance covers bills in, and those that it doesn't. Most health insurance covers, as you will learn in the process, only pay for bills incurred in certain (select) healthcare facilities, while leaving it up to you to foot your healthcare bills if you happen to incur them at certain other facilities.

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