Things to know about Health Insurance

Things to know about Health Insurance

Whether you are still wondering to buy health insurance or still considering the best health insurance in the market, here we discuss the things you should know about health insurance.

Insurance, as we all know is a compensation that providing protection against a possible eventuality. The “eventuality” is a measure of personal risk and likely of an event to occur. The Personal risk refer to personal medical history, family medical background, age an occupation, while likely of event to occur refers to accidental death, permanent disablement, injury or sickness. All of these are unpredictable in nature. So insurance is needed to cover the expenses and provide protection to personal wealth in the event of these unwanted things occur to personal.

Health Insurance is also known as Personal Accident (PA) Insurance is an annual policy which provides lump-sum compensation in the event of injuries, disability or death caused solely by violent, accidental, external and visible events. Generally cheaper than Life Insurance, due to a more restrictive policy. Sometimes insurance agent will refer health insurance as medical card.

The main difference between Health insurance and Life insurance is the purpose of that insurance. Life insurance purpose is to ensure the policyholder’s  family or/and dependents can maintain their lifestyle in his absence. While, Health insurance aims at covering the actual cost towards treating illnesses or medical conditions subject to the sum assured. However, most of health insurances do provide some compensation to the family in case of death but more restrictive policy than life insurance.

There are several factors you need to consider for choosing health insurance plan.

1. Cost or premium-

The main things you need to consider is your budget. Once you decided the maximum commitment you can put into health insurance, only then you can compare the cost of health insurance between difference providers. The cost of a Health Insurance policy depends on several factors such as

i. The length of coverage

ii. Compensation

iii. Additional coverage on exclusion,

iii. Age (premium can rise with age),

iv. Occupation (Class 3 jobs have a higher risk than Class 1 and 2),

v. What activities you normally do,

vi. health history

vii. Number of people who benefit.

2. Coverage

You need to ensure the policy gives you what YOU need. Make sure the things you need is covered and things that you do not need is not included in your policy. Here are the list to consider for your health insurance coverage:

i. accidental death,

ii. permanent disablement,

iii. temporary total or partial disablement,

iv. medical expenses included maternity and newborn care

v. Mental health and substance-abuse treatment

vi. corrective surgery,

vii. hospitalization benefits incl. outpatient care and emergency services

viii. Outpatient care (doctors and other services you receive outside of a hospital)

ix. Pediatric services, including dental and vision care.

x. Prescription drugs

xi. Preventive services (such as immunizations and mammograms) and management of chronic diseases such as diabetes

xii. Rehabilitation services

xiii. laboratory test

xiv. Preventive services and management of chronic diseases (high blood pressure and diabetes)

xv. funeral expenses.

3. Exclusions

Be aware of exclusion clause in the policy as well to avoid dispute in the event of claim for the compensation. Most of insurance excludes the following:

i. war risks

ii. suicide and insanity

iii. terrorism

iv. self-inflicted injury

v. influenced by liquor, drugs or narcotics

vi. provoked murder or assaul

vii. illness and disease like AIDS, HIV

viii. childbirth, pregnancy or miscarriage

ix. involvement in unlawful activities,

x. hazardous sports, operating or riding a two-wheel motor vehicle.

4. Scale of benefits and sum insured

You need to know all the amount of compensation payable by the insurance company in the event of injury to or loss of limb, sight or hearing or anything is covered under the insurance policy

i. Get to know the scale of benefits and sum insured

ii. Compare the benefits with other providers

iii. Choose the best benefits that meet your needs

The sum insured normally depends on the individual’s annual earnings. As a rule of thumb, the highest insurable sum of a PA policy is based on 6-7 times the individual’s annual earnings.

5. Claim

Make sure your agent or insurance representative explain how to claim for the compensation, the required evidence and all supporting documents should be submitted for the claim, the limitation, period of claim etc.

6. Access to doctors and hospital

It is important to know the list of panels doctor and hospital so that you can easily use your medical card and know where you should go in case of medical illness or even emergency.

To know things you need to know about health insurance, you will not overbuy the insurance and know the questions you need to ask  to the insurance representative. This will ensure the insurance representative would not pitch you unnecessary products for them to sell to you. In addition, you can test the knowledge and effort of the insurance representative put into the insurance product he want to sell to you. If the representative could not satisfy most of your questions and needs, it is better to look for other representative or provider.


Here are some of thumb rules to buy for your health insurance:

  1. Things to consider
    • Affordability (total cost)
    • Coverage and benefits
    • Access to doctors and hospitals
    • Exclusions and limitations
    • Health and wellness resources
  2. Don’t overbuy-consider choosing a policy with a high deductible,
  3. Check the network.- have a primary care physician and specialists you like, be sure they’re in the network of any plan you consider buying.
  4. Know your share of the costs-cost you’ll pay out of pocket, through flat fees called copays and through coinsurance, a form of “cost-sharing
  5. Look into annual limits on coverage and services.
  6. Health insurance review your health insurance coverage after marriage. Compare monthly premiums, deductibles, and co-payments, and additional coverage provided, including dental, vision care and prescription drugs, before making any decisions.


Leave a Reply