You usually pay a monthly amount for your health insurance, which is called the premium. Your insurance can pay out if you need treatment that it covers while the policy is active.It is designed to offer treatment alongside the service provided by the system. For example, appointments with your GP would still be through the system. But with medical insurance you could get:
- Treatment sooner
- A choice of where you get treatment
- Better facilities or a private room
- A wider range of treatment types and drugs
What does it cover?
Health insurance can include cover for treatment you get as:
- An inpatient: This includes staying in a hospital bed for tests or surgery.
- An outpatient: This includes consultations, diagnoses and treatment when you do not need to stay overnight.
- A day patient: This includes regular appointments but not staying overnight.
What is not covered?
Each policy has different limits and exclusions, but most do not cover:
- Chronic illnesses like HIV, including ongoing treatment for long term or incurable conditions
- Elective treatment you choose to have, including cosmetic surgery and fertility treatment
- Emergency treatment because ambulances and A&E departments at hospitals are usually run by the system
- Treatment for drug abuse, e.g. spending time in rehabilitation
- Treatment abroad, but this should be covered by your travel insurance
- Care and treatment during pregnancy, although emergencies and health complications are sometimes covered
What does a Health insurance policy cover?
Your private health insurance plan will cover you for treatment as an inpatient. It will also cover when you stay overnight in a hospital bed, for example for surgery as an outpatient. Consultations, diagnosis and treatment that do not need an overnight stay, so you would be a day patient. This means you attend regular appointments, but don’t need to stay in a hospital overnight.
Think about what you want your private health insurance to cover. This could be illnesses, symptoms, injuries, and treatments. The more illnesses and injuries you cover, the more your health insurance will cost.If you want to cover serious illnesses like cancer, your private healthcare could cost more. The price would go up if you cover existing conditions too, such as asthma or physiotherapy.
Most medical insurance policies do not cover long-term conditions or emergencies. They also don’t cover treatment you choose to have, drug abuse, treatment abroad or pregnancy care. Health insurance is usually for severe, curable and short-term conditions.
Why do I need health insurance?
Health insurance can help protect you financially from the medical bills – like an accident or illness diagnosis you were not expecting. Paying for medical care out of pocket 100% can get extremely expensive. Surgical treatment for a broken arm averages $16,000. But with health insurance coverage, you will be able to manage your expenses. Not only does health insurance help you access providers like hospitals and doctors, it helps cover your expenses. Depending on your plan, you may have to meet a deductible and pay a co-pay amount for doctor’s visits, but insurance can cover a significant portion of your insurance bills. You can secure lower deductibles with higher level ACA plans (silver, gold, platinum) and with Short term health insurance. Short term life insurance plans do have a lifetime maximum, so if choosing a short term plan, check the amount.