What is major medical expense insurance and how does it work?

The human being is always prone to accidents and diseases of all kinds and at all levels. And sometimes, taking care of some of them is too expensive and can cause many financial problems. Medical expense insurance seeks to balance that.

The opinions expressed by collaborators are personal.

“Prevention is better than regret”, this phrase applies to the insurance of major medical expenses, since under the premise that we are all prone to accidents and diseases, it is recommended that the population have one, despite having the insurance of a public institution.

What is major medical expense insurance and how does it work?
What is major medical expense insurance and how does it work?

And what exactly is major medical expense insurance? It is a contract that provides financial security against medical care expenses in the event of any unforeseen event, such as an accident or illness, seeking to ensure that there is no economic imbalance for the insured.

What do they cover? Coverages vary according to the company you hire. For example, in the case of accidents, some policies offer no deductible in the event of an accident.

But in general, major medical expenses insurance ranges from hospitalization expenses, medical care, surgical interventions, medications, and clinical tests, among other professional services. This will depend on the insurance company and the plan that you hire.

But in addition, it can include home health service, alternative medicine, basic dental treatments or psychological care, although many times these rights are unknown, that's why, experts recommend that you read very carefully all the specifications and requirements they ask for.

In addition to taking into account all of the above, it is important that you consider that the insurance is old, that is, it does not immediately cover the insured.

Other issues to consider when you go to buy health insurance are the information you must provide and the terminology, which is sometimes complex to understand well what is inscribed in the policy and that will be crucial to know if it is the right insurance for your needs.

It is important that you define whether you want insurance for the country or for a visit abroad, since not all insurance has this modality, and even if it has the possibility of covering you in another country, they also have specific specifications.

When hiring your insurance, they will question you about your health, if you have any chronic illness and / or disease. Giving a false answer in this regard could affect the validity of your policy.

You must get an idea of ​​the sum insured that you require, that will depend on your age and profile and, hand in hand, the level of coverage you want.

Regarding the concepts, you should take into account the following:

1. Premium. Refers to the amount you must pay your insurance company to maintain coverage for your employees. At the cost of medical expense insurance, this is the first thing to consider, making sure to balance it with other expenses like copay, deductible, and coinsurance.

According to the payment cycle, the premium is classified as unique (a single payment during the term of the contract) and periodic (monthly, semi-annual, annual payment, etc.). While it is classified as fixed (the amount of payment remains constant) and variable (the amount to pay varies) according to the value of the premium.

Keep in mind that the premium that everyone pays is how insurance is sustained.

2. Copayment. Employee medical expense insurance may include a copayment, which is a small sum of money paid each time a medical service is used. The insurance plan may require a copayment for a medical visit or for a prescription drug, even if the insurer pays the rest later. Co-payment insurance is very useful if your collaborators do not visit the doctor frequently, but if they make frequent visits to the doctor's office, consider choosing an accessible and consistent co-payment.

3. Deductible. It refers to the amount of money that your collaborators will pay before the insurer reimburses that amount for covered medical claims.

Keep in mind that not all insurance plans require it, but if your employees choose a plan with a high deductible they can reduce their monthly premiums. Of course, it is recommended that the deductible does not exceed 5% of your annual gross income.

4. Coinsurance. It is the amount that your collaborators must pay for medical services after covering the copay or deductible of their insurance plan. For example: the insurer limits coverage of certain services to 80% of charges. The insurance benefits would then cover 80% of the x-ray charge, while the beneficiary would pay the remaining 20%, even if they have already paid their deductible.

5. Out of pocket limit. This is the limit amount that your collaborators will pay for services in a plan year. Once the costs have been paid on your own (usually through deductibles, copays, or coinsurance), the insurance company covers expenses 100 percent for any additional medical services.

Finally, we remind you that you can use your insurance for major medical expenses when the total expenses derived from an illness or accident are greater than the deductible to be considered a major medical expense.

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