What is health insurance, and what does it cover?

In general terms, medical insurance is the contract through which a certain insurance company undertakes to cover the expenses that the insured or their beneficiaries must pay in terms of health in exchange for the payment of a premium.

The health insurance covers the expenses that are indicated in the policy. Such expenses may be medical, clinical, pharmaceutical, or hospitalization.

What is health insurance?

Basically, health insurance is an agreement that you sign with an insurer so that, in exchange for a periodic premium, it takes care, in whole or in part, of the expenses derived from medical and health care that you may need. It is, in short, a type of insurance that will provide you with health or care coverage in the event that you suffer from certain ailments or illnesses.

Taking out insurance of this kind will protect you against high medical and health costs, thus guaranteeing your peace of mind and that of your loved ones, knowing that you have doctors and hospital centers at your disposal to provide you with medical assistance.

What does health insurance cover?

Health insurance coverage is the factor that you should prioritize the most when choosing one policy or another. Even on the basis that some modalities include more guarantees than others, we can affirm that complete health insurance would be the one that covers the following coverage:

  • Primary medical assistance. This would include general medicine consultations, pediatric service, nursing service, and ambulance service.
  • Access to specialties. It would be interesting if it had at least traumatology, cardiology, dermatology, and gynecology.
  • Diagnostic tests. Among others, the insurance should cover analytical tests, ultrasounds, and radiology services.
  • Surgical interventions.
  • Hospitalization service with covered expenses for at least 24 hours.
  • 24-hour emergency service.
  • Dental service that includes at least basic treatments, such as oral cleaning, simple extractions, and a visit to the dentist.
  • Birth. It should include both the childbirth preparation service, as well as the delivery itself and the obstetric services.

Types of health insurance

Within the different types of health insurance, they could be included in insurance with copayment or without a copayment, maximum coverage, and basic coverage, insurance with reimbursement coverage. The two most important would be the medical chart and the reimbursement.

Medical insurance with a copay

Medical insurance with copayment must be paid in a previously fixed amount each time some of the medical services are used.

Medical insurance without copay

Unlike the previous ones, in medical card insurance with copay, no additional payments will have to be paid since, with the payment of the premium, you will be able to use all the medical services you need.

medical chart

In this option, the insurer puts at your disposal a list of doctors and hospitals that you can go to at no additional cost since they are arranged with the company.

Refund

This modality allows you to visit the doctor you want. You go to your consultation, pay for the services received, and then the company reimburses the bill. It offers the advantage of not having to limit yourself to a medical chart, although, in return, in most cases, the insurer will not reimburse you for the entire amount paid, but rather a percentage that usually ranges between 75 and 100% of the invoice.

What must be taken into account to take out health insurance?

If you consider hiring private health insurance, you should keep in mind the following elements:

  • Coverages included. Check that the policy you are going to contract includes those benefits that interest you the most and that you may need the most, even if this means a higher premium.
  • Medical chart. It is essential to know the list of doctors that the insurer makes available to you, as well as the associated health centers. Likewise, it is important to know which emergency centers are available and if home care is also included.
  • Grace periods. Make sure before taking out health insurance what are the waiting periods imposed by the various medical benefits.

Leave a Reply

Your email address will not be published.