How to get the best medical cover
It is prudent to have health insurance to shield you. PHOTO | FOTOSEARCH
What you need to know:
- It is prudent to have health insurance to shield you.
- This may be offered by your employer, in addition to the compulsory National Hospital Insurance Fund cover for those in formal employment, or you may buy an individual cover if you have none or as a supplement to what you already have.
- As with any other financial decision, you need to understand exactly what you are getting to avoid disappointment.
The one thing about illness is that it can creep up on you after years of relatively good health, leaving you physically, emotionally and financially drained. In the absence of a buffer, you might be forced to sell your assets or call a fundraiser to raise the money you need.
Therefore, it is prudent to have health insurance to shield you. This may be offered by your employer, in addition to the compulsory National Hospital Insurance Fund cover for those in formal employment, or you may buy an individual cover if you have none or as a supplement to what you already have.
As with any other financial decision, you need to understand exactly what you are getting to avoid disappointment. Here are some things to keep in mind on health insurance.
NHIF
Whether you just got into a job or have been employed for a while, make sure to have your NHIF card and details at hand and check that your account is up to date. If you are not in formal employment, don’t disregard NHIF. Sign up, get the card and keep up the payments.
NHIF now has a vibrant outpatient cover in accredited hospitals, so even as you keep up with the payments, get to understand how NHIF works for you, and the benefits that are available to you since they are not applied uniformly across the board.
VALUE FOR MONEY?
Corporate covers under employers tend to be a better deal than individual covers, but at the end of the day all covers have their limits, allowances and exclusions. Get acquainted with yours.
If you are buying an individual cover, weigh the costs against what you need now, and your emerging needs too. The cheapest cover might not be the best.
Some of the needs you should consider is if you are single, married, have kids or plan to have kids because your dependents and their needs need to be factored in.
Taking what you need into account will keep you from having a cover that is not meeting your actual needs and paying for more than you need and having an underutilised cover. The idea is to get value for your money.
WHAT YOU GET
The devil is in the details. Don’t make assumptions only to discover that your assumptions were inaccurate.
Find out the hospitals and doctors, including specialists, that your insurance pays for.
Do they have a variety of hospitals and specialists near your main areas of operation? Don’t take the insurance’s word for it; get a confirmation from the healthcare providers.
What is covered and what is excluded? Find out where your insurance stands on pre-existing and chronic conditions. What requires preauthorisation (prior approval from the insurer)?
Your annual limits i.e. the amount of money the insurer has committed to paying for your covered outpatient and inpatient costs, after which you are on your own. Use these limits to choose your hospitals wisely, especially if you have an array to choose from.
HAVING A BABY?
NHIF has your back on this one but if your preferred hospital is not in its radar, then you need your maternity cover before you get pregnant, and not after.
Some covers have an inbuilt maternity cover, while for others, it comes as an add-on. Get to know the limits. The baby will require its own cover after birth, and many insurers will cover biological and adopted (proof required) children up until their early 20s.
TRAVEL INSURANCE
If the worst happens and you fall sick abroad, you will need travel insurance. If you are a frequent traveller, an international cover with a panel of hospitals and doctors in the countries you frequent might be a better bet.
RESPONSIVENESS WHEN IN DISTRESS
You need an insurer who is responsive to your queries when you need care and there is a need for clarifications or preauthorisation.
If you are shopping for a cover, talk to people, including hospital staff, to find out their experiences with different health insurance providers.
Talking to a couple of recommended brokers can also help you gauge the kind of service you can expect, dig up more about the bare facts and finer details of covers from different providers and help you make a good choice that meets your needs based on the resources you have at your disposal.
Felista runs 52-Week Savings Challenge Kenya, a money management group on Facebook. You can email her on [email protected]
