Know Your International Health Plan: What’s Covered and What’s Not
“Is it covered?” When having a healthcare plan, this is one of the most common questions that is asked to an insurer or broker. As an insured person, it is your responsibility to navigate the ins and outs of your plan coverage.
What happens when it’s covered?
A service or treatment is covered when the insurer will pay either some or all of the cost. In most situations, the doctor should be on the list of your insurer’s network. What type of care and where you can get treatments also depends on how comprehensive your plan coverage is.
For example:
- There are covered services that cost completely free to consumers such as visiting the doctor for an annual checkup. The plan pays for everything.
- Meanwhile, others pay a fee when being prescribed covered antibiotics or seeing a chiropractor for back pain. The amount to pay varies depending on his type of plan.
These are the types of benefits that are usually covered in an international health plan:
INPATIENT AND OUTPATIENT CARE
Some plans cover only inpatient care while others cover both inpatient and outpatient. Inpatient care is a medical service that requires admission into a hospital or medical facility such as treating a surgery, organ transplants, and staying in the ICU. On the other hand, outpatient care does not require a prolonged stay at a facility, like scheduled health checkups or visits to clinics.
PRESCRIPTION DRUGS
Prescription drugs are drugs or medicines which are necessary to treat a confirmed medical diagnosis or medical condition. They are drugs that are prescribed by a doctor and that are not available without prescription. Normally, the costs of these prescribed medicines can be reimbursed.
Health supplements are not consumed to counter disease and do not qualify for reimbursement. Examples of these are lifestyle products, dietary products, vitamins, and food supplements.
PREVENTIVE CARE AND WELLNESS
Preventive care services may also be covered by a health plan to prevent the onset of illness. These services are categorized into three buckets: for adults, for women, and for children.
Wellness programs are also included in most health plans as part of their preventive services. They are designed to promote health and fitness as well as to improve their overall well-being.
Examples of preventive care and wellness benefits are baby care, vaccinations, routine eye test, adult physical examination, mammogram, and pap-smear test.
DOCTOR’S FEES
These are consultations with a legally registered general practitioner, family doctor, or specialist as a result of common illnesses and bodily injuries, where hospitalization is not required. Surgical fees and anesthetic fees are the types of doctor’s fees that can be reimbursed.
EVACUATION AND REPATRIATION
International health plans commonly cover evacuation and repatriation for accidents and emergencies abroad. Medical evacuation is an emergency evacuation for a patient who needs to be transported to the most adequate medical facility. When the emergency treatment or medical procedure is not available in any medical facility in the current location, the patient will be transferred to a higher level of medical care either via land, sea, or air.
Medical repatriation is the process of transporting a person back to his country of citizenship for rehabilitation or recovery. This is common for people who experienced tragic trauma or injury and needed to be flown back to their home country.
What is usually not covered?
All insurance policies are different and may also vary depending on state regulations. It is essential to know the conditions, treatments, and services your healthcare plan does not cover. Some of them are:
PRE-EXISTING CONDITIONS
A pre-existing condition is a disease, medical illness, or injury that you have before starting a new health plan. Certain conditions such as diabetes, cancer, lupus, epilepsy, and sleep apnea are examples of pre-existing medical conditions.
In most cases, these conditions are not covered in a health plan because they tend to be chronic or long-term.
HAZARDOUS ACTIVITIES
A hazardous activity is a hobby and is considered high-risk. Most sports such as paragliding, skeleton, bobsleigh, ski-jumping, mountain climbing with rope, and bungee jumping are usually not covered in standard policies because of increased injury or loss.
If your hobby falls under the insurer’s list of hazardous activity, there is a possibility that you may pay a higher premium or the insurer will approve your policy but specifically exclude the hazardous activities from your coverage.
WAR AND TERRORISM
Insurance policies have war clauses because it is hard for insurers to accurately compute the risk and liability of a terrorist act, which can be extremely large. In short, your policy will not cover the losses and damages caused by war-related events.
This includes not paying for treatment of any condition resulting directly or indirectly from any acts of terrorism such as civil war, rebellion, revolution, mutiny, riot, strike, martial law or state of siege, or attempted overthrow of the government.
COSMETIC SURGERY
Generally, cosmetic surgeries such as liposuction, breast augmentation, and eyelid surgery are not covered in a health plan. Because these treatments are optional, they are not considered a medical necessity to function a person’s body and to maintain his quality of life.
But when a person encountered a major accident or a situation where his body needs to be repaired, then this is when cosmetic procedures would likely be covered in a health plan.
Get a Comprehensive International Health Plan with A+
If you are looking for comprehensive yet affordable international health coverage that covers all the essential benefits, A+ International Healthcare has the right plans for you.
Whether you plan to move abroad or want to get the best healthcare locally, you can choose from our wide range of international health plans: Easy Care, Southeast Asia, and Worldwide Plans— each plan can be tailored to your specific needs. Moreover, you can have access to a network of over 10,000 doctors, hospitals, and clinics in more than 150 countries.
Contact us to get in touch with our Brokers or Get a Quote now.
Since 2008, A+ International Healthcare has been providing best-in-class medical health plans around the world. To know more about our products and services, visit http://www.aplusii.com, or follow us on LinkedIn, Facebook, and Twitter for more updates.
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