When talking about insurance for major Medical Expenses, it is important to know some terms that we will find in a policy of this Branch. For example: sum insured, deductible or coinsurance, etc.
These concepts are also very important to handle when requesting a budget. In Aseguratemexico we list the 10 main concepts:
- What is the sum insured?
It is the maximum amount you have available to cover any condition.
- What is the deductible?
It is a fixed amount that is established at the time of hiring, which you have to cover when requesting the insurer to take care of your medical expenses. That is to say; you must cover that first expense and then the insurer will start to pay.
Most insurance companies offer with an additional charge the reduction or elimination of the deductible payment in the event of an accident.
- What is coinsurance?
Coinsurance; It is a percentage with which you participate- Most of the insurers handle different options that can go from 0% to 30%. And this will apply to the expenses that you claim from the insurer and that she must pay. You as the insured will pay that percentage. Many insurers offer a maximum payment limit for this concept (you will pay up to a limit)
- What is the Medical Tab?
The medical tabulator is a maximum limit of money that is available to cover the fees of the doctors who treat you, due to illness or accident. On many occasions this cap can be adjusted but the cost of your policy will also change.
- If I go abroad, what coverage do I need?
Medical Expenses insurance generally has coverage within the national territory. If you go on a trip abroad, you must have coverage for “Medical emergency abroad.” This coverage only applies to expenses that are generated from any medical emergency or accident that you have while traveling. And in these cases there is a different deductible and coinsurance than your current plan. Typically $ 50.
- What are the Hospital Levels? Can I attend any hospital?
Insurers classify or categorize Hospitals in Tiers. They will generally be grouped according to average cost. You must go to the Hospitals that indicate your hospital level or a lower one. Otherwise, if you go to a higher level, the insurer may charge a penalty. It is important to know the hospitals that belong to your insurer’s network
- Does the insurance pay automatically the expenses generated by hospitalization or consultations?
No. The insurer will administratively verify that your claim is valid. Therefore, it is extremely important to report any hospitalization to the insurer immediately so that the insurer can cover the expenses. Since this can sometimes take up to 48 hours. In addition, the Hospital and Doctor must be in agreement with the insurance company or to be able to pay directly, otherwise it will proceed via reimbursement.
- Are there restrictions for hiring major medical insurance?
Yes. The insurers reserve the right to accept or not the candidate according to their policies. Here are some of them:
Age. In many cases, new policyholders over 64 years old are accepted. There are insurers that can accept them when they are of legal age but they could request tests for medical evaluation.
People with serious or terminal illnesses.
People with a diagnosis of degenerative diseases.
People who perform risky jobs that cannot be included in the coverage.
People with sports activities at a professional level.
Remember that some other restrictions depend on the insurance company’s own policies.
- Does it cover maternity expenses?
Insurers do not consider maternity as a disease, so in these cases to cover expenses they will give you compensation or help for childbirth. The amount varies depending on the insurer and plan. It generally ranges from $ 15,000 to $ 50,000. There are some plans that can give even more, but for obvious reasons the cost will be higher.
One advantage is that the maternity allowance does not apply deductible or coinsurance. Plus, some complications of maternity will be covered as part of your plan’s medical coverage. For this coverage to apply there is a waiting period that goes from 10 months and with some insurers up to a year. (From the hiring until the baby is born).
- If I have insurance with the IMSS, is it advisable to take out insurance for major medical expenses?
A Major Medical Expense insurance will give you access to private medical care. That is the big difference. Since you will also choose the doctors who treat you.
- If I practice extreme sports, does the insurance company cover them?
By default, major medical insurance does not contain a coverage clause for this case, however, if you practice it, you can request that it be included in the insurance, but consider that this will increase the price of your policy since it is a additional risk.
- Does my insurance cover cosmetic surgeries?
It does not cover cosmetic surgeries. General health insurance seeks to restore your health. It does not cover aesthetic, psychological, nutritional or any kind of ailments that are not considered strictly necessary for this.
Now that you are more informed about insurance for major medical expenses, we invite you to visit our website where our advisors will help you find your best option according to your needs. HERE