The liability of an insurance company is usually limited to the total amount of your policy. However, there can be a dispute regarding this. If there is one, it can be settled in a court of law. The insurance company decides which services, medicines, diagnostic screenings, etc., it will cover. These points are pre-mentioned in the contract and are based on the medical requirements of a majority of people.
The Health Insurance Contract
The contract lists the complete package of various health benefits that the insurance company will cover, these are known as ‘covered benefits’. The remaining services come under ‘uncovered services’ and you are required to pay for them.
Your insurance policy is in the form of a contract, with certain conditions, which you agree to follow. There are certain exclusions, which refer to clauses that are not covered in your health insurance policy. Thus, exclusion is a condition, which does not apply to your insurance contract. That condition is ‘excluded’ from the company liabilities. For instance, it may be mentioned in the contract that there will be no coverage if any problem arises in relation to your existing heart ailment.
The insurance policy also has some ‘limitations’, which are similar to exclusions. The only difference between the two is that limitations apply for a fixed time period or only under certain conditions. For instance, you will be paid the insurance cover for any surgical treatment, only after the policy completes one year.
People not having health insurance can also take a short term insurance. In case of a short term insurance for health, your insurance cover is for a short duration, ranging from one month to two years. Such a health insurance is usually for traveling to other countries. It covers any emergency medical conditions, and does not take care of any medical condition that you already have, immunizations, etc. The premium for short-term insurance is less as the coverage amount is very small.
You may have a medical necessity that is not covered in your insurance policy. In such a case, your doctor will try to give you treatment that’s closest to the covered benefits in your policy. Sometimes, the insurance company also makes upfront payment on presentation of prescription. If not, you can appeal against the judgment of the insurance company. You must seek your doctor’s guidance in this regard and also understand the appeal process of the insurance company. If the company still denies, you have the right to appeal in the court of law.
To sum up, with health insurance, you can stay in good health year after year. A little financial planning can go a long way in providing perfect health to you and your family.