Pakistan being an underdeveloped country, lack a structural health care system. Although the constitution of Pakistan acknowledges basic health care as a fundamental right but due to the lack of resources government always allocate a meager percentage of the GDP to health in the budget.
Although the public sector hospitals, which include the BHUs and RHCs as well, do provide health services at a minimum cost. But if anyone had an experience in any government facility they will never recommend anyone to use their services.
Most people are aware of this fact. Therefore, a large bulk of the population utilizes the private sector for their health concerns. But the private sector is extremely expensive. And in case of emergency you might find yourself in a position where large sum money is required.
Health insurance companies provide different packages that can cater to the need of an individual or a family. It can be considered as risk management because if some medical emergency do arise in the future and you have health insurance, you have got it covered.
Buying a health insurance policy can be a tricky business. You may come across a lot of jargons that you won’t understand. You might not understand which areas you need to cover. This blog will try to answer the different queries that one might have before buying health insurance so that you can easily compare different health insurance policies and buy the one that suits your needs.
What is Health Insurance?
Health insurance is the cost covered by an insurance company in case of illnesses, disease or accidents. You pay certain amount of premium to the health insurance company, and when the need arises they will pay your medical bill as per the terms and conditions of the policy.
Now that you know what a health insurance is, let’s consider the different aspects of it before you purchase a health insurance plan.
Basic Cover/ Optional cover:
Most health insurance policies cover the basic expenses in case of hospitalization. They may include room charges, outpatient pre/post diagnostic tests, consultation and medications post hospital emergency evacuation, emergency accidental. The maximum coverage and the number of benefits will depend upon the type of package that you have.
But if you are planning to have a baby the basic policy will not cover the maternity costs. For that you have to buy the optional plan of maternity cover that can pay admission fee, gynecologist consultation fees, Labor room charges etc. again depending upon the package you have.
And if you have to visit the doctor regularly then you might consider buying the OPD cover that some insurance companies offer. They can pay off the doctor’s fees, lab tests and even dental if you chose to include it.
Deductible is the amount you pay before your insurance company starts to pay your medical bill. For example if you and your insurer has agreed on a deductible of PKR 5,000, the insurance company will pay after you have paid this amount.
The plan with low monthly premium will have a high deductible. So you have to be careful before buying an insurance plan. A low monthly installment may turn out to an expansive plan in the long run.
Co-pay is the minimum amount you pay whenever you avail any service. It can be different for different services and plans.
For example you have bought an OPD cover plan and your doctor’s fee is PKR 2,000. Your co-pay might be 500 for this service meaning that you have to pay 500 and the remaining amount will be paid by your insurer.
So if you visit your doctor often you should go for a plan with low co-pay.
In coinsurance your insurance company shares the medical bill with you instead of paying the full sum. Usually this is determined in percentage.
Like deductibles the lower the monthly installments the higher your share of the coinsurance will be.
Family Cover/ Individual Cover:
One of the main differences between individual cover and family cover is that in family cover any member of the family can avail the service and you will be paying a lump sum amount for the entire family.
For example you pay more in monthly installments for four individual insurances than on a family package that can cover all four members in a single plan.
But you must consider a limitation to this option. If you are solely buying a family package for your elderly parents then it will not be beneficial because some companies put an upper limit of 60-65 to be eligible to qualify to buy a health insurance plan.
Many insurance policy providers have a long list of exclusions. Exclusions are certain situations or conditions or some disease in which your insurance will not come in to effect.
This may include mental illness, self-harm like attempted suicide, or an accident occurred due to a risky sport like skydiving. Some of the costs that occur during the hospitalization may also be excluded from the plan like non-medical expenses.
Every Insurance company has a set number of hospitals where you can cash in your health insurance policy. Generally all reputed hospitals are covered by the insurer. But if you have a preference for a particular hospital or a particular doctor who works in a certain hospital, make sure that hospital is on the list.
Even if it is not, some companies may cover the cost. But it will take a long process comparing the differences of the costs between the hospital you visited and network hospital.
Insurance while Travelling:
Any health related problem can cause you significant problem when you are outside your home country. If you are a frequent traveller, look for the plan that can cover the health insurance abroad.
This is an added feature that some companies offer. You will have a 24 hour hotline where you can talk to a doctor in case of emergency. They doctor can guide you about your patient’s condition and advise you for the next course of action.