Health Insurance Options: Finding The Perfect Plan For Your Needs

Health insurance, as we’ve established in the first part of this blog series, is a necessity that no one can afford to overlook. Shopping for a plan, however, is not as easy as it sounds. It can be quite technical and there are a number of things that you might want to know before you get started.

What To Look For In A Plan

Picking up from where we left off last week, you should look for plans that cover pre-existing illnesses, congenital illnesses, and special procedures one-hundred percent in your first year. Let’s go through each of these one by one.

Pre-existing illness covers illnesses or conditions that you’re already suffering from prior to signing the policy. Most providers don’t cover pre-existing illnesses one-hundred percent in your first year. It’s typically only included once you reach your second year, and even then it’s only fifty percent of your limits. You usually have to wait until your third year to get full coverage. The problem is that if you ever decide to switch providers or stop paying premiums, you’ll lose these benefits entirely and will have to wait another three years with a different provider to enjoy them again.

Congenital illness are illnesses or conditions that are present since birth. Health maintenance organizations (HMO) typically don’t cover these. And if they do, it usually comes at a huge cost. But there are providers out there that offer it at a reasonable enough price. Be sure to shop around and read the fine print thoroughly to check for its inclusion.

Lastly, special procedures are, by its name, specific medical procedures meant to diagnose or treat patients. Not all HMOs offer this benefit on the onset. Those who do might cap your coverage to a certain amount or an inner limit. What you should keep an eye out for instead are plans that cover special procedures based on your plan’s total limits. This way, you have more coverage to enjoy, making it less likely for you to need to pay out-of-pocket.

Your Other Options

There are, of course, other options to secure yourself aside from the standard group health plans.

For instance, if your employer does not offer a group plan, you can round up several of your co-workers and sign-up for a third-party administrator (TPA) plan. This is a self-insuring method wherein the third-party assumes the risks and pays all the insurance claims on behalf of the insurer. It allows you to avail the same benefits at HMO rates, plus you only pay for what you use. It’s also highly customizable, allowing you to select the benefits you want and set your own limits and exclusions. This makes it a very affordable option in case you’re a little strapped.

Alternatively, you can round-up your family for a family health plan, if the benefits and price prove to be better. It also might be easier to talk to your family about this than your co-workers. If not, you can just stick to an individual plan for yourself.

What’s important to remember is that you have something to fall back to in case of unexpected happenings.

Take this analogy as an example: You’re driving on a long stretch of empty road, a highway, and you suddenly hear thumping sounds from your car. You pull over to check, and you notice that you have a flat tire. On a highway, you’re probably not going to find a nearby auto repair shop and calling a mechanic is surely going to take a long while. However, if you have a spare tire, you can easily do the repairs yourself and be on your way. You’ll also be thankful that you were prepared for an emergency.

Let’s apply this now to our health and put it all into perspective using a hypothetical situation: You one day start feeling abdominal pain. The following day, you get it checked by doctors and they find that it’s appendicitis.

You’ll now need surgery, which, according to health care website Medical Pinas, can cost anywhere between P12,000 to P65,000. While there are several factors that can determine the total cost of your expenses, we think the numbers are just about right, given how PhilHealth offers a P24,000 payout for appendicitis.

Add in doctor’s professional fees, hospital stays, and other miscellaneous expenses, and you could be facing a hefty sum. But if you have insurance, it could all be covered and you don’t have to pay a single centavo.

If you’re, say, paying P8,000 annually for a health plan that covers emergencies for up to P100,000 and all the bills you incur for your bout with appendicitis add up to just P80,000, won’t your plan be worth it in the end? You essentially saved P72,000 by preparing ahead.

You don’t really know when an emergency can happen. It’s best to just have that “spare tire” always ready.