10 Vital Questions to Ask When Buying Health Insurance

By James Kiumbe
Head of Technical Underwriting & Reinsurance

Health insurance is essential for safeguarding one’s well-being and financial security. It provides individuals with access to necessary medical care while protecting them against unforeseen health emergencies. Without health insurance, people risk facing significant financial burdens and limited access to essential healthcare services, making it a paramount investment in one’s overall health and stability.
While having health insurance is undeniably crucial, navigating the process of choosing a plan can feel daunting for many. Many individuals dive into the world of health insurance without fully understanding what they’re signing up for, only to later feel misled or disappointed.
One of the most common mistakes that individuals make is assuming that all insurance policies are essentially the same. This misconception can lead to inadequate coverage and unexpected out-of-pocket expenses.
Another major pitfall is failing to ask the right questions when purchasing an insurance cover. This results to frustration and distrust when the purchased policy does not meet expectations.
I would like to share some key factors that you should consider in order to secure the coverage plan that best suit your needs.
Here’s Your Essential Guide:

1. What Does the Policy Cover?
   • Understand the scope of coverage provided by the policy. Does it include hospitalization, outpatient care, prescription drugs, and preventive services? Knowing what is covered can help you assess whether the policy aligns with your healthcare needs.
2. What is the Premium, are there any Copayments or Out-of-pocket costs?
   • Clarify the costs associated with the policy, including annual premiums, and copayments (the fixed amount you pay to access outpatient service). Balancing these costs with your budget is crucial for financial planning.
3. Are There Any Hospital Restrictions that I can’t visit?
   • Determine whether the policy has your network of preferred healthcare providers. There are hospitals or providers traditionally known to be more affordable and often results in managing your limits efficiently ensuring your cover doesn’t run out before policy expiry. Find out if your current healthcare providers are included in the network.
4. What is the Cover Limit?
   • Know the maximum amount the insurance company will pay for covered services over the policy cover period. Understanding coverage limits helps you assess potential financial risks and confirm if it is sufficient for your needs.
5.  Are Pre-existing Conditions Covered?
   • Inquire about coverage for pre-existing medical conditions. Some policies may exclude coverage for pre-existing conditions or impose waiting periods before coverage begins or cover the conditions up to a specific limit. Understanding these limitations is essential, especially if you have existing health concerns.
6. What is the Process for Filing Claims?
   • Familiarize yourself with the claim submission process and whether your policy allows for reimbursement claims. Understand how to file claims, what documentation is required, and the timeframe for reimbursement. Clear communication and efficient claims processing can alleviate stress during medical emergencies.
7. Are There Any Additional Benefits, Discounts or Value Adds Available?
   • Explore other benefits or discounts available that can benefit you or can enhance your health cover. These may include dental and optical coverage, maternity benefits, or wellness programs. Assess whether these additional features align with your healthcare needs and budget.
8. How Does the Health Policy Handle Emergency and Urgent Care?
   • Understand the coverage for emergency medical services and urgent care visits. Clarify whether there are any limitations on coverage for out-of-network emergency care and how the policy defines emergencies.
9. What is the Renewal Process?
   • Ask about the policy’s renewal terms and conditions. Understand whether the premiums and coverage will change upon renewal. Knowing the renewal process helps you plan for potential adjustments in healthcare costs.
10. Are There Any Exclusions or Limitations I Should Be Aware Of?
    • Inquire about any specific exclusions or limitations in the policy. This could include restrictions on certain treatments, experimental procedures, or elective surgeries. Understanding these limitations upfront prevents any surprises later.DOS AND DON’TS:
    • DO Compare Multiple Policies: DON’T settle for the first policy you come across. Compare multiple options to find the one that best suits your needs and budget.
    • DO Ask for Clarifications: DON’T hesitate to ask your insurance intermediary to clarify any terms or provisions you don’t understand. It’s essential to have a clear understanding of your cover.
    • DO Review the Policy Documents Carefully: DON’T overlook the fine print. Review the policy documents thoroughly to understand all terms, conditions, and exclusions.
    • DO Consider Your Future Needs: DON’T just focus on your current healthcare needs. Consider how your healthcare needs may change in the future and choose a policy that provides flexibility and long-term coverage.In conclusion, it’s crucial to recognize that the decisions you make today about your health insurance can profoundly impact your future well-being. Remember, failing to ask the right questions may leave you vulnerable to unexpected expenses, inadequate coverage, and unnecessary stress. Take the time to understand your policy and advocate for your needs.Proactive insurance management isn’t just about meeting immediate needs—it’s about safeguarding your long-term health and financial stability. By staying informed, comparing options, and considering your future needs, you not only protect yourself from potential pitfalls but also ensure that you’re prepared for whatever the future may hold.

    Your health and peace of mind are too important to leave to chance.