The devil's in the details
Private medical insurers offer fairly standard generic types of cover. However, the limitations, exclusions and details vary to such an extent that only those with specialist knowledge will be able to decipher and advise on the most appropriate policy. What makes medical insurance more complex than, for example, motor insurance is the diversity of the risks being covered and the wide array of options available.
Know your boundaries
Broadly speaking, there are three types of geographical coverage. Cover is either local (UAE only), regional, which means that medical care can be provided only in certain countries in regions such the Middle East, Africa, South East Asia or the Indian subcontinent, or a combination thereof. Then there is international cover, which will pay for treatment anywhere in the world (either including or excluding the United States). Many insurers offer a basic plan that will only pay for medical treatment when admitted to hospital (in-patient treatment). Then there are more comprehensive plans that will also pay for day-to-day medical consultations and prescribed medicines, known as out-patient treatments.
Do you like networking?
In medical insurance terms, the "network" can be very important. This is effectively a list of pre-approved healthcare providers who will be able to offer you treatment in a "cashless" environment as agreements are already in place to receive payment directly from the insurance company on your behalf. The "network" being offered can have a significant effect on premium, depending on the quality of the providers and facilities included. Going for treatment outside of your insurers "network" will mean that you need to pay and then claim for re-imbursement.
Sharing the burden
To manage premium expenses and claims, there are several ways that a patient can share the cost of treatment with the insurer. Deductibles are small fixed amounts payable by the patient each and every time they present themselves for consultation or treatment, typically set at either Dh50 or Dh100. An excess is a fixed amount of claim cost that the patient agrees responsibility for, only after which the insurer will pick up the remaining costs. Co-insurance is where the patient is required to pay a certain percentage of treatment costs, typically set at 20 per cent. Choosing any/or a combination of these options will reduce your plan premiums.
History matters
Remember to ask about how previous medical history is treated. Some companies will exclude previous medical conditions altogether, while many will provide a moratorium clause, which means you will not be covered for a previous medical condition until you have undergone a set period of time without symptoms or treatment for that condition. Larger group schemes may have all "medical history disregarded", meaning that previous or pre-existing conditions may be covered.
Keeping it in the family
If you have children, there are many products on the market that provide cover for each member of the family as a group. These can often work out cheaper than purchasing individual cover. There are also insurers who will offer standalone policies for your children if, for example, you already have cover for yourself via an employer.
Critical illness
You may wish to consider critical illness cover, which allows you to obtain reimbursement for loss of earnings while you have been receiving medical treatment and are unable to work. This is especially important for those who are self-employed.
Read the fine print
Make sure you read through the policy and take advantage of all of the provisions you are paying for. There can be many benefits included in a medical insurance policy that you are unaware of or you may forget about. You may have coverage for routine dental care, where it is advisable to have a regular check-up and undergo preventative treatments such as cleaning, scaling and polishing. You may have optical cover, where it is advisable to have a regular eye test and the insurer will pay for corrective eye wear or contact lenses. You might also have a "wellness" option, where your insurer will cover the costs of an annual general health check.
How to choose
Few individuals or HR departments will have the specialist knowledge required to make the most appropriate choice of benefits or provider. You could approach insurance companies directly, but the advice you receive will not be independent and unbiased. A good insurance broker will have in-depth knowledge and understanding of the insurance company offering in the market. You should seek help from a broker that has access to multiple providers and has specialist staff dealing in the area of private medical insurance.
Duncan Crerar is the head of employee benefits at Nexus Insurance Brokers
