Time to get real and talk about insurance which touches all of us in a personal manner, I remember when I was young you had to be rich to have a privilege of health or life insurance. This is not the case anymore because with the evolution of time and the insurance industry in Tanzania we are spoilt for choice and there is something for everyone’s budget.
The problem I have with health insurance in Tanzania is the insensitive way it is marketed and sold and that the people who are on the front line from the insurer’s point of view don’t see the importance of being informative. My background in insurance started in health so I know how things should work. There are a few leading companies in this sector but in my eyes the level of cover against the premiums people have to pay is an unbalanced ratio (which is being corrected).
The days when people paid whatever was asked from them for health insurance are long gone, and now people are asking more questions like the level of cover in respect to the limits and exclusions on the policy. We should all ask and investigate what we are getting for our money especially in Health Insurance, because taking the wrong product can mean the difference between life and death. Most companies are now using health insurance as an added incentive to get employees to join them, this is good but you should always break down and digest the policy offered because you may find out that it’s not worth the paper it’s written on.
Having talked to many people most are aware of ARR, Strategis, and Jubilee for health insurance and Alliance and African life for life insurance; but there is another company which is causing huge ripples in the lake which is was called GoodHealth and is now called Aetna Global Benefits. So this area of insurance is fast becoming very competitive which should work in our favor, only problem is very little is known about the policies and most of the time the jargon and terminology used can be very disheartening.
So here are a few tips to make sure you get the right policy for you and your family.
JACOBS USEFUL HINTS:
What is the difference between Day-patient treatment and In-patient treatment? In terms of health insurance policies there is no real difference except the length of time you are admitted to a hospital for treatment. Some health insurance policies cover only for treatment which involves admission to a hospital and others only cover for treatment with no admission required (Out-patient treatment). Thus for treatment requiring an admission it must be medically necessary for you to be admitted to a hospital bed and not dependent on whether or not you need an over night stay.
Out-patient treatment is simply when you receive treatment at a hospital, but you are not admitted to a hospital bed.
Some policies require a pre-authorisation of treatment before you under go anything. If this is the case then you will need to contact you health insurance provider and give them all the details of the treatment you will be having, for them to give you the go ahead or decline your treatment due to the level of your policy. Typical cases where pre-authorisation is required are Planned in-patient or day-patient treatment, Pregnancy or childbirth treatment, Planned surgery, Evacuation, Second medical opinions, Psychiatric treatment, Home nursing charges, Planned MRI and CT scans just to name a few.
On some health insurance policies a primary referral is required from a general doctor to a specialist and what we term self referral is not covered (going to a specialist direct). Always check before heading to see a specialist just because you have a health insurance policy because you may find a nasty surprise waiting for you.
Check what is classified as a pre-existing condition, because you may not be covered for some things which you have suffered from in the past or you are currently suffering from.
Like all insurance policies an excess may apply. An excess is the amount that you will have to pay in respect of your treatment and any amount remaining there after will be payable by the insurer.
JACOBS TIPS:
Affordability. What can you afford to spend on health insurance? Granted, it is a necessity in today’s society, but there are limits to what we can afford. Be realistic, you don’t want to lose your insurance policy because you can’t afford to make a few premiums.
See what’s available. You may have an option to purchase health insurance through your employer or your employer may offset some of the costs of a policy. This may be a more affordable option, but be sure to see what the limitations of these policies are. Less expensive is not always the best way to determine if the cover is the right one.
Compare and Consider. There are several types of health insurance policies available to choose from. Carefully compare the pros and cons of each policy, and consider which will be more beneficial to you and your family.
Shop around. Get quotes from various insurance companies in order to make the best decision. By comparing various companies, you may save some money and also find greater benefits. Be sure that you are comparing similar types of policies, because prices and coverage of different plans will vary.
Kinds of policy. What are your needs? Are you planning on starting a family, and therefore in need of both maternity and child coverage? Would you like your office and/or hospital visits included in your coverage? Do you need coverage for prescriptions? Be sure to consider your current and future needs when looking for health insurance.
Hospitals. Another thing to consider when looking for health insurance is which hospitals are part of your provider network. Where is the nearest included hospital located? These are major considerations when choosing insurance coverage.
Pre-existing Conditions. What are the limitations on pre-existing conditions, if any? Be familiar with the limitations your policy. There are many insurance plans that place restrictions on accepting clients with pre-existing conditions, including waiting periods before coverage begins. If you have a pre-existing condition there may be other options for you.
Take your time. Don’t feel pressured to make an instant decision because you need a policy and don’t let anyone pressure you into buying the wrong type of policy for you. You don’t want to sign and pay for something that is essentially useless for you.
Read before signing. Be sure to carefully read the contract of the policy, and don’t be afraid or ashamed to have someone explain it to you. This is an important decision, and you need to know that it will provide the benefits to cover your needs.
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