Health Care Benefits:Considerations

There is always need for individuals to do a thorough evaluation of existing health care benefits provided by insurance companies.

The analysis will be informed by the needs of the insurance cover beneficiaries, who could include:

  • An individual
  • A family
  • Corporate group

Health care benefits: Considerations to be made

When doing a review of existing health care benefits catered for by hospitals or health insurance companies, one needs to ask him/herself several questions. For example:

  • What is the premium amount required for  a given health care package
  • How should this premium be paid-whether it’s a one-off  payment or it can be staggered over a  given period
  • Which health facilities can one access under this  health care package
  • What diseases are covered under the health care plan
  • What happens when one develops a chronic condition  during the cover  period
  • What limits do exist In case of congenital conditions
  • In case the cover is exhausted mid-year, is there a provision for topping it up
  • Does this cover cater for access to health care outside the country

Health care benefits

These vary from firm to firm. Hence need for individuals to do a thorough analysis of these in line with their family needs i.e.

Health care benefits for those not married:

These individuals need to find out the following:

  • What amount are they required to per annum
  • Can the cover be extended to their dependents, namely parents? This is in cases where these individuals are shouldering the medical expenses of their parents
  • What conditions are catered for
  • What happens in cases where this individual sires a child outside wedlock
  • what happens should this individual’s marital status change mid-the current health plan

Health care benefits for married individuals

  • what is the required premium amount
  • What  are the requirements for adding a spouse or children as dependents
  • How soon does the health insurance provider add new born babies into the health care plan
  • What  is the  outpatient and inpatient limit for each of the members
  • What conditions will not be catered for as part of the package
  • Should the male partner enter into a polygamous union, will the second wife be added as a beneficiary (this is in cases where the 1st wife is the  principal member of the health care plan)
  • Does the plan cater for adopted children

Health care benefits for women

Women who at one time plan to have children as singles or once married should consider the following before taking up a health care package:

  • What reproductive health services can they access using this cover
  • Who are the recognized specialists that can be accessed by these women
  • How accessible or within reach are these selected providers
  • What type of major or minor operations can be catered for under the health care plan

For their maternity health care package women should consider whether the services cater for the following:

  • Pre and post natal services
  • 3 days of hospitalization  after a normal delivery and 4-5 days after a caesarean  section
  • Basic immunization of the child as  per the KEPI schedule
  • Routine check-up of both mother and child 2 weeks after delivery

Summary of health care benefits to be offered by health insurance firms

That said and done, there are basic provisions all insurance plans cater for. These include:

  • Doctors consultancy fees
  • Routine and scheduled laboratory services
  • Basic immunization services under KEPI
  • Maternity benefits
  • Diagnostic services eg scans and X-Rays
  • Evacuation services  where necessary

Most health care plans do not however cater for the following:

  • Dental care
  • Optical requirements
  • Long term rehabilitative equipment and supplies e.g. oxygen and wheel c hairs
  • Physiotherapy on a long term basis

In closing

Everyone should    review all existing insurance health care plans in the market before making an informed decision

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