INSURANCE BENEFITS COVERAGE PREMIUMS FAQ
Benefits, coverage and premiums
1. Questions
a) How much does a health insurance cost? How much will my premium be?
Help! Our premium increased at renewal. We’ve been told it’s due to premium inflation. What can we do to avoid this? Answer
b) What’s the difference between a deductible and a co-pay? Answer
c) What does 1st USD and 1st EURO mean? Is it the same as Full Cover? Answer
d) Will my premium increase as I get older? Answer
e) The more filed claims, the higher my premium at renewal? Answer
f) It’s not clear where I can be treated. How about a treatment outside my provider network? Answer
g) Am I covered outside my area of coverage? What is evacuation and repatriation cover? Answer
h) Help! I have a policy, but I am confused. I need a specific therapy and I don’t know if I will be covered...? Answer
i) What’s the difference between inpatient and outpatient treatment? Answer
j) I will have a small surgery next week and this will be done in the hospital. Is it outpatient or inpatient ? Answer
k) I want to stay with my ill and hospitalized child. Is my hospital accommodation covered? Answer
l) What is a chronic condition and will it be covered? Answer
m) I’m surveying a pre-existing condition. Will moratorium or full medical underwriting (FMU) provide coverage? Answer
n) How about dental care? Answer
o) Does my plan cover maternity? And how about possible complications? Answer
p) How about plastic surgery? Answer
q) Is infertility or sterilization covered? Answer
r) Are chiropractic and osteopathy covered? Answer
s) Are psychiatric treatments covered? Answer
t) How about plastic surgery? Answer
u) Are vitamins covered? What about nutrition? My doctor would like to prescribe them to prevent bone diseases and because I suffer so much fatigue lately. Answer
v) In my country of residence there are so many medications available over the counter, whereas in my home country they had to be prescribed. How come? Are OTC drugs covered if I go to the pharmacist and buy some pills? Answer
2. Answers
a) How much does a health insurance cost? How much will my premium be?
Help! Our premium increased at renewal. We’ve been told it’s due to premium inflation. What can we do to avoid this?
Your policy premium depends on:
• age and health condition
• level and area of coverage
• country of residence
• payment frequency
• Underwriting type.
• deductible and co-payment (the higher your deductible, the lower your premium)
• Pre-existing medical conditions
b) What’s the difference between a deductible and a co-pay?
They both represent an amount you will have to pay before the insurance company comes in and pay all further medical expenses. How they do, that’s a bit different.
Let’s show an example.
A policy with a “$1000 deductible per year” means the first $1000 will be paid by you no matter which treatment or diagnostics. So if you received some medical care which you paid $200 for, and later on during the same policy year you have to be admitted to the hospital for a total cost of $2000, then $800 (= 1000 deductible - 200 already paid) will be on your behalf and the insurer will pay the remaining $1200.
For the remainder of the same policy year, all further medical expenses will be on behalf of the insurance company: they pay everything.
And if you have a policy with "$1000 per condition" it’s basically the same but the amount you will have to pay goes for each condition like sinusitis and gastritis.
On the other hand a plan with a 10% co-payment for outpatient treatment implies your insurance company will cover and reimburse 90% of all outpatient expenses.
c) What does 1st USD and 1st EURO mean? Is it the same as Full Cover?
They are similar to a 0 deductible: your insurer will pay all medical expenses.
So yes, it’s the same as Full Cover as you will be 100% reimbursed for your medical expenses.
d) Will my premium increase as I get older ?
Yes.The older you get, the higher the risk to become sick. This translates into a higher premium. Even more, at a sudden age (between 60 and 75, arbitrary to the insurer), you can’t apply anymore for a health insurance.
e) The more filed claims, the higher my premium at renewal?
No. The amount of filed claims doesn’t influence your premium.
f) It’s not clear where I can be treated. How about a treatment outside my provider network?
Well, benefits apply for sure within your medical provider network which basically consists of a huge database full of approved clinics, dentists, doctors and so on. Usually you don’t have to pay for medical care as your insurer will be charged directly. You only have to show your member card. This is called direct billing.
Outside this network however, it all depends on your plan: some won’t cover medical care, others apply a deductible or copayment or benefits remain the same but without direct billing services. To be sure check your plan or ask AOC.
g) Am I covered outside my area of coverage? What is evacuation and repatriation cover?
Sort of. Usually emergency treatment, evacuation and repatriation benefits are included in your expat health policy. So during short business or holiday trips you are covered for live-saving medical interventions and medical transport expenses.To be sure, check you health plan before travelling or ask AOC.
Evacuation and repatriation cover - This means you are covered for medical transport expenses.
For instance, while travelling in a rural region you get seriously injured or critically ill, and then you might have to be evacuated to a larger medical facility more appropriate to your medical needs. Transport usually by a regular ambulance, helicopter or airplane. This is covered under an evacuation benefit.
If all this happened outside your country of residency and your medical condition is not critical anymore, you will be escorted to a hospital in your country of residence for further medical care.
Well, most likely your treatment can be found in your policy’s table of benefits.
Some benefits like inpatient treatment require a letter of guarantee and as such you will have to follow a pre-approval procedure. This means that your insurer’s medical department team will have to evaluate whether your upcoming medical treatment is covered according to your policy’s benefits.
i) What’s the difference between inpatient and outpatient treatment?
In practice we consider any hospital overnight as inpatient. So any medical procedure in the hospital taking from some minutes to a few hours is outpatient.
From health insurance perspective outpatient and inpatient medical care is defined in separate benefits and might differ in coverage.
Small surgery for minor or intermediate procedures (and usually under local anesthesia) is mainly intended for overall healthy patients. To reduce redundant hospital costs, they can be discharged within the same day.
So no hospital overnight required for further treatment or monitoring and as such it’s an outpatient treatment, more specifically outpatient day case surgery. Usually a separate benefit.
k) I want to stay with my ill and hospitalized child. Is my hospital accommodation covered?
Yes, it’s possible and called parental accommodation. Please contact AOC if you are not sure your plan covers parental accommodation or if you feel like this benefit has to be added to your current policy.
l) Will chronic conditions be covered?
Whether or not they will be covered, and if there’s a waiting period, depends on your health plan. Plus the fact that some insurers define a chronic condition differently makes it difficult to provide a complete answer in a few lines.
Please contact AOC to get more info about coverage for your chronic condition.
For FMU you will have to complete a medical questionnaire. Based on this information the insurer will do a risk analysis and inform you if your pre-existing medical condition will be excluded in your policy or included along with a premium increase.
FMU’s advantage it’s cheaper than moratorium and from a certain age the only possible option.
For moratorium underwriting no medical questionnaire has to be completed and after 2 policy years, your pre-existing medical condition might become covered according to your plan’s benefits, but only if you had no signs or any kind of treatment related to your pre-existing condition during this 2 years waiting period.
Moratorium underwriting might be an interesting choice if you suffer a non-chronic, pre-existing condition like a meniscus injury due to a sports accident a few years ago. FMU would exclude any medical care related to your meniscus, even if symptoms would show up due to a new trauma, while moratorium might cover after a 2 years waiting period.
However moratorium is a bit more expensive and many pre-existing conditions will not be covered.
We at AOC Insurance Broker would like to assist you to find out which underwriting type is better to get your pre-existing condition covered.
Dental care is a separate benefit with different levels of coverage available.
Some plans might only cover routine dental treatment like non-surgical tooth extractions and polishing/scaling. Other plans will include dental surgery and prosthesis.
We feel emergency inpatient dental coverage is definitely worth considering. So at least you will be covered for expenses caused by dental trauma.
o) Does my plan cover maternity? And how about possible complications?
Maternity is a separate and common benefit with different levels of coverage available. Usually routine prenatal care and natural childbirth are under the same benefit. Caesarian childbirth is sometimes covered under maternal complications... Newborn care usually is covered as well. Different limits might exist.
Please contact AOC for more information.
Cosmetic surgery is not covered.
Neither are thalassotherapy, rejuvenation treatment and bariatric surgery.
However reconstructive surgery secondary to trauma is covered under inpatient treatment.
q) Is infertility or sterilization covered?
No, usually not.
Nor investigations, nor treatment like intrauterine insemination (IUI) or in vitro fertilization (IFV) are covered.
However some might, but with restrictions and limits.
Contact AOC to see which current plans offer some benefits.
r) Are chiropractic and osteopathy covered?
Health insurances typically consider chiropractic and osteopathy as complementary medicine and will offer manual therapy as separate benefits. Different exclusions and limitations may apply depending on the plan.
Ask AOC to see which current policy is more beneficial if you rely regularly on an osteopath or chiropracticioner.
This counts for acupuncture and homeopathy as well.
s) Are psychiatric treatments covered?
It’s a separate benefit and different exclusions and limitations may apply depending on the plan.
Contact AOC for current information.
Cosmetic surgery is not covered.
Neither are thalassotherapy, rejuvenation treatment and bariatric surgery.
However reconstructive surgery secondary to trauma is covered under inpatient treatment.
No. Vitamins and supplements like iron (Fe) and magnesium (Mg) are not covered.
Neither are lotions, creams, soaps, shampoos, oils and baby products.
However vitamins and supplements will be covered under these 3 specific medical conditions and if enclosed by a medical report:
- (Laboratory confirmed) vit B12 or iron (Fe) deficiencies resulting into anemia.
- Certain chronic conditions: i.e. vit D in case of osteoporosis and Paget’s disease and vit B complex as part of treatment for diabetic neuropathy.
- During pregnancy multivitamins, iron, calcium (Ca) and folic acid supplements are covered (however there’s only evidence based medical proof for folic acid).
Many patients call and ask if a specific nutrition or vitamin is covered as they are recommended or even prescribed by their doctor to prevent a medical condition.
Unfortunately - and even though we acknowledge there’s certain proof they do prevent some coronary pathology and bone diseases - insurance companies won’t cover due to the lack of sufficient evidence based proof.
It’s a legislation issue.
For instance antibiotics, in order to get them, most western countries require a doctor’s prescription. But in other parts of the world more common antibiotics like Augmentin and Ciproxine are available over the counter which means no prescription is required.
And no, your OTC medication will not be covered as the reimbursement of medication requires a physician’s description.
