YOU ASK:

What does health insurance cover?

WE ANSWER:

This depends on the kind of plan you have. But a standard health insurance policy will cover:

  • Emergency services (This includes ambulance services and emergency room fees. Please take note, though, that emergency services are only for emergency cases and not for instances where you get the sniffles and feel you need to go to the emergency room for it.)
  • Routine services - This includes regular check-ups such as annual physicals and pap smears.
  • Hospital accommodation
  • Doctor's check-ups/visits
  • Vision services (excluding glasses and contact lens)
  • Diagnostic services - This includes CT scans, x-rays and in more comprehensive plans MRIs.
  • Surgeries (for covered conditions) and surgical-related fees (including anesthesiologist's fees and theater fees).
  • Medicine. This is only for prescription drugs. Over-the-counter medicines, particularly, those that you use to self-medicate (take without the doctor's recommendation) will be excluded from the cover.
  • Intensive care

With the full implementation of the health care reform bill, the standard coverage of insurance is made more comprehensive. The bill will require insurance companies to offer preventive services and benefits, most of which will not have deductibles. Examples of preventive services will be regular wellness visits to your doctor, routine screenings such as x-rays and pap smears.

Now, to give a full answer, we should talk about what are excluded from a standard health insurance policy. Depending on the provider and the policy, these may include:

  • Injuries that are self-inflicted (including attempted suicide)
  • Sexually transmitted diseases
  • War-inflicted injuries
  • Experimental procedures or treatments
  • Elective procedures such as cosmetic surgery
  • Vision correction
  • Airline travel that is counted as non-commercial

The best thing you can do to insure what is covered under your specific policy is to check with your HR department, if you have employer-sponsored health insurance. Ask if they have leaflets that outline the coverage provided by your plan.

If you buy through the individual market, you can also take a look at the policy provisions to check the coverage that you have. It is important to know this before you even make a claim because you will already know what benefits you can claim under the policy.

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