Major Medical Expenses Insurance - Frequently Asked Questions

When talking about Major Medical Expenses insurance, it is important to know some terms that we will find in a policy of this Branch. For example, sum insured, deductible or coinsurance, etc.

These concepts are also very important to handle when requesting a quote. We list the 10 main concepts:

1. What is the sum insured?

It is the maximum amount you have available to cover any condition.

 

2. What is the deductible?

It is a fixed amount that is established at the time of contracting, which you have to cover when requesting the insurer to take care of your medical expenses. That is to say; You must cover that first expense and later the insurer will begin to pay.

Most insurance companies offer, with an additional charge, the reduction or elimination of the deductible payment in the event of an accident.

 

3. What is coinsurance?

Coinsurance is a percentage with which you participate- Most insurers handle different options that can range from 0% to 30%. And this will apply to the expenses that you claim to the insurer and that she must pay. You as the insured will pay that percentage. Many insurers offer some maximum payment limit for this concept (you will pay up to a limit)

 

2. What is the medical tabulator?

The medical tabulator is a maximum limit of money that is available to cover the fees of the doctors who treat you, due to illness or accident. On many occasions, this cap can be adjusted but it will also change the cost of your policy.

 

3. If I travel abroad, what coverage do I need?

Medical Expenses insurance generally has coverage within the national territory. If you go on a trip abroad, you must have "Medical Emergency Abroad" coverage. This coverage only applies to the expenses that are generated from any medical emergency or accident that you have while you are traveling. And in these cases, there is a deductible and coinsurance different from your current plan.

 

4. What are hospital tiers? Can I be treated at any hospital?

Insurers classify or categorize Hospitals in Tiers. They will generally be grouped according to average cost. You must go to the Hospitals indicated by your hospital level or a lower one. Otherwise, if you go to a higher level, the insurer may charge a penalty. It is important to know the hospitals that belong to your insurer's network

 

5. Does the insurance automatically pay the expenses generated by hospitalization or consultations?

No. The insurer will administratively verify that your claim is appropriate. Therefore, it is of the utmost importance to report any hospital admission to the insurer immediately so that the insurer can cover the expenses. Since this can sometimes take up to 48 hrs. In addition, the Hospital and Doctor must be in agreement with the insurer or be able to pay directly, otherwise, it will proceed via reimbursement.

 

6. Are there restrictions for contracting insurance for major medical expenses?

Yes. Insurers reserve the right to accept or reject the candidate according to their policies. Here I list some:

Age. In many cases, new policyholders up to 64 years of age are accepted. There are insurers that can accept them with greater age but they could request tests for medical evaluation.

• People with serious or terminal illnesses.
• People diagnosed with degenerative diseases.
• People who carry out risky jobs cannot be included in the coverage.
• People with sports activities at a professional level.

Remember that some other restrictions depending on the insurer's own policies.

 

7. Does it cover maternity expenses?

Insurers do not consider maternity as an illness, so in these cases, to cover the expenses, they will give you compensation or help for childbirth. The amount varies depending on the insurer and plan. It generally ranges from ₹1,50,000 to ₹5,00,000. There are some plans that can give even more, but for obvious reasons, the cost will be higher.

One advantage is that there is no deductible or coinsurance for maternity compensation. And also some maternity complications will be covered as part of the medical coverage of your plan. For this coverage to apply there is a waiting period that goes from 10 months and with some insurers up to a year. (From the hiring until the birth of the baby).

 

8. If I have insurance with the IMSS, is it advisable to take out insurance for major medical expenses?

Major Medical Expenses insurance will give you access to private medical care. That is a big difference. Since you will also choose the doctors who treat you.

 

9. If I practice extreme sports, does the insurer cover them?

By default, insurance for major medical expenses does not contain a coverage clause for this case, however, if you practice them you can request that they be included in the insurance, but consider that this will increase the price of your policy since it is an additional risk.

 

10. Does my insurance cover cosmetic surgeries?

It does not cover cosmetic surgeries. Medical insurance, in General, seeks to restore your health. It does not cover aesthetic, psychological, nutritional, or any other conditions that are not considered strictly necessary for this.