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5 Things You Should Know When Using Medical Insurance

Updated 14 May 2019 – By Loanstreet


In collaboration with  

Most of us already know that private clinics and hospitals aren’t cheap. That is why we need a giant invisible umbrella to prepare us from hefty medical bills. And, to those who already have medical insurance, you’d probably agree that dealing with medical insurance plans can be quite intimidating because you’re unfamiliar with the terminology and it can be confusing. 

But, that shouldn’t stop you from knowing your rights as a policyholder so that you can avoid future conundrums. With that in mind, we asked Prudential what are things that you need to be aware of when using your medical insurance - here’s what we’ve gathered.
 

1. Understand what your medical policy covers 

The first thing you need to do once you get your policy is to read through what is covered and what is NOT. Waiting until you are seriously ill or involved in an accident is a major mistake and can have a major impact on your health and financial life.

For example, there are certain things that most insurance companies do not cover such as vitamins or supplements to promote health or enhance bodily functions, as well as treatments that are elective, cosmetic and experimental in nature.



Apart from that, you should also know the maximum amount that you can claim for under your policy, whether it’s:
  • room and board limit (the cost of your room per night), 
  • annual limit (the max. amount you can claim per year), or 
  • lifetime limit (the max. amount you can claim on your policy) 
For instance, if your treatment costs RM30,000 but the annual limit of your medical plan is RM20,000, you would have to pay RM10,000. 
 
You will also need to look at whether your insurance payment scheme is a fully insured plan or a cost-sharing plan like an annual deductible or co-insurance. For the fully insured plan, you will be insured against the full amount of your medical fees (subject to benefit limits) whereas for cost-sharing plans you will be bound to pay a fixed or variable amount before the benefits come into effect.



In general, one would buy medical insurance for his/ her long term needs and when there is no need for immediate hospitalisation. Hence, it would be more beneficial for one to buy a medical cover with co-insurance to enjoy a lower premium. To illustrate how a 20% co-insurance policy works, if you are hospitalised, you’ll have to pay 20% of your medical treatment while the other 80% will be covered by the insurance company. 

Long story short, if you’re not aware of what your policy covers, you may end up facing more financial issues in the future. Also, this would also give you an idea if you’re getting the right plan for your needs and financial capability - something you should discuss with your insurance agent.
 

2. Get a second opinion before getting your treatment

Making decisions on medical care aren’t a walk in the park. You may have questions like: Is surgery the only solution? Do I really need to take that expensive test? Is it best to get treatment now, or should I wait and see? Just so you know, it’s normal to have these questions in mind. 



To answer these questions, it's always a good idea to talk to more than one doctor. This is called getting a second opinion. And, don't worry about offending your doctor because second opinions are expected. Just ask your doctor for a referral to another doctor or medical specialist or discuss with your current doctor about other treatment options that are available.

Apart from that, you can also ask your medical insurance provider if it covers second opinions. For example, Prudential offers Expert Medical Opinion (EMO) as a value-added service to their customers - they can seek a second medical opinion for selected major health conditions from a doctor within the same speciality before they are admitted. Not sure what to ask? Take a look at below list.
 

5 QUESTIONS to ask your doctor before you get any test, treatment or procedure

1. Do I really need this test or procedure? Medical tests help you and your doctor or another health provider decide how to treat a problem; medical procedures help to treat the problem.
2. What are the risks? Will there be side effects? What are the chances of getting results that aren’t accurate? Could that lead to more testing or another procedure?
3. Are there simpler, safer options? Sometimes all you need to do is make lifestyle changes, such as eating healthier or exercising more. 
4. What happens if I don’t do anything? Ask if your condition might get worse — or better — if you don’t have the test or procedure right away.
5. How much does it cost? Ask if there are less-expensive tests, treatments or procedures, what your insurance may cover, and about generic drugs instead of brand-name drugs.

 

3. You don’t have to be hospitalised if it’s not necessary

Before you get yourself hospitalised for treatment, ask yourself: Does the procedure require admission or can it be done through a daycare procedure? Not sure what daycare procedure means? Basically, it’s a pre-planned surgery that allows you to be admitted to the hospital and discharged on the same day. In other words, you don’t have to stay overnight at the hospital. You can check with your insurer about this. Prudential offers Day Surgery for Vascular, Urology, Orthopaedic and more that doesn’t require hospitalisation.



And yes, there’s a word of mouth out there saying that you can only claim for your medical insurance if you’re admitted/ hospitalised. This is NOT entirely true. Most medical insurance policies don’t require you to be hospitalised (unless necessary) in order to make your claims. Double check your policy so that you can get a clearer picture of this.

Some might say, “If my policy covers hospitalisation, why not use it?” Well, although the hospital is known for the best place to recover, it’s doesn't necessarily mean it’s squeaky clean. There’s still a risk for contamination and your recovery may take a longer time because you’re not mobile (put on bed rest). On top of that, this can also affect your insurance coverage limit. Whether it’s annual or lifetime limit, you don’t want to waste it on something that’s not needed.
 

4. Take a look at your hospital bill


Usually, we tend not to look at our hospital/medical bill because we know that our insurance has got it covered. If you have been in the hospital, you know that bills can be complex and confusing. While it may seem hard to do, it’s time to make it a point to check your bills for questionable charges e.g. medicine you didn’t take, services you didn’t use or overpriced treatment.

Although your medical insurance is covering the bills, you shouldn’t take it lightly. Looking closely at your bill can help you save money because overpaying your bills can affect your annual or lifetime limit.
 

5. Know how to claim

If you have no clue how to go about it, here’s a guide to help you make a claim with as little hassle as possible! Before that, do understand that claims procedures tend to vary depending on the insurance provider and policy features. 

For example, even though you have a medical card, the hospital will request a deposit to cover non-coverable items (see point #1). This will be refunded to you by the hospital when you are discharged if you did not utilise any non-coverable items. Prior to hospitalisation or if you need to make a claim, just call your insurance provider or agent to inform them of your situation. 



Meanwhile, reimbursement policies will require you to pay the medical bills first and then make a claim for reimbursement later on. Be sure to file your claim as soon as possible because if you wait too long, the insurance company may decline the claim. Most reimbursement policies will require you to submit your claim within 30 days of the incident. 

And don’t worry as most insurance providers will state their claims procedures on their website. So just log on and follow instructions. For example, Prudential provides a service called PRUE-pay where you can register for e-payment and the amount reimbursed will be directly credited to your registered bank account. You can also ask your Prudential agent about e-claims where claims can be submitted electronically to save time and paperwork. 

Whichever claim type you have, don’t forget to notify your insurance provider or agent when you plan to get treatment or if hospitalisation is imminent to prevent delays or confusion.
 

All in all, be familiar with your medical insurance coverage and be a smart consumer

So now that you know the important things to take note when using medical insurance, we hope that you’ll make good decisions for your physical and financial health. Also, don’t forget to review your medical plan at least once a year as medical inflation continues to outpace general inflation rate. Chances are, the plan you that bought previously may not be enough to meet your future and long-term needs.

And, to those who don’t have medical protection yet, get your comprehensive medical plan with PRUMy Medical Plus to keep you safe medically and financially. With this medical plan, you have the flexibility to choose a plan that suits your needs - from a basic medical coverage that rewards you for staying healthy, to high medical coverage that will safeguard you from rising medical costs in the years to come.
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