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Medical insurance: the comprehensive guide from Amanleek
Definition: Medical insurance is a method protection against health risks that an individual might get exposed to, as it supports individuals in facing such risks by providing coverage for medical examination, diagnosis and treatment of conditions that occur to the insured individual; creating an effective system that helps reduce the burden of healthcare expenses per person by distributing risks and sharing them with a diverse pool of individuals
The principle of insurance is based on an individual obtaining the insurance coverage in exchange for an annual subscription that is paid to the insurance company, which in turn collects subscriptions from a wide pool of individuals and provides the coverage to address the medical conditions that any of the insured persons are exposed to. In its essence health insurance is a safety net that helps an individual to deal with the expenses associated with treatment of medical conditions that might be unaffordable and to pay out of pocket if a person is not insured.
Features & Benefits:
The biggest benefit of insurance is the peace of mind it offers for the insured person through getting coverage from a reputable insurance company through:
- Feeling secure about using insurance in the event of a medical treatment is required to obtain adequate medical care
- Worrying less about paying the costs of medical treatment from his/her own savings as insurance will cover big portion of the costs of treatment
Health insurance coverage varies according to the insurance program as insurance providers typically offer various levels of coverage and benefits that suit different needs and budgets. The key and most obvious aspect that differentiate policies is the policy annual ceiling which is the maximum amount that can be spent by the insured within a year and it could range from 10,000 Egyptian pounds per year per person to 1,000,000 Egyptian pounds or even more. Consequently, the higher the maximum coverage of the policy, the more expensive the annual premium/subscription would be and generally the coverage includes:
- Doctor visits, x-rays, lab tests and medications
- Surgeries & Inpatient treatment and stay inside hospital
- Pregnancy and childbirth, with a specific waiting period
- Optional dental and optical coverage at an additional cost
It is worth mentioning that typical coverage does not include plastic surgeries or operations for weight loss. Also, there are two key terms that are highly associated to the coverage which are essential to understand and are explained below
- Co-payment rate:
The percentage that the customer bears from the cost of the medical service, for example if you buy a drug and the co-payment is at 20%, it means that you will have to pay 20% of the total value of the bill for buying the drug with the insurance company paying for the rest which would be 80% in this case. Generally, the insurer bears 100% of the inpatient treatment and one-day surgeries. With regards to other services the co-payment rates range according to the type of service and the level of coverage in the policy.
- Pre-existing conditions:
These are the medical conditions that an insured individual has prior to buying his/her insurance policy. These conditions are excluded from the coverage entirely or in some cases to a specific limit of the total coverage (i.e.: employee insurance provided by their employers)
Types of medical insurance:
local vs. International medical insurance:
|- Provides coverage through a network of medical service providers within the borders of the country of subscription.|
- Value of the subscription is calculated in the local currency
|- Provides coverage through a network of medical services providers that extend around the world and allows the subscriber to obtain all services in any country of his/her choice.|
- Value of the subscription is calculated in a foreign currency
Also, some international health insurance companies have no age limit for subscription and provide the option of covering pre-existing conditions for individuals at an additional cost.
2- Individuals/families vs. Corporate medical insurance
|- Covers individuals and families.|
- Annual maximum ceiling coverage reaches one million pounds per person for local coverage.
- Does not cover pre-existing conditions.
|- Covers the employees and their families in some case.|
- The annual subscription is paid fully or partially by the employer.
- The annual coverage ceiling is less than individual insurance.
- Covers employees who have pre-existing conditions with a specific annual limit for each.
The difference between insurance and healthcare provider/operators’ companies:
There is a clear distinction that must be made between these two types of companies that might face a person while shopping for health insurance coverage:
These are companies registered under the Financial Regulatory Authority (the supreme authority governing the insurance sector). The registration requires a large minimum capital. Also, the details of the various programs and subscriptions are reviewed by the Financial Regulatory Authority and require its approval. Moreover, the financial regulatory authority act to protect the rights of the insured individuals and accept and review complaints of insured individuals. Examples of insurance companies would be (Allianz , AXA , GIG)
- Healthcare providers/ operators’ companies:
These are companies whose primary role is contracting with hospitals, medical centres, and pharmacies to form a medical network and presenting them to insurance companies' clients they manage the medical files of clients. In some case these companies offer their services directly to individuals or companies, example of these companies would be (Globe med , Nextcare , Medright)
The pricing of the annual health insurance subscription:
The annual subscription price is calculated based on 3 main factors:
- The age of the insured person, the older the more expensive the annual premium/subscription would be
- The level of coverage and the maximum annual ceiling, the higher the maximum annual ceiling and the higher the level of the coverage the more expensive the annual premium/subscription would be
- Additional benefits that are optional, such as dental and optical coverage, leads to additional cost and makes the policy more expensive.
Through Amanleek.com you can instantly get medical insurance prices and calculate the actual cost of the annual subscription of various programs from a diverse set of insurance companies operating in Egypt for individuals, families, and corporates. Also, the website allows you to see all the details and compare them to make a confident choice in a matter of minutes.
How to subscribe and its conditions:
It is possible to subscribe for individual health insurance as a policy holder starting from 16 years to 64 years and some companies offer coverage until the age of 75, provided that they participate before the age of 65 with a review of the value of the policy and its exceptions annually on the period from 65 to 75 years. As for families, it is possible to insure children, but as dependent for the parents or at least one of them from birth until 21 years old, but the insurance will not be valid for a single child, who is less than 16 years old, without the participation of at least one of his parents.
Obtaining medical insurance does not require a medical examination before subscribing, but it is sufficient for the subscribers to answer a set of a questionnaire regarding their medical condition and health history mentioning any chronic diseases he/she suffers from, and it goes without saying that answer must be honest and transparent to avoid later discovering of any false information during the coverage period.
Getting your policy: Once the you are settled on a specific program matching your needs through Amanleek.com – An Amanleek insurance advisor will contact you to confirm and review the program details and start the procedures for issuing the policy which consist of the following steps:
- Filling out the application and questionnaire
- Paying the annual subscription amount and providing the necessary documents
- Delivering the insurance cards, the healthcare providers network and user booklet to you
Getting your medical insurance policy through Amanleek gives you an additional option of having dedicated customer service to help you use your policy throughout the subscription period.