How healthy is your health insurance?

LAST UPDATED: 21 Aug, 2014 @ 10:12
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How healthy is your health insurance?

THE recent world recession has served to highlight that the welfare state in Europe is basically no longer sustainable.

Governments around the continent are putting more emphasis on individuals to bear the rising cost of healthcare… and this in turn is leading to an increasing demand for health insurance.

Luckily the insurance industry is starting to respond with a wider variety of products to plug the gaps left by the state.

Insurance is fraught with potential problems, pitfalls and the dreaded exclusions, at the best of times.

This is particularly true of the health insurance market, where we have the added complication that we are dealing with the sensitive area of someone’s health and wellbeing.

Currently health insurance products in Spain fall into two main categories, and premium rates tend to be very competitive, although by the same token the limits and sub-limits contained within the policies tend to be lower than in the UK.

The first category is where, for a premium, an insurer provides an extensive network of doctors, specialists, medical centres and hospitals throughout Spain. All the client needs to do on falling ill is visit one of these approved centres with their card and the centre will invoice the insurer directly without the client having to part with any money.

Certain treatments and diagnostic procedures may require prior authorisation by the insurer so it’s best to check with your broker first or indeed the helpline provided by the insurer.

The second category is where, in addition to this network of specialists, the insurer also allows the client to go to any healthcare specialist not on the approved panel. The insurer is then forwarded the corresponding invoice to reimburse up to 90% of it.

This means the client can choose medical professionals and centres both inside and outside of Spain, but again, it’s always best to keep your insurer informed of any treatment as often it will need to approve certain treatments.

For anyone seeking to buy private health insurance, or indeed for those who already have it, but who want to avoid any nasty surprises in the event of a claim, I would highlight the following ‘golden rules’.

1. Ensure that you disclose any pre-existing medical conditions when applying for insurance. If in doubt declare it, and do not give insurers an excuse to contest your claim.

2. If you have private health insurance, and have an existing medical condition, be aware of being tempted away by cheaper alternatives, as the new insurer might exclude any future treatment of existing conditions or anything related to them.

3. Make sure you fully understand how your policy functions, and in which circumstances you must seek approval from your insurer before treatment.

4. Make sure that you fully read the policy wording, so you are completely aware of any limits, sub-limits and above all exclusions. Most insurers in Spain now have policy wordings in different languages. If you are unsure, or the policy does not fully meet your requirements, flag your concerns to your broker and he should be able to recommend alternatives.

5. Ensure that the policy you choose suits your lifestyle, and if you travel extensively and require overseas cover, then make sure that this option is included.
Private Health Insurance plays a very important role in modern society, and many people experience first-hand the enormous benefit of having this type of insurance.

However, it is also only fair to say that health insurance is a minefield of options, limits, exclusions etc, and if you are considering it, the best advice is to arrange to meet an independent and regulated broker, who should be able to recommend a suitable policy.

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