Sunday 10th February, 2008

 

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“We put 30 spokes together and call it a wheel; But it is on the space where there is nothing that the usefulness of the wheel depends.

Just as we take advantage of what is, we should recognise the usefulness of what is not.”

From the ancient Chinese text:

Tao Te Ching, by the Taoist sage Lao Tzu.So what is it that individual critical illness or disease health insurance will not cover? The first answer that jumps to mind is diabetes; the second is high blood pressure.

While expenses for such illnesses will be covered by employer-sponsored ordinary group health insurance, critical illness or dread disease insurance will not cover expenses for such chronic conditions.

The critical illness or dread disease policy will list a specific number of medical conditions that are covered. For example, you can claim expenses for a kidney transplant, or for blindness, both of which conditions may have been the result of chronic diabetes.

But you cannot claim the expenses incurred in treating the diabetes, itself. For example, expenses for insulin or treatment of a diabetic foot will not be covered.

Expenses incurred from a stroke, or death of heart muscles will be covered by the typical Critical/Dread Disease policy, but expensive hypertensive drugs for hypertension or high cholesterol will not be covered.

You must pay

The point here is that for comprehensive health coverage, you need the both forms of coverage.

In employer-sponsored group health plans, expenses that are considered unreasonable will not be covered.

While these health plans cover routine surgeries, diagnostics, drugs and hospitalisation, as well as ordinary doctor’s visits for everyday illnesses, if the claims for such procedures or visits are above a reasonable dollar amount, a permutation will be enforced.

For example, if an appendectomy is performed and the surgeon charges $15,000, there is no hope of recovering that amount, since $15,000 is an exorbitant fee for such a procedure.

Health claim adjudicators have a fair estimate of what it costs for medical care, and they will impose a standard, on the $15,000 claim.

This is because in order for you to transfer the risk of you own ill health onto the shoulders of the insurance company; the insurer requires you assume responsibility for your own good health and well being first.

This means you will always have to pay some of the expenses from your own pocket.

We sew two pieces of cloth into the sides of our pants and we call it a pocket. The pocket is really the space, but the pocket is only useful if you have something in it—like cash, a health card, or a heath insurance premium receipt.

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Designed by: Randall Rajkumar-Maharaj · Updated daily by: Nicholas Attai