ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Health Insurance

Updated on February 25, 2016

Some Key Facts When Buying Private Medical Insurance Schemes in the UK

Regulation

The Prudential Regulatory Authority (PRA) and the Financial Conduct Authority (FCA) regulate private medical insurance policies in the UK. This was earlier done by the Financial Services Authority (FSA).

Complaints

Private medical insurance providers and brokers are required by the FCA to have complaints procedures in place. In case one is not satisfied with the response of the insurance company in resolving a problem, one may approach the Financial Ombudsman Service (FOS). It is a free and independent service to settle disputes.

Compensation

The Financial Services Compensation Scheme (FSCS) is UK's legal fund for clients of authorised financial services. It is an independent organisation set up under the Financial Services and Markets Act 2000. In the event of insolvency of the insurer or its inability to honour a claim, the FSCS pays compensation to the insurance holder.

Confidentiality

The Data Protection Act 1998 and other ancillary laws mandate medical insurer companies to treat personal information including medical details confidentially. Insurers are required to inform policyholders about personal information usage and circumstances when such information is shared with third parties. Policyholders have the right to seek details of information an insurer has about them.

Primary Health Care For You And Your Family

Primary health care, also known as PHC, comprises of all the basic services that are offered to individuals and families for their wellbeing. So whether you need a general check-up or you have suffered from a twisted ankle, your first point of contact would be with one of these professional care-givers. They will help you with your lifestyle habits, manage chronic diseases and provide preventive measures to keep your body and mind healthy.

PHC forms an integral part of society. Whether they are looking for a physician, pharmacist, dentist or nurse, many families prefer to go to a medical profession that they can visit on a regular basis rather than go to something who they do not know for their basic wellness. Since it the first point of contact between a patient and the healthcare system, it is necessary for these services to be available in every community, allowing the individual to be more aware of their basic medical needs.

The Role of PHC

The role of a primary physician will vary depending on various environmental and economic factors along with their specific area of practice. However, some of the common roles of a physician include:

• Providing constant and comprehensive care to the patient
• Guiding the patient through the various social welfare schemes that are present
• Referring them to specialists and other hospitals or clinics whenever required
• Coordinating different kinds of services for the patient so as to provide them with the best combination at a given time
• Considering the different economic situations that are prevailing and the situation of a particular patient and giving them the best medical and wellness treatment plans based on this

New-Age PHC

With the development of this form of care, the role of your regular physician has not expanded in a large way in order to allow you a number of services conveniently. Teams of professionals offer different services so that you have the best medical opinions for any condition that needs to be treated. Sharing of information is also made easy so that your different providers have access to all your important information, allowing them to diagnose and treat you better. Patients are now also encouraged to play a bigger role in their own fitness so that they have control over their wellbeing. And all this is available right at a community level so that it still stays personal and comfortable for every member of the family.


Still Doubtful About Buying Health Insurance?

Health procurement has been a major cause of concern and area of research for every civilization of the past and of the modern world. The evolution of medicines and courses of treatment is very diverse and dramatic. So much money and effort is being spent on research to find cure of diseases every year. So many medical schools are dedicatedly working to bring out quality medical professionals to solve health issues. With continued efforts and resources we have sufficient know how and infrastructure to cure or control many diseases and thus saving many lives or improving life quality in the process.

But can the common man avail this treatment? Availing medical treatment can be a big financial pain. Many in a country like India die or worsen their health condition because they don't take the required treatment or delay the treatment because of affordability issues. That is why health insurance is very important. Health insurance saves you in your most critical times. It acts as an alternative source of financing your hospital bills (including medicine bills of one month prior to hospitalization and three months post hospitalization).

Even though medical emergencies do not happen frequently to most people one cannot afford to not have health insurance. With rising medical costs one would be exposing oneself to high amount of risk if not well equipped with insurance. Generally the attitude of young people towards health insurance is very lax. Most people ignore when they are told the importance of having health insurance. Some still treat it as an avoidable expense or a luxury. They realize its value when they see some of their relative or friend in that situation where they need health insurance the most.

Guide to Individual Health Insurance

The new Covered California health insurance marketplace offers a wide range of affordable health plans for you to choose from. Whether you are self-employed, or looking for coverage over and above what your employer currently offers, there is a plan that will likely meet your needs. Federal regulations require that health plans operating under the Affordable Care Act (ACA) meet certain access requirements. In California, those requirements include timely access to healthcare providers, as well as geographic access standards.

Here is a general guide to individual health insurance that you can refer to when choosing a plan. And do not forget these important dates regarding open enrollment for 2016.

Provider Networks

When selecting a health insurance plan, it is important to verify the plan's provider network of doctors, hospitals, nurse practitioners, therapists, and other health care providers. It is equally important to understand what is not covered as well. Understanding your plan's provider network helps you save money, receive better care, avoid unexpected fees and costs, and be happier with the care you receive.

Out-of-Network Care

You are not restricted to health care providers in your network, but should you decide to use one outside of your network, health insurance will cover less resulting in a higher out-of-pocket cost for you, except in the case of emergencies.

Provider No Longer in Network

If your health care provider leaves your network, you will generally need to find a new doctor inside the network, and most plans will assist you in doing so. As a rule, a health plan's continuity of care policy allows a patient to continue care with a doctor no longer in the network for a certain period of time at the lower cost-sharing rate.

Managing High Deductible Health Plans

What If Something Does Happen?

It is not outside of the realm of possibilities that a medical emergency could occur, even to the healthiest person. Hearts sometimes don't work properly, accidents happen and unfortunately, cancer discriminates against no one. If you have been generally healthy otherwise, and therefore chose a HDHP, one of these unfortunate scenarios could drain your bank account or worse, put you into serious debt.

This is where supplemental insurance plans can really save the day. Many people are unsure of the purpose of these plans, and others have never even heard of them. Accident and critical illness plans can offer tens of thousands of dollars of protection should you have an unexpected injury or serious illness.

Suppose you walk outside and slip on some ice on your steps in the winter time. This could cause dozens of injuries, but let's say that when you slip, you break your right ankle. You can't drive yourself to the hospital because (besides the fact that you're in excruciating pain), you can't work the brake and gas pedals because of your fractured ankle. On top of a trip to the hospital, x-rays, and any procedures necessary to fix the break, an ambulance ride certainly is not cheap.

How the Plans Work

In the event of an accident, an accident plan typically reimburses you for covered injuries. If you are diagnosed with a critical illness such as a heart attack or cancer, a critical illness plan will usually pay out a lump sum of cash. Amounts and reimbursements/payouts will vary for each policy and are determined based on the value that you decide on upon enrolling.

With these supplemental policies, your life has just been simplified and your financial concerns put at ease. If you experience a covered illness or accident, your high deductible is no longer a problem because you'll receive money from your plans to handle those high dollar amounts.

You may be thinking "the point of a HDHP is to save money, and you want me to buy more insurance?" Well technically, yes. HDHPs paired with supplemental plans can still save you money because supplemental plans are also pretty inexpensive. You will likely still be paying less to have three plans versus one major medical plan with a lower deductible.

"Have Not" Health Insurance

Something has happened that I could never have imagined. Everyone in the U.S. that purchases health insurance have been divided into the "Haves" and "Have Not" categories.

I worked in corporate America for many years and I was always able to access a good doctor, pay my "co-pay", get whatever care that was needed and move on to the next item on my "to do" list.

Now that I started my own business, I no longer have an "employer sponsored group plan" for my health insurance. I now have insurance that costs $600+ per month that I will apparently have great difficulty getting to use.

If you are fortunate enough to "have" an employer sponsored group plan, you will have better access to using your insurance. If you "have not" this type of plan and have an individual plan either because you own a small business or your employer no longer sponsors a group plan; my sympathies are with you.

I rarely get sick. (Knock on wood.) Last year, I went to my doctor who I have had for 12+ years with my "new" health insurance and was told by the receptionist that they accepted my insurance so I gave them a $25 check for my co-pay. I just needed to renew prescriptions. Upon leaving, I was notified that they did not accept my insurance and I would need to pay an additional $175.00 in addition to the $25 check I had already given them. They gave me the paperwork to get "reimbursed." I sent it in to the insurer the same day. I was never reimbursed.

This year, I got a different company who had my doctor listed as a preferred provider on the insurer website. I have a PPO plan. I called my doctor to make an appointment and was told that she was no longer accepting insurance and would be moving to a "cash only" service in about a month. The receptionist said she would make an appointment for me if I had an employer sponsored group plan otherwise they were already only offering their service as cash only. I would have to submit paperwork for reimbursement. I asked how much it would cost for this "cash" appointment. She said she had no idea but finally said "perhaps" $80 after I pressed her for an answer. The same appointment cost $200 last year so I'm guessing the prices have not been reduced this year.

Comments

Submit a Comment

No comments yet.