10+ Types of Health Insurance Benefits by ITI190 – Insurance Top Info 190. What are the types of health insurance benefits for the insured? It is important to know this before deciding to buy insurance. Determine which benefits are appropriate and which are not.
The more benefits offered, of course, the more expensive the premium. Therefore, it is necessary to choose which benefits are your priority.
The Covid-19 pandemic that has hit the world has caused deep wounds to society. Not only the economic effect but also many families who lost their family members.
The Covid-19 virus reminds us that health is the most valuable thing in life. When you fall sick, everything will be in vain. So that wealth and power become worthless.
What to do in the face of all these possibilities?
Insurance is the most efficient way of managing risk from all possibilities.
We pay a certain amount of insurance premiums and get a large amount of coverage. “Small money buys big money, that’s insurance. If you don’t force yourself to pay small money, then you will be forced to pay big money,” said Mario Teguh, an Indonesian motivator.
Medical costs continue to increase from year to year. According to the Global Medical Trends Survey Report, released by the firm Willis Tower Watson, it states that gross medical inflation or health costs in the world in 2019 rose by almost 10% from the previous year.
Meanwhile, in 2021, health costs are predicted to skyrocket again to 11%. This increase is allegedly going to be higher than the average cost of health care in Asia Pacific countries which touched 7%.
The following are ten more types of Health Insurance Benefits, including Covid-19 protection:
1. Health Insurance Hospitalization Benefits
Hospitalization is a basic benefit of health insurance. In every health insurance, hospitalization benefits are always there and are the main benefits.
This benefit provides reimbursement for hospitalization costs. Commonly covered matters include:
- Room Fee, ICU Fee
- General Practitioners, Specialists Dokter
- Surgical Fees,
- Cost of various hospital treatments, including drug and laboratory costs
- Companion Fee
- Ambulance Fee
- Non-Medical Expenses
- Prosthetic & Implant Fees
- Cost of Organ Transplant Cost of HIV/AIDS Treatment
- Palliative Care Costs
In addition to hospitalization, insurance also provides outpatient benefits related to hospitalization. If you have to be outpatient after undergoing hospitalization, outpatient costs will be covered by insurance, even though you do not take outpatient benefits. Insurance offers many choices of hospitals according to needs.
Outpatient is an additional benefit (rider)—optional benefits, which may or may not be taken by insurance participants.
This benefit provides reimbursement of outpatient costs at a hospital or clinic. The difference with inpatient care, for outpatient treatment, participants do not have to be hospitalized.
Things that are covered in outpatient care, among others, are:
- General Practitioners, Specialists Dokter
- Cost of various hospital treatments, including drug and laboratory costs
- Outpatient Dialysis
- Cancer Outpatient Cost
- Outpatient Physiotherapy Biaya
- Cost of Treatment for Mental and Mental Disorders
- Alternative Medicine Cost
- Annual Medical Examination Fee
Not all insurance companies provide outpatient benefits in health insurance. Only a small number of companies offer outpatient care.
Childbirth is an additional benefit (rider). Optional benefits for participants.
This benefit is reimbursement of costs for delivery in a hospital or clinic.
The costs covered, among others, are:
- Cost of normal delivery
- Surgical delivery costs
As with outpatient benefits, not all insurance companies provide maternity benefits in health insurance.
Dental care is an added benefit (rider). The benefits that can be taken may not be by participants.
This benefit is reimbursement for dental treatment at a hospital or clinic. The costs covered, among others, are:
- Cost of dental prevention
- Dental care costs
5. Daily Compensation (Hospital Cash Plan)
The hospital cash plan provides daily compensation in a certain amount while the participant is hospitalized. The amount of compensation per day depends on the benefits package taken.
For example, a participant takes a package of USD 70,09, so if he is hospitalized for five days, the insurance will pay USD 350,46.
In contrast to general health insurance, which reimburses based on hospital bills, in a hospital cash plan, reimbursement does not look at the amount of the bill, but how many days of treatment multiplied by the number of replacements per day
Hospital cash-plan reimbursement is also known as lump-sum reimbursement—a one-time payment for each hospitalization.
The hospital cash plan sets a maximum limit of days of hospitalization that can be claimed in a year. After the specified number of days, the claim cannot be made again.
Currently, some health insurers add a daily benefit to the list of benefits offered.
6. Dengue Fever, Typhus
Insurance companies make special products that cover hospital costs due to dengue fever and typhoid. If not hospitalized for this disease, insurance will not provide reimbursement.
Dengue fever and typhus are among the most common diseases in the community. The cost is also quite expensive, around USD 350.46 to 1051.37 once sick.
The purpose of this type of benefit is to offer health insurance at a lower premium, with a focus on protection for certain diseases.
In 2020, the era of the Covid-19 pandemic hit the world. Many people get sick, even die from Covid-19.
Insurance offers protection for Covid-19 disease, one of which is providing daily compensation if hospitalized. The compensation can be up to USD 112.15 per day, depending on the package taken.
This type of insurance only requires one payment for three months, six months, or 1-year protection starting from USD 3.15 per 3 months regardless of age group.
This insurance applies “One premium price” by protecting ages 0-50 years without any difference in premium prices. Especially suitable for providing protection during a Covid pandemic like this, the risk knows no age.
When traveling, one of the risks is an accident or illness that requires hospitalization. The cost is certainly not cheap, especially abroad.
Insurance provides protection for those who are sick abroad while traveling. This protection is sold as a package with travel insurance, one of which is protection for hospital expenses abroad.
Travel insurance with health cost protection is also one of the mandatory prerequisites in some countries to apply for a visa.
It is necessary to pay close attention to the benefits covered by travel insurance. Not all automatic travel insurance covers hospital costs.
9. Cancer, Critical Illness
Cancer, Dialysis, Heart, Stroke, and other critical illnesses are types of diseases that are not only deadly but also require expensive treatment costs. An online agency survey shows that cancer treatment costs IDR 100 million per month.
Health insurance offers benefits only for sufferers of certain critical illnesses, for example, Cancer, Heart Attack, Stroke, Coronary Artery Surgery & Angioplasty. The sum assured benefit will be paid if the insured suffers from the disease and fulfills the clauses set out in the insurance policy.
The way critical illness insurance works is different from health insurance. Benefits are paid at once (lump-sum), not reimbursed according to hospital bills.
For example, the insured takes cancer protection insurance with a sum insured of USD 70091,6. When the insured suffers from cancer, the insurance company will pay at once USD 70091,6, and after that, it has not paid anymore.
10. Health Insurance Limit
How does the insurance company determine the limit or limit of benefits that can be claimed by participants? This is important to know because it often becomes a problem when participants use their insurance.
Health Insurance applies several types of benefit limits, namely:
- Limit per Disability
This limit stipulates that per disability, there is a maximum cost that can be claimed. Disability is the language of the police, which means every admission to the hospital.
When admitted to the hospital and hospitalized, many services are received by patients—starting from doctors, drugs to laboratories.
Insurance stipulates that in each service, there is a maximum limit that can be claimed. For example:
- Maximum hospitalization 120 days a year with room class USD 35.05 per day
- Maximum ICU 30 days a year with room class USD 70.09 per day
- Specialist USD21.03 per visit
- Cost of various treatments, including medicine, laboratory USD 700.92 per hospital admission
Participants must pay attention to the size of the limit. Entering a room class exceeding the insurance limit will result in excess claims that must be paid by participants.
Not only the limit per hospital admission, but health insurance also sets an annual limit. The annual limit limits the total claims in a year.
The existence of an annual limit makes even though the limit per disability still exists, if the annual limit has exceeded the limit, then the claim can no longer be made.
This, as a charged limit, is the largest type of limit; namely, reimbursement is given according to the hospital bill. The insurance company reimburses the claim based on the amount stated on the hospital receipt.
However, insurance companies usually apply reimbursement according to the bill (as-charged) only for the following costs, namely:
- General Physician Visit Fee
- Specialist Doctor Visit Fee
- Cost of Various Hospital Treatments
Apart from the above costs, the limit is still set by the insurance company. For example, the cost of room class has been pegged to the maximum.
It is important to note that to be able to make a claim according to the bill, the room class must match the insurance package taken. If the room takes a higher class, the as-charged condition does not apply.
Replacement using a card, or often referred to as ‘cashless.’ With cashless, insurance participants do not have to pay during hospitalization.
Participants only need to show their insurance card at the hospital counter. After that, the cost will be covered by insurance to the hospital.
Cashless is one of the health insurance benefits that really help insurance participants. But, of course, the conditions must be done in a hospital that has cooperated.
12. Cash Value
Many health insurance products are bundled with investments, which are often referred to as Unit-Links. Premium payments are not only to pay for health insurance costs but are also invested in investment instruments.
The benefit is that the policyholder can get the cash value of the investment returns, which can be withdrawn after a certain period of time.
However, this is on the condition that the return on investment is as expected.
In reality, this one is often different from the proposal, and the investment returns are not as expected because:
- investment return is lower than predicted in the proposal;
- Insurance costs are increasing, which reduces the money that can be invested.
As a result, low investment returns make the cash value that can be withdrawn small. In fact, participants may have to pay additional premiums because the increase in insurance costs is not proportional to the small return on investment.
Tips for Choosing Benefits
It can be seen that the benefits of health insurance vary. Different people’s needs require different service offerings.
Of course, if possible, participants want to get all the benefits. However, it is expensive.
Health insurance premiums are notoriously expensive, and every year the possibility of premiums going up is always there.
Therefore it is necessary to choose benefits.
Some things to consider in choosing health insurance benefits, namely:
1. Take Hospitalization
The first priority is to take inpatient benefits because this is the type that costs the most if you are hospitalized.
Try to be able to take hospitalization that replaces based on the amount of the bill (as-charged). Limit as – charged is calming because participants don’t have to worry about exceeding the limit.
However, as-charged limit, participants must ensure that they enter the room class that is in accordance with the insurance policy. You should not take the room class above because as-charged will be lost or have to pay a large excess claim.
2. Daily Compensation, If Budget is Limited
If you feel that your financial capacity is limited, so you cannot take hospitalization, try to get participants to take daily compensation. The very easy nature of daily claim benefits will be very helpful when you need to pay for the hospital admission.
3. Take Critical Illness
This critical illness benefit provides significant additional money when it is really needed. The cost of critical illness care is not small.
Even though you already have health insurance from the office, but when someone suffers from diseases, such as Stroke, Heart, Cancer, the need for costs is quite large.
What I see, when someone suffers from a critical illness, there are many costs, which cannot all be covered by outpatient care. This non-coverable cost uses the benefits of critical illness insurance.
4. Think Again Outpatient, Childbirth, Dental
I once calculated premiums for outpatient, maternity, and dental benefits. In conclusion, this benefit premium is expensive.
The cost for this type of benefit should be taken from savings or emergency funds. If you rely on insurance, the cost is too expensive.
If you really want to take this benefit, make sure that the previous benefits have been taken. Already have hospitalization, daily compensation, and critical illness, take outpatient care, and others.
4. Hospital List
One of the important health insurance benefits is the cashless facility. However, this facility can only be done in hospitals that have collaborated.
Therefore, when choosing health insurance, make sure the hospital that the participant subscribes to cooperates with cashless facilities. If not, there must be another hospital close to where you live that can accept cashlessly.
5. Pure Health Insurance
I prefer pure health insurance over investment combined health insurance.
- Premiums are much cheaper. A large number of discounts in unit-linked insurance makes the premiums more expensive.
- Investment returns are not optimally combined in insurance. It is better to invest directly without the need for a combination with insurance.
Getting sick and expensive health costs are risks that everyone faces. The Covid-19 pandemic reminds us again about these risks.
The many choices of benefits make policyholders need to choose which type of benefit is the most appropriate to take: the more benefits, the more expensive the premium.
We need to make a priority plan about the type of health insurance that should be taken first. If you already have health insurance from the office, what type of insurance do you need to take yourself?
10+ Types of Health Insurance Benefits by ITI190 – Insurance Top Info 190. Hope it will be useful for you.