Medical Card

Medical Card (Most of the Problems) 

Medical card is a cashless card and it do not guarantee you a 100% admission to hospital's  sometime it can be decline if the Insurance company find something not right and can ask for more information from you.

When you are getting a medical card my personal advice is to get a life policy with a medical card as you will lock up your payment. You will know how much you will be paying for the rest of your life or as long as you want to be covered. A stand alone medical card is for a short period of time and I don't recommend for long terms as the payment will increase as you age and a time will come you will be unable to make the payment. And there are lot of other reasons which I can't write here. 

 

1. Before you get admitted to a hospital make sure the hospital is  a Panel.
2. Make sure the hospital has sent an admission report to your insurance company.
3. If you have any problem for you guarantee letter, call your agent for help or call the Insurance Company to confirm.  

Guarantee letter approval

If you have a problem for your guarantee letter  it's normally because:

1. Your policy is less than 1 year.
2. You are in specified illnesses waiting period.
3. You have Exclusion in the policy.
4. Company needs more information about the sickness
5. Suspect fraud case.
6. Pr-existing illness.( You have this problem before you bought the policy)
7. Have not declared it in your policy. (Most of the problem)
8. Others

In this cases you may need to pay the Hospital first and do a reimbursement. (I know it is hard but that is the only way).

You need to get the claim forms and send all the medical report to the company. If the company is satisfied they will pay you.

The company may ask additional reports. If the company declines your claim you can appeal to the company. (Get your Agent’s help if you have problem there is nothing much he/she can do but he/she can go to the root of the problem.)

4. When you get discharged from the hospital make sure the hospital have send all the information to your insurance company. Check the time they have faxed it as most of the problems are:

1. Doctor came to see you at 10am and he discharged you. You can go home. Doctor is still visiting his patient in the hospital. But you are ready to go home.
2. The doctor have not wrote his report for the insurance company but he has gone to operation theater or went to another hospital / clinic .The report is not done yet.
3. The staff are unable to send your report to your insurance company,  You are waiting to go home when you ask the hospital staffs. They will say’s we have not received anything from your insurance company. They will blame the insurance company.
4. Make sure and ask them what time they have faxed the report to the insurance company and call your insurance company or your Agent. Otherwise you will have to wait 2 to 6 hours for the doctor to come back and make the report before you can go home.

Co-Insurance

A co-insurance provision is a policy provision that requires the insured to pay a certain percentage of the eligible medical expenses in excess of the deductible.

The purpose of this clause is to reduce premium and prevent over utilization policy benefits since the insured has to pay part of the bill.

Premium can be offered at cheaper rates it is also for the insured to check the hospital's bills so as not to be over charged by the hospital for treatment not received. 

                                                                                 Extender

Most Insurance company have came up with a extender which is very important to make unlimited claim over life time. You need to remember your basic medical card still may have a life time limit, if you have use up you basic limit you may need to pay before you can use the extended.  Make sure use your medical card wisely don't think it is unlimited you can just use it.

About the author:Kertar Singh has joint Great Eastern Life Assurance in August 1995 as a part time agent.

Became a full time agent in 2000 after retiring from the army after 22 years.

He deal with all kind of Insurance from Life Insurances to General Insurances and Will Writing.

Kertar.en@gmail.com

H.P 013-322 8582

Notes: Reference have been made from MII and Gela