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Health Insurance Tips

Health insurance is great. It provides real peace of mind that you will be able to avoid public health waiting lists and have your choice of health care professional. But there are things you need to know to ensure your health insurance works well for you. Here are some tips from the office of the Insurance and Financial Services Ombudsman:

Health Insurance will not provide cover for all treatments, medical procedures or medications. Check your policy for limitations and exclusions. When you apply for insurance, tell your insurer your whole health history to avoid issues later if you need to make a claim. Pre-existing conditions are not usually covered, unless the insurer says they are.

Check your policy

Get a copy of your policy and check what you are, and are not, covered for. Ask questions if you don’t understand.

Look out for policy exclusions

Declined health insurance claims due to exclusions are a common complaint to the IFSO Schemes. Examples of health insurance exclusions might include treatment or procedures for cosmetic, dental or pregnancy-related issues; alternative or experimental treatments; and anything relating to a symptom or health issue you had before you took out the insurance (pre-existing conditions).

Pre-existing conditions will not be covered unless the insurer has agreed to cover them

Pre-existing conditions are commonly defined as any condition, sign, symptom or circumstance that you know about or ought to have reasonably known about. This can be something as simple as having a sore knee or back that you may have discussed with your doctor, was not diagnosed as a medical condition. Health insurers won’t provide cover for pre-existing conditions unless they have specifically agreed to cover them.

Tell your insurer the full details of your medical history, even if you don’t think they are important

Declined health insurance claims due to non-disclosure are a common complaint. Even if you accidentally leave out details about your medical history, your claim could be declined, and your policy treated as though it didn’t exist. If in doubt, tell your insurer everything. It can be helpful to get a copy of your medical notes you can refer to when filling out the insurance application form, or provide a copy to the insurer.

Before you incur medical costs, make a claim to your insurer to make sure it will be covered

If you want to make a claim for the cost of a treatment, procedure or doctor’s visit, you will need to apply to your insurer to make sure it will pay the claim before you have the treatment, procedure or visit. This is called pre-approval.


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