QUESTION: I am 44 years old and married, with two teenaged children. I am self-employed. My wife works with the government. We have health insurance under a group plan that forms part of my wife's benefits. The amounts under that plan cannot cover a cardiac bypass operation. Can I get cheap insurance, either locally or overseas, to top up the amounts under my wife's plan?
- G. D., Kingston 5
Answer: There are no cheap health insurance plans. Bioethicist and associate lecturer in the Faculty of Medical Sciences at UWI, Dr. Derrick Aarons, puts it this way, "The need for individuals to pool resources in order to pay for health care would not probably exist if health care was inexpensive."
I agree totally with him. So, if you are looking for low-cost coverage, forget it.
The local market for health insurance is small. The choices are therefore very limited. One way around that problem is, as you say, to top up the local plan with an overseas plan. This assumes, of course, that you have access to foreign currency and that buying an overseas policy is not illegal. The Insurance Act, 2001, does not prohibit the buying coverage overseas. Section 20 which applies only to registered insurers and intermediaries, is very clear on this point. This is no different from other buyers here (including government) who purchase goods and services from abroad.
You must fully understand your family's basic plan to buy the right "top-up" coverage. Here are some questions you will need to answer to properly determine your family needs and help you assess the existing plan. This may seem like a lot of work but it is very important that you do the exercise to make proper provisions for your family.
Does the existing plan cover the services your family is likely to use?
Are the doctors, hospitals, laboratories and other providers that your family use in the network of service providers approved by the insurance company?
What are the financial consequences in the event that your family uses service providers out of the insurer's network?
Do you need permission to consult a medical specialist?
What are procedures for getting medical care overseas?
Is the major medical limit under the plan adequate?
Does the plan reimburse alternative medical therapies and treatment for mental illnesses?
What is the situation in case of pre-existing medical conditions?
What is the limit for prescription drugs?
Do members of your family suffer from chronic conditions such as asthma, diabetes, cancer or HIV/AIDS? How are they treated under the plan?
HOW AFFORDABLE IS
THE COST OF THE CARE?
What is monthly premium paid for the existing insurance benefits?
What deductibles do your family members have to pay before the insurance kicks in?
What percentage of your family's medical expenses are reimbursed after the deductibles have been paid?
If your family uses healthcare professionals outside of the insurer's network how much less will they be paid?
Are you more interested in buying coverage to take care of the normal health maintenance costs or to provide for life-threatening illnesses?
Buying health insurance is a complex exercise. It requires a broad range of skills and lots of homework. Buying extra coverage overseas to top-up an existing plan is even more difficult. I would suggest that you consult a broker that specialises in the subject. This way you should get no nasty surprises and achieve a balance between coverage, a fair price and financial security.
Cedric E. Stephens provides advice on risks and insurance. If you need free information or advice to solve a problem, write to The Financial Editor or,
contact Mr. Stephens directly at aegis@cwjamaica.com
