However, this insurance does not always completely cover his needs. Some insurance covers hospitalization costs without providing any protection for consultations with general practitioners or specialists.
Hospital coverage: I am only covered for hospitalization
If you only have inpatient or hospital and surgical coverage on your contract, this means that you are only covered for hospitalization costs. You will not be reimbursed for regular care and specialist consultations.
Limites hospital and surgical : I am covered for hospitalization up to a limited amount
Every insurance policy has limits. It is essential to know the limits of your halth insurance contract and the maximum amount it covers.
Some insurances will provide different coverage in different hospitals. In some cases, your contract will only cover treatment in public hospitals but will not cover costs in private hospitals.
If you need a hospital consultation or hospitalization, it is important to know which hospitals are covered by your insurance.
Limit per disease (disability )
Health insurance plans offered by companies generally cover patients with a limit per illness or disability. This means that reimbursement is limited to a fixed amount per illness.
For example, an uncoplicated surgery at Raffles Medical Hospital will cost around S$21,000.
With an employer health insurance having a limit per illness, you will have to pay the difference between this limit and the cost of the operation:
As cover in the event of hospitalization may be limited, reimbursement of pre-hospitalization and post-hospitalization costs may also be very limited. It is important to check these limitations in your health insurance contract because these costs can also be very high depending on the treatment you will need.
Major medical case
When your policy contains a limit per illness, your insurance may provide you with a major medical option. This option will supplement the limit per illness to increase your coverage in the event of critical illness or hospitalization.
Your health insurance contract may also cover you with an annual limit.
For example, you can be covered for any hospitalization with an annual limit of S$250,000 based on as charged up to a limit of . This means that you are 100% covered for all hospitalizations, within the limit of S$250,000 accumulated per year. Once this limit is reached, all other hospital expenses will be your responsibility.
Optical and dental care
Consultations with general practitioners and specialists can be included in your health insurance contract. However, you should take special care with optical and dental covers as they are usually not included in the general outpatient cover. If they are included in your policy, they will be clearly specified.
Annual deductible and co-payment
Some companies do not cover specialists but grant Flexibenefit to their policyholers. In this case, your insurance company will offer you a fixed amount that you can use for certain types of consultations, specified in your contract.
For example, your company will give you S$2,000 worth of Flexibenefit per year that you can use for dental or optical care. In some cases, this amount can also be used to supplement your insurance with other coverage.
Territorial limits: I am only covered in Singapore
Where health insurance is provided by the employer, the coverage area is often limited in Singapore. We strongly advise you to check whether repatriation and emergencies abroad are covered.
If you travel often for work, you might want to have business travel insurance. This insurance generally covers your business trips but not your personal trips.
My loved ones are not covered
Some companies only cover their employees while others may offer to cover your spouse and children or give you the option of adding them to your plan at your own expense. It is important to understand what coverage will apply to your family as this can be quite limited. In some cases, it may be more advantageous to take out separate coverage for your loved ones.
You now have all the keys in hand to understand how your employer’s insurance covers you. In order to determine if this one really meets your needs, we invite you to meet next week to consult the advice of UEX and to fully understand what you really need to cover .
If you feel you need additional coverage, you can always purchase additional protection, called top-up. Our Health Guide gives you an overview of health insurance and top-ups.
