Health insurance

Health insuranceTermInsurance×التأمينA contract where you pay a regular fee to transfer the financial risk of a specific event to a company that agrees to cover the cost if it happens.Open the term is an agreement between a person and an insurance company: the person pays a regular premium, and the company covers part or all of the cost of medical care. Cover typically includes consultations, medication, surgery and hospital stays.

Four things in the policyTermCar insurance×تأمين السياراتA contract that covers the cost of damage to your vehicle or injury to others, depending on the type of policy you hold.Open the term document decide what it is actually worth: the network of hospitals and clinics it pays at, the deductible paid before the insurer pays anything, the annual ceiling on what it will pay in total, and the list of exclusions. The premium is not one of the four.

Because the premium is the smallest number in the contract and the one people shop on. What decides whether the cover works when it is needed sits further down the page.

The network comes first. A policy pays at the hospitals and clinics it has contracted with, and treatment outside that list is reimbursed at a lower rate or not at all. A cheap policy is often cheap because its network is small, and that is invisible until the nearest hospital that accepts it is an hour away, or until the specialist a case actually needs sits outside it.

Then the two limits, which work in opposite directions. A deductible is the amount paid before the insurer pays anything, so it removes the small claims. An annual ceiling is the most the insurer will pay in a year, so it removes the large ones. A policy carrying both protects a household in the middle and leaves it exposed at both ends, and it is the far end that bankrupts people: the ceiling is the number that matters in a serious illness, and it is usually the one nobody reads.

Exclusions are where a policy is really written. A condition that exists before the policy starts is commonly excluded, either permanently or for a waiting period counted in months. Pregnancy, dentistry, mental health and long-term medication are each frequently carved out or capped on their own. A policy that covers everything except what a particular household is likely to claim for is still sold as comprehensive.

The last question is whose policy it is. Cover provided by an employer belongs to the job rather than to the person: it ends when the employment ends, usually on the same day, and it usually takes any dependants on it with it. That is also the moment a condition acquired while insured becomes a pre-existing condition on the next application, which is what makes the gap between two jobs more expensive than it looks.

• The network defines the cover in practice. Treatment outside the contracted hospitals is reimbursed at a lower rate or not at all, whatever the headline benefit says.
• A deductible removes small claims and an annual ceiling removes large ones. The ceiling is the number that decides what happens in a serious illness.
• Co-insurance is separate from the deductible: a policy can pay 80% of every bill with no cap on the remaining 20%, which grows with the size of the claim.
• Conditions that exist when the policy starts are commonly excluded outright or subject to a waiting period measured in months.
• Employer-provided cover ends with the employment, normally the same day, and dependants lose it at the same time.