How do I know what is covered by health insurance?

Medical Video: Health Insurance Made Easy

Health insurance plays an important role when you are sick. Without health insurance, there is a lot of spending on a large scale that you have to spend from your personal pocket. Both private and public insurance (BPJS Kesehatan) both have their own facilities. This facility determines what actions are funded and what is not. So to find out what are the actions covered by health insurance how? Do you really have to pay for it and have to pay for it personally? See below.

How do I know what is covered by health insurance at the hospital?

Actually to find out what details will be covered by insurance, this will depend on the agreement or policy that has been agreed upon. Before using it further, you can consult in full with your insurance company about the product you choose.

Ask for a detailed explanation of the conditions that will be borne and not borne in the hospital. If you are still confused, you have the right to request examples of each case to be explained in more detail.

Each private insurance usually has a special partnership with several hospitals or other health services. This is where there has been a mutual agreement between the hospital and insurance regarding what will be covered if there are insurance participants who come.

In addition, before taking action at the hospital, you can also contact the insurance to ascertain whether an action is included or not. In essence, good communication is needed between the client and the insurance provider.

If you are using a health BPJS, usually the hospital itself will confirm the BPJs what actions are taken. If you pay for it, you don't need to pay again.

Be sure to read the policy

After you officially have health insurance and get a policy, you must understand all the contents of the policy, including the exception clause section.

An example in the exception clause is written things like this:

Critical diseases such as coronary heart disease and other critical illnesses attached can be claimed after 6 months of premium payment. Well, so if there is coronary heart disease before 6 months you cannot claim it, it takes 6 months to 1 year to claim back to insurance according to applicable regulations
For pre-existing diseases (such as birth defects), this will not be borne by the insurance company. Well, if you want to seek treatment regarding the condition of a congenital disease, it will not be covered by insurance.
The contents of this exception clause are exceptions that make you unable to claim insurance. From here you can also find out that there are some actions that are not covered.

As with private insurance, in public insurance, the BPJS health also has a few exceptions to the action. With this exception, outpatients and inpatients cannot use BPJS insurance under these circumstances.

What is not covered by health insurance?

There are several diseases and actions that are not covered by insurance. Non-borne diseases such as:

HIV / AIDS
Microcephaly, which is a rare neurological condition so that the baby's head is smaller than his age.
Other diseases caused by disasters and epidemics. The insurer will not be responsible for this condition. Examples of diseases such as polio, cholera, ebola.

Examples of actions not covered by health insurance: