Health insurance is a type of insurance that gives protection against the risk of incurring medical expenses among individuals, corporates or groups. The benefit is administered by a central organization such as a government agency (NHIF), private business (AAR/ JUBILEE/ RESOLUTION/ STRATEGIS), or not-for-profit entity (CHF)
THE BENEFITS OF HEALTH INSURANCE
No one plans to get sick or hurt, but most people need medical care – like a doctor visit, a prescription drug, a lab test, physical therapy, or counseling – at some point. These services can be expensive.
And if something happens that requires surgery or emergency medical care, it’s really important to have coverage. Fixing a broken leg can cost up to Tsh 2 Million, and the average cost of a 3-day hospital stay is around Tsh 1Million. This one-off costs for an individual is enough to cater for an average family of three annual medical insurance premium.
The Health Insurance Marketplace offers a variety of high-quality health coverage choices for routine and non-routine medical services that can work for your family or corporate budget.
This policy pays on behalf of the insured all sums in relation to the following benefits:
- Emergency evacuation services
- Hospitalization inpatient services
- Maternity and newborn care
- Outpatient services
- Prescription drugs
- Rehabilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services,Dental and Optical care
- Additional coverage
There may be additional benefits of health insurance through the Marketplace, like plans that offer funeral benefits, personal accident , organ transplant , free medical checkup,congenital illness and coverage for chiropractic or acupuncture services.
Terms commonly used under health insurance cover
- Premium: The amount the policy-holder or employer pays to purchase health coverage.
- Co-payment: Is the amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. A co-payment is paid each time a particular service is obtained.
- Co-insurance: Is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%.
- Exclusions: Not all services are covered. The insured are generally expected to pay the full cost of non-covered services out of their own pockets.
- Coverage limits: Health insurance policies only pay for health care up to a certain annual coverage maxima. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
- In-Network Provider: A health care provider on a list of providers preselected by the insurer. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers.
- Out-of-Network Provider: A health care provider not on a list of providers preselected by the insurer.
- Prior Authorization: A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an authorization means that the insurer is obligated to pay for the service, assuming it matches what was authorized. Many smaller, routine services do not require authorization.
- Product benefits schedule: A document that may be sent by an insurer to a member explaining what was covered for a medical service.
Call for action
Considering the changing faces of our modern society it’s imperative for one to consider taking up health insurance even on a shoestring budget. The peace of mind that accompanies such a decision is incomparable to the stress of looking for cash deposits or loan to pay for medical assistance during an emergency.
Taking a step to insure your staff / family medically is the best decision you could ever make. Staff health insurance cover is important because it helps employees get medical care in a timely manner and helps in improving their productivity.
Having no health insurance is therefore gambling with life in this modern times.