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How Health Insurance Claims Process Works

Health insurance is an interesting type of cover in various ways. First, it’s the only cover that deals directly with your health, arguably your most prized asset. Secondly, the health insurance cover can be claimed in bits as needs arise, as opposed to other covers where you can only make one claim. When it comes to claims, here is how the claims process works.

  1. Claim as you go: Health insurance claims are made when you visit a hospital access medical services. When you visit a hospital to access treatment, the insurance company will pay for your treatment based on the cover limits of your policy. You can make claims as many times as you need to provided you have not exceeded your limit
  2. Co-payment: Most insurance companies will have a copayment policy on their cover. This works a bit like “excess” in the motor insurance cover. What this entails is that each time you visit a health facility, you will have to pay a fixed amount to the hospital. The specific amount varies from hospital to hospital and also varies according to specific policy. The goal of copayment is to discourage frivolous visits to healthcare institutions.
  3. Exclusions: The third issue you need to bear in mind is that health insurance usually comes with certain exclusions. These exclusions may include some medicines and procedures that do not meet the threshold for services that can be insured against. The most common exclusions are cosmetics procedures, food supplements, and elective procedures.As you plan your health insurance, remember that Pacific Group is here to support you all the way.
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